A new Penn State study examining the PROmoting School-community-university Partnerships to Enhance Resilience (PROSPER) prevention model has found that how prevention programs were delivered and implemented, how skillfully facilitators presented the material and how fully families engage with it were linked to lower substance use three years later, especially for young people at higher risk of substance abuse.  

PROSPER is a community-based prevention system that brings evidence-based substance prevention programs to middle schoolers and their families through partnerships with schools, families, communities and universities. 

"Our research interest is not only measuring whether prevention programs work, but understanding the mechanisms behind why they work," said Yoon Hur, assistant research professor at the Edna Bennett Pierce Prevention Research Center (PRC)and first author on the paper published in Prevention Science. "We wanted to identify what aspects of implementation are actually driving positive outcomes."  

The study measured three qualities of its implementation: adherence (whether facilitators covered the required content), facilitation quality (responsive and skilled facilitators), and participant responsiveness (how actively families and young people engaged in the sessions).  

Facilitator quality and how engaged families and young people were in the sessions made a difference, specifically for the students at higher risk. Higher-risk youth were identified using five markers at the start of 6th grade: lifetime use of gateway substances, engagement in problem behaviors, eligibility for free or reduced-price school lunch, low family cohesion, and living with one or no biological parents. 

"Youth and their family's engagement in the material matters and it turns out that this is especially important for those kids at higher risk for developing a problem with substance misuse," said Sarah Chilenski, research professor in the College of Health and Human Development and co-author of the study.  

What set effective programs apart, the researchers found, was the relational quality of delivery — facilitators who were responsive and sessions that genuinely engaged families. These qualities can be cultivated through training, and supported by selecting strong facilitators, paying them reasonable wages, and providing coaching alongside data-based feedback. The findings also argue for tracking engagement routinely rather than just completion. 

All of this requires more implementation support and monitoring than a typical community program provides. But the researchers contend the investment is worth making: the students for whom delivery quality mattered most are also those most likely to develop costly substance use problems later. 

The study reinforced the importance of engaging with families early; before problems start. PROSPER combines school-based programs with family-focused programs at a crucial developmental transition – that transition from elementary school into middle school, when kids typically start connecting with their friends more and spend less time with their families.   

"Even this relatively short seven-week family program has lasting impacts," Hur said. "We found that family-focused prevention during the sixth grade can help reduce substance use through the high school years."  

Both Hur and Chilenski credited PROSPER partners, including university researchers, technical staffs, schools and local communities, with sharing important insights. 

"That collaboration helped us better understand what is happening behind the data and why these programs make a difference," Hur said.  

The study was co-authored by Patrick O'Neill, doctoral student in human development and family studies; Damon Jones, research professor in the College of Health and Human Development; Mark Feinberg, research professor with the PRC; Max Crowley, director of the PRC; and Richard Spoth, director of the Partnerships in Prevention Science Institute and F. Wendell Miller Senior Prevention Scientist, Iowa State University.  

The study was supported by the National Institute on Drug Abuse of the National Institutes of Health.