Behavioral Health Central – February 19, 2010
By Dennis Miller, BHC Senior Writer
Classroom lectures, assembly-hall speeches and informational brochures can give teens the facts on drug and alcohol use, but fall short of offering a direct, realistic and emotional experience of drug abuse’s often devastating consequences. The interactive educational experience called Reality Tour® is designed to add that element to drug education programs. Created by Norma Norris of Candle, Inc., Reality Tour takes participants through many of the potential consequences of drug abuse with staged but realistic simulations of a drug arrest, overdose, funeral and other events an addict may experience.
The Reality Tour experience includes innovative computer software that adds a personal dimension to each child’s Reality Tour experience, a 40-minute parent/child coping skills segment, and a self-assessment tool that offers suggestions for activities parents and children can do to help prevent drug abuse, including a six-week challenge to assess their own powers of self-discipline. It also provides first-person accounts from law enforcement and addicts in recovery through a carefully structured interactive interview process.
The innovative program, designed to grab the attention of young teens raised on reality TV dramatics, moves its audience through a series of settings and vignettes that realistically depict events in the life of a drug addict. The package comes as a Program Model which is licensed to organizations to present the Reality Tour at one declared site. Presenting organizations are encouraged to improvise dialogue and details, using actual local law enforcement, hospitals, doctors and even funeral home directors. The model includes a 150-page manual and a 90-minute DVD that trains volunteers, along with other materials such as pre- and post-tests, and exit surveys. It is designed to be experienced by parents and children from 10 to 18 years of age.
An initial three-month run extended indefinitely
“I wanted to do something about kids becoming addicted to drugs and dying from heroin overdoses in my community,” says Reality Tour’s creator, Norma Norris, on the Candle, Inc. website. “Since kids have drug prevention education from K-12, either they didn’t believe what they were being told in class, or they didn’t think the consequences could happen to them. I realized that parents, like me, were clueless as to what temptations our children experience daily. One in four families have a member struggling with addiction. I felt that parent and child needed to be on the same page, with the same information. That information had to be delivered in an engaging manner; it had to be true, emotionally charged and consequence-driven.”
The Tour was first presented in 2003 in Butler County, Pennsylvania, and planned to run for just three months as part of a drug prevention and education campaign. The response was so positive that Norris decided to abandon her career in advertising and devote herself full-time to making the Tour available to others nationwide. Today, 29 percent of Pennsylvania counties offer it as part of their drug education and prevention efforts, and it’s beginning to spread to other states. It has won the national Acts of Caring Award and was named Community-Based Crime Prevention Program of 2008, and in January of 2008 was accepted to the federal government’s National Registry of Evidence-Based Programs and Practices (NREPP).
Watch a video clip of a Reality Tour presentation:
One community’s experience
One organization that recently decided to add the Reality Tour to its educational efforts is Wyoming Valley Alcohol and Drug Services (WVADS), located in northeast Pennsylvania. Carmen Ambrosino, Chief Executive Officer of WVADS, says it has proven to be one of the most effective educational tools his organization has ever used. “I’ve been doing this work for 37 years now and I must say that the Reality Tour is one of the most powerful of all prevention programs that we’ve ever done,” says Ambrosino. “It’s very poignant, it’s very vivid, realistic, and the content and the comprehension of the program to clearly get across where the journey of addiction takes one is real critical.”
The program is not designed to be presented from a stage in front of a seated audience. Instead, it is best experienced in settings that allow small groups or parents and teens to move through a series of spaces where each element of the action takes place. WVADS received permission to use a county office building to stage it, which allowed the organization to stage the different vignettes in separate rooms which the audience moved through as the action unfolded.
As for the “cast,” for that Ambrosino turned to people in his own community who knew the consequences of drug abuse firsthand and could accurately portray the action of the various scenes — his own staff of drug counselors, aided by members of local law enforcement and the business community. “One of our young counselors was the fellow that they kind of arrested in the room and the crowd had no idea that this was going to be taking place. They manacled him, cuffed him, read him his rights, and then we said, ‘Welcome to the Reality Tour. You’ve just gone through the first scene.’ And then we followed that to the jail, on to the overdose scene, and then on to the death — the funeral scene — where literally every child and adult in attendance walked through that scene and signed the guest book and paid their respects at the casket and went through the whole grieving process with the actors, which are our staff, our counselors and prevention workers.”
This expertise and experience is vital to the presentation’s authenticity, as the actual dialogue is unscripted and therefore largely improvised by the presentation’s cast. “It was more of an improv,” explains Ambrosino. “They understood what the parameters were. The overdose scene is about five to seven minutes in length. So, when we met with the physicians and EMTs and nurses, what we did is basically say, ‘What happens? What’s the language that occurs at bedside when you’re trying to save a human being from dying of an overdose?’ And if you stick to that and you do that, that’s what we’re looking for.”
Building stronger community bonds
The exercise of researching precisely how to stage each scene not only provides participants with a realistic experience of each event, it also builds stronger connections between drug prevention organizations and the local police, medical and business community. “We’re talking about some large health systems that have bought into us and have said, ‘If you need our physicians, if you need our nurses, if you need our EMTs, if you need our ambulance, if you need our gurney, if you need our crash cart, you’ve got all that, Carmen.’ Law enforcement has basically said, ‘If you need our police officers, we’re there to assist you.’ And the funeral home in the area, P.J. Adonizio, said, ‘Anytime you need a prop or a casket and/or a sign-in book, etc., you can count on us. We will be there because we see the benefits of this type of program.’”
The Reality Tour is aimed primarily at a young teen audience, in the hope that participants will get the message at an early age before they’ve begun using. “Some national statistics show that one out of eighteen 6th graders use marijuana; one out of six 7th graders use it,” says Ambrosino. “So, we believe that the critical age for drug prevention education is the elementary school, if you will, on to middle school.”
Not ‘scared-straight,’ but simply the facts
Ambrosino is careful to point out that although the program presents realistic depictions of some of drug abuse’s most devastating consequences, it is not a ‘scared-straight’ type of program and has been delicately tuned to present events as neutrally and authentically as possible. “It’s a reality tour. It’s the reality of it,” Ambrosino explains. “I think to create a situation where you’re actually scaring individuals by using inappropriateness of data or misinformation would be a scared-straight type of program. This instead is a reality. This is a journey along the different points — the destinations that drugs take us: the jails, law enforcement interaction, ER rooms, and again unfortunately in some cases, death. It doesn’t use an approach whereby the information is out of the ordinary. It’s very simple, right to the point. ‘Keep it simple, stupid’ — that whole ‘KISS’ philosophy, if you will. This is the hard, cold reality, the underbelly of the beast of what could happen if we use drugs and alcohol.
“And I think that Norma has struggled at times — Norma Norris — with some undue criticism by a small group of people who say, ‘Well, this represents the old scared-straight programs.’ When in fact, it does not, because, one, 37 years into this profession and I never would condone that. But secondly, I really think if people had an opportunity to clearly understand how these components really interact with each other, it’s done in such a way that it’s just a good educational experience.”
For her part, Norris points out that although the Reality Tour does use simulated jail scenes, it is in strict compliance with the Juvenile Justice and Delinquency Prevention Act which prohibits juvenile offenders from having sight or sound of a prisoner. Candle, Inc. strictly enforces this provision in its licensing contracts for Reality Tour sites that use an authentic jail or prison.
Norrris also cites research that proves the efficacy of the Reality Tour’s dramatic enactment approach and clearly differentiates it from ‘scared-straight’ types of programs. Dr. Janice Pringle of the University of Pittsburgh School of Pharmacy and the Reality Tour’s principal researcher states, “There is a growing body of literature pertaining to the use of dramatic enactments for drug and alcohol prevention and other health-related behaviors (see Stephens-Hernandez, et. al., Substance Abuse Treatment, Prevention, and Policy, Vol. 2, No. 11,2007). The use of dramatic enactment as a prevention strategy should not be confused with more direct and confrontational strategies, such as those associated with deterrence programs like ‘scared straight.’”
For more information on the Reality Tour and how to present it in your community, visit Candle, Inc. at www.candleinc.org.
To listen to the complete interview with Carmen Ambrosino, click on the audio icon above. Or, continue reading for a complete, edited, written transcript.
BHC: Tell us about this Reality Tour.
CA: Well, I’ve been doing this work for 37 years now and I must say that the Reality Tour is one of the most powerful of all prevention programs that we’ve ever done. And those who attended — about 125 — have also stated that. It’s very poignant, it’s very vivid, realistic, and the content and the comprehension of the program to clearly get across where the journey of addiction takes one is real critical.
BHC: Who developed the program?
CA: A young lady from Butler County, Pennsylvania, out by the Pittsburgh area, Norma Norris, who runs a group by the name of Candleinc.org and she is the originator, the author of the Reality Tour. This was the first time it’s been done in northeastern Pennsylvania, so we’re excited about it and about the potential to continue it. [Ed. Note: The Reality Tour has also been presented in Pike and Wayne counties in northeastern Pennsylvania.]
BHC: Now, for those who are unfamiliar with where you are located, give us a little description. I assume you’re nowhere near Wyoming.
CA: That’s correct. We are about two hours north of Philadelphia and about an hour and forty-five minutes from New York City, right nestled about thirty minutes from the Pocono Mountains. Scranton, Pennsylvania would be our neighbor to the north, about ten miles.
BHC: And how is the situation in your area with teen drug abuse and addiction?
CA: Well, that’s an interesting question. One of the things that we’ve done and continue to do is to measure data from our area. There are 479 overdose deaths in the county in which we work, Luzerne County, in the past nine years. That I think is just unbelievable. Heroin is our number-two drug of choice in this area after alcohol. The age of experimentation when I started with this agency back in 1973 was about 17, and it’s now down to 10.5 years of age for experimentation. The number of DUI deaths, over nine years, is about 145 in this area. So, this is a real hotbed unfortunately for drug and alcohol issues.
BCH: Tell us how your connection with this Reality Tour exhibit — if that’s the right term — tell us how it came about. Did you approach these folks to develop it or did they come to you with it as an already developed package?
CA: We had heard for the past few years about the efficacy of the Reality Tour and the need for us to at least kind of investigate it. And again, as I mentioned earlier, we’ve been around for 37 years and we have a lot of prevention education. We do about 14,000 hours in public schools in this area with a staff of about 12 prevention specialists and about another 600 community programs. When this was highly recommended, we decided to go out to go through the tour. So, we contacted Norma Norris and asked her if we could come out to Pittsburgh and literally go through the three-hour tour and walked away just saying, “Wow, this has some real merit.”
And we bought it. The Luzerne Foundation and the United Way were kind enough to give us a grant of $3,500 and we purchased the copyright. [Ed. Note: Presenting organizations purchase the Reality Tour Program Model. The copyright remains with Candle, Inc.] And we decided that Monday, January 25, 2010, was going to be our first event. And as I said, the reaction of those in attendance from the children (and there were about 80 young people from 5th through 8th grades) and their parents that went through the first tour — the reaction and the cooperation we got from law enforcement, Geisinger Medical Center, EMTs and physicians and a local funeral parlor and many other entities was very heartwarming. And next week, as a matter of fact, they’re going to have a follow-up meeting to discuss how we can carry this on.
BHC: So, the Reality Tour itself has been in existence for a couple of years and it sounds like it’s available for any organization that wants to kind of lease it or, as you say, to purchase a copyright and present it.
CA: I think I might have said earlier candleinc.com, it’s candleinc.org and Norma Norris would be more than happy to discuss it with individuals. In the Butler County, Pittsburgh, area of Pennsylvania, this is done monthly and has been done monthly now for several years. And one of the things that they frown upon is to move it around to destinations.
So, they’re really encouraging us to try to identify a permanent site. So, we are meeting with local realtors two weeks from today in an effort to see if they might be interested in possibly leasing a building for $1 per year to our agency and if so, then we will have a permanent residence for the Reality Tour that the community can identify with.
BHC: And where did you hold the session that you did in January?
CA: The West Pittston Borough Building, which is one of the municipalities in Luzerne County. The Mayor of West Pittston, Mr. Goldsworthy has been really instrumental on task forces and has been a real activist. He suggested that we consider the Borough Building and when we went out to analyze it, each room lent itself to the tour.
What’s interesting was the cooperation I got from my own staff. One of our young counselors was the fellow that they kind of arrested in the room and the crowd had no idea that this was going to be taking place. [They] manacled him, cuffed him, read him his rights, and then we talked about welcome to the Reality Tour. You’ve just gone through the first scene. And then we followed that to the jail, on to the overdose scene, and then on to the death, the funeral scene, where literally every child and adult in attendance walked through that scene and signs the guest book and pays their respects at the casket and goes through the whole grieving process with the actors, which are our staff, our counselors and prevention workers.
The other unique part of the Reality Tour is a PowerPoint presentation, which is very artfully done and captures informationally the physiological and psychological complications that come with drug use.
BHC: So this is not a presentation that observers would sit in an auditorium and watch up on stage, this is very interactive in a way that — if you’ll excuse the analogy — sounds a bit like a fun house.
CA: That’s a great point that you made about the small group. The Reality Tour is designed for small groups no larger than anywhere from 75 to 100. In fact they discourage large-assembly presentations and that’s why the frequency of the program is real critical. It does allow the interaction. There is a lot of interaction, again, throughout the program and there is an opportunity for people to really bond, if you will, with the cast and with all the informational pieces of it.
We did something neat afterwards by having some pizza and soda — ‘pop’ for those who understand that word! And we really kind of critiqued what the experience was of going through that. And from parent to parent and child to child, the response was that every single child needs to go through this experience and very clearly understand that this is the journey that drugs will take you on.
BHC: Carmen, many years ago as I recall, drug education experts decided to kind of get away from — for lack of a better word — scare tactics and focus education efforts more on the straight facts on drugs. Does this represent somewhat of a turning away from that more dispassionate approach?
CA: Well it’s a reality tour; it’s the reality of it. I think to create a situation where you’re actually scaring individuals by using inappropriateness of data or misinformation would be a ‘scared-straight’ type of program. This instead is a reality. This is a journey along the different points — the destinations that drugs take us, the jails, law enforcement interaction, ER rooms, and again unfortunately in some cases, death.
So, when I say it’s tastefully done, very artfully done, it doesn’t use an approach whereby the information is out of the ordinary. It’s very simple, right to the point. ‘Keep it simple, stupid’ — that whole KISS philosophy, if you will. This is the hard, cold reality, the underbelly of the beast of what could happen if we use drugs and alcohol.
And I think that Norma has struggled at times — Norma Norris — with some undue criticism by a small group of people who say, “Well, this represents the old ‘scared-straight’ programs.” When in fact it does not, because, one, 37 years into this profession and I never would condone that. But secondly, I really think if people had an opportunity to clearly understand how these components really interact with each other, it’s done in such a way that it’s just a good educational experience.
BHC: Now you said that it was members of your own staff that made up the cast of this. Help us understand how this works. Are you essentially buying a script or is there more involved?
CA: Yes, you’re buying actually a script [Ed. Note: The presentation is not formally scripted but instead described as part of the Program Model. Presenting organizations create their own wording.] that you need to follow and the flow of the scenes. What it doesn’t do is basically tell you how to do an arrest and the words, but it tells you there should be an arrest and it should be drug-related. The jail scene, because of the ‘scared-straight’ legislation across the United States, you’re not able to have any sight or sound so you can’t put the children in an institution where there are adult inmates that they can hear or see. So, the jail cell is simply a barren jail cell, which they can walk into and get the feeling of what a jail cell feels like.
The overdose is the same way. In the first scene we had counselors that were dealing with the police and the overdose, the family members who came to bedside as the physicians and nurses and EMTs struggled to save the life — the mother and father and cousin — were portrayed by staff of our agency, who then ultimately became the ones who were standing next to the casket as the ones who were actually grieving the loss of their loved ones.
So, throughout the scenes, there were not professional actors and actresses. They were staff who took a look at to what some of the script was basically saying and then they brought it to life.
BHC: And as you were planning the staging of this, did you develop your own internal script or was it more of an improv kind of a thing among your people?
CA: It was more of an improv. They understood what the parameters were. The overdose scene is about five to seven minutes in length. So, when we met with the physicians and EMTs and nurses, what we did is basically say, “What happens? What’s the language that occurs at bedside when you’re trying to save a human being from dying of an overdose?” And if you stick to that and you do that, that’s what we’re looking for. So, we did have some rehearsals, I might add, on the weekend of the presentation. We had from 12:00 to 5:00 a set-up day where we made sure all the scenes and all the props were in place and the people very clearly understood their roles.
And then the next day we had a rehearsal where we literally from the top we walked through spontaneously what a scene may look like. But the beauty of the Reality Tour is that if we did that two or three nights in a row there would be some wiggle room, if you will, in terms of how they portray it.
BHC: So, this takes some work on the part of the organization that wants to present it. This is not a simple plug-and-play kind of a demonstration.
CA: It does take some work to understand all the components of it and once that’s understood — I think we’re at a point even after one showing that we would be more than comfortable to put that on with some frequency without a great deal of effort, because we have all the players now identified and all the commitments from these partnership groups in our area. We’re talking about some large health systems that have bought into us and have said, “If you need our physicians, if you need our nurses, if you need our EMTs, if you need our ambulance, if you need our gurney, if you need our crash cart, you’ve got all that, Carmen.” Law enforcement has basically said, “If you need our police officers, we’re there to assist you.” And the funeral home in the area, PJ Adonizio, said, “Anytime you need a prop or a casket and/or a sign-in book, etc., you can count on us, we will be there because we see the benefits of this type of program.”
So, I think it becomes a little easier as you move along.
BHC: It sounds as though it takes a little bit of effort upfront as well to get the whole community involved. It sounds as if it’s as interactive for the folks presenting it as it is for the kids who are experiencing it.
CA: Yes. What we did, Dennis, in order to kick this off, is that every school district that we serve — which are 12 public school districts — has a full-time prevention worker from our staff. We charged each of them with the responsibility of establishing ATOD — Alcohol, Tobacco, and Other Drugs — teams at schools that were comprised of 15 middle-school kids between fifth and eighth grades, And the first inaugural project that they would be involved with was the Reality Tour. So, the audiences were these newly identified action teams — ATOD action teams — and their parents.
We did it with two of the schools and now there are ten more, so we have a commitment to do ten more Reality Tours, so we can get all these other ATOD action teams the benefit of going through this. And then we will open it up to the general community.
BHC: And this is intended for students of any kind, not necessarily only for those who may have already been showing some signs of a problem with drugs.
CA: That is correct. Some national statistics show that one out of eighteen 6th graders use marijuana; one out of six 7th graders use it. So, we believe that the critical age for drug prevention education is the elementary school, if you will, on to middle school. [That’s] not saying we have written off the high school — the secondary — because we have a lot of prevention which we have aimed at that particular grade level.
BHC: Well, great! Carmen, anything we haven’t covered that you’d like to mention before we close?
CA: No, I just want to thank you very much for the opportunity to talk about this program and again for your real commitment to drug prevention.
BHC: And for folks who want to get some more information about the Reality Tour, again, what was that website you mentioned?
CA: They can go to candleinc.org.
BHC: Super. Carmen, thank you very much.
CA: A real pleasure. Thank you.