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As a researcher who has spent the last 14 years working closely with schools and ministries of education across Canada and the US, advocating for the delivery of evidence-based prevention programs in schools, I was so pleased to see this priority identified in the Sharing Together report. Sharing Together is an evidence priority agenda for Ontario, developed by Evidence Exchange Network (EENet). (EENet is a part of CAMH’s Provincial System Support Program, where I work.)

In the last 30 years, there has been substantial and significant evidence that school-based prevention programs that address mental health, violence, drug use, and delinquency can make youth feel better, act better, and make better choices.  In other words, the availability of programs that work within school settings has the potential to improve the lives of young people, and those around them. Each year, billions of dollars are spent in schools around the world on programs designed to improve student health, mental health, and behaviours. Schools provide the perfect setting to address the behavioural, emotional, and social needs of youth since most of them spend a good portion of their day at school. And what has been so exciting in recent years is the advances that have been made with respect to school-based prevention programs.

But while the Sharing Together report highlights the participants’ views that schools need access to tools and best practices for supporting students, in my experience what happens on the ground in classrooms every day is problematic.

For one, there’s a need for greater integration between schools and communities. We need to build processes and structures that will ensure that programs that are known to work are delivered and implemented with high quality.  But in schools, even if a program is shown to be effective and can help young people with their wellbeing or health, unless it’s embedded within the provincial ministerial guidelines for curriculum education, teachers simply don’t have the time to do anything extra. And how many prevention programs in Canada meet Ministry of Education expectations and guidelines for curriculum? (Actually, it turns out there’s one out of 100s developed, called the The Fourth ; 

The other issue is that even if you have the one prevention program that meets ministry of education guidelines and curriculum expectations, it might not get delivered by all teachers consistently, in a manner that ensures the outcomes we are expecting it to produce. In fact, most research shows that prevention programs in schools are very poorly implemented.  Teachers often find research-based prevention programs are difficult to implement in real-world settings.

So what can we do? First of all, we must continue to develop, evaluate, and implement evidence-based prevention and promotion programs in schools. A program can have a glossy cover, can be the most popular product on the market, and can promise to improve the health and wellbeing of all students. But you have to demand the highest quality of evidence to support these claims before you use it. If a program has not undergone a randomized control trial, it’s really hard to determine its long term effectiveness on youth outcomes. Not all teachers feel comfortable teaching youth prevention strategies about substance use or violence. We have to provide more opportunities for training and instruction, and ongoing coaching and feedback that’s often critical for program success. Third, not all evidence-based programs are designed for school settings, and that makes them very difficult to implement completely in classroom settings. Finally, it’s not uncommon for a school administrator to sometimes mandate the use of a program that may not align with the teachers’ beliefs, classroom environment, or readiness to implement the intervention. 

My final thought which is not really final because I think about it all the time in my daily work: you can have the most creative, compellingly valid, productive idea in the world, but whether it can become embedded and sustained in any complex setting is really a function of readiness, fit, organizational capacity and leadership, willingness of everyone involved to take risks, fail, learn from mistakes, and always a little bit of luck.

 Link to full report:

For more information about Sharing Together and additional resources:  

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Wonderful post linking Sharing Together with issues on the ground and putting it in context! Great ideas on how we can move this work forward 

For those who haven't had a chance to check out the first post in the Sharing Together blog series by Season Kam, have a look here: here:, as well as another post on EENet Connect asking folks to share their thoughts about the evidence priority agenda:

Gabor Mate, M.D. will be doing a joint presentation with Vincent Felitti, M.D.-of US CDC/Kaiser-Permanente ACE [Adverse Childhood Experiences] Study fame (also authored the 2004 [english language version] paper: "The Origins of Addiction: Evidence from the Adverse Childhood Experiences Study"--which I hope makes it into the EENet Evidence Base. I don't immediately recall the particulars of their scheduled joint presentation (I may have re-posted the seminar/simulcast summary on the Linked In 'Trauma-Informed' group and/or Facebook. I'll try to get the particulars if anyone would like them. I believe the sponsoring group is offering CEU's.

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