The purpose of this session is to review some prevention research findings and to give team members a common understanding that they can use throughout the Institute. This section also stresses that sound research must support the planning and prevention programming approaches used by the partnership.
On Day 1, participants learned about developing a vision and about the importance of developing a comprehensive planning system. This unit provides some concepts and ideas that will help teams understand how the planning model relates to prevention programming. It also gives participants information from which the team can develop a common definition of prevention and clarify the partnership's basic beliefs about prevention.
The 2 easels, overhead projector and screen, and computer equipment should be in the front of the room. One round table that seats 12 people should be set up for each partnership team.
Two newsprint sheets and 4 markers of different colors need to be placed on each team's table before the session starts. Computer and backup transparencies need to be reviewed.
In addition to the articles under Trainer Resources below, trainers for this unit may wish to consult the articles in this Trainer Manual that appear at the end of Unit 2C.
Alcohol, Drug Abuse and Mental Health Administration. (1989). Report of the secretary's task force on youth suicide. Vol 3, Prevention and interventions in youth suicide. DHHS Publication No. (ADM)89-1623. Washington, D.C.: Supt. of Docs., U.S. Government Printing Office.
Benard, B. (1988). An overview of community-based prevention. OSAP prevention monograph 3. Prevention research findings: 1988 DHHS Pub. No. (ADM) 89-1615. Rockville, MD: Department of Health and Human Services, Office for Substance Abuse Prevention Alcohol, Drug Abuse, and Mental Health Administration, 126-147.
Benard, B. (1991). Fostering resiliency in kids: Protective factors in the family, school and community. Portland, OR: Western Regional Center for Drug-Free Schools and Communities, Northwest Regional Educational Laboratory. August.
Ewart, C.K. (1991). Social action theory for a public health psychology. American Psychologist, 46:931-946.
Goplerud, E.N., ed. (1990). Breaking new ground for youth at risk: Program summaries. OSAP Technical Report-1. Rockville, MD: U.S. Department of Health and Human Services, Office for Substance Abuse Prevention.
Hawkins, J.D., R.C. Catalano, and J.Y. Miller. Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood. Psychological Bulletin*.
McLeroy, K.R., D. Bibeau, A. Steckler, and K. Glanz. (1988). An ecological perspective on health promotion programs. Health Education Quarterly, 15:351-377.
B. Tell participants that it is important for each team to come to a common definition of prevention (T-1: Learning Objectives).
C. Ask each team to spend 10 minutes using the newsprint and markers to draw a picture that defines prevention for their team.
D. Ask each team to show its picture and to explain it briefly to the large group. (8 min.)
E. Explain that the following definitions that have been developed by others can serve as ideas for the team's own definition of prevention (T-2: Definition of Prevention and T-3: Selected Definitions of Prevention, 5 min.).
Content Points
Prevention is a "proactive process that empowers individuals and systems to meet the challenges of life events and transitions by creating and reinforcing conditions that promote healthy behaviors and lifestyles."
Trainer Note: The following definitions are from the California State Plan.
Multiple processes
"Prevention is about multiple processes which involve people in a proactive effort to protect, enhance, and restore the health and well-being of individuals and their communities. It defines health as not simply the absence of disease; it is something positive-a joyful attitude toward life" (Central Valley Regional Prevention Forum, Framework for Community Prevention, 1988).
Protective
"The objective of primary prevention is to protect the individual in order to avoid problems prior to signs or symptoms of problems. It also includes those activities, programs, and practices that operate on a fundamentally nonpersonal basis to alter the set of opportunities, risks, and expectations surrounding individuals" (Office for Substance Abuse Prevention, Prevention Plus II, 1989)
Comprehensive
"Prevention must be comprehensive, involving all systems (educational, medical, law enforcement, religious, business, etc.). Prevention efforts must be focused on programs and strategies that deal with individual risks and environmental conditions." (The White House Conference for a Drug-Free America, Final Report, 1988)
Directed
"In order for prevention to be successful, prevention system efforts must be directed toward the potential and active users (the host), toward the sources, supplies, and availability of the drugs (the agent), and toward the social climate that encourages, supports, reinforces, or sustains problematic use of alcohol, tobacco, and other drugs (the environment)." (Center for Substance Abuse Prevention, Community Prevention System Framework for Alcohol and Other Drug Prevention, 1990)
Proactive process
"Prevention is a proactive process intended to promote and protect health and reduce and eliminate the need for remedial treatment of the physical, social, and emotional problems associated with the consumption of [drugs and] alcoholic beverages. It addresses individuals, the environmental settings in which they live, and the larger community." (Lawrence M. Wallack, John W. Ratcliffe, and Friedner C. Whitman, Comprehensive Alcohol and Drug Abuse Prevention Strategies, 1984)
Collaborative
"Prevention can now be defined as a collaboration of school and community process to plan and implement multiple strategies that: (1) reduce specific risk factors contributing to tobacco, alcohol, and drug use, and related behavioral problems among youth; and (2) strengthen a set of protective factors to ensure young people's health and well-being." (California Department of Education, Not Schools Alone, 1990)
Directions
F. Tell participants to keep these definitions in mind throughout the rest of the session. Many of the concepts talked about in these definitions will be explained.
Trainer Note: This material comes from Bonnie Benard, An Overview of Community Based Prevention. In Office for Substance Abuse Prevention Prevention Research Findings: 1988. OSAP Prevention Monograph 3.
Directions
A. Review the information presented below about characteristics of effective prevention programs.
Content Points (T-4: Characteristics of Effective Prevention Programs)
This session begins by focusing on some recent research about what a comprehensive prevention system looks like. Benard talks about 3 key areas-(1) a systematic planning process, (2) a comprehensive approach, and (3) multiple program strategies (T-5: Planning Process).
Systematic planning process (T-6: Comprehensive-ness and T-7: Program Strategies)
Sound planning with
common vision,
assessment of needs and resources,
goal setting,
task sequencing,
clear responsibilities,
management,
evaluation, and
replanning;
Collaboration;
Realistic, multiple, measurable goals;
Evaluation of effectiveness;
Flexible and adaptable to the unique needs of the community; and
Careful marketing.
Comprehensive approach
Targets multiple systems and uses multiple strategies;
Targets whole communities with prevention efforts;
Targets all youth as opposed to only "high- risk" youth;
Part of a broader effort focused on health and success promotion;
Long term;
Concerned with adequate services for targeted populations;
Integrated with other activities-family, school, work, and community life; and
Builds supportive environment that encourages participation and responsibility.
Multiple program strategies
Directions
Review the need for developing comprehensive program strategies, using the following 6 areas suggested by Benard:
Information and education. Must be appropriate to each audience. Used in conjunction with other strategies and geared toward specific needs. (Was used during the early 1970s in a way that may have actually increased drug use. Must be a part of a comprehensive approach.)
Life skills. Promote healthy intrapersonal and interpersonal functioning. Include targeted trainings like resistance/refusal skills. (Began being used in late 1970s.)
Alternatives. Include recreational and outdoor activities described in the evolution-of-prevention session as well as rites-of-passage issues and appropriate ways to deal with boredom, pain, and powerlessness. (A late 1970s/early 1980s strategy.)
Social policy. Must look at all levels of policy, involve all stakeholders, and provide clear and consistent messages. Include both policy changes to inhibit alcohol and other drug abuse and ways to promote social and economic changes that create healthier environments and opportunities for success. (Early 1980s.)
Training impactors. Significant individuals and role models in the community who give powerful signals to the community about credibility and participation. They may hold informal or formal roles in the community.
Early intervention systems. Look at how to intervene as early as possible in children's lives and to reach nonusers and potential users to prevent any future use.
Ask for examples of programs being used by partnership communities.
The 6 program strategies may sound familiar, because they are some of the same ones that have been used unsuccessfully in the past. What is important is that these strategies be used simultaneously, and programs be chosen because evaluations have shown them to be effective.
B. Show T-8, the blank community wheel. Ask participants to turn to that page and spend 5 minutes as a team completing what sectors of their community are currently involved in their partnership (T-8: Community Wheel, Blank).
C. After 5 minutes, show T-9, and let participants know this is an example of segments that can be involved (T-9: Community Wheel, Completed).
D. Tell participants that the segments of the community identified for involvement in the partnership can also be thought of as potential targets for services. By placing the prevention strategies over the community wheel, one sees that services are targeted to each sector. (Turn the prevention strategies so that the inner wheel rotates within the outer, community wheel.) Observe where each segment is targeted with each of the program strategies to develop a truly comprehensive system (T-10: Prevention Strategies).
A. Acknowledge that participants are at different levels with regard to the following information. The purpose of this section is to provide a brief review of the research. Suggest that people who are familiar with this information can help team members for whom it is new.
B. Note that one way to increase the chance that prevention strategies will be effective is to look at how they work in a comprehensive and systematic way. One model for doing this is the public health model (T-11: Public Health Model).
Content Points
The public health model looks at the system that creates a health problem.
This system contains 3 components-host, agent, and environment.
The host is the individual(s) affected by the health problem.
The agent is the catalyst, substance, or organism that causes the health problem.
The environment is everything outside the host or agent that creates conditions that increase or decrease the chance that the host will become susceptible and the agent effective.
Directions
C. Ask the group to brainstorm risk factors that might lead to lung cancer in the host, agent, and environment.
Examples are listed below:
Host
genetic susceptibility
other illnesses that weaken the immune system
lifestyle factors (e.g., smoking tobacco or marijuana)
Agent
tobacco smoke
air pollution
toxic chemicals
Environment
tobacco advertising
living near factories
living in an urban area (higher air pollution)
D. Point out that the public health model helps us understand why we must be comprehensive in our approach. The most effective approaches work simultaneously in all 3 components of the system.
Content Points
E. The same model may be adapted easily to the ATOD abuse example (T-12: ATOD abuse Example for the Public Health Model).
The host includes nonusers, potential abusers, and abusers. We can design programs to intervene at each level. (This relates to primary, secondary, and tertiary prevention.)
The agent includes any illegal or legal drug, including alcohol and tobacco.
The environment refers to the communities themselves and to all the conditions within the community that promote or inhibit use or abuse.
F. The ecological model is a second way of looking at the prevention system (T-13: An Ecological Model for Health Promotion).
Content Points
Like the public health model, the ecological model tries to look at the whole system. It assumes that behavior is determined at a number of interactive levels.
Intrapersonal factors. Characteristics of the individual such as knowledge, attitudes, behavior, self-concept, skills. Includes the developmental history of the individual.
Interpersonal processes and primary groups. Formal and informal social network and support systems, including the family, work group, and friendship networks.
Institutional factors. Social institutions with organizational characteristics and formal (and informal) rules and regulations for operation.
Community factors. Relationships among organizations, institutions, and informal networks with defined boundaries.
Public policy. Local, State, and national laws and policies.
Prevention planning efforts must look at how to link all these 5 levels and to intervene in each system to decrease the conditions that promote alcohol and other drug abuse and increase the factors that inhibit use.
G. Some of the most promising prevention research is looking at what are called risk factors.
Risk factors can be defined as the conditions that, when experienced by children, place them at a greater risk of developing problems with alcohol, tobacco, and other drug abuse.
This is one model, developed by Hawkins and Catalano.
Ask participants to recall the risk factors that they identified for lung cancer as examples.
Directions
H. Ask participants to turn to HO-1 and silently read the case study. Now ask participants to spend 10 minutes as a team identifying risk factors for alcohol and other drug abuse (HO-1: Risk Factor Case Study).
I. Review T-14 through T-17. Ask participants to point out the risk factors that they identified in the case study.
Content Points
Community risk factors (T-14)
Economic and social deprivation;
Low neighborhood attachment and community disorganization;
Community norms and laws that facilitate use of tobacco, alcohol, and other drugs; and
Availability of tobacco, alcohol, and other drugs.
Family risk factors (T-15)
Lack of clear behavioral expectations;
Lack of monitoring/supervision;
Lack of caring;
Inconsistent or excessively severe discipline;
Positive parental attitudes toward alcohol and other drug abuse;
Low expectations for children's success; and
History of alcohol and other drug abuse.
School risk factors (T-16)
Lack of clear, enforced school policy about the use of tobacco, alcohol, and other drugs;
Availability of tobacco, alcohol, and other drugs;
School transitions (changing schools, elementary to junior high school);
Academic failure;
Lack of student involvement; and
Little commitment to the school.
Individual and peer risk factors (T-17)
Early antisocial behavior;
Alienation and rebelliousness;
Antisocial behavior in later childhood and early teens;
Favorable attitudes toward drug use;
Susceptibility to peer influence; and
Friends who use tobacco, alcohol, and other drugs.
Directions
J. Understanding risk factors helps prevention planners and providers to target certain behavior and conditions for change. Risk factorsdo not predict future alcohol and other drug use. It is important to not "label" children based on these criteria.
K. Research has also identified protective or resiliency factors. These factors explain why some children and youth who grow up under high-risk conditions choose not to use tobacco, alcohol, and other drugs. Again, these factors do not assure that someone will not use drugs, but they do seem to occur in a higher frequency among nonusers. Review the content points below (T-12):
Protective/resiliency factors (T-18)
A relationship with a caring adult role model;
Having an opportunity to contribute and be seen as a resource;
Effectiveness in work, play, and relationships;
Healthy expectations and a positive outlook;
Self-esteem and internal locus of control;
Self-discipline;
Problem-solving/critical-thinking skills; and
A sense of humor.
Protective factors help give direction to prevention programs by pointing out behaviors and conditions that build the capacity of children and youth to remain nonusers.
To be effective in using risk and resiliency factors, programs must use comprehensive programs that use multiple approaches.
L. Read the 2 quotes, and ask participants to think about what they say about developing a community partnership.
Trainer Note: Ask one member of each team to be responsible for bringing his/her team's picture of prevention to the next session.
Content Points
"The real issue is not creating a team merely to accomplish a specific goal, but to create a critical mass of leaders within communities who can be a support for each other as they work on a variety of different issues they have mutual interest in." (T-19, Cathy Small)
"Prevention readiness is a condition in which a significant portion of a community's leadership, resources, policies, energies, values, and various organizational missions are committed proactively to creating conditions that promote the well-being of its citizens." (T-20, Bill Lofquist)
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