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
Definitions of Prevention
 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.
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 outcomefocused.
Outcome-Based Prevention
Substance
Abuse and
Related
Problems
Intervening
Variables
(Causal/ Risk
Factors)
Programs,
Policies,
Practices,
and
Strategies
Planning, Monitoring, Evaluating, and Replanning
Risk Factors (Root Causes)
Summary of Risk Factors
Availability of drugs
Availability of firearms
Family history of the problem behavior
Community laws and norms
Family management problems
Media portrayal of violence
Family conflict
Transition and mobility
Low neighborhood
attachment
Community
Family
Extreme
economic
deprivation
Early and persistent
antisocial behavior
Rebelliousness
Individual
School
Favorable parental
attitudes and involvement
in the problem behavior
Academic failure
beginning in late
elementary school
Friends who engage in
the problem behavior
Gangs
Favorable attitudes towards the
problem behavior
Early initiation of the problem behavior
Constitutional factors
Lack of commitment to school
The table below describes how risk and protective factors affect people in five domains,
or settings, where interventions can take place.
Risk Factors
Early Aggressive
Behavior
Lack of Parental
Supervision
Substance Abuse
Drug Availability
Poverty
Domain
Individual
Family
Protective Factors
Self-Control
Parental
Monitoring
Peer
Academic
Competence
School
Anti-drug Use
Policies
Community
Strong
Neighborhood
Attachment
Protective Factors Within the
Family, School, and Community
• Caring and Support
• High Expectations
• Opportunities for Participation and
Involvement
Public Health Model
HOST
HOST
(Individual)
Prevention or
Interventions focus
on one or more of
the three areas
AGENT
ENVIRONMENT
ENVIRONMENT
(Cnditions)
Mental health intervention spectrum
SOURCE: Adapted from Institute of Medicine (1994, p. 23).
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
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
Strategic Prevention Framework
Five Steps
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
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 13-18
Prevalence (%)
With severe
impact (%)
Anxiety disorders
31.9
8.3
Behavior disorders
19.1
9.6
Mood disorders
14.3
11.2
Substance use disorders
11.4
n/a
Overall prevalence (with severe
impact)
22.2
Tilting the Scale
Risks
Protectors
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: 0-309-12675-4, 592 pages, 6 x 9, (2009)
This PDF is available from the National Academies
Press at:
http://www.nap.edu/catalog/12480.html
COMMUNITY
RISKS
GROUP
OR
INDIVIDUAL RISKS
INDIVIDUAL
SYMPTOMS
ASSESSMENT
UNIVERSAL
SELECTIVE
INDICATED
TREATMENT
SCREEN
FOR RISK
EXPOSURE
SCREEN
FOR RISK
EXPOSURE
SCREEN
FOR SYMPTOMS
AND
BEHAVIOR
DIAGNOSIS
DISORDER
CRIMINAL
EXPOSURES
HIGH-RISK
GROUP EXPOSURES
•POVERTY
•VIOLENCE
•.LACK OF
HEALTH CARE
•UNSAFE
•SCHOOLS
•MATERNAL DEPRESSION
•BEREAVEMENT
•MALTREATMENT
•FOSTER CARE
•CATASTROPHIC EVENTS
HIGH RISK
INDIVIDUAL
CHARACTERISTICS
•FUNCTIONAL
IMPAIRMENT
•BEHAVIORAL ISSUES
•BIOLOGICAL
PREDISPOSITION
SCREENING AND PREVENTION
DIAGNOSABLE
SYMPTOMS
•DSM V
Consistent Evidence Shows
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.
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
•
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Preventing Mental, Emotional, and Behavioral Disorders Among Young
People: Progress and Possibilities
http://www.nap.edu/catalog/12480.html
Western Center for Application of Prevention Technology (West CAPT)
http://captus.samhsa.gov/western/resources/bp/step7/eval10b.cfm
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 www.samhsa.gov
Community Anti-Drug Coalitions of America (CADCA) www.cadca.org
Find and apply for federal government grants www.grants.gov
www.jointogether.org
National Institute on Drug Abuse www.nida.gov
National Clearinghouse for Alcohol and Drug Information
www.ncadi.samhsa.gov
Office of National Drug Control Policy www.whitehousedrugpolicy.gov
The Community Toolbox www.ctb.ku.edu
Jan Cairnes, CPP
jan@hanleycenterfoundation.org
561-841-1122
Director of Prevention Services