The primary goal of prevention science is to improve public health by identifying risk and protective factors, assessing the effectiveness of preventive interventions and identifying ways to provide information. The field involves the study of human development and social ecology as well as the identification of factors that lead to positive and negative health behaviors and outcomes. Theories of human development are used to design interventions (programs and policies) that target the reduction of risk and the enhancement of protective factors at the individual, familial, peer, community, and environmental levels.
Prevention science is multidisciplinary, as the expertise necessary to conduct this science draws from many fields. Prevention scientists include epidemiologists, psychologists, physicians, sociologists, social workers, educators, health practitioners, public health scientists, bio-statisticians, nurses, geographers, mental health counselors, anthropologists, policy analysts, economists, criminologists, neuroscientists, and geneticists.
Behavioral Health refers to “a state of emotional/mental well-being and/or choices and actions that affect health and wellness.” Individuals engage in behavior and make choices that affect their wellness, including whether or not to use alcohol, tobacco or other drugs. Communities can also impact choices and actions that affect wellness, such as imposing and enforcing laws that restrict youth access to alcohol and assuring that all pregnant women have access to prenatal care.
Behavioral health problems include:
• Substance abuse or misuse
• Alcohol and drug addiction
• Mental and substance use disorders
• Serious psychological distress
The term behavioral health can also be used to describe the service systems surrounding the promotion of mental health, the prevention and treatment of mental and substance use disorders, and recovery support. The public health approach and the Institute of Medicine (IOM) Continuum of Care co-exist and both influence the field of prevention in behavioral health.
The Institute of Medicine’s continuum of care is a classification system that presents the scope of behavioral health interventions and services including: promotion of health, prevention of illness/ disorder, treatment, and maintenance/recovery. A comprehensive approach to behavioral health also means seeing prevention as part of an overall continuum of care. The Behavioral Health Continuum of Care Model recognizes multiple opportunities for addressing behavioral health problems and disorders. Based on the Mental Health Intervention Spectrum, first introduced in a 1994 Institute of Medicine report, the model includes the following components:
- Promotion - These strategies are designed to create environments and conditions that support behavioral health and the ability of individuals to withstand challenges. They enable people “to increase control over, and to improve, their health.” Promotion strategies also reinforce the entire continuum of behavioral health services.
- Prevention - Delivered prior to the onset of a disorder, these interventions are intended to prevent or reduce the risk of developing a behavioral health problem, such as underage alcohol use, prescription drug misuse and abuse, and illicit drug use. There are 3 main types of prevention interventions including:
- Universal: focus on the “general public or a population subgroup that have not been identified on the basis of risk.”
Examples: community policies that promote access to early childhood education, implementation or enforcement of anti-bullying policies in schools, education for physicians on prescription drug misuse, and social skills education for youth in schools
- Selective: focus on individuals or subgroups of the population “whose risk of developing behavioral health disorders is significantly higher than average.”
Examples: prevention education for new immigrant families living in poverty with young children, and peer support groups for adults with a history of family mental illness and/or substance abuse
- Indicated: focus on “high-risk individuals who are identified as having minimal but detectable signs or symptoms” that foreshadow behavioral health disorders, “but who do not meet diagnostic levels at the current time.”
Examples: information and referral for young adults who violate campus or community policies on alcohol and drugs; and screening, consultation, and referral for families of older adults admitted to emergency rooms with potential alcohol-related injuries
- Treatment - These services are for people diagnosed with a substance use or other behavioral health disorder. They include case identification and standard forms of treatment.
- Maintenance - Includes interventions that focus on compliance with long-term treatment to reduce relapse and recurrence, and aftercare including rehabilitation and recovery support.
- Recovery - These services support individuals’ abilities to live productive lives in the community and can often help with abstinence. This is a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.
Source: SAPST, Version 8, November 2012 – SAMHSA Reference #277-08-0218
A commonly used definition of public health from the IOM: “It is what we, as a society, do collectively to assure the conditions for people to be healthy.”
- Promotion and Prevention – The focus is on promoting wellness and preventing problems.
- Population-based –The focus is not on one individual but on the population that is affected and at risk.
- Risk and Protective Factors – These are the factors that influence the problem.
- Domain – The ecological model in which the individual is influenced by different environments, such as the family, neighborhood, school, community, and peers (see the Social-Ecological Model below)
- Developmental Perspective – Consider the developmental stage of life of the populations at risk (e.g. adolescence, young adults)
- Planning Process – Public health utilizes a deliberate, active, and ongoing planning process.
Introduction to the Strategic Prevention Framework
The Strategic Prevention Framework is SAMHSA’s five-step planning process for instituting an intervention in your community, region or state. There are five steps, and each is guided by principles of sustainability and cultural competency. Sustainability meaning the process of an effective system achieving and maintaining desired long-term results. Cultural competency refers to a defined set of values and principles that encourage behaviors, attitudes, policies and structures that enable an organization to work effective cross- culturally.
Prevention Specialist Training: Substance Abuse Prevention Skills Training (SAPST)
SAPST training introduces the fundamentals of substance abuse prevention based on the current knowledge and practice in the field. The training was developed for individuals new to substance abuse prevention or early in their prevention career. In addition to the four days of training, participants will also be sent a link and need to complete an on-line course prior to the training.
For a brief introduction to the principles of the SPF process: go to: SAMHSA
The five steps of the SPF include:
- Assessment: Collect data to define behavioral health problems and needs within a geographic area.
- Capacity: Mobilize and/or build capacity within a geographic area to address identified needs.
- Planning: Develop a comprehensive, data-driven plan to address problems and needs identified in assessment phase.
- Implementation: Implement evidence-based prevention programs, policies, and practices.
- Evaluation: Measure the impact of implemented programs, policies and practices.
Sustainability and cultural competence should be integrated into all steps of the SPF.