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
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 Healthwe're
working to unleash that power of research knowledge to achieve the
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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 criteriaincluding
such factors as theoretical underpinnings, data analysis, attrition
rate, and cultural appropriatenessto come up with a score
for each nominee.
Depending on the score it receives, a program earns one of three
- 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,
- 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
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
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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 studenta former college football player who had used
steroids himselfapproached 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
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 usewith 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
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.
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 approvaland the fact that ATLAS became an exemplary
award-winner in the U.S. Department of Education's Safe and Drug-Free
Schools initiative in 2001has 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
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 email@example.com,
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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