National Conference on Drug Abuse Prevention Research:
Presentations, Papers, and Recommendations

Invited paper
Reconnecting Youth: An Indicated Prevention Program

Leona L. Eggert, Ph.D., R.N.
Reconnecting At-Risk Youth Prevention Research Program
Psychosocial and Community Health Department, School of Nursing
University of Washington

Introduction

This paper reflects the past 12 years of extensive work by the Reconnecting At-Risk Youth Prevention research team. Much of this material has been synthesized from Reconnecting Youth: A Peer Group Approach to Building Life Skills (Eggert, Nicholas, and Owen 1995). This work has involved more than 2,000 youth, both high-risk and typical high school students. After four program evaluations, the author and colleagues have demonstrated that prevention can work. The Reconnecting Youth program was proven effective in helping high-risk youth improve their achievement in school, reduce their drug involvement, manage their depression and/or aggression, and decrease their suicidal behaviors. In addition, the results show that improvement in personal control and school bonding occurred (Eggert, Thompson, et al. 1995; Eggert et al., Preventing adolescent, 1994; Thompson et al., n.d.).

This paper, which details Reconnecting Youth as an indicated (see below) prevention program, is directed to professional school personnel - teachers, counselors, school nurses, and other human service professionals - who work directly with high-risk youth. It also speaks to policymakers - principals, administrators, school board members, and legislators - whose job it is to select effective programs for high school dropout and drug prevention programs.

This paper addresses what is meant by indicated prevention and then describes what has been learned from high-risk youth in schools. This information provides a profile of the students for whom Reconnecting Youth was designed. The paper also includes a brief synopsis of the prevention goals, key elements, unique features, and theoretic framework of the Reconnecting Youth program. The core program element, the Personal Growth Class, is detailed and followed by a discussion of issues to be considered before adoption and implementation of the program. The paper concludes with evidence of how and why the program helps high-risk youth achieve the program goals and enhance their personal and social protective factors.

The goals of this paper are to provide

• An understanding of what indicated prevention programs are and what makes Reconnecting Youth a model of such programs

• A broader understanding of what was learned about high-risk youth's disconnections, vulnerabilities, and strengths and how this knowledge informed the overall structure, activities, and implementation processes in Reconnecting Youth

• A grasp of the key features of Reconnecting Youth - how it works and the evidence supporting its effectiveness

• Guidance for those who may be considering implementation of Reconnecting Youth

• A commitment to consider initiating or supporting school-based indicated prevention efforts.

Indicated Prevention: What It Means

Prevention is defined as either a strategy that reduces the likelihood of health problems ever occurring or a process that stems the progression of a health problem from early warning signs to a diagnosable disease or disorder. A prevention program is a set of coordinated approaches regarded as necessary to counteract the multiple factors involved in attempting to reduce adolescent problem behaviors.

A New Public Health Model of Prevention

Prevention approaches traditionally were defined as primary, secondary, and tertiary. Gordon (1987, pp. 20-26) proposed a more precise, less confusing prevention scheme that was adapted by the Institute of Medicine (1994). This new model includes a continuum of universal, selective, and indicated prevention approaches. Each type of prevention intervention has a different focus and mission. When applied to the prevention of drug use/abuse in schools, the key points are as follows:

• Universal prevention programs benefit everyone in the school by providing needed education. The overall mission is to keep students from ever initiating drug use and to keep the school community drug-free.

• Selective prevention programs benefit known at-risk groups. One implication is that these groups must be identified for the delivery of prevention efforts (Kumpfer and Alvarado 1997). The overall mission is to impede the onset of drug use in known at-risk groups.

• Indicated prevention programs benefit identified high-risk individuals who already show signs of drug involvement (Eggert et al., Preventing adolescent, 1994; A prevention, 1994; Powell-Cope and Eggert 1994, pp. 23-51). The mission of indicated prevention is to stem the progression and reduce the frequency of drug use among these youth. The school population must be screened in order to find the individuals who are at risk to provide them with a suitable prevention program.

Universal prevention programs are insufficient as vulnerability to drug use increases to higher risk levels (Institute of Medicine 1994). When there are increasing numbers of risk factors and diminishing protective factors operating in a youth's life, a prevention program that is more comprehensive and of greater duration is required. An important principle, however, is that indicated prevention programs on a compre-hensive level are not necessary for most youth.

Unlike universal prevention programs, where all students in a school or classroom receive the prevention intervention, indicated prevention programs are best reserved for those in greatest need, such as those already involved with drugs. In addition, indicated prevention programs require an understanding and assessment of a student's risk and protective factors related to drug abuse. To be most effective, the prevention program is designed to directly influence these individual risk and protective factors.

Reconnecting Youth fits the definition of an indicated prevention program for particular high-risk individuals; that is, those on a high school dropout trajectory. This is because the intended participants demonstrate increased vulnerability to both drug involvement and suicide risk. These are students in need of a stronger "dose" of prevention interventions.

Characteristics of High-Risk Youth

The author and coworkers conducted a series of descriptive ethnographic and survey studies to enhance their understanding of high-risk youth. Identifying causal risk factors and their linkage to school dropout were critical challenges in the beginning. Accurately identifying the youth thought to be at highest risk of school dropout was another.

In repeated studies, the vulnerabilities for high-risk youth (Eggert and Herting 1993; Eggert and Nicholas 1992; Thompson et al. 1994) pointed to significant differences between high-risk youth and "typical" high school students. High-risk youth had more negative school experiences, greater drug involvement, more emotional distress (anger, depression, stress, suicidal behaviors), more deviant peer bonding, greater family strain, and less social support provided by school teachers, and other special persons in their social networks. The factors exerting the greatest negative influences on adolescent drug involvement included school strain, family strain, and deviant peer bonding (Randell et al., in press). Key predictors of suicide ideation included depression, drug involvement, family distress, and the likelihood of dropout (Thompson et al. 1994).

The following accounts are from high-risk youth (Eggert 1996b). They represent approximately 25 percent of the Nation's youth and 7 million of those age 10 to 17 years. Their growing numbers in high schools and the challenges they present were the motivating factors for determining the requirements of an indicated prevention program.

For many high-risk youth, negative school experiences are longstanding:

Drug involvement, by the students' own admission, hurts more than it helps and is out of control for high-risk youth:

Drug involvement and poor school experiences are linked with depression and suicidal behaviors. In their own words, youth make these connections:

Problems with peers and parents are also common. Characteristic of more than two-thirds of the youth, negative peer influences, family distress, and social disorganization, are illustrated below:

Overview of the Reconnecting Youth Indicated Prevention Program

Achieving the central aims of Reconnecting Youth meant (1) targeting potential dropouts, one of the most elusive and highest risk groups; (2) testing theory-based interventions that focus on the multiple risk factors and supporting the assets of these high-risk students; and (3) integrating these interventions into high schools whose culture is not necessarily friendly toward research.

The Program Goals

Risk reduction and resiliency enhancement (Hawkins et al. 1992) are key objectives used in achieving the indicated prevention program goals in Reconnecting Youth (Eggert, Nicholas, and Owen 1995). This means focusing strategies on the individual or environmental risk factors linked with the co-occurring problem behaviors of poor school performance, drug involvement, and suicide risk behaviors. The program has the following three central risk-reduction goals:

1. Decreased school deviance - reflected by decreased truancy, increased GPA (grade point average) across all classes, and increased credits earned toward graduation

2. Decreased drug involvement - reflected by decreased frequency of alcohol and other drug use, drug use control problems, and adverse drug use consequences

3. Decreased emotional distress - reflected by decreased depression, aggression, and suicidal behaviors.

Specific risk-reduction objectives that support these goals include:

• To change personal risk factors such as impulsive decisionmaking and actions through skills training in personal control strategies and interpersonal communication

• To decrease related interpersonal and school risk factors (primarily deviant peer bonding and lack of school bonding) through enhancing positive peer-group support and teacher support. Specific objectives that focus on enhancing resiliency include the following:

• To increase the youths' personal resources, including enhancing a strong sense of self-worth, a belief in one's ability to handle life's problems, and a positive view of the future (personal protective factors) (Powell-Cope and Eggert 1994, pp. 23-51)

• To change social or environmental protective factors, including surrounding the youth with a network of caring and supportive friends and family, and enhancing positive school experiences and social support from favorite teachers (Powell-Cope and Eggert 1994, pp. 23-51; Eggert et al., A measure, 1994), from the school, and from parents.

The objectives are aimed at reducing risks and enhancing resiliency, not just for the youth but also for their networks of close friends, family, school, and community (Eggert and Parks 1987; Hansen 1992; Hawkins et al. 1992). Focusing on both risk and protective factors enhances decreased drug involvement (Eggert and Herting 1991; Eggert et al. 1990; Eggert et al., A prevention, 1994; Eggert et al., Preventing adolescent, 1994) and reduced suicide potential (Eggert et al., Reducing suicide, 1995).

Theoretic Framework

The framework for Reconnecting Youth is a social-network-support model (Eggert 1987, pp. 80-104; Eggert and Herting 1991). This framework explicitly embodies the idea that any student's drug involvement and school performance develop and are maintained within a social context. If change in these behaviors is desired, interventions must occur and take into account this social context. In Reconnecting Youth, this context comprises a social network component (the school community, including the students' parents or guardians); the social support processes (the relations between the key individuals within the social network); and the desired outcomes (increased school performance, reduced drug involvement, and decreased emotional distress).

Especially important for bringing about change are the social support processes, including school network relations, family relations, and the teacher-student and peer-to-peer interpersonal relationship ties. Through these interpersonal relationships, the social support is delivered and received by the students. This social support is characterized by "expressive support," in terms of acceptance and belonging, and "instrumental support," in terms of skills training. Expressive and instrumental support motivate and influence changes toward program goal achievement.

Reconnecting Youth is designed to be high school-based and is grounded in a partnership model among youth, parents, school personnel, and prevention practitioners in the community.

The program is unique in several important ways, including the following:

• It is a comprehensive and sustained indicated prevention program.

• It has a psychoeducational framework that integrates small-group work and life skills training within a social network support system.

• It is delivered by trained school teachers capable of creating a sustaining positive peer-group support to counteract negative peer influences on truancy and using drugs.

• It is expressly designed to modify risk factors linked with adolescent drug involvement such as truancy, poor school performance, depression, aggression, suicidal behaviors, and deviant peer bonding.

• It is expressly designed to enhance personal and social protective factors such as self-esteem, personal control, school bonding, and family support.

• It is grounded in a partnership model among students, school personnel, parents, and prevention practitioners/researchers.

Reconnecting Youth is designed to reach high-risk youth who are not having a successful school experience. The intended participants are potential school dropouts in grades 9 through 12. Students identified as potential school dropouts are invited to participate in the program. The message is a strong appeal to join; it is an invitation to "drop into school" rather than dropping out. From the outset, the students are motivated and encouraged to benefit from the program in specific ways - at school, at work, with friends, and at home - by developing a greater sense of personal control, supportive communication skills, adaptive coping behaviors, and improved interpersonal relationship skills. In other words, they can belong and help themselves and others succeed at school.

Reconnecting Youth integrates four key elements into the school environment.

1. The Personal Growth Class (PGC) - The core element, PGC is structured as an elective course in the overall curriculum. It is conducted in daily, hour-long class sessions during regular school hours for a full semester (typically 90 days). An optional second semester program is currently being tested for its efficacy in preventing relapse and promoting continued growth. PGC is taught by specially selected and trained high school teachers (or another school-based staff member such as a counselor, nurse, or psychologist). The teacher-to-student ratio is 1:10 to 1:12.

2. School Bonding Activities Component - This element focuses on social, recreational, and school activities. Interventions are designed to reconnect students to school- and health-promoting activities that address a student's need for fun activities as an alternative to drug involvement, loneliness, or depression.

3. Parent Involvement Component - Parents are important partners in Reconnecting Youth. They are essential for providing support at home for day-to-day life skills learned in PGC. The PGC teacher contacts parents to take the first step in establishing the partnership relationship and to enlist their support in helping their child make important changes by reinforcing the program goals in appropriate ways at home. Currently, a separate Parents as Partners intervention component is being tested for its efficacy in enhancing the effectiveness of PGC (Eggert 1996a).

4. School Crisis Response System - A school-based crisis response plan was established because of the feelings of depression and suicidal behaviors evidenced by many of the high-risk youth. This element provides guidelines for classroom teachers and other school personnel for recognizing the warning signs and helping suicidal youth.

The school activities component, parent involvement, and crisis response plan all foster the development of a schoolwide network of support. These elements help the high-risk youth sustain the desired behavioral changes fostered in PGC and apply them at school and at home.

The Personal Growth Class Model

The PGC component is grounded in a psycho-educational model. It is unique in that it adapts and integrates the following previously tested approaches:

1. A peer-group counseling model designed to intervene with delinquent youth (Positive Peer Culture by Vorrath and Brendtro 1995).

2. An adolescent life skills training approach (Life Skills Counseling With Adolescents by Schinke and Gilchrist 1984).

Group work and skills training are vitally linked. Skills developed in four areas are applied to the three program goals within a positive group context (see figure 1). Through this positive group experience, students give and receive support in the form of acceptance and caring. They also help each other with life skills training applied to their personal issues.

The Group Work Submodel

Central to the effectiveness of PGC is a positive group experience, because social support is the motivating force for behavior change. The aim is to provide each youth with support from the leader and other PGC participants, making socialization a positive experience. Group work is characterized by group belonging and acceptance for all members and a heavy dose of expressed support and help from the leader and all group members.

A positive peer group is the key to the success of PGC. The group leader fosters the development of the positive peer-group culture by consistently demonstrating or modeling care and concern in interactions with the group and with each student. In this way, the group members learn to care about each other, and a climate for the desired behavioral changes is established.

The group leader is the "heartbeat" of the program, establishing group norms that reflect care and concern. During the invitation process and throughout the group sessions, it is the leader's task to ensure that each student feels welcomed, experiences a strong sense of belonging, and has a good experience in the group. Each student can develop trust in this culture, become motivated to change, internalize the program goals and key concepts, acquire and practice key life skills, and apply these skills in other classes at school and in life situations at home and at work.

Group work in PGC follows a predictable sequence of stages - from early, to middle, to late (see figure 2). Accompanying these stages also are predictable phases through which the group progresses, such as the following:

• Forming and storming in the early stage of PGC - Ground rules are negotiated and established by the group and then tested as the students become more comfortable.

• Norming and working in the middle stage - The students develop a common sense of purpose after "storming" and evidence the group norms and adopted behavior changes.

• Working and ending in the late stage - The group reaches "maturity" during this stage, working on applying behavioral changes and preparing for life without the PGC group.

The Life Skills Training Submodel

While the group work submodel provides the critical foundation and "glue" for making PGC work, key behavior changes would be unlikely without the personal and social life skills training. The life skills training provides PGC students with the building blocks they need to achieve the program goals. It also provides new ways of thinking, feeling, and behaving and creates opportunities to apply these new skills to their current problems, concerns, strengths, and successes.

In life skills training, leaders motivate, coach, reward, and reinforce. The leader's challenge is to make the training relevant and fun, for these are high-risk youth who reject traditional modes of learning. The leader also invites and encourages students to get back on track when they "slip." The goal is to prevent relapse into self-destructive or group-destructive behaviors. Another leader task is to help students carry the skills they learn in PGC into other classes, friendships, family, and work relationships.

Life skills training in PGC follows a sequence of motivating the student to become involved, then ensuring that the student is competent in a particular skill before expecting him or her to apply it to real-life situations. The four sequential stages are

• Motivational reparation

• Skills-building

• Skills practice and application

• Skills transfer.

The mode is to learn it, practice it, apply it, report back in the group on how it worked, and then get support, positive reinforcement, and praise.

Integrating the Group Work and Skills Training Submodels

Teaching PGC is both art and science. The art is in the process of integrating the skills training and group counseling submodels. The science is in the framework, content, and sequencing of the group stages and skills training. Integrating skills training within a PGC group is unique because only the objectives and key concepts of each lesson are standardized. The examples and situations used for skills-building and application must come from the individual student's experiences and be developmentally appropriate for adolescents and multicultural groups.

PGC group work, life skills training, and monitoring are combined to achieve the following specific purposes:

• Group support and caring to enhance a feeling of acceptance and belonging

• Life skills training to enhance personal and social protective factors

• Monitoring to help youth gain awareness of their need for behavior change and chart their progress toward success.

After developing a supportive group environment and acquiring basic life skills, the students practice these life skills by addressing their real-life problems. Boosters, or activities that reinforce understanding, use, and competency of the new skills, are promoted both within and beyond the PGC group. Cross-cultural understanding and acceptance are prominently featured and promoted. By using the students' real-life problems, beliefs, and values, PGC promotes cultural sensitivity in multicultural groups. Table 1 provides the organization and examples of group skills training units.

The Daily PGC Experience

A daily agenda helps to integrate group work and skills training. At the beginning of the class, the teacher starts with a "check-in" to monitor and assess each student, then leads into "bring 'n' brag," during which students are encouraged to report on successes. This is where the norm of support - praising steps taken toward minigoals and program goal achievement - is exercised. The teacher asks if anyone wants group support and problemsolving time for a personal issue, which leads into a preview of the training focus for the day. Once the leader has an idea of the students' issues, he or she finesses the relationship between issues and the skills-building and application objectives for the day. The students help set the agenda and take turns posting it on a flipchart, which helps focus the group work and group time.

The Anti-Drug-Use Message

In PGC, students share their feelings about many personal problems, including drug use and no drug use. Two key concepts are that problems are an opportunity for growth and that students can improve with the help of their friends. Many students already understand that their personal and school problems are linked with drug involvement. The PGC teacher helps the students assess their current drug involvement and set goals to reduce levels of drug use incrementally toward no use.

The PGC approach assists youth to become and be drug-free. The teacher stops "war stories," so drug use is never positively reinforced. At the same time, the teacher supports a leadership role for those students who do not use drugs and enlists their help in sharing the reasons for not using and strategies for remaining drug-free. The leader provides praise and positive reinforcement for these behaviors and consistently counteracts any drug use "contagion effect" that occurs within the group. Not using drugs is rewarded as a healthy decision and a worthy model during check-in and during bring 'n' brag sessions.

The PGC component is only one of four important elements in the Reconnecting Youth indicated prevention program. PGC as a stand-alone program is unlikely to be sustained. The PGC teacher and youth need a supporting cast to help reconnect at-risk youth to school, home, and community.

Implementation Issues

Anyone considering use of Reconnecting Youth will want to look at several essential issues and procedures before implementing the program.

Administrative Leadership and Planning

Launching Reconnecting Youth requires effective administrative leadership, community support, and talented group leaders/teachers. Program success requires the support of all partners. School personnel, parents, and community members all have important roles to perform, and all need to be involved from the start to coordinate the activities of Reconnecting Youth. Strong, committed administrative leadership is the "master key" for accomplishing the following tasks:

• Develop a partnership model - Initiate a series of meetings with important stakeholders. These individuals need to understand Reconnecting Youth - what it is, for whom it is designed, why it is needed, what evidence there is for its effectiveness, and how it might be paid for. Follow an agreement to proceed with planning meetings to establish in detail all aspects of an implementation plan.

• Establish a community support team - Create linkages with community groups to form and strengthen the overall community support for Reconnecting Youth and enhance the quality of program implementation. The key is to determine ways that willing community members can become constructively involved as partners in the school's efforts to implement each component of the program.

• Set up a school-based crisis response plan - Work out a crisis intervention plan to connect PGC youth with appropriate resources if needed.

Preparation for Implementing the Personal Growth Class

Having accomplished the "readiness tasks" listed above, the school administrator turns the focus to teaching PGC.

Scheduling the Class

PGC has to be part of the regular school curriculum, either as an elective or to meet certain required credits such as psychology or health.

Identifying and Selecting the Intended Participants

Use the identification and selection model (Herting 1990), working from the school or school district's computer database. Alternately, select 9th- to 12th-grade students at random from the identified pool. This ensures a heterogeneous group across age, gender, ethnicity, maturity level, and the three presenting problems of school failure, drug involvement, and depression. Avoid existing cliques of deviant youth, which offer powerful pressure for them to continue to act out, be resistant, and negatively influence the other youth in the group.

Inviting the Students To Join PGC

Students from the eligible pool should be individually invited by the PGC group leader/teacher. The invitation must be motivational and appealing while simultaneously communicating the purpose of PGC.

The PGC Group Leader/Teacher

The key to the success of the program is the leader/teacher. Leaders provide the most important human resource influencing the success of PGC. The group leaders observe firsthand the signs of underlying drug abuse or suicide risk in PGC youth. Without a competent, motivated group leader who has a history of being able to connect with these students, the program will not succeed.

Identifying an Appropriate PGC Group Leader/Teacher

Successful PGC leader candidates have experience working with high-risk youth. Motivated leaders also are enthusiastic about the program and its goals and want to make a difference in the lives of these youth. Regardless of the discipline of the candidates, the common characteristic is the candidate's capacity for consistent and long-term caring for high-risk students.

Selection Criteria

Key criteria for selecting PGC leaders/teachers include the following:

• Skilled in establishing helpful relationships with high-risk youth

• Nominated by professional peers and by high-risk students as being effective

• Motivated to teach PGC and work with high-risk youth

• Stable with high self-esteem so they can put the needs of the youth first and consistently implement the key concepts of PGC as a healthy role model

• Willing to regularly participate in teacher training and ongoing peer consultation groups, having the attitude that there is always more to learn in being an effective group leader/teacher

• Highly regarded by their faculty colleagues and an "insider" in the high school, therefore having greater opportunities for promoting school bonding

• Committed to implementing the program (Eggert, Nicholas, and Owen 1995; Eggert, Thompson, et al. 1995; Eggert et al., Preventing adolescent, 1994).

PGC Group Leader Training and Support

PGC group leader training is essential to the success of the program. The program is unlikely to achieve the expected outcomes unless it is implemented as designed. Two of the primary reasons why programs fall short of expectations are (1) the program is changed without consideration of how these changes alter the basic philosophy and interventions known to contribute to its original success, and (2) the program is only partially or selectively implemented, which alters the "dose" of what is delivered.

Initial PGC Leader/Teacher Training

Initial training typically consists of a 5-day workshop covering the program philosophy, design, and rationale for the central goals of Reconnecting Youth. Also included is training in small-group discussion methods, skills-training strategies, and specific drug use and depression/suicide prevention strategies. Detailed plans for the PGC sessions and implementation guidelines are studied and practiced extensively by means of videotape analysis and feedback.

Ongoing Leader/Teacher Support and Consultation

During the implementation of PGC, leaders need an ongoing source of support, encouragement, and consultation. A program coordinator from within the district can create a peer consultation and support group for the PGC leaders within a school district. When this type of ongoing support and training was provided twice monthly in tests of PGC, all original teachers were sustained for the 5-year duration of the program evaluation research. In addition, prevention of PGC group leader burnout was successful, and only two PGC leaders required replacement on the basis of factors unrelated to performance or interest. The teachers benefited from viewing each others' videotapes, comparing notes and experiences, and providing each other with exceptional peer supervision and consultation.

Special Administrator and PGC Leader Working Relationship and Support

To enhance success, the group leader must have the support of school principals. They must support, in theory and practice, the need for the class and the unique nature of the curriculum. It is especially important to work out ahead of time issues related to (1) confidentiality, (2) discipline, (3) serious depression and suicidal behaviors, (4) support from the counselors and other teachers in the school, and (5) collaboration with community agencies and services. Policies related to all these issues must be consistent with the overall philosophy and prevention goals of PGC.

The teacher who conducts PGC as only one of his or her other regular daily classes cannot be expected to provide all the support needed for the high-risk youth involved. A coordinated team effort is essential to support these high-risk youth in schools. The school administrator should assume a key role in developing and maintaining the necessary collaborative teamwork that is essential to the success of Reconnecting Youth.

PGC Group Leader/Teacher Preparation: Ready, Get Set, Go!

The successful PGC group leader is most often a school teacher who believes in the high-risk student for whom the program is intended and believes in the philosophy, integrity, and framework of Reconnecting Youth. This teacher is committed to these youth and to implementing the program as designed. Thus, in preparing to implement the program, the selected teacher needs to do the following:

• Get ready to conduct the class by thoroughly understanding the "big picture," the basic framework and psychoeducational approach, and the structure and design

• Understand the specific details and sequencing of the lessons

• Study and practice implementing the first 10 days, which are a microcosm of the whole curriculum

• Know how to assess his or her leadership effectiveness so that when in doubt about the teacher's responsibilities and appropriate actions, he or she can be guided by the under-lying principles of the PGC model

• Know how to monitor the students' progress and use this feedback to help students, by using both the PGC process evaluation and outcome evaluation tools provided to measure progress toward program goal achievement.

This brief discussion of issues to consider before implementing Reconnecting Youth illustrates that there is more to "getting started" than assigning a teacher to be the group leader for a class called Personal Growth. Careful planning, preparation, and teacher training are essential. A coordinated effort among the students, parents, school personnel, and community members is critical.

Evidence Gained From Reconnecting Youth

Various aspects of the Reconnecting Youth prevention program were developed, implemented, and evaluated in stages in collaboration with Pacific Northwest high schools over the past 12 years. Since 1985 the primary purpose has been to experimentally test school-based prevention efforts. This involved not only experiments with Reconnecting Youth as an indicated prevention program but also measurement studies and descriptive studies of high-risk youth and typical high school students. Some of the more important findings that are listed below demonstrate that high-risk students benefited and that their PGC leaders/teachers made a difference.

• For students, not only has Reconnecting Youth had an effect on reducing drug involvement, it also has reduced other co-occurring problems, such as poor school performance, aggression, depression, and suicidal behaviors (Eggert et al. 1990; Eggert, Thompson, et al. 1995; Eggert et al., Preventing adolescent, 1994).

• Students who participated in the program showed sharp increases in personal control and school bonding; young women especially showed reductions in deviant peer bonding (Eggert, Thompson, et al. 1995; Eggert et al., Preventing adolescent, 1994).

• The PGC teacher's expressed support and caring for the high-risk youth seemed to have the greatest influence on the positive outcomes for the program participants. It influenced decreased drug involvement (Eggert and Herting 1991), greater school achievement (Eggert et al., A prevention, 1994), and decreased depression and suicidal behaviors (Thompson et al., n.d.).

During the course of these experiments, Reconnecting Youth was refined in response to what was being learned. Stronger effects for reducing hard drug use and emotional distress occurred in the later years of program implementation. The current refined program (Eggert, Nicholas, and Owen 1995), which includes more anger management (Eggert 1994b), depression management, and monitoring activities, works better than earlier versions (Thompson et al. 1997).

Findings suggest that the program provided the typical participant with a positive experience in which the desired changes in school performance, drug use control, and emotional well-being occurred.

Much also was learned from experiences with high-risk youth, specifically from studies that sought to explain more about the underlying causes of their poor school experiences and drug involvement. Some important findings and their implications include the following:

• The effects on decreased drug involvement were primarily related to reductions in hard drug use (including use of crack, cocaine, amphetamines). These were associated with decreases in adverse drug use consequences and increased drug use control. Findings suggest that a second semester of Reconnecting Youth would be beneficial for obtaining stronger effects in reducing drug involvement and preventing relapse. This program refinement is currently being tested with support from NIDA (Eggert 1996a).

• A major factor that impeded progress for Reconnecting Youth participants in reducing their drug involvement was family strain (Randell et al., in press). These findings suggest that having a stronger parent involvement component might also result in greater decreases in drug involvement for the students. An initial demonstration project to test the feasibility of this approach is in progress and is supported by NIDA (Eggert 1996a).

• Youth who received an indepth assessment of their risk and protective factors related to suicidal behaviors benefitted from this assessment protocol. They demonstrated sharp decreases in depressed mood, suicidal behaviors, aggression, stress, and hopelessness. As a result, this protocol has been expanded into two brief interventions. How these work to help potential high school dropouts who are also at risk of suicide is currently being tested with support from the National Institute of Nursing Research and the National Institute of Mental Health (Eggert 1995).

Before the studies noted above were conducted, it was necessary to develop some measurement tools. Two instruments in particular have proven reliable for assessing change over time in adolescents' levels of drug involvement and emotional distress: (1) the DISA, Drug Involvement Scale for Adolescents (Eggert et al. 1996; Herting et al. 1996), and (2) the MAPS, a computer- assisted Measure of Adolescent Potential for Suicide (Eggert 1994a; Eggert et al., A Measure, 1994). These instruments are unique. The DISA not only measures the frequency of alcohol use and other drugs used but also taps the levels of access to drugs, drug-use control, and adverse drug use consequences. This is important because researchers can analyze the effects of the various program components in Reconnecting Youth on these separate dimensions of adolescent drug involvement. This ability will help in discovering more about how to best help high-risk youth achieve the goal of becoming drug-free.

Similarly, the MAPS is unique in that it provides a comprehensive assessment of the risk and protective factors associated with not only suicide potential but also adolescent drug involvement and potential for dropping out of school. Because it is a computer-assisted interview, it provides the interviewer with an instant profile of the student interviewed. When current refinements and tests are complete, this instrument should provide the kind of data required for implementing indicated prevention programs for high-risk youth. In developing Reconnecting Youth, the researchers also developed a full set of tools useful for process evaluation. With these tools, provided in the leader's guide (Eggert, Nicholas, and Owen 1995), those implementing the program are able to assess whether the program is being implemented as designed and how the students respond to their program experience.

Conclusion

The Reconnecting Youth program is one model of how prevention science is advancing. The promised benefits of indicated prevention programs for stemming adolescent drug involvement and related problem behaviors far outweigh the emotional and economic costs of doing nothing. The costs of prevention are also far less than those of treatment, once drug involvement and depression are diagnosed as disorders.

Adolescence may represent the last best chance for high-risk youth to change their life course. To do this, they need our best efforts in prevention programming. Schools are ideal for indicated prevention programs for high-risk youth. School is central to the way in which these youth are socialized, and school is a place where they use and share drugs. By addressing the challenges of these youth and providing a better school experience that fosters a sense of belonging and purpose, key risk and protective factors in their lives are altered. School performance improves, drug involvement decreases, and the emotional distress expressed in depression, aggression, and suicidal behaviors declines. This experience should stimulate others to join in supporting indicated prevention programs for potential high school dropouts, as well as for other high-risk individuals.

References

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