Prevention has at its core, scientific principles taken from the aforementioned fields.
On the one hand we have been taught to analyze, to use our rational ability, to trace direct paths from cause to effect, to look at things in small and understandable pieces, to solve problems by acting on or controlling the world around us. That training, the source of much personal and societal power, leads us to see presidents and competitors, OPEC and the flu and drugs as the causes of our problems. On the other hand, long before we were educated in rational analysis, we all dealt with complex systems. We are complex systems — our own bodies are magnificent examples of integrated, interconnected, self-maintaining complexity. Every person we encounter, every organization, every animal, garden, tree, and forest is a complex system. We have built up intuitively, without analysis, often without words, a practical understanding of how these systems work, and how to work with them. Because of feedback delays within complex systems, by the time a problem becomes apparent, it may be too late, or unnecessarily expensive, to solve...that is why evidence-based Prevention is so critical!
SAMHSA's Strategic Prevention Framework (SPF) is a 5-step planning process to guide the selection, implementation, and evaluation of effective, culturally appropriate, and sustainable prevention activities. The effectiveness of this process begins with a clear understanding of community needs and depends on the involvement of community members in all stages of the planning process. The SPF includes these five steps: • Step 1. Assess Needs • Step 2. Build Capacity • Step 3. Plan • Step 4. Implement • Step 5. Evaluation These steps are guided by the principles of cultural competence and sustainability. The SPF is designed to help States, Jurisdictions, Tribes, and communities build the infrastructure necessary for effective and sustainable prevention. Each step contains key milestones and products that are essential to the validity of the process. Focused on systems development, the SPF reflects a public health, or community-based, approach to delivering effective prevention. The SPF focuses on population-level change. Earlier prevention models usually measured success by looking at individual program outcomes or changes among small groups. For example, a prevention program aimed at middle-school students might look for individual increases in resiliency or changes across one grade level. Under the SPF, a community might instead decide to implement a range of programs and practices which could collectively produce more broad-scale change—in this case, among all participating 7th and 8th graders, instead of just one grade level. Population-level change also forces practitioners to look at the constellation of factors, across related systems, which influence substance use.
Assessment involves gathering data– Behaviors and their related problems cannot always be changed directly , so with the SPF we focus instead on addressing the underlying risk and protective factors for the behaviors and problems.
Look for trends...is problem getting better or worse over time? If there was a 100% increase in motor vehicle accidents from 2010 to 2012 in Smithtown, what would you think? But if there was 1 motor vehicle accident in 2010 and 2 in 2012 what would you think? As this example illustrates, when looking at small numbers in percentages, it may appear as if there has been a significant increase, but when looking at the actual numbers we see that the increase is very small. So use caution with small numbers .
Different criteria can be used to prioritize risk and protective factors: Importance Changeability. The epidemiological data collected during the community assessment will be used to determine importance and changeability. The most important identifiable problem may not always be the one to choose because we may lack the capacity and resources to address.
Evidence-based Risk and Protective factors exist and need to be addressed in multiple contexts.
Promotion=Integrated into entire prevention and health care system Universal=Least Expensive covers an entire group or population Selective=A subgroup, more expensive Indicated=a high risk group, most expensive approach
The National Prevention Strategy (June 2011) aims to guide our nation in the most effective and achievable means for improving health and well-being. The Strategy prioritizes prevention by integrating recommendations and actions across multiple settings to improve health and save lives. The Strategy identifies four Strategic Directions: Healthy and Safe Community Environments: Create, sustain, and recognize communities that promote health and wellness through prevention. • Clinical and Community Preventive Services: Ensure that prevention-focused health care and community prevention efforts are available, integrated, and mutually reinforcing. • Empowered People: Support people in making healthy choices. • Elimination of Health Disparities: Eliminate disparities, improving the quality of life for all Americans.
This is a great prevention tool and we have full access to SAMHSA’s CAPT resources. Additionally, as a part time SAMHSA National Trainer, I am fully engaged with all issues related to evidence-based prevention that I will always share with you, staff, and contractors for a collective impact in our community.
BC PC December 13 2012
The InterdisciplinaryScience of Prevention Bernalillo County DWI Program Planning Council Meeting December 13, 2012 Frank G. Magourilos, MPS, CPS, ICPS Prevention Works Consulting email@example.com
The science of prevention utilizestheories and applications frommany other fields:• Psychology• Sociology• Public Health• Environmental Sciences
SYSTEMS THINKING APPROACH Individuals & EnvironmentCore Prevention Foundations:•SAMHSA Strategic Prevention Framework•Institute Of Medicine Model•Risk & Protective Factors Theory•National Prevention Strategy (HP2020)
Risk & Protective FactorsFor over 20 years, two researchers fromthe University of Washington (J. DavidHawkins, PhD and Richard F. Catalano,PhD) have been examining whatcontributes to or protects against a childsdeveloping problem behaviors.
IOM HEALTH MODEL Tr ea on tm n ti en t ve Indic ation re P Iden ase tm rd tific a t Se en ea da ted Maint C le Tr an c tiv St e Un men t iv e eat enanc rsa h Tr l e wit c ianPromotion pl Com e Promotion After-care
SAMHSA CAPT’s & NREPPThe Substance Abuse & Mental Health ServicesAdministration has five regional Centers forApplied Prevention Technologies (CAPT’s) thatoffer technical assistance and resources toprevention grantees strategically placedthroughout the United States.Additional resources are SAMHSA’s NREPP, asearchable online registry of more than 220interventions supporting mental health promotion,substance abuse prevention, and mental healthand substance abuse treatment.
References-Resources• The Substance Abuse and Mental Health Services Administration (SAMHSA) http://www.samhsa.gov/• SAMHSAs Collaborative for the Application of Prevention Technologies (CAPT) http://captus.samhsa.gov/• The National Registry of Evidence-based Programs and Practices (NREPP) http://www.nrepp.samhsa.gov/Search.aspx• Center for Substance Abuse Prevention (CSAP) http://www.samhsa.gov/about/csap.aspx• The National Prevention Strategy http://www.healthcare.gov/prevention/nphpphc/strategy/report.pdf• The National Institute on Drug Abuse (NIDA) http://www.drugabuse.gov/• http://www.drugabuse.gov/publications/preventing-drug-abuse-among- children-adolescents/chapter-1-risk-factors-protective-factors• The Institute of Medicine (IOM) http://iom.edu/• The NM Prevention Network www.nmpreventionnetwork.org