Intervention Summary

Peer Assistance and Leadership (PAL)

Peer Assistance and Leadership (PAL) is a peer helping program that seeks to build resiliency in youth by pairing youth with peer helpers who receive training and support from teachers participating in the program. The peer-based assistance provided through PAL is designed to help youth avoid risk factors for substance use as well as other problems, such as low achievement in school, dropout, absenteeism, violence, teen pregnancy, and suicide. PAL peer helpers act as guides, tutors, mentors, and mediators to peers or younger students (PAL mentees) by utilizing skills learned through PAL, including cultural competency, effective communication, decisionmaking, higher order thinking, and resiliency building. PAL peer helpers are placed in helping roles with younger students from feeder campuses and peers from their own campus. Through a combination of leadership and assistance, they offer individual and group peer support, tutoring, welcoming and orientation of new students, assistance to students with special needs, classroom presentations, and school/community outreach projects. PAL mentees generally are referred to the program by a contact person at the service site because of concerns about the students' school performance (e.g., absences, tardiness, academic achievement) or personal or other problems. Students also can request to be referred to a PAL peer helper. PAL mentees are linked to specific peer helpers based on the needs of the PAL mentee and the skills and interests of the PAL peer helper.

Teachers recruit, train, monitor, and evaluate the performance of the PAL peer helpers. The PAL teacher's manuals (separate versions for high school and middle school) provide the foundation for teacher training, covering program orientation and the recruitment, selection, training, supervision, evaluation, and maintenance of student participants. An elementary advisor manual is available for educators serving elementary schools. The PAL student handbooks (separate versions for high school and middle school) provide instructions, worksheets, sample forms, and activities for peer helpers to use with their mentees.

Descriptive Information

Areas of Interest	Substance use disorder prevention
Outcomes	1: Academic performance 2: Classroom attendance 3: Classroom behavior 4: Relationships with family, peers, and school
Outcome Categories	Education Family/relationships Social functioning
Ages	6-12 (Childhood) 13-17 (Adolescent)
Genders	Male Female
Races/Ethnicities	Asian Black or African American Hispanic or Latino White Race/ethnicity unspecified
Settings	School
Geographic Locations	Urban Suburban Rural and/or frontier
Implementation History	PAL began in combining peer assistance and peer leadership strategies originally developed. Over the past 15 years, these basic prevention strategies have been expanded, evolving the peer helping program from an informal, extracurricular activity in a single school district to a formally structured, curriculum-based program that has been adopted by the Texas Education Agency as an accredited elective course. Over 750 school districts throughout Texas have requested services from PAL Services Workers Assistance Program, Inc. (WAP), and WAP has documented substantiated the use of PAL in over 1,000 elementary, middle, and high schools in Alabama, Arizona, Arkansas, California, Iowa, Kansas, Louisiana, Nebraska, New Mexico, New York, Oklahoma, Oregon, Texas, Utah, and Washington.
NIH Funding/CER Studies	Partially/fully funded by National Institutes of Health: No Evaluated in comparative effectiveness research studies: No
Adaptations	No population- or culture-specific adaptations of the intervention were identified by the developer.
Adverse Effects	No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories	Universal Selective

Quality of Research

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Outcomes

Outcome 1: Academic performance
Description of Measures	Academic performance was assessed using grade point average (GPA); academic failure in courses the participants were taking; and reading, writing, and math scores on the Texas Assessment of Academic Skills (TAAS). The TAAS was the standardized academic achievement test used in the State of Texas at the time of the study. The TAAS math and reading sections consist of multiple-choice items, and the writing section consists of a series of prompts for which essays have to be written. The analysis compared GPA and TAAS scores from the semester prior to participating in PAL (pretest) and the final semester of participation in PAL, typically 1 year later (posttest).
Key Findings	On average, students who participated in PAL had significant pre- to posttest improvements in GPA (p < .0001), TAAS reading scores (p = .011), and TAAS math scores (p < .0001) and a significant decrease in the number of failed courses (p < .0001). When PAL peer helpers and PAL mentees were analyzed separately, both groups had significantly improved GPA scores (p < .0001 for both groups) and TAAS math scores (PAL peer helpers: p = .004 and PAL mentees: p = .043). However, only PAL peer helpers had a significant decrease in the number of failed courses (p = .001), and only PAL mentees had a significant improvement in TAAS reading scores (p < .0001).
Studies Measuring Outcome	Study 1
Study Designs	Preexperimental
Quality of Research Rating	2.0 (0.0-4.0 scale)

Outcome 2: Classroom attendance
Description of Measures	Classroom attendance was assessed using school records of the number of student absences. The analysis compared students' absence rates for the semester prior to participating in PAL (pretest) and the final semester of participation in PAL, typically 1 year later (posttest).
Key Findings	On average, students who participated in PAL had a significant decrease in absences (p < .0001) from pre- to posttest. When PAL peer helpers and PAL mentees were analyzed separately, both groups had a significant decrease in absences from pre- to posttest (p < .0001 for both groups).
Studies Measuring Outcome	Study 1
Study Designs	Preexperimental
Quality of Research Rating	2.0 (0.0-4.0 scale)

Outcome 3: Classroom behavior
Description of Measures	Classroom behavior was measured using school records of the number of discipline referrals for each student. The analysis compared referral rates for the semester prior to participating in PAL (pretest) and the final semester of participation in PAL, typically 1 year later (posttest).
Key Findings	On average, students who participated in PAL had significantly fewer discipline referrals at posttest (p < .0001). When the PAL peer helpers and PAL mentees were analyzed separately, both groups had significantly fewer discipline referrals at posttest (PAL peer helpers: p = .022 and PAL mentees: p < .0001).
Studies Measuring Outcome	Study 1
Study Designs	Preexperimental
Quality of Research Rating	2.0 (0.0-4.0 scale)

Outcome 4: Relationships with family, peers, and school
Description of Measures	PAL peer helpers completed the self-report Communities That Care Youth Survey. This survey examines domains of risk and protective factors as well as current levels of substance abuse, violence, and delinquency.
Key Findings	By the second semester of the school year following PAL participation, PAL peer helpers had significantly greater increases compared with control students in the following areas: Perception of being included in important school projects (p = .001) Praise received from their teachers for hard work (p = .001) Communication with their mothers (p = .04) Appropriate responses in dealing with peers (p = .007) Perception that the school had positive communication with their parents (p = .035)
Studies Measuring Outcome	Study 2
Study Designs	Quasi-experimental
Quality of Research Rating	2.3 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study	Age	Gender	Race/Ethnicity
Study 1	6-12 (Childhood) 13-17 (Adolescent)	65.1% Female 33.6% Male	53.4% Hispanic or Latino 29.5% White 14% Black or African American 1.7% Race/ethnicity unspecified 1.4% Asian
Study 2	13-17 (Adolescent)	Data not reported/available	100% Race/ethnicity unspecified

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

Reliability of measures
Validity of measures
Intervention fidelity
Missing data and attrition
Potential confounding variables
Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome	Reliability of Measures	Validity of Measures	Fidelity	Missing Data/Attrition	Confounding Variables	Data Analysis	Overall Rating
1: Academic performance	2.7	2.7	1.5	1.8	1.5	2.0	2.0
2: Classroom attendance	2.8	2.8	1.5	1.8	1.5	2.0	2.0
3: Classroom behavior	2.5	2.5	1.5	1.8	1.5	2.0	2.0
4: Relationships with family, peers, and school	3.5	3.5	1.8	1.8	1.8	1.8	2.3

Study Strengths

The researchers used multiple data sources to evaluate outcomes, including school records, standardized test scores, self-reports from PAL peer helpers and PAL mentees, and parent and administrator reports. The reliability and validity of the Communities That Care Youth Survey have been established by independent investigators. Participating teachers received training on how to administer the program, and manuals were provided to guide implementation.

Study Weaknesses

Little information was provided on the reliability and validity of most of the outcome measures. No systematic collection of fidelity data was reported (e.g., data on actual programmatic activities administered, whether activities were administered according to the manual, and participation rates). Attrition was not sufficiently addressed. Missing data were addressed by the mean substitution method, but it is not clear how many participants or questions had missing data. The limitations of the first study include the lack of a control group, the predominance of PAL peer helpers in the sample (less than 38% were PAL mentees), and the potential for selection bias from surveying more successful PAL mentees. In addition, degrees of freedom and sample size per test were not reported, and it is unclear whether the tests were dependent or independent t-tests. In the second study, separate sets of analyses were conducted for between-group effects (at posttest only) and time effects (with the intervention group only); a more appropriate approach would have been to combine these analyses.

Readiness for Dissemination

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

Availability of implementation materials
Availability of training and support resources
Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation Materials	Training and Support Resources	Quality Assurance Procedures	Overall Rating
4.0	4.0	3.9	4.0

Dissemination Strengths

The teacher's manuals are consistently well developed, highly detailed, and thorough. All aspects of implementation, from planning to intervention delivery, are addressed in the manuals, with appealing layouts, clean handout masters, and thoughtful organization facilitating ease of use. The student handbooks and training materials are equally detailed and user friendly. A number of training and technical assistance opportunities are available to support implementation, and they are clearly advertised on the program Web site. Multiple data collection tools are provided, including a variety of forms, a fidelity checklist, a peer self-evaluation measure, and an agency evaluation tool. Clear guidance on both process and outcome evaluation is provided to support quality assurance.

Dissemination Weaknesses

Though measurement of intervention impact is noted in the manuals as a necessary step, little guidance is provided on the measurement instruments or strategies to be used.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description	Cost	Required by Developer
Materials packets: Elementary School packet--includes PAL Elementary Advisor Manual, curricula for grades 3/4 and 5/6, and quality assurance tools Secondary School packet--includes Teacher's Manual, Student Handbook, and quality assurance tools	$160 per packet	Yes (one grade-specific packet is required)
2-day, off-site teacher training	In State (Texas residents attending training in Texas): $250 per participant plus $160 for manual, or $400 for both purchased together Out of State (teachers from other States attending training in Texas): $500 per participant plus $160 for manual	Yes (one teacher training option is required)
On-site teacher training	$2,000 per day	Yes (one teacher training option is required)
1- to 2-day, on-site initial student training	$6 per student	Yes
Phone and email technical assistance	Free	No