Prevention & Promotion What does this mean? “An ounce of prevention is worth a pound of cure.” Chapter 9 Fall 2010

Prevention: It’s Everywhere Fluoride in Water Seat Belts Condoms Hand Washing Self-exams (breast & testicular cancer) Fall 2010

Key Concepts Prevention – Promotion – Fall 2010 - Distinction in field of preventing something negative vs. promoting something positive PREVENTION IS A COMMON SENSE CONCEPT THAT DERIVES FROM THE LATIN WORDS MEANING "TO ANTICIPATE" OR "BEFORE SOMETHING TO COME". THE LANGUAGE OF PREVENTION IS PERVASIVE IN THE CULTURE--PARENTS TRYING TO PREVENT CHILDREN FROM GETTING IN TROUBLE, POLICE PREVENTING CRIMES, LEGISLATION PREVENTING VIOLATION OF RIGHTS. PREVENTION IN COMMUNITY PSYCHOLOGY FOCUSES ON TWO MAIN AGENDA: PREVENTING SOMETHING BAD FROM HAPPENING (DEVELOPING A PSYCHIATRIC CONDITION SUCH AS DEPRESSION, SCHOOL PHOBIA, OR ANTISOCIAL PERSONALITY. PROMOTING SOMETHING GOOD WHICH WILL SERVE AS A PROTECTIVE FACTOR AGAINST DEVELOPING SOMETHING BAD OR SOMETHING VALUABLE BECAUSE OF ITS GENERALLY POSITIVE IMPORTANCE FOR THE INDIVIDUAL: SOCIAL SKILLS, FOR EXAMPLE, DO NOT PREVENT SOMETHING SPECIFIC BUT MAY COME IN HANDY IN A VARIETY OF POTENTIALLY STRESSFUL SITUATIONS, SUCH AS DEALING WITH INTERPERSONAL CONFLICT, DISCUSSING PARENTAL DEMANDS WHICH DIFFER FROM YOUR HOPES, AND NEGOTIATING SAFE SEX WITH A PARTNER. Fall 2010

Practice Problem: Smoking Develop an example of prevention program Develop an example of promotion program Fall 2010

3 Models of Prevention/Promotion Bower’s Model of Competence Development Kiss Aid Ice Kaplan’s Prevention Model Primary Secondary Tertiary Institute of Medicine Methods of Prevention Universal Selective Indicative Fall 2010

Model for Competence Development (Eli Bower) 3 types of settings where all societies prepare young for adult life: Key-Integrated Social Systems (KISS) Ailing-in-difficulty institutions (AID) Illness correctional endeavors (ICE) Fall 2010

(1) KISS: Key Integrated Social Systems Formal & informal settings where individual interacts from conception through childhood Primary KISS Systems: Health care, family, school, peers, & religion are key systems Secondary KISS Systems: workplace, leisure/recreational systems, community organizations, internet Fall 2010

(2) AID: Ailing-in-Difficulty Institutions Institutions that come into play if KISS is not loving enough Mental health clinics Local police Hospital emergency rooms These institutions are 1st responders Fall 2010

(3) ICE: Illness Correctional Endeavors Facilities where people go when AID is not enough Fall 2010

Bower’s Quote “With a good loving KISS early in life, people will need less AID & fewer will have to be treated with ICE.” Fall 2010

Bower’s Approach: Summary An ecological perspective on prevention How institutions can play a role in furthering individual development (from socialization to rehabilitation) Provides framework for prevention interventions by specifying different key arenas Fall 2010

3 Models of Prevention/Promotion Bower’s Model of Competence Development Kiss Aid Ice Kaplan’s Prevention Model Primary Secondary Tertiary Institute of Medicine Methods of Prevention Universal Selective Indicative Fall 2010

(2) Caplan’s Prevention Model Three Levels of Prevention Primary Secondary Tertiary Fall 2010

(1) Primary Prevention An intervention given to an entire population when they are not in a condition of known need or distress Goal is to lower new occurrences of a disorder DARE Baby Inoculations Fall 2010

(2) Secondary Prevention Early Intervention – Programs targeted to individuals considered “at risk” for development of bad outcomes Head Start Risk Factor Assessment Fall 2010

(3) Tertiary Prevention Intervention given to people who already have a disorder with intention of limiting the disability caused by disorder Reducing its intensity & duration, thereby preventing future re-occurrence E.g., Neighborhood attitudes toward mentally ill Fall 2010

3 Models of Prevention/Promotion Bower’s Model of Competence Development Kiss Aid Ice Kaplan’s Prevention Model Primary Secondary Tertiary Institute of Medicine Methods of Prevention Universal Selective Indicative Fall 2010

(3) IOM Methods of Prevention Emphasis on prevention of illness, not promotion of health Universal (primary) Selective (people with above average risk for disorder) Indicated (people with high risk for disorder) Fall 2010

Best Practice Principles of Effective Prevention/ Promotion Programs for Children & Youth Address risk & protective processes identified in research Involve families, peers, schools, & communities to address multiple, related goals Are sensitive to cultural traditions Strengthen social-emotional skills & ethical values & foster applications to everyday life Fall 2010

Best Practice Principles of Effective Prevention/ Promotion Programs for Children & Youth Use teaching-learning approaches that involve participants actively at multiple points in their development Focus on second-order change Involve skills training & support for staff to foster high-quality implementation of programs Monitor local needs & program quality to promote continuous improvement Fall 2010

Prevention & Promotion: Implementing Programs Chapter 11 Fall 2010

Implementation: The Efficacy Effectiveness Dilemma What happens to programs conducted under optimal conditions High resources Highly selected & trained personnel Conducted in non-random settings High control over what happens Incentives for participants What happens when these programs confront the real world? What happens when these programs conf Fall 2010

Have prevention/promotion programs been widely adopted? No School Intervention Implementation Study (SSIS; Maurice Elias) 550 school districts in New Jersey mandated to develop prevention programming related to substance abuse & social competence promotion 65% response rate Fall 2010

SSIS Results Most schools were doing “something” Implementation was sporadic Programs used not necessarily those supported by empirical evidence 1/3 of the districts had no programming at all in at least 4 grades Even well-resourced districts had as many schools that failed to successfully implement Fall 2010

Why? Bad Directions? Didn’t think it would work? Tired of being told to do new programs each year? Too expensive/complicated to do it? Inadequate training? Lots of possibilities for things to go wrong Fall 2010

Sustainability Capacity of project to continue to deliver its intended benefits over time Program continuity Program effects Sustaining Skills Sustaining Effects Fall 2010

Program-School Fit/Match Factors Factors for initial engagement Relevance to local needs: If a program offers solutions to meet a school’s specific needs, it is likely to be perceived as attractive and likely to be engaged for a try out at least (foot in door) Fit with school practices: If a program embodies principles and approaches already extant in a school, the school will find the program attractive, as it is likely to be compatible with current thinking and initiatives. Fall 2010