1. Chapter 10: Prevention INTRODUCTION TO CLINICAL PSYCHOLOGY 2E HUNSLEY & LEE PREPARED BY DR. CATHY CHOVAZ, KING’S COLLEGE, UWO

2.  Prevention – overview  Approaches to prevention  Prevention – central concepts  Development of a program  Prevention of violence  Prevention of internalizing disorders  Prevention of substance abuse  Prevention of problems from trauma or loss Topics

3.  Prevention programs  Designed to decrease the risk of serious problems including physical and mental health disorders  Health Promotion Designed to increase activities that are beneficial to many aspects of physical health Examples: Meals on Wheels, Ontario free public vaccinations Prevention - Overview

4. Community Psychology:  Branch of psychology concerned with the reciprocal relationship between the community and the individual  Clinical psychologists are developing programs utilizing the results of community psychology research Prevention

5.  UNICEF (2003) – Estimates 1 billion children worldwide do not have adequate food, shelter, education, etc.  Approximately 15% of Canadian children live at or below the poverty line  Many risk factors for poverty: increased violence, environmental pollutants, physical and mental health disorders  Prevention programs designed to decrease poverty Poverty

6.  Primary Prevention: Intervention before a disorder has developed (to prevent its occurrence)  Secondary Prevention: Intervention after the onset of the disorder (usually called treatment)  Tertiary Prevention: With chronic disorders  Focus is on rehabilitation and long-term adaptation Approaches to Prevention

7. Distinction among prevention programs:  Universal Preventive Interventions: Applied to the general population (e.g., vaccines, etc)  Selective Preventive Interventions: Targeted to individuals at high risk of developing a disorder  Indicative Preventive Interventions: Targeted to individuals at high risk and showing subclinical signs of the disorder Approaches to Prevention

8.  World Health Organization defines mental health promotion activities as those designed to increase well-being and resilience  Risk reduction model: Identifies high risk groups and, using research, develops intervention programs  Risk factors: Characteristics of the person or environment that increases his/her chances of developing a disorder  Protective factors: Characteristics of a high-risk person or environment that decrease his/her risk of developing a disorder Prevention – Central Concepts

9.  Identify the target  Determine how serious the problem is  Review the research evidence about the problem  Identify high-risk groups  What is known about protective factors?  Design the intervention  Design the study Development of a Program

10. Exhibit 10.1, Risk Factors for the Development of Psychopathology in Children & Youth  Individual Factors  School Context  Family/Social Factors  Life Events and Situations  Community and Cultural Factors Example of Program Development

11. Exhibit 10.2, Protective Factors for the Development of Psychopathology in Children & Youth  Individual Factors  Family/Social Factors  School Context  Life Events and Situations  Community and Cultural Factors Example of Program Development

12.  Importance of determining the outcome of a program  Incidence rates: Number of new cases in a given year (requires a very large sample)  Number needed to treat: the number of people needed to treat to save one person from getting the disorder (e.g., Aspirin = 130)  Meta-analysis: Comparing the outcome on several studies of a prevention program  Efficacy and effectiveness Prevention – Central Concepts

13.  Home Visiting Programs: At-risk (low-income teenage single mothers) given several interventions on pregnancy, health care, parenting, etc.  Triple P Positive Parenting: multi-level system designed to target different at-risk parents  Enhancing knowledge, skills, confidence  Promoting safe environments for children  Promoting children’s competence Promoting Evidence-Based Parenting

14. Incredible Years:  Designed originally for kids (3-8) with conduct problems and expanded to cover a wider age group and offered now as a prevention program  Uses group discussion, videotaped examples, behavioural rehearsal  Trains parents to praise positive behaviours, play effectively with kids, and set limits appropriately Promoting Evidence-Based Parenting

15.  Physical Abuse of Children  Meta-analysis indicates that home visit programs, behavioural parent training and multimodal (i.e., multi-faceted) programs are effective in reducing abuse  Bullying and delinquency  Triple P and Incredible Years are effective in treating these problems.  School-based programs on anger management and conflict resolution have mixed success  The Centre for Children and Families in the Justice System  London, Ontario Prevention of Violence

16.  Bullying and delinquency (cont.)  Olweus Bullying Prevention Program: focus on changes in school and classroom, produced effective outcomes  Fast Track Program: focus on engaging the community with a high risk population  noted success in preventing conduct problems Prevention of Violence

17.  Canadian Community Health Survey (2003)  Similar numbers of Canadians (≥ 15 yrs) suffer from anxiety disorders (4.7%) or depressive disorders (4%) as from chronic physical disorders i.e. heart disease, diabetes, thyroid  Anxiety: Coping Koala  Effective program  Identification of at-risk children and treating in group format for children and small number of session for parents  Depression: Universal programs  Not particularly effective but did observe small effects for selective and indicated programs Prevention of Internalizing Disorders

18.  Two types of universal programs:  Interactive: work on the development of interpersonal skills (more effective)  Non-interactive: more lecture-based information  Key features of efficacious programs  Active parental involvement (universal programs)  Identification of social pressures  Work on life skills  Involvement with several levels of school, home, community  Very systematic Prevention of Substance Abuse

19.  Critical Incident Stress Debriefing:  Immediately following a traumatic event with counsellors trained to help people process and discuss the experience (in groups)  Outcome indicates not helpful and can be harmful (as different people process information differently)  Similar findings for bereavement interventions Prevention of Problems from Trauma or Loss

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