Prevention & Promotion

Chapter 9

Fall 20101

Prevention: It’s Everywhere

Fall 20102

Fluoride in Water

Seat Belts

Condoms

Hand Washing

Self-exams (breast & testicular cancer)

Key Concepts

Fall 20103

Prevention –

Promotion –

Practice

Fall 20104

Problem: Smoking

Develop an example of prevention program

Develop an example of promotion program

3 Models of Prevention/Promotion1. Bower’s Model of Competence Development

Kiss Aid Ice

2. Kaplan’s Prevention Model Primary Secondary Tertiary

3. Institute of Medicine Methods of Prevention Universal Selective Indicative

Fall 20105

Model for Competence Development (Eli Bower)

Fall 20106

3 types of settings where all societies prepare young for adult life:

1. Key-Integrated Social Systems (KISS)

2. Ailing-in-difficulty institutions (AID)

3. Illness correctional endeavors (ICE)

(1) KISS: Key Integrated Social Systems

Fall 20107

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

(2) AID: Ailing-in-Difficulty Institutions

Fall 20108

Institutions that come into play if KISS is not loving enough

Mental health clinics Local police Hospital emergency rooms

(3) ICE: Illness Correctional Endeavors

Fall 20109

Facilities where people go when AID is not enough

Bower’s Quote

Fall 201010

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

Bower’s Approach: Summary

Fall 201011

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

3 Models of Prevention/Promotion1. Bower’s Model of Competence Development

Kiss Aid Ice

2. Kaplan’s Prevention Model Primary Secondary Tertiary

3. Institute of Medicine Methods of Prevention Universal Selective Indicative

Fall 201012

(2) Caplan’s Prevention Model

Fall 201013

Three Levels of Prevention

1. Primary

2. Secondary

3. Tertiary

(1) Primary Prevention

Fall 201014

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

(2) Secondary Prevention

Fall 201015

Early Intervention – Programs targeted to individuals considered “at risk” for development of bad outcomes Head Start

Risk Factor Assessment

(3) Tertiary Prevention

Fall 201016

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

3 Models of Prevention/Promotion1. Bower’s Model of Competence Development

Kiss Aid Ice

2. Kaplan’s Prevention Model Primary Secondary Tertiary

3. Institute of Medicine Methods of Prevention Universal Selective Indicative

Fall 201017

(3) IOM Methods of Prevention

Fall 201018

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)

Best Practice Principles of Effective Prevention/ Promotion Programs for Children & Youth

Fall 201019

(1) Address risk & protective processes identified in research

(2) Involve families, peers, schools, & communities to address multiple, related goals

(3) Are sensitive to cultural traditions

(4) Strengthen social-emotional skills & ethical values & foster applications to everyday life

Fall 201020

(5) Use teaching-learning approaches that involve participants actively at multiple points in their development

(6) Focus on second-order change

(7) Involve skills training & support for staff to foster high-quality implementation of programs

(8) Monitor local needs & program quality to promote continuous improvement

Best Practice Principles of Effective Prevention/ Promotion Programs for Children & Youth

Chapter 11

Fall 201021

Prevention & Promotion:Implementing Programs

Implementation: The Efficacy Effectiveness Dilemma

Fall 201022

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?

Have prevention/promotion programs been widely adopted?

Fall 201023

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

SSIS Results

Fall 201024

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

Why?

Fall 201025

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

Sustainability

Fall 201026

Capacity of project to continue to deliver its intended benefits over time Program continuity Program effects

Sustaining Skills

Sustaining Effects

Program-School Fit/Match Factors

Fall 201027

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.