European drug prevention quality standards

From 2008 to 2010, Dr Harry Sumnall, Reader in Substance Use, and Angelina Brotherhood, Public Health Researcher, of the Centre for Public Health, led an EU funded research project to generate European drug prevention quality standards. The project proceeded in collaboration with partner organisations across Europe, and built upon academic and applied research conducted by the applicants at national and EU level over the previous years.

Project lead:

Liverpool John Moores University (LJMU), United Kingdom

Associated partners:

Azienda Sanitaria Locale della Città di Milano (ASL), Italy
Consejeria de Sanidad - Servicio Gallego de Salud (Xunta de Galicia) (CS-SERGAS), Spain
Azienda Sanitaria Locale n. 2 - Savonese (ASL2), Italy
Institute for Social Policy and Labour (SZMI-NDI), Hungary
National Anti-Drug Agency (NAA), Romania
National Bureau for Drug Prevention (NBDP), Poland

Collaborating partners:

European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)
Institute for Alcohol and Drug Research (SIRUS), Norway
Federal Centre for Health Education (BZgA), Germany
Institute for Drugs and Drug Addictions (IDT), Portugal
Studio Consulenza e Valutazione nel Sociale (CEVAS), Italy

The need for European standards

At the time of beginning the project, drug prevention quality standards were available only in some Member States of the EU. The available guidance varied in terms of its content, methodological rigour, and applicability beyond the regional/national context. Consequently, a common European framework on drug prevention was missing. It was also not clear to what extent internationally available guidance was relevant to drug prevention in Europe, and how it could be adapted to the European context (for example, the "Standards of Evidence" published by the USA Society for Prevention Research in 2004).

The need for a European drug prevention framework is apparent in EU policy documents, such as the EU Drugs Action Plans. These have expressed an intention to develop and implement best practice in drug prevention, but without being able to provide a reference framework on how to do this. Therefore, the standards project aimed to provide an empirically derived reference framework to bridge the gaps between science, policy and practice. The specific objectives of the project were to compile, review and analyse existing drug prevention standards in EU Member States, and to publish a common set of European drug prevention quality standards.

The availability of an agreed framework that is adaptable to local circumstances should provide an incentive for EU Member States to develop quality standards where these did not previously exist, or to review and update existing quality standards, and adopt these quality standards for their own use. Adoption of the standards will improve drug prevention practice and efficiency of funding, and reduce the likelihood of implementation of ineffective and iatrogenic interventions. Thus, the standards will support the fulfilment of local, regional, national and international drug strategies and policies.

The European drug prevention quality standards

The European drug prevention quality standards provide the first European framework on delivering high quality drug prevention. The standards outline the necessary steps in planning, implementing and evaluating drug prevention activities. Organised in an eight-stage project cycle, they cover the following areas: needs assessment; resource assessment; programme formulation; intervention design; management and mobilisation of resources; delivery and monitoring; final evaluations; and dissemination and improvement; as well as: sustainability and funding; communication and stakeholder involvement; staff development; and ethical drug prevention (see Figure 1).

The standards help users understand how people, programmes/interventions, organisations, and (governmental) strategies contribute to drug prevention, and to think about how existing efforts can be improved in order to obtain better and sustainable results. Drug prevention work in line with the standards is characterised by an evidence-based approach, internal coherence, and an orientation towards both policy and participants.

The standards are applicable to a wide range of drug prevention activities (e.g. drug education, structured programmes, outreach work, brief interventions), settings (e.g. school, community, family, recreational settings, criminal justice), and target populations (e.g. young people, families, ethnic groups). Drug prevention activities targeted by these standards may focus on legal substances, such as alcohol or tobacco, and/or illegal substances.

The standards will be of interest to all prevention professionals. These professionals are likely to be involved in one or more of the following activities: policy- and decision-making; service management; front-line work/ work in direct contact with the target population; training; supervision; programme development; consultancy, evaluation and/or academic research.

The standards can be used for a range of purposes; including: information, education and guidance; self-reflection; discussion in group settings; performance appraisals. Further work is planned to make the standards suitable for other purposes such as formal self-assessment, funding decisions, or external accreditation.

Methodology

From a theoretical point of view, the project distinguished between quality standards and practice guidelines. Quality standards focus on formal aspects of general quality assurance, while guidelines give instructions on the content of interventions for specific circumstances. It has been observed that adherence to minimal technical standards improves design and outcomes of prevention interventions. The focus on quality standards therefore allows: (1) transference of knowledge and evidence between different countries, and (2) to establish common ground in public health, where guidelines are rarely as specific as clinical guidance.

The project methodology proceeded across three dependent stages:

(1) Available national and international drug prevention standards and guidelines were collated, and documents suitable for review were identified. This included two sets of guidelines and nineteen documents containing quality standards. Guidelines were reviewed using an adapted version of the AGREE tool as well as the AGREE II tool. Quality standards were synthesised in a systematic and iterative manner through qualitative content analysis, and a first draft of standards was generated.

(2) The standards' relevance was then rated through an online Delphi survey consisting of two rounds (423 participants). Additionally, expert focus groups were conducted in five European countries with drug professionals and policy makers (122 participants). The findings highlighted the most important items in the draft standards and how the framework might fit within the wider European context. Consequently, a second draft of the standards was produced.

(3) In the final stage, the practical applicability of the standards in professional's everyday practice was explored. In structured consultations, the second draft standards were assessed in terms of their practical feasibility and usefulness, and information was collected on how the standards might be developed further in the future (72 participants).

This feedback enabled the partnership to produce a final version of the standards, consisting of basic and expert standards and detailed guidance on how to use them.

Further details on the methodology used to develop the standards can be found in the final project report submitted to the European Commission.

Publication of the standards

The standards were published in December 2011 by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) in its Manual series. The official launch took place on 9th December 2011 in Lisbon, Portugal, at the conference of the European Society for Prevention Research (EUSPR) (http://euspr.org).

The standards are available for electronic download and to order for free from the EMCDDA website at http://www.emcdda.europa.eu/publications/manuals/prevention-standards.

The manual includes the standards as well as further information on their development and considerations for implementation. Additional materials, including a brief checklist derived from the standards, are also available on the EMCDDA website.

Efforts to introduce and disseminate the standards at a national level are already underway in Hungary, Italy, Poland and Romania. Where available, translations of the standards will be made accessible on the EMCDDA website.

Next Steps

It is hoped that additional funding will support the research partnership in the future to develop materials, education, and training to allow policy makers and practitioners to put the standards into practice.

The European drug prevention quality standards have been adapted to form the prevention strand of the "Study on the Development of an EU Framework for minimum quality standards and benchmarks in drug demand reduction" (EQUS), led by the Research Institute for Public Health and Addiction (ISGF), University of Zurich. Further details on the EQUS project can be found on the ISGF project website (see the Executive summary for the adapted list of EQUS prevention standards). Appendix 10.7, entitled "Correspondence of EQUS prevention standards and European drug prevention quality standards", illustrates how the original and the adapted set of prevention standards correspond to each other, i.e. how the EMCDDA Manual on European drug prevention quality standards supports the EQUS prevention standards, and vice versa.

Timeline

The project started in September 2008 and finished in November 2010, with publication of the standards in December 2011.

Funding

The project was co-funded (60%) by the European Commission (EC) under the Programme of Community Action in the field of Public Health (2003-2008). Project name: "European standards in evidence for drug prevention", Project No. 2007304.

Contact details

General enquiries about the standards can be sent to prevention-standards@ljmu.ac.uk.

Mrs Angelina Brotherhood
Public Health Researcher (Research & Development)
Centre for Public Health, Liverpool John Moores University
Henry Cotton Campus, 15-21 Webster St, Liverpool L3 2ET
Tel. +44 (0)151 231 4498
Email: a.brotherhood@ljmu.ac.uk