PREVENTION “An ounce of prevention is worth a pound of cure”!

1. PREVENTION “An ounce of prevention is worth a pound of cure”!

2. PREVENTION LECTURE OUTLINE • Why prevention? • Definition • Historical perspectives on prevention • Risk and protective factors • Types of prevention/promotion • Barriers to prevention/promotion • Critique of prevention/promotion

3. PREVENTION • Why Is Prevention So Important? • High prevalence rates for disorders • Many people with disorders do not seek treatment • Savings in both human misery and costs • Not enough trained therapists, and therapy is not 100% effective

4. PREVENTION George Albee’s (1990) Prevention Mantra “No mass disease or disorder afflicting humankind has ever been eliminated by attempts at treating individuals. . . Primary prevention is an approach to reducing the future incidence of a condition through proactive efforts aimed at groups, or even a whole society.”

5. PREVENTION • Definition of primary prevention • new cases of a problem do not occur; reduction of incidence • focus is on population or sub-population, not individuals • intentional focus on preventing mental health problems

6. PREVENTION • Definition of mental health promotion • focus on strengths, not problems; wellness, not illness • focus is on population or sub-population, not individuals • multidimensional – from individual to society • ongoing, not time-limited

7. PREVENTION • Historical perspective • pre-germ theory – possible to do prevention without knowing causes – e.g., scurvy, Snow and the Broad St. pump, Semmelweiss • public health approach – the host, the environment, the agent

9. PREVENTION • Risk and protective factors (diathesis-stress) • risk factors – those that increase the likelihood of disorder • protective factors – those factors that help to buffer or offset the impacts of risk factors • ecological perspective – micro, exo, macro (bio-psycho-social)

10. PREVENTION Albee’s equation Incidence = Risk factors Protective factors = Organic causes + Exploitation + Stress Coping skills + Self-esteem + Support

11. PREVENTION • Risk and protective factors – mechanisms for promoting wellness and preventing problems (Rutter, 1987) • reducing risk impact • interrupting unhealthy chain reactions • enhancing self-esteem and self-efficacy • creating opportunities for personal growth

12. PREVENTION • Types of promotion and prevention – Strategies for promoting wellness (Cowen, 1994) • promoting attachment • building competencies • enhancing social environments • fostering empowerment • providing resources to cope with stress

13. Primary prevention Secondary Tertiary Universal – population-wide Selective – high-risk approach Indicated – early detection and intervention (not true prevention) Treatment – problem is well established PREVENTION Types of promotion and prevention – Strategies for prevention

14. Better Beginnings, Better Futures A 25-year universal primary prevention policy research demonstration project

15. There is much rhetoric about the importance of programs beingcomprehensive, ecological, holistic, community-based, collaborativeand/orintegrated • However, there are virtually no well-researched programs for young children which have successfully incorporated these characteristics into the program model

16. Programs and evaluations need to be more ecological • Consider development of “whole child” – physical, social, behavioural, cognitive and emotional development and well-being • Parent and family functioning and characteristics • Neighbourhood characteristics and change

17. Better Beginnings, Better Futures: Goals Prevention • To reduce the incidence of serious, long-term emotional and behavioural problems in children Promotion • To promote the optimal social, emotional, behavioural, physical and educational development in children Community Development • To strengthen the ability of disadvantaged communities to respond effectively to the social and economic needs of children and their families

18. Program Model High Quality Programs • For children from conception to age 4 or from age 4 to age 8 and their families Integrated Programs • Service organizations and providers “blend and unite” Community Involvement • Parents and other citizens participate as equal partners with service-providers in planning, designing and carrying out programs for children and families in the local community

19. Younger Child Sites (0-4yrs) Guelph: Willow Road • 625 children Kingston: Northern Area • 1095 children Ottawa: Albion- Heatheringrton-Farlea-Ledbury • 690 children Toronto: Moss/Regent Park • 1125 children Walpole Island First Nation: • 250 children

20. Older Child Sites (4-8yrs) Cornwall: 4 Francophone primary schools • 530 children Etobicoke: Highfield Junior School • 517 children Sudbury: Flour Mill/le Moulin à Fleur and Donovan • 503 children

21. Research Question 1 How do the Better Beginnings communities develop and implement programs? Are they characterized by: • Parent and community involvement? • Integration of services? • High quality programs? Project Development & Program Model Research

22. Research Question 2 Are the Better Beginnings programs effective in: • Preventing serious problems in young children? • Promoting healthy child and family development? • Enhancing the abilities of disadvantaged communities to provide for children and their families? Outcome Evaluation Research

23. Research Question 3 What are the annual costs of these programs? Economic Analysis Research

24. Research Question 4 What are the long-term effects and cost-benefits for children and their families in terms of: • Educational achievements and high school graduation rates? • Use of special education, health, and social services? • Employment and social assistance? • Criminal charges and convictions? • Teen pregnancy? • Drug and alcohol abuse? Long Term Follow-up Research

28. Low and Declining Family Income • 1990 mean family income for Highfield was $43,841, compared with the provincial average of $57,227 • 1995 mean family income for Highfield was $36,054, compared to the provincial average of $59,830

29. Highfield 1991 - 14.1% for men 1991 - 12.6% for women 1996 - 13.3% for men 1996 - 17.5% for women Ontario 1991 - 8.6% for men 1991 - 8.4% for women 1996 - 8.7% for men 1996 - 9.6% for women Unemployment Rates

30. A Culturally Diverse Community • 1991 - 53.6% born outside Canada • 1995 - 59.8% born outside Canada • 9 languages were mother tongue to 100 people or more

31. Major Program Components • In-school • Family support • Community development

32. In-school Programs • Staff coordinator and committee of parents, teachers and other service-providers oversee in-school programs • Nutrition program - snack, breakfast, hot lunch, classroom instruction • School-wide social skills program - Lion’s Quest • Educational assistants in primary grades • Summer programs • Translation services for parent-teacher conferences

38. Family Support Programs • Staff coordinator and committee of parents and other service-providers oversee family support programs • Family Resource Centre - including toy lending library, parent relief, drop-in, parenting programs conducted in different languages by staff from different cultural backgrounds • Family enrichment workers provide home visitation and bridge home and school

44. Community Development Programs • Staff coordinator and committee of parents and other service-providers oversee community development programs • Before and after-school programs • Cultural celebrations • Volunteer coordination and recognition • Field trips • Resident participation and leadership development

50. Significant Child Findings • Fewer emotional and behavioural problems (as rated by parents) • Enhanced social skills (according to both parent and teacher ratings) • Significant improvements in children’s health