The Florida Level I DUI curriculum is an educational intervention that is required for license reinstatement for DUI first offenders and some drug offenders.  The current Level I curriculum is unstructured, relying on very well qualified instructors to develop individual curricula within program guidelines.  It is generally presented as a mix of risk-reduction and harm-reduction models.  The risk-reduction component is oriented toward reducing impairment per se by reducing consumption.  The harm-reduction component concentrates on reducing the chance that program participants will continue to drive while impaired.

In January 1996, the Emory University School of Medicine, was awarded a contract from the Florida Department of Highway Safety and Motor Vehicles to evaluate the Level I curriculum which all DUI first offenders are required to attend.  The objectives of the evaluation were:

• to determine the goals and objectives of the curriculum,
• to determine whether the current curriculum met those goals and objectives,
• to compare the effectiveness of the current curriculum to two other curricula: the first is a highly structured curriculum developed by the Prevention Research Institute (PRI) that is the standard curriculum used in several other states including Georgia, where we conducted a previous evaluation, the second was developed for this study by Responsible Driving, Inc. (RDI) directly from the current curriculum and the goals and objectives developed for this study, and
• to make recommendations for changes to the curriculum and present an action plan for future evaluation.

After familiarizing ourselves with the curriculum and the system under which it operates, with the assistance of the DUI Programs section, we convened a meeting of 25 stakeholders in the Level I system including curriculum instructors, DUI school administrators, law enforcement agents, DHSMV officials, judges, legislative representatives and others.  The purpose of this meeting was to formally establish a set of written goals and objectives for the Level I curriculum. After compiling the results of the meeting and distributing draft goals and objectives for comment, a set of four goals and their accompanying objectives were accepted.  Those goals and objectives served as the basis for all subsequent work in the evaluation.  The final Level I Curriculum Goals and Objectives are appended to this summary.

A questionnaire designed to evaluate student progress with respect to the goals and objectives was then developed and validated using a pilot study sample of 353 student from 18 classes at 6 DUI schools.  The final questionnaire consisted of 75 items.  The recommendations are based on responses of 1654 students before-class and after-class questionnaires, responses of 604 students to a follow-up interview three months after they completed the class, our observations of classes and discussions with curriculum instructors and administrators.  The detailed results of these studies are presented in the accompanying reports.

Recommendations:

1. Introduce a standard, mandatory exit exam that tests program participants’ knowledge and understanding of the information that the curriculum needs to impart to meet its goals and objectives.  The exam should focus on students’ ability to generalize the information in a manner applicable to real-world drinking/substance use situations.  This recommendation is made for two primary reasons.  First, under the current system, students have no external motivation to master the curriculum material and internal motivation to learn in this population is very likely to be weak.  Telling students at the start of class that they will be required to pass a "final exam" will increase attention and learning.  Second, if the exams are entered into a central database, they will provide the State with a powerful tool for continuing evaluation of program effectiveness and for monitoring the effectiveness of individual instructors.

 
2. Limit the maximum length of classes.  I recommend a maximum of three class hours per day, which would require a minimum of four class meetings.  Nearly one-half of the classes for which we have data in this study were taught in two-day sessions on a single weekend.  As expected from the literature of the psychology of learning, students in the two-day classes did not learn as much or show as much attitude change as students in classes that met more often.  Increasing the number of class sessions also provides the instructor the freedom to use an important educational tool to improve student learning – homework.

 
3. Increase the standardization of curriculum materials.  The quality and content of the materials currently in use is highly variable and students generally leave class without a resource for reviewing the curriculum material should they so choose.  There is also concern regarding the amount of class time that is spent showing videotapes, some of which may contribute little to meeting the goals of the curriculum.

 
1. Introduce a standard text, perhaps in the form of a workbook.  This would assure that students have access to all of the information that will be included in the exit exam.  It could also provide useful in-class and homework exercises.
2. Limit the amount of class time spent viewing videotapes.  The current 12-hour duration of the curriculum is very short for meeting the ambitious goals that the State has set for the curriculum.  Devoting two or more hours of that time to viewing videos is probably not effective.  The State should also consider limiting the videos that may be used to those whose content justifies the time they require.
3. Broaden the discussion of the nature and extent of problems related to substance use.  The most common mode of presentation of substance abuse that we saw during this evaluation focused on the classic model of alcoholism.  There is a wide range of problems, at both clinical and sub-clinical severity, which result from substance use and which are not adequately covered in presentations focused on the very severe problems associated with alcoholism per se.  The less severe substance use problems are present at high prevalence among the students in these classes, as shown by very high rates of clinical referral in the Level I system.  Time spent discussing such problems might enhance the ability of students to take a personal, vested interest in the risk-reduction message of the curriculum because they will recognized the presence of or the beginnings of such problems in their own lives.
 
4. After implementing these changes, the State should re-evaluate the effectiveness of the curriculum in meeting its goals and objectives.  Should further improvement be deemed necessary, additional steps, such as moving to a more highly structured curriculum and/or increasing the total length of the curriculum should be considered.

• Based on responses of program participants to before-class, after-class and follow-up questionnaires addressing the Level I Curriculum Goals and Objectives, I concluded that the current Level I curriculum is, at best, partially successful in meeting its goals and objectives.  This conclusion is based on the following observations:

 
• The overall mastery of the curriculum material, especially as it pertains to the use of alcohol, was less than desirable.  The most frequently missed questionnaire items were those which pertained directly or indirectly, to how much alcohol a person is actually consuming and the effects of that amount.
• The pattern of responses to knowledge-based items indicated that students had not developed a generalized understanding of the curricular material.  The resulting pattern of erroneous beliefs might actually reinforce high-risk substance use among many program participants.
• Very limited changes in targeted attitudes about substance use indicated that a large fraction of students leave the curriculum still believing that they have little risk of problems from substance abuse and little intention of changing their substance use behavior.
• Variation among instructors in student improvement with respect to each of the curriculum goals was very substantial.  No instructor participating in the study ranked in the top 25% of average student improvement for all four goals.  Increased standardization of the curriculum and more intensive monitoring of instructors might reduce this variablility.
 
• Based on observations of entire classes and discussions with curriculum instructors and administrators, several factors were identified which might contribute to the limited success of the curriculum:

 
• Class scheduling.  Nearly one-half of students participating in this study attended classes in which the 12-hour curriculum was taught on two consecutive days.  In general, students from classes that met more than twice learned more and showed greater positive changes in attitudes toward the use of alcohol and other drugs than those attending the two-day classes.
• Participant motivation.  Participants in the Level I curriculum are nearly universally attending for the sole purpose of reinstatement of driving privileges.  The current rules for the curriculum require that students arrive for all class sessions on time and without having used alcohol or drugs, and that they stay awake and not disrupt the class.  There is no general motivation to learn.
• Curriculum materials.  Instructors of the classes that we observed used a wide variety of materials – handouts, videos, slides, etc. – many of which were dated or even incorrect.  The lack of a standard text or workbook supporting the curriculum was viewed as a deficiency that may have contributed to the limited success of the curriculum.  Furthermore, up to 25% of class time was spent watching videotapes, which probably substantially dilutes the impact of the curriculum.
• Curriculum orientation.  It was my impression that in the area of substance abuse, most instructors focus discussion on classic models of alcoholism.  Although all participants in this program have had at least one substance use related problem – their DUI or drug offense – few have reached the stage of severe and chronic problems characteristic of alcoholism.  Many, however, are at or near the threshold for clinically significant problems resulting from their substance use.  Concentration solely on the most extreme end of the spectrum of substance use related problems might support or even reinforce the denial of risk that was expressed by many participants at the end of class.  Discussion of substance use problems to which students can personally relate and how those problems are determined by how much and how often they use alcohol and/or other drugs can motivate attention to the factual content of the curriculum, student awareness of consumption, and reinforce the risk-reduction message.  This concern applies nearly equally to all three curricula evaluated in this study.
• Class length.  It is possible that, given ambitious goals of the curriculum and the concerns cited above, there is also too little time in the 12-hours allotted to the curriculum to permit instructors to successfully present the curriculum.
 
• Neither of the two alternative curricula that were evaluated performed substantially better than the current curriculum.  This was attributed to the problems cited above, most of which are independent of the curricular content or approach.