Program Profile: Bicultural Competence Skills Approach

This program is designed to prevent substance use in American Indian adolescents by teaching them bicultural social skills. The program is rated Promising. Youth who participated in the program demonstrated lower rates in use of smokeless tobacco, alcohol, marijuana, and inhalants. Program youth also showed better knowledge of substances and alternatives to substance use, self-control, and assertiveness, compared with control group youth. These differences were statistically significant.

A Promising rating implies that implementing the program may result in the intended outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

This program's rating is based on evidence that includes either 1) one study conducted in multiple sites; or 2) two or three studies, each conducted at a different site. Learn about how we make the multisite determination.

Program Goals

The Bicultural Competence Skills Approach is an intervention designed to prevent abuse of tobacco, alcohol, and other drugs by Native American adolescents by teaching them social skills.

Program Theory

The program draws on bicultural competence and social learning theories. A bicultural competence approach teaches American Indian individuals to draw on both Native American and popular American cultures—instead of identifying with only one culture—to better adapt to, interact with, and thrive within both cultures. Social learning theory suggests the utility of developing skills in problem solving, decision making, nonverbal and verbal communication, and social network building (Schinke et al. 1988).

Program Components

Intervention groups are led by two Native American counselors, and ten to fifteen 50-minute sessions are delivered. Through cognitive and behavioral methods tailored to the cultural prerogatives and reality of the lives of Native American youth, participants are instructed in and practice communication, coping, and discrimination skills. Communication skills are introduced with biculturally relevant examples of verbal and nonverbal influences on substance use. For instance, leaders model refusing offers of tobacco, alcohol, and other drugs from their peers without offending their Native American and non–Native American friends. While participants practice communication skills, leaders offer coaching, feedback, and praise. Participants learn discrimination skills to better identify and avoid situations that encourage or support substance use and to learn about healthy alternatives to high-risk behaviors. Coping skills include self-instruction and relaxation to help subjects handle pressure and avoid substance use situations. Participants also learn about building networks of prosocial peers, family, and tribal members. Leaders suggest alternatives to using tobacco, alcohol, and other drugs and teach participants to reward themselves for positive decisions and actions. All sessions include Native American values, legends, and stories.

Two 50-minute booster sessions are delivered semiannually and include developmentally appropriate content and strategies.

In some versions of the program, substance abuse awareness is also brought into the community. Families, schools, neighbors, law enforcement officials, and commercial establishments are included in a series of activities to raise awareness. Activities include media releases, flyer and poster distribution to community businesses and organizations, and informational sessions at local schools.

Study 1

Schinke and colleagues (1988) used an experimental design to assess the impact of the Bicultural Competence Skills Approach program on the use of tobacco, alcohol, and other drugs. Subjects were voluntarily recruited and (after pretesting by reservation site) randomly divided into prevention and control conditions. The sample of 137 Native American youths, whose average age was between 11 and 12, came from two western Washington State reservation sites in a population drawn from tribal and public schools. A majority of the sample (54 percent) was female. The evaluation established group equivalence at pretest on the children’s demographics, household composition, acculturation level, and current place of residence.

All subjects completed outcome measures before, immediately following, and 6 months after the intervention that measured culture-relevant peer influences on use of tobacco, alcohol, and other drugs (“interactive behavior”); self-reported levels of substance use in the past 14 days (for smoked and smokeless tobacco, alcohol, marijuana, inhalant, amphetamine, barbiturate, cocaine, and nonmedical drug use); and changes in substance abuse knowledge and attitudes relevant to Native American culture. The unit of assignment matched the unit of analysis (individual). The attrition analysis showed that attrition averaged 9 percent across the sample at 6-month follow-up, with no dropout differences identified between conditions. No subgroup analysis was conducted.

Study 2

Schinke, Tepavac, and Cole (2000) used an experimental design to randomly assign 1,396 Native American third- through fifth-graders, with a mean age of 10.28, to one of three groups: 1) a treatment group consisting of both the life skills training and community component, 2) a treatment group consisting solely of the life skills training, and 3) a control group consisting of no intervention. Nearly half of the participants (49 percent) were female, and 55.6 percent lived in two-parent households. Youth were from 27 tribal and public schools on 10 reservations in North and South Dakota, Idaho, Montana, and Oklahoma. The schools were determined to be socioeconomically comparable.

Attrition over the course of the study was 1.58 percent at 6 months post-baseline, 3.28 percent at 18 months post-baseline, 4.59 percent at 30 months post-baseline, and 5.44 percent at 42 months post-baseline, for an overall attrition rate of 14.11 percent. No dropout differences were identified between conditions. No pretest differences were identified among the three arms of the study on use of cigarettes, smokeless tobacco, alcohol, or marijuana.

Posttests were administered 6 months after the intervention and every 12 months thereafter for 3 years. Measures included self-reported substance use and saliva sampling to verify substance use. The CrimeSolutions review focused on the differences between the life skills treatment group and the control group at the 6-month follow-up. The study authors conducted subgroup analyses to determine the potential effects of gender on outcomes.

Subgroup Analysis

Schinke, Tepavac, and Cole (2000) conducted subgroup analyses to determine the potential effect gender had on the program outcomes. They found that girls were more likely than boys to use cigarettes in both treatment groups and in the control group. However, boys were more likely to use smokeless tobacco, alcohol, and marijuana, compared with girls in both treatment groups and in the control group. These differences were statistically significant.

These sources were used in the development of the program profile:

These sources were used in the development of the program profile: