the changing face of prevention jan cairnes, certified prevention professional director of...
TRANSCRIPT
The Changing Face of Prevention
Jan Cairnes, Certified Prevention ProfessionalDirector of Prevention Services
Today’s Agenda
Evidence-based Prevention–Definition of Prevention–History of Prevention–Prevention Research –Environmental Strategies –Strategic Prevention Framework
Health Care ReformQuestions and Follow-up
Prevention is a pro-active process of helping
individuals, families, schools, communities and society to develop the resources needed to promote and maintain healthy lifestyles. Prevention is a broad based and comprehensive approach to the reduction of a wide range of correlated at-risk behaviors.
Definitions of Prevention
Prevention…
Opportunities must occur before the curve!
History of Approaches to Prevention
• 1960s = What are now considered to be scare tactics.
• 1970s = Information dissemination and later in the 1970s, affective education was promoted.
• 1980s = Alternatives were promoted early and by the end of the decade there was increasing emphasis on comprehensive prevention approaches.
• 1990s-Present = Comprehensive approaches have become increasingly science-based and outcome-focused.
Planning, Monitoring, Evaluating, and Replanning
Outcome-Based Prevention
Substance Abuse and
Related Problems
Intervening Variables
(Causal/ Risk Factors)
Programs, Policies,
Practices, and
Strategies
Risk Factors (Root Causes)
Community
Individual
Family
School
Availability of drugs
Availability of firearms
Community laws and norms
Media portrayal of violence
Transition and mobility
Low neighborhood attachment
Extreme economic deprivation
Family history of the problem behavior
Family management problems
Family conflict
Favorable parentalattitudes and involvementin the problem behavior
Academic failurebeginning in lateelementary school
Lack of commitment to school
Early and persistentantisocial behavior
Rebelliousness
Friends who engage inthe problem behavior
Gangs
Favorable attitudes towards theproblem behaviorEarly initiation of the problem behavior
Constitutional factors
Summary of Risk Factors
Risk Factors Domain Protective Factors
Early Aggressive Behavior
Individual Self-Control
Lack of Parental Supervision
FamilyParental Monitoring
Substance Abuse
PeerAcademic Competence
Drug Availability SchoolAnti-drug Use Policies
Poverty CommunityStrong Neighborhood Attachment
The table below describes how risk and protective factors affect people in five domains, or settings, where interventions can take place.
Protective Factors Within the Family, School, and Community
• Caring and Support• High Expectations• Opportunities for Participation
and Involvement
Public Health Model
AGENT
HOST
ENVIRONMENT
HOST(Individual)
ENVIRONMENT(Cnditions)
Prevention or Interventions focus on one or more of
the three areas
Mental health intervention spectrumSOURCE: Adapted from Institute of Medicine (1994, p. 23).
Promotion
Universal
Selective
Ind
icated Cas
e Id
entif
icat
ion
Stan
dard
Tre
atm
ent
for K
now
n D
isor
ders
Compliance w
ith Long-Term
Treatment (G
oal: Reducti
on in
Relapse and R
ecurre
nce)
After-Care (including Rehabilitation
Pro
mot
ion
Prevention
Treatment
Maintenance
Promotion
IOM Definition of Promotion
• Mental health promotion interventions:– Usually targeted to the general public or a whole
population. – Interventions aim to enhance individuals’ ability to
achieve developmentally appropriate tasks (competence) and a positive sense of self esteem,
– mastery, well-being, and social inclusion,– strengthen their ability to cope with adversity.
IOM Definition of Prevention Populations
• Universal (Indirect) – Targeted to the general public or a whole population that has not been identified on the basis of individual risk. The intervention is desirable for everyone in that group. (Support population-based programs and environmental strategies such as changing laws and policies.)
IOM Definition of Prevention Populations
• Universal (Direct) – Targeted to the general public or a whole population that has not been identified on the basis of individual risk. The intervention is desirable for everyone in that group.
Institute of Medicine (IOM) Definition of Prevention Populations
• Selective – Targeted to individuals or a population subgroup whose risk of developing mental or (substance abuse) disorders is significantly higher than average. The risk may be imminent or it may be a lifetime risk.
IOM Definition of Prevention Populations
• Indicated – Targeted to high-risk individuals who are identified as having minimal but detectable signs or symptoms foreshadowing mental, emotional, or behavioral disorder, or biological markers indicating predisposition for such a disorder, but who do not meet diagnostic levels at the current time.
Promotion and Prevention
Both focus on changing common influences on the development of children and adolescents in order to aid them in:
• functioning well in meeting life’s tasks and challenges
• remaining free of cognitive, emotional, and behavioral problems that would impair their functioning
Mental health intervention spectrumSOURCE: Adapted from Institute of Medicine (1994, p. 23).
Promotion
Universal
Selective
Indicated Cas
e Id
entif
icat
ion
Stan
dard
Tre
atm
ent
for K
now
n D
isor
ders
Compliance w
ith Long-Term
Treatment (G
oal: Reducti
on in
Relapse and R
ecurre
nce)
After-Care (including Rehabilitation
Pro
mot
ion
Prevention
Treatment
Maintenance
Promotion
Developmental Framework
CSAP’s Six Prevention Strategies
• Information Dissemination
• Prevention Education
• Alternative Activities
• Community-Based Processes
• Environmental Approaches
• (Early) Problem Identification and Referral
Strategic Prevention Framework
1. Profile population needs, resources and readiness to address needs and gaps
2. Mobilize and/or build capacity to address needs3. Develop a Strategic Substance Abuse Prevention
Plan4. Implement evidence-based substance abuse
prevention programs, policies and practices5. Monitor, evaluate, sustain and improve or replace
those that fail
Strategic Prevention FrameworkFive Steps
CSAP’s SPF is Based on Several Key Principles
• The term “mental, emotional, and behavioral disorders” encompasses mental illness and substance abuse, while including a somewhat broader range of concerns associated with problem behaviors and conditions in youth.
The Nature and Extent of the Problem for Ages 13-18
Prevalence (%) With severe impact (%)
Anxiety disorders 31.9 8.3
Behavior disorders 19.1 9.6
Mood disorders 14.3 11.2
Substance use disorders 11.4 n/a
Overall prevalence (with severe
impact)
22.2
Tilting the Scale
Risks
Protectors
Health Care ReformPreventing Mental, Emotional, and BehavioralDisorders Among Young People: Progress andPossibilitiesMary Ellen O'Connell, Thomas Boat, and Kenneth E.Warner, Editors; Committee on the Prevention of MentalDisorders and Substance Abuse Among Children, Youthand Young Adults: Research Advances and PromisingInterventions; Institute of Medicine; National ResearchCouncil
ISBN: 0-309-12675-4, 592 pages, 6 x 9, (2009)This PDF is available from the National Academies Press at:
http://www.nap.edu/catalog/12480.html
COMMUNITY RISKS
GROUPOR
INDIVIDUAL RISKS
INDIVIDUALSYMPTOMS
ASSESSMENT
UNIVERSAL SELECTIVE INDICATED TREATMENT
CRIMINALEXPOSURES
• POVERTY• VIOLENCE• .LACK OF HEALTH CARE• UNSAFE • SCHOOLS
HIGH-RISKGROUP EXPOSURES
• MATERNAL DEPRESSION• BEREAVEMENT• MALTREATMENT• FOSTER CARE• CATASTROPHIC EVENTS
HIGH RISKINDIVIDUALCHARACTERISTICS
• FUNCTIONAL IMPAIRMENT
• BEHAVIORAL ISSUES• BIOLOGICALPREDISPOSITION
DIAGNOSABLESYMPTOMS
• DSM V
SCREENFOR RISK
EXPOSURE
SCREENFOR SYMPTOMS
ANDBEHAVIOR
DIAGNOSISDISORDER
SCREENFOR RISK
EXPOSURE
SCREENING AND PREVENTION
MEB disorders should be considered as commonplace as a fractured limb: not inevitable but not at all unusual.
The prevalence of these disorders is the same in young people as it is in adults.
An implication for prevention is that universal programs will not be wasted on large numbers of risk-free children.
Consistent Evidence Shows
National Priorities
(1) assurance that individuals who are at risk receive the best available evidence-based interventions prior to the onset of a disorder
(2) the promotion of positive MEB development for all children, youth, and young adults.
References and Resources• Preventing Mental, Emotional, and Behavioral Disorders Among Young
People: Progress and Possibilities http://www.nap.edu/catalog/12480.html
• Western Center for Application of Prevention Technology (West CAPT) http://captus.samhsa.gov/western/resources/bp/step7/eval10b.cfm
• Native American Center for Excellence (NACE) • Substance Abuse Prevention, The Intersection of Science and Prevention,
Hogan, Gabrielson, Luna, Grothaus.• Substance Abuse and Mental Health Services Administration (SAMHSA),
Center for Substance Abuse Prevention www.samhsa.gov • Community Anti-Drug Coalitions of America (CADCA) www.cadca.org • Find and apply for federal government grants www.grants.gov• www.jointogether.org• National Institute on Drug Abuse www.nida.gov • National Clearinghouse for Alcohol and Drug Information
www.ncadi.samhsa.gov • Office of National Drug Control Policy www.whitehousedrugpolicy.gov • The Community Toolbox www.ctb.ku.edu
