Title: Adapting and piloting the ASSIST model of informal peer-led intervention delivery to the Talk to Frank drug prevention programme in UK secondary schools (ASSIST+Frank): an exploratory trial
Funder: Division for Social Care and Health Research (Wales)

Abstract: This project involves intervention development piloting and an exploratory trial of two informal peer-led interventions designed to prevent illicit drug use among secondary-school students. The aim is to test the feasibility of adapting an effective school-based smoking prevention intervention (ASSIST) to disseminate information from Talk to Frank the UK national drug education service. The project has 3-stages: Stage 1: Development of intervention materials for ASSIST+Frank and FRANK friends;Stage 2: Piloting of ASSIST+Frank and FRANK friends in one school. Refinement of the intervention;Stage 3: Exploratory trial with schools as the unit of randomization with an embedded process evaluation.What is the intervention? ASSIST is an informal peer-led smoking prevention intervention to diffuse and sustain non-smoking norms via secondary school students social networks in year 8 (aged 12-13). ASSIST has five stages: 1) Identification of the most influential 17.5% of year 8 pupils based on peer nominations; 2) Recruitment of the most influential students as peer supporters; 3)2-days of training for peer supporters on the risks of smoking develop their communication listening and negotiation skills and enhance their confidence empathy and decision making; 4) a 10-week peer-led intervention where supporters have informal conversations with their peers on smoking which are logged in a diary four follow-up visits are made to schools by trainers to meet with peer supporters and 5)acknowledgement of peer supporters.Talk to Frank (www.talktofrank.com) provides up-to-date youth-friendly information and advice on the risks of illicit drug use. Information is provided through a website with instant messaging confidential 24 hour telephone and an email or text service. In ASSIST+Frank ASSIST year 8 peer supporters will be invited to continue and extend the role in year 9. Those agreeing to do so would attend 1-day of training based on Talk to Frank. This will include education on the effects and potential harms of different drugs and how to minimize known harms Peer supporters will be asked to have conversations with their peers on the risks of different drugs and log these interactions. One follow-up visit would be made by an ASSIST+Frank trainer with further contact via email text and/or Facebook on updates to Talk to Frank. At the end of the intervention supporters would receive a certificate with an additional gift voucher for those who handed in their diary.We will also develop a drug prevention version of ASSIST. In FRANK friends we will replace content on smoking with content from the Talk to Frank website on drug use. We will use the existing training materials used in ASSIST as well as information from the Talk to Frank web-site. Replicating the stages in ASSIST we propose that FRANK friends uses the same stage 1 (Nomination of peer supporters); stage 2 (Recruitment of peer supporters). One important change is that peer nomination will occur in FRANK friends in Year 9 instead of Year 8 as occurs in ASSIST. The training of FRANK friends peer supporters will use the ASSIST training materials on: developing communication skills including listening cooperation and negotiation and conflict resolution; enhance students’ confidence empathy assertiveness attitudes to risk-taking and exploration of personal values. This will be supplemented with more extensive information from Talk to Frank. The intervention period and acknowledgement of peer supporters will replicate that in ASSIST+Frank except that as occurs in ASSIST four follow-up visits will be made by trainers to provide support to FRANK friends peer supporters. The exact content of ASSIST+Frank and FRANK friends will be determined during a period of intervention development and then refined after piloting.What is the delivery setting?The interventions will be delivered in eight state-funded secondary schools (two pilot schools and six in the exploratory trial) in relatively deprived areas of south Wales (Communities First areas) where ASSIST is currently being rolled out by Public Health Wales (PHW).Who will deliver the intervention?PHW are committed to deliver ASSIST to 40-50 secondary schools per year in Wales. PHW staff trained to deliver ASSIST have agreed to deliver ASSIST+Frank to year 9 students in the academic year 2014-15 at three schools which implemented the ASSIST smoking prevention intervention in 2013-14 school year. FRANK friends will be implemented concurrently with ASSIST+Frank in year 9 in three schools which did not receive ASSIST in year 8.Who will fund the intervention costs?PHW have agreed to fund the costs of implementing ASSIST+Frank and FRANK friends.Who will participate?Participants will be 13-14 year-old students at twelve secondary schools.What will be the comparator?Two comparison arms: 1) Three schools that did not receive ASSIST+Frank or FRANK friends and continue their usual activities 2) Three schools which received ASSIST in year 8 but will not receive ASSIST+Frank or FRANK friends.What will be the primary outcome measure?The primary outcome measure will be incidence of any illicit drug use in the 18 following baseline data collection. Secondary outcome measures will examine: frequency and type of drug use in past 18 months; cannabis dependence; other health-risk behaviours (incidence of smoking up-take; smoking frequency; units of alcohol per week; alcohol dependence; antisocial behaviour); adolescent mental health; and school engagement. We will examine intermediate outcomes to explore potential mechanisms such as drugs literacy drug use norms peer communication and social network data on contacts between peer-supporters and pupils and between drug using and non-drug using peers. Interviews and focus groups will examine the feasibility of delivering and evaluating ASSIST+Frank and FRANK friends. We will also examine socio-demographic differences (parental socioeconomic status % pupils in receipt of free school meals ethnicity and gender) to assess the feasibility of the intervention for reducing health inequalities.


Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: MENTAL HEALTH