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From Science to Service: Making a Model Program

By Rebecca A. Clay

Ask researchers about the frustrations of academic life, and chances are good they'll say that a lot of their research ends up sitting on a shelf somewhere unread.

That's not the case for Linn Goldberg, M.D., a Professor of Medicine and Head of the Division of Health Promotion and Sports Medicine at the Oregon Health and Science University in Portland. Thanks to a Model Programs initiative developed by SAMHSA's Center for Substance Abuse Prevention (CSAP), an intervention he developed to prevent anabolic steroid and other drug use among young athletes is now being used throughout the country.

"When CSAP called us about becoming a model program, my fellow investigator and I were looking at each other and saying, 'Is this for real?' The Federal Government is saying it would like to help us get this program out into the world?" says Dr. Goldberg. "I was totally floored."

But helping researchers communicate their findings to the field is the whole point of the Model Programs initiative. Accelerated by SAMHSA's new focus on disseminating effective interventions rather than generating new ones, the initiative gives communities a convenient way to find prevention and treatment programs that have been scientifically proven to work. So far, the initiative has identified dozens of programs that can help communities prevent drug and alcohol use, HIV/AIDS, violence, school absenteeism and dropouts, family dysfunction, and other problems.

"It's been said that the real power of knowledge is unlocked only when it is used to achieve the common good," says SAMHSA Administrator Charles G. Curie, M.A., A.C.S.W. "And that's what SAMHSA's science-to-services agenda is all about. In partnership with the National Institute on Drug Abuse (NIDA)—and the National Institute on Alcohol Abuse and Alcoholism and the National Institute on Mental Health—we're working to unleash that power of research knowledge to achieve the common good."

A SAMHSA Seal of Approval

Bringing science-to-service delivery is a multi-step process. Staff at SAMHSA's National Registry of Effective Programs scan the literature for evidence-based programs that are likely candidates for the Model Programs initiative. Because the review process is ongoing, researchers can also nominate their own programs at any time.

Once a program is officially submitted for review, experts at the Registry subject it to a rigorous screening process to determine whether or not it is methodologically sound, has produced a pattern of consistently positive results, and is ready to be introduced to a wider audience. The Registry uses more than a dozen criteria—including such factors as theoretical underpinnings, data analysis, attrition rate, and cultural appropriateness—to come up with a score for each nominee.

Depending on the score it receives, a program earns one of three rankings:

A model program meets the highest scientific standards and its developers have the capacity to provide high-quality materials, training, and technical assistance to communities that wish to use the program.
An effective program meets every condition as a model except being ready for dissemination. A program's developer might not have the capacity to help other communities adopt the intervention, for example.
A promising program requires strong evidence of scientific rigor and positive results, but to a lesser degree than that required of an effective program.

SAMHSA then promotes the Model Programs to communities looking for science-based interventions. SAMHSA uses a variety of promotional techniques, including a toll-free hotline, brochures, outreach to national organizations, an annual compendium of Model Programs (See Science-Based Prevention Programs and Principles, 2002), and e-mail alerts about new funding and program developments.

At the heart of the initiative's promotional activities, however, is the Model Programs Web site. Featuring information about all model, effective, and promising programs, the site allows users to search for programs by name or by content focus. Users can even compare various programs according to criteria they themselves select, producing a comprehensive matrix with just a few clicks of a mouse.

The Web site's goal is user-friendliness, emphasizes Paul J. Brounstein, Ph.D., Director of the Division of Knowledge Application and Systems Improvement at CSAP. "Using the Model Programs Web site is very much like building a model from a box," he explains. "You select the program that matches your needs, read the instructions, and build the program. If you have problems, there's even somebody to go back to and ask for help in fixing it."

The science-to-services cycle doesn't stop once communities have selected a program, however. In addition to the program developers themselves, SAMHSA's six Centers for the Application of Prevention Technologies can provide information, training, and technical assistance to communities using Model Programs. The Model Programs Web site also includes a list of funding resources, and the information specialists who staff the Model Programs hotline also provide information about additional Federal, state, and local resources.

In addition, Dr. Brounstein says, CSAP holds workshops for program developers and their evaluators on ways to document the evidence for their grassroots programs so that this knowledge can then be used to inform research efforts.

A Case Study

Dr. Goldberg's anti-steroid program is a perfect example of how this science-to-services cycle works. The program was born when a medical student—a former college football player who had used steroids himself—approached Dr. Goldberg for help in developing an anti-steroid message to take to boys participating in high school athletic programs. They developed and studied several different approaches-at least one of which actually increased the students' desire to use steroids-before coming up with an intervention that appeared to be successful.

Athletes Training and Learning to Avoid Steroids brochure

Dubbed ATLAS (Athletes Training and Learning to Avoid Steroids), the intervention relies primarily on student athletes themselves to share anti-steroid information in a highly scripted program. With coaches as facilitators and peers as instructors, student athletes working in small "squads" learn about steroids, alcohol, and other drugs by playing educational games, role-playing ways to refuse drugs, analyzing advertisements for steroids and supplements, and even producing mock public service announcements for each other-with sometimes "hilarious results," Dr. Goldberg says. Pocket-sized food and exercise guides emphasize the lessons well beyond the 10 45-minute sessions.

No matter what the activity, the emphasis is on a drug's immediate impact on athletic performance rather than abstract, long-term consequences. The activities are also designed to be fun.

In one exercise, for instance, the coach asks each squad a question about steroids and offers three, often humorous, answers. If the squad chooses the right answer, a squad member gets a chance to double the squad's points by choosing a target on a poster of "Steroid Man" and then hitting that target-whether it's acne, receding hairline, enlarged liver, shrunken testicles, or another side-effect of steroid use—with a soft, foam ball.

"Nobody's standing up there saying, 'You're going to get this and this and this,' " Dr. Goldberg explains. "But while they're laughing and playing this game, it's imprinting on them that these are the side effects of steroids."

To find out if ATLAS really worked, Dr. Goldberg applied for and received a grant from NIDA. "The folks at NIDA recognized that steroids represented a developing area of drug abuse," says Wilson M. Compton, M.D., Director of NIDA's Division of Epidemiology, Services, and Prevention Research. "It was important to have some research to inform the development of policies and programs."

With the 5-year NIDA grant, Dr. Goldberg was able to conduct a randomized, controlled study of ATLAS with more than 3,200 students in 31 schools in Oregon and Washington. The results were striking: A year after the intervention, new steroid use and new substance use decreased 50 percent in students who received the ATLAS intervention. Drinking and driving declined 24 percent. The students reduced their use of alcohol and illicit drugs, reduced their use of performance-enhancing supplements, and improved their nutrition and exercise behaviors.

"After NIDA got the results, they said to us, 'You should really get this out there,' " Dr. Goldberg recalls. "I said, 'How do you do that?' They said, 'We don't know.' We were all clueless."

Drs. Diane Elliott and Linn Goldberg are designers of the ATLAS and ATHENA programs

Enter the Model Programs initiative. In 2000, Dr. Goldberg and his colleague and co-investigator, Diane Elliott, M.D., received a call from CSAP asking if they would like ATLAS to be considered for Model Program status. After submitting the required documentation, meeting with CSAP staff, and agreeing to help communities interested in using the ATLAS program, Dr. Goldberg found himself the grateful recipient of Model Program status for his creation.

This labor-intensive process is what makes SAMHSA's Model Programs initiative stand out, says Stephen E. Gardner, D.S.W., Acting Deputy Director of the Division of Knowledge Application and Systems Improvement at CSAP. "Providing a list of programs that have good outcomes and good science but aren't necessarily ready for prime time doesn't really fulfill the science-to-services cycle," he explains. "We make sure that once programs are listed, they're up and ready. We give programs the SAMHSA seal of approval."

That seal of approval—and the fact that ATLAS became an exemplary award-winner in the U.S. Department of Education's Safe and Drug-Free Schools initiative in 2001—has helped the program spread to communities around the Nation and even the world. In Salt Lake City, for example, the mayor was looking for science-based prevention programs for the city's schools, consulted SAMHSA's Model Programs, and ended up with ATLAS. To help showcase this success story, SAMHSA provided funding for a press conference and the production of promotional materials.

In addition to Utah, school districts in Arkansas, Hawaii, and Massachusetts have already received ATLAS training, and school districts in Iowa, Kansas, Louisiana, Maryland, New York, and Tennessee are also planning to implement the program. ATLAS has also expanded to the middle schools and the collegiate level. Portland State University, for instance, is now using the program with some of its athletes.

Drs. Elliott and Goldberg subsequently designed a similar program for girls, "Athletes Targeting Healthy Exercise and Nutrition Alternatives" (ATHENA), which is currently being tested in middle and high schools around Portland.

ATLAS has even attracted international interest, with calls coming from communities as far away as Norway, the Netherlands, and the Caribbean.

For SAMHSA's Administrator, the ATLAS story is the perfect example of SAMHSA's evolving mission. "SAMHSA is working increasingly to get evidence-based practices to communities, to services providers, to consumers of services, and to their families," says Mr. Curie. "At its root, it's really all about leveraging our resources across SAMHSA and the National Institutes of Health to identify and implement best ways to take new knowledge to the communities where it can best be used."

For more information about the ATLAS program, visit www.ohsu.edu/som-hpsm/atlas.html . To learn more about the Model Programs initiative, visit www.modelprograms.samhsa.gov, send an e-mail to modprog@samhsa.hhs.gov, or call toll-free at 1 (877) 773-8546. For a copy of Science-Based Prevention Programs and Principles, 2002, contact SAMHSA's National Clearinghouse for Alcohol and Drug Information, at P.O. Box 2345, Rockville, MD 20847-2345. Telephone: 1 (800) 729-6686 (English and Spanish) or 1 (800) 487-4889 (TDD).

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