WITHDRAWN: Lessons Learnt from Testing the Dissemination Model of the School Drug Prevention Program #Tamojunto (Brazilian version of EU-DAP Unplugged)

Introduction: In 2013, the Coordination on Mental Health at the Brazilian Ministry of Health (MoH) initiated a cultural adaptation of the EU-DAP school prevention program Unplugged in partnership with the UNODC and University College Ghent. In the pre-pilot, the program was implemented in 3 municipalities, at 8 schools, benefitting 2.161 adolescents. Based on the inputs from the federal multipliers, who accompanied closely the professionals, and on the results of the process evaluation conducted by the UNIFESP and UFSC, the program was adapted to the Brazilian version entitled #Tamojunto. Besides the content and language adaptation, MoH developed a dissemination model to attend the demand of the municipal and state governments interested in #Tamojunto in a sustainable way and maintaining quality and fidelity of implementation.

Methods: The dissemination model tested in 2014 and 2015 has the following features: a) local (state and municipal) Secretaries of Health and Education appoint local multipliers who are trained by MoH trainers to support and monitor the professionals in territories; b) teachers and health professionals are accompanied in collective meetings; c) step-by-step manuals systematize the role of federal trainers and local multipliers; and d) monitoring instruments were developed to assess the feasibility of the dissemination model, fidelity and quality of implementation and perceptions of effects.  

Results: In 2014, the #Tamojunto expanded to 130 schools in 12 municipalities in all 5 regions of Brazil, benefitting 13.589 adolescents and in 2015, 10 more municipalities adhered, contemplating more than 20.300 adolescents in total. No local government backed off after experimenting the program.

Conclusions: The 2014 and 2015 experience highlighted the importance of the transference of governance over the program implementation to local (state and municipal) governments, articulating both Health and Education sectors. The school principals and health care unit coordinators need to provide support to teachers and health professionals. The local multipliers need to be de facto designated and supported by their supervisors at the Secretaries of Health and Education in order to accomplish their tasks.

The identification of a local articulator is essential for “making the program happen”. The expansion of the program is more likely in territories with local governance and ownership over program implementation (case of Curitiba municipality).

Brazil´s specifics of the public health and education (lack of professionals, overload and high staff turnover) require new capacity building in every cycle of the implementation, thus compromising the sustainability of the current presential model. It is necessary to amplify the team of trainers and/or to introduce e-learning.

High proportion of missing data (from local multipliers and teachers) indicates a need for simplification of monitoring instruments and review of monitoring process.