The Changing Face of Prevention Jan Cairnes, Certified Prevention Professional Director of Prevention Services

Today’s Agenda Evidence-based Prevention –Definition of Prevention –History of Prevention –Prevention Research –Environmental Strategies –Strategic Prevention Framework Health Care Reform Questions 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 parental attitudes and involvement in the problem behavior Academic failure beginning in late elementary school Lack of commitment to school Early and persistent antisocial behavior Rebelliousness Friends who engage in the problem behavior Gangs Favorable attitudes towards the problem behavior Early initiation of the problem behavior Constitutional factors Summary of Risk Factors

Risk FactorsDomainProtective Factors Early Aggressive Behavior IndividualSelf-Control Lack of Parental Supervision Family Parental Monitoring Substance AbusePeer Academic Competence Drug AvailabilitySchool Anti-drug Use Policies PovertyCommunity Strong 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 spectrum SOURCE: Adapted from Institute of Medicine (1994, p. 23). Promotion Universal Selective Indicated Case Identification Standard Treatment for Known Disorders Compliance with Long-Term Treatment ( Goal: Reduction in Relapse and Recurrence) After-Care (including Rehabilitation Promotion 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 spectrum SOURCE: Adapted from Institute of Medicine (1994, p. 23). Promotion Universal Selective Indicated Case Identification Standard Treatment for Known Disorders Compliance with Long-Term Treatment ( Goal: Reduction in Relapse and Recurrence) After-Care (including Rehabilitation Promotion 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 needs 3.Develop a Strategic Substance Abuse Prevention Plan 4.Implement evidence-based substance abuse prevention programs, policies and practices 5.Monitor, evaluate, sustain and improve or replace those that fail Strategic Prevention Framework Five Steps

CSAP’s SPF is Based on Several Key Principles Prevention is an ordered set of steps along a continuum to promote individual, family, and community health; prevent mental and behavioral disorders; and support resiliency, recovery, and relapse prevention.

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 Prevalence (%) With severe impact (%) Anxiety disorders Behavior disorders Mood disorders Substance use disorders11.4 n/a Overall prevalence (with severe impact) 22.2

CSAP’s Key Principles Continued Prevention is prevention is prevention. Common risk and protective factors exist for many mental health and substance abuse problems. Good prevention focuses on these common risk factors that can be altered.

Tilting the Scale Risks Protectors

CSAP’s Key Principles Continued Resiliency is built by developing assets in individuals, families, and communities through evidence-based health promotion and prevention strategies. Systems of prevention services work better than service silos.

CSAP’s Key Principles Continued Baseline data, common assessment tools, and outcomes shared across service systems can promote accountability and effective prevention efforts.

Strategic Prevention Framework Steps Sustainability and Cultural Competence Assessment: Profile population needs, resources, and readiness to address needs and gaps Evaluation: Monitor, evaluate, sustain, and improve or replace those that fail Implementation: Implement evidence- based prevention programs and activities Planning: Develop a Comprehensive Strategic Plan Capacity: Mobilize and/or build capacity to address needs Department of Health and Human Services - Substance Abuse and Mental Health Administration - Center for Substance Abuse Prevention

Health Care Reform Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities Mary Ellen O'Connell, Thomas Boat, and Kenneth E. Warner, Editors; Committee on the Prevention of Mental Disorders and Substance Abuse Among Children, Youth and Young Adults: Research Advances and Promising Interventions; Institute of Medicine; National Research Council ISBN: , 592 pages, 6 x 9, (2009) This PDF is available from the National Academies Press at:

COMMUNITY RISKS GROUP OR INDIVIDUAL RISKS INDIVIDUAL SYMPTOMS ASSESSMENT UNIVERSALSELECTIVEINDICATEDTREATMENT CRIMINAL EXPOSURES POVERTY VIOLENCE.LACK OF HEALTH CARE UNSAFE SCHOOLS HIGH-RISK GROUP EXPOSURES MATERNAL DEPRESSION BEREAVEMENT MALTREATMENT FOSTER CARE CATASTROPHIC EVENTS HIGH RISK INDIVIDUAL CHARACTERISTICS FUNCTIONAL IMPAIRMENT BEHAVIORAL ISSUES BIOLOGICAL PREDISPOSITION DIAGNOSABLE SYMPTOMS DSM V SCREEN FOR RISK EXPOSURE SCREEN FOR SYMPTOMS AND BEHAVIOR DIAGNOSIS DISORDER SCREEN FOR 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 Western Center for Application of Prevention Technology (West CAPT) 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 Community Anti-Drug Coalitions of America (CADCA) Find and apply for federal government grants National Institute on Drug Abuse National Clearinghouse for Alcohol and Drug Information Office of National Drug Control Policy The Community Toolbox

Jan Cairnes, CPP Director of Prevention Services