Prevention Principles in Case Management and Addiction
Dr. Dawn-Elise Snipes walks through prevention frameworks for addiction case management: the six-dimension health model, three levels of prevention, and how to design campaigns using the 4 P's. She covers community assessment, stakeholder engagement, and tailoring programs to specific populations and settings.
Chapters
This episode was pre recorded as part of a live continuing education webinar on demand. CEUs are still available for this presentation through all CEUs. Register@allceus.com Counselortoolbox you I'd like to welcome everybody to today's presentation on wellness and illness prevention concepts and strategies. I am Dr. Donnelly Snipes. Today we're going to explain the purpose of wellness and disease prevention. Probably doesn't need much explanation, but we'll go there. We'll identify the benefits of it, identify three types of prevention and intervention activities. We'll describe the steps to initiate a change. You know, what can we do to start these prevention programs and apply knowledge of the principles of effective programs. One of the things I want you to think about when we're going through this is how can I or my organization start implementing some of these in a cost effective way, in a way that's meaningful to our, you know, customers, to our consumers, to our communities. One of the things we find with prevention, if you're not at an agency that is lucky enough to have a prevention grant, prevention activities are excellent outreach activities to raise your, raise people's awareness of your organization in the community. So it's, it's good marketing, it's good PR if you get out there and you're doing prevention activities. If you're involved in coalitions, the purpose of prevention and early intervention activities are to attain the highest possible standard of health through comprehensive holistic approaches to care, which go beyond the traditional curative approaches and involves communities, health providers and other stakeholders. We want to get away from this reactive process that we have where we wait till somebody's sick and then we say, okay, let's see what we can do to help you along. Want to improve people's health literacy. We want to help people prevent illness. Now, some of you may be going, well, you know, I get paid by people that are coming in because they need help. There's always going to be people who need help. I can't believe that we are going to do such a good job with prevention that we will prevent ourselves out of a job. A holistic approach should empower individuals and communities to take action for their own health, foster leadership for public health, promote intersectional interaction to build healthy public policies and create sustainable health systems in society. And that intersectional interaction is going to be really important. We need to get the politicians on board because they're the ones that hold the purse strings. We're going to need to get schools on board because they have all of our youth and that's one of the best places to reach the youth. We want to get community places on board, like religious organizations and community centers. We want to get the average person on board and businesses, especially big businesses, but any businesses in your community, you want to get them on board. Because if they can prevent burnout in their work environment, if they can have a healthy workforce, then that's a great thing. We want to try to reach out to places everywhere that we might be able to touch people, people and create a healthy community. If we've got individuals who are trying to be really healthy and implement healthy lifestyle practices, well, that's great. But if they are going to schools and workplaces that are unhealthy, it kind of undoes a lot of the work that they're doing to try to be healthy when they're not at work. If they're going to work every day and they're just like, oppressively stressed out, probably not. You know, it's working against their activities. So we want to make sure that we use this intersectional approach. Benefits of wellness and illness prevention. Well, it increases knowledge about risk factors for developing health problems. We want to help people know ahead of time the importance of. And here's my soapbox again, healthy nutrition, adequate quality sleep, exercise, sunlight, social support. All of those things that are important to prevent vulnerabilities, to enhance our physical and emotional health are really important. But a lot of people don't know that. A lot of people. If you ask five people today, how much sleep does the average adult need? Most of them will probably say five to six hours. Some of them may just say, but, you know, and why is sleep important? Most people can't answer that question. Illness and prevention and wellness programs also increase awareness of personal risk factors. It makes people stop for a second. You know, we can take in all this information and go, okay, these are all the things you need to do. But we don't take a look at our own behaviors. We just take this information in. And it doesn't go from information to practice. It's just bouncing around up there in our head. These programs help people take this knowledge that they have and apply it to themselves and go, oh, you know, maybe I could start making some modifications in these risk factors here. These programs enhance screening to identify whether health conditions may be present. When we're talking about these different programs, we can have depression screenings, high blood pressure screenings, asthma screenings, whatever is prominent or seems to be a prominent issue in your community. We can provide coaching about how to manage newly identified health problems. Just because somebody has a health problem doesn't mean they don't need prevention programs anymore. We need to prevent that health problem from getting worse, and we need to prevent that health problem problem from causing more problems. We also need to help people figure out what they need to do to address this newly identified health problem, whether it's Crohn's disease or arthritis or cancer, whatever it is. And these programs also help provide strategies for the prevention of future health problems. If people get this information and they have a high level of health literacy, then they will know a lot of the things that are important to prevent or preventable factors that they can address to try to prevent or slow down the progress of dementia, diabetes, cancer, the list goes on. The dimensions Model of health includes six dimensions, hence the fact it's called dimensions Model. The biophysical dimension, the psychological and emotional dimension, the behavioral, the sociocultural, the environmental, and the health systems. The biophysical is obviously what our health is, whether we're sleeping, whether we're eating, whether we're getting enough medication, whether we're able to manage any chronic health conditions. Psychological and emotional dimension involves how people perceive the world, their emotional health, whether they have, you know, PTSD or anything like that. Behavioral involves the activities that we do in order to improve our health or likewise, you know, hurt our health. Are we getting enough sleep? Are we. Do we have access in the environment? Are we getting out and walking? Are we, you know, doing. Contacting social supports. Sociocultural dimension involves how our culture perceives health and wellness. Not every culture sees health and wellness exactly the same way. They may define health a little bit differently, but what the supports are for maintaining health and wellness. The environmental dimension is obviously what people's environments are like. If we want them to be healthy, they need to be in a healthy environment. Now you've got to figure out how you're going to define that, and that depends on the community and the culture in general. You don't want smog, you don't want overcrowding. You don't want high levels of noise. You want a place that's safe and where people aren't constantly worried that they're going to be assaulted in some way. And then the health systems dimension is the one that's a little less obvious, and that really reflects people's ability to access health services and can they access doctors and nurses and dentists and optometrists and all those things in order to optimize their health? I'm going to be talking a lot about health today, not just mental health. Because the two are so intertwined. If we have chronic health conditions, they can negatively impact our mental health. If we have mental health conditions, they can negatively impact our physical health. It's important that we address both goals of these programs are to reduce risk factors on the individual level. Help people recognize what individual emotional, cognitive, behavioral, environmental factors that they've got going on that may be risk factors. They can look around and they can say, all right, you know, I can't move out of the middle of this city where there's a lot of smog, but what can I do to protect myself? Well, maybe certain times a day it's safer to go out and exercise. I know we have a lot of ozone warnings here in Tennessee. When it gets really hot, and my daughter has chronic lung problems, it's important for her not to go outside and exercise when the ozone levels are extremely high. Individual factors. Sunlight. Sunlight's great. It helps set our circadian rhythms. However, you don't want to go out when the UV rays level is super high because that increases your risk of skin cancer. Just taking these risk factors into consideration for your individual person, the microsystem. If we're reducing risk factors, we want to look at the immediate family. If people are in a family that is dysfunctional. If people are in an immediate family where a member has an addiction or a mental health issue or a disability, we need to help them access the resources they need in order to improve their quality of life so it doesn't put a strain on the individual's quality of life. The exosystem is the neighborhood. You know, have the person look around in their neighborhood and identify risk factors and that. I've done a lot of other presentations on risk and protective factors, so we're not going to go into a bunch of those here. We're really talking about the meta concept of wellness programs and illness prevention. What are we looking at? We want to involve the individuals. We want to involve their immediate family members. We want to involve stakeholders from the exosystem, the principal, the teachers, the PTA from work, the companies that employ the people that are in the neighborhood, and local law enforcement. Anybody like that who's in that exosystem in order to help them improve that situation. If you put somebody in a healthy environment, then it's probably going to help them have a higher quality of life. If you plop somebody in a unhealthy environment, then that increases their risk factors. It increases their exposure to risk factors. Then we want to look at the risk factors in the Macro system or in the culture, what sorts of things are going on in a particular culture that might be increasing stress and in what ways can we address that? One of my pet peeves right now, or always, but more prominently right now, is the news. The news is just negative, negative, negative. I turn on the news and I want to turn it right back off again because it seems like it feels like every story they do is about death, destruction, calamity and this and that. And it makes me feel like the world is going to hell in a handbasket when I know that, yes, there are parts that are, you know, not going so great right now, but there are also parts that are wonderful, but the news doesn't focus on that. And if you remember from one of the other presentations I did, I can't remember which one it was right now. But there is a principle and research has shown that for every negative thing that we experience, we need five positive things to balance it out because our brain naturally errs towards survival. So it gives heavier weight to the negative thing and less weight to the positive things. I would love to see the news start balancing it out and going, okay, well, there's this negative thing that happen, but let's talk about these three to five positive things that also happened in the community this week in order to help us see that it's not all doom and gloom. Okay, that was my soapbox. Enhancing protective factors. We don't want to just reduce the risk factors. We also want to enhance the protective factors. Some of the risk factors we can't get rid of completely, like smog, for example. Okay, well, if we can't get rid of smog, what is something else we can do in the short term? What is something else that we can do to that's protective? We can encourage communities to enhance clean air regulations on an individual level. We can make sure that as individuals we are exercising and doing the things that we need to do in safe places, like indoors. You know, it's not as fun, so to speak, sometimes, but, you know, that's a protective factor. We can make sure that we are getting enough sleep, that we are getting enough nutrition, yada yada, in the microsystem, in the immediate family and peers. We can enhance protective factors by encouraging healthy relationships and really devoting time to nurturing those relationships in the exosystem. Protective factors can include making sure there are things to do, especially for youth, you know, that there are skate parks and community centers and places that they can go that are pro social and, you know, affordable and Accessible to all youth who may want to go there. And safe parks, making sure that they're safe. They're not just places that people hang out to be up to no good. And in the macrosystem, the protective factors that we can enhance are again, communicating and talking about health and wellness. And yet maybe we can't change the country or the world, but we can change our little corner of it. Our macrosystem, the culture of our community, we can address. And, you know, maybe that's just our neighborhood, maybe it's a larger part of our community. Depending on what your function is in the community, you may or may not have pull, but these things can all affect, you know, when we're talking about diabetes, reducing risk factors. You know, individual risk factors for diabetes can be, you know, being overweight, microsystem in the immediate family and peers. Risk factors for diabetes can be having immediate family and peers who promote, you know, overeating and unhealthy eating and lack of exercise and all that kind of stuff. The exosystem in the neighborhood, lack of safe places to exercise, lack of access to healthy foods, you know, lots of fast food, greasy food, high sugar food is a risk factor. So, you know, making sure that there's access and as a culture, paying attention and educating the culture, educating everybody about the impact of diabetes, for example, and what they can do to prevent it, and encouraging healthy behaviors. You don't have to be a size poo, but being a healthy weight for your person is really important and encouraging people to talk with their doctors about what that is, because BMI isn't going to give you a good number. People with a lot of muscle mass are going to have a high bmi, but they're going to be very lean. So it's important for people not to just kind of use random figures and to talk with their healthcare provider. Primary prevention is wellness. This is when we're preventing something from ever occurring. We don't want people to ever get diabetes or traumatic brain injury. We don't want them to ever start smoking or become depressed. That would be great if we could totally prevent it. So how do we do that? We can provide education about healthy and safe habits to prevent these sorts of things. We'll use traumatic brain injury in this set of slides, you know, educating parents about risks for falls for their toddlers. I remember when my son was little, he fell down one time and he conked his head on the little bar that comes out of my chair where the, where the wheel attaches. And he got this big old goose egg on his head. And I was just, you know, terrified and mortified that, you know, he had really, really hurt himself. And, you know, we watched him, watched his pupils and all that kind of stuff. But educating people about how important it is to pay attention, even when little kids fall and bump their head, yes, they do it a lot, especially when they're learning to walk, but it's still important to pay attention and make sure they don't have some sort of, you know, concussion from it when they get older. Making sure that they wear their helmets when they're riding their bikes, if they play football, if they, you know, paying attention to the best practices to prevent football, brain related brain injuries. All of those things we can educate parents about, and parents can educate their kids. You know, it's important to be riding or to be wearing your helmet when you're riding your skateboard or riding your bike. For these reasons, we can make sure that schools are safe and communities are safe through effective enforcement of community laws and norms regarding health and mental health behaviors, enforcement of drug and alcohol behaviors, laws, and all that kind of stuff. Obviously important in terms of tbi. Making sure that schools, you go out on the playground and there's not a place or that a child could fall easily get a concussion. Now, children can get concussions, you know, just about anywhere. But, you know, making sure that there is ample padding underneath the monkey bars. Making sure that there's not a teeter totter that is, you know, too big, where it's just going to flip a child off and through midair. All those things are important. Making sure that coaches and PE teachers pay attention to anything that might cause traumatic brain injury. Making sure that students are educated about the need for wearing their helmets if they ride their bike to and from school. Making sure parents understand all the rules about car seat safety. Because, you know, in a car accident, little kids can get very badly hurt or killed very easily. They are kind of breakable. And traumatic brain injury is not uncommon to come across in communities. You know, another cause of traumatic brain injury, especially in infants and very young children, is shaken baby syndrome. Making sure that laws and norms are being enforced in terms of following up, providing parent education, making sure that any suspicions of child abuse or neglect are followed up with quickly, yada yada. Annual universal screenings for health and mental health issues. Obviously, TBI is an acute injury, but paying attention to children when they come in, asking them whether they've fallen and hit their head or had anything that may have started causing headaches when Doing those screenings, looking for symptoms of after effects from traumatic brain injury, such as chronic neck pain, headaches or changes, sudden changes in personality since the injury. Access to safe housing, nutrition and medical care, you know, that's helpful for anybody. The event of a brain injury, in the event of a head injury or a concussion, some people don't seek out medical treatment because they can't afford it. Which means, you know, some of these mild TBIs may go unnoticed or they're noticed by the parents, but the parents just keep an eye on it and make sure the kid doesn't lose consciousness or start throwing up. But there's a possibility that with early medical care, you know, some things could be prevented. So we want to make sure that parents don't have an obstacle or people don't have an obstacle to getting a head injury checked out early on. Opportunities for gainful employment, to prevent poverty and increase community connection. You know, that's going to be one of those prevention activities that's going to help with just about anything. It's not specific, specifically related to tbi. And access to parenting education is also going to be helpful. Again, to reduce shaken baby syndrome, to educate about proper car seat usage, to educate about helmets and you know, how to, how do you know if a helmet fits correctly and your kid is safe, et cetera. Secondary prevention reduces the impact of problems that have already begun with the goal of halting and reversing the progression. We're going to stick with tbi, but again, you can apply these principles to everything from addictive behaviors to depression to physical problems. We want to make sure in secondary prevention we don't want it to get worse. So if somebody gets a head injury, we don't want it to develop into some sort of permanent problem if at all possible. So access to early intervention is important. Medical intervention, in this case, self help groups. If somebody has a brain injury that does cause some sort of permanent biological or physiological damage to their brain, they may need to be in self help groups and counseling and occupational therapy and physical therapy to prevent it from causing other problems and to reverse the progression of any problems caused by that brain injury. We want to make sure they have access to medication and patient assistance programs if they need it, so they can have any medication they may need and access to safe and sober housing. I always put sober in there in addition to safe. Just to be clear, if somebody has a traumatic brain injury, they need to have a safe place to put their head. Everybody needs a safe place to put their head. Tertiary prevention prevents additional issues from the problem. So if you've got a traumatic brain injury, we don't want the person with a traumatic brain injury to become depressed, addicted to pain pills and homeless because they are unemployed. You know, all of those are tertiary problems that can result from TBI or depression or addiction or any of those things. We want to prevent that. So tertiary prevention says, okay, you got this problem. We're doing what we can to prevent it from getting worse, but let's also prevent ancillary problems from developing. Job coaching and advocacy to ensure employment are important. Ensuring that the person knows what their rights are under the Americans with Disabilities Act. Financial counseling and assistance to prevent poverty and financial stress. They may have time between their injury and when they can go back to work that they're not able to be employed. They need to have significant physical therapy because they've lost some physical functioning or lost the ability to communicate verbally or whatever the case may be. They may need financial assistance at that point, access to adequate nutrition, medication and health care for overall health and well being. We don't want this person, even if they're struggling, they're not able to work right now. They're trying to go through rehabilitation in order to make that effective. They need to get enough sleep, they need to have nutrition so they have the building blocks for their body to recover. They need to be able to reduce their stress as much as possible so they can recover instead of, you know, recovery is exhausting. But if you're trying to recover and you're also stressed out about finances and not getting enough sleep and not getting a good diet, you, you know, that works against the recovery process. We want to make sure that people have all the tools and resources they need in order to move forward in their recovery. And again, access to safe, sober housing to prevent homelessness. That would be a really bad ancillary consequence of traumatic brain injury or depression or whatever. Looking around, knowing about the housing resources in your community, and if you don't know about them, go to United Way Information and referral. That is the best place to start looking for any sort of resources that your clients may need. So you have primary, secondary and tertiary interventions. Prevent it from ever happening, prevent it from getting worse, and prevent additional problems. Then you have universal, selective and indicated interventions. Universal interventions attempt to reduce a specific health problem across all people in a particular population, such as children in your county, by reducing and promoting protective factors like preventing traumatic brain injury or preventing depression. Selective interventions are aimed at a subgroup determined to be at high risk due to their exposure to risk Factors. Football players are at a higher risk of traumatic brain injury. Selective interventions may target athletes or football players in particular. And indicated interventions are targeted to individuals who are already experiencing problems or distress. Football players with traumatic brain injury, we want to make sure that it doesn't get worse and they're able to live a rich and meaningful life. When we talk about depression, you know, universal interventions would be aimed at preventing depression in, you know, the population. Could be the adult population, could be kids, could be everybody. Selective would look at a subgroup at high risk due to their exposure to risk factors. You may want to look for preventing depression in people with ptsd. And indicated interventions are targeted at people who are already experiencing depression. How do we initiate change? Well, the first thing is to complete a community needs assessment and identify your community's priorities. You know, what's most important in your community. So get a coalition together, get your stakeholders all in the same room or on the same video chat and identify your priorities. What is most important to change in your community? What three or five things do you want to see improve and what resources do you have to make that happen? In terms of people that can make something happen in terms of finances, in terms of space, timing, yada, yada. Collect the information from those who would benefit from the interventions and indicate how you will gather information. If you're targeting, maybe you're trying to prevent opioid abuse. Okay, so you're trying to prevent opioid abuse in your communities. Who's going to benefit from these interventions? Well, people at risk for opioid abuse. Who are those people in your community? You're probably going to look at people who have chronic pain issues. You may look at people who have, who are already experiencing issues with opioid use or abuse. You want to define who you're looking at. Or you could just look in general at the population and do a universal intervention and go, let's educate the public about opioids and how they can be effective for some things but really dangerous for others. Figure out who's going to be there and then randomly select some people to get information from. Listen to people in public forums about their concerns about opioid use, about what they're seeing as trends in your community. Interview members of prioritized groups and create focus groups, interviews, and surveys in order to identify what's going on. Prioritized groups and their subgroups would be. If you're talking about addiction, you know, you might want to interview people who are in recovery from opioid dependence and also their subgroups would be their significant others, you know, and what their subgroups see as a need in order to prevent relapse and prevent more people from becoming addicted. Indicate what you're going to ask about, including the knowledge of the issue and including how often the problem behavior occurs. How often, how prevalent is opioid addiction in your community in terms of what they perceive, the importance of the desired behavior for the audience. Why is it important to not develop opioid addiction? Why is it important for people to know about opioids? The expected benefits of adopting the changed behavior. If we increase this knowledge and provide you alternate tools, then what are the expected benefits? And what are the expected benefits and costs of continuing the behavior? If we don't intervene, if we just let things go as they are, what do we expect to see happen in our communities? And you can pull out all kinds of statistics about the current impact. If we're still talking about opioids, the current impact of opioids in the community. For example, once you know what people's perceptions are and you have an idea about what you need to educate on and what their priorities are and what they think is important, and you have stakeholders that have bought in and they're like, yeah, this is important. Let's devote some resources to it. Then you're going to state the issue or broadcast goal the campaign is trying to address, Outlining the basic principles, including the product. What are the behaviors or outcomes that you're trying to change and among whom? We want to prevent opioid misuse among, you know, adults over the age of 18. Price, how much time, effort and other consequences, money lost opportunity, social approval, et cetera. Will it cost a person to change their behavior? Well, when we're talking about opioid use, 1 of the effort, it's more effort than anything. They may want to look for alternate sources of pain control besides opioids. Even after something like dental surgery, it may require a little bit of discomfort on their part if they decide to opt for nsaids instead of opioids. The place, where should the behaviors occur or not occur, and what are the barriers for the behavior to occur? We want to look, where should this prevention program occur? Where should people not be using opioids, basically, and when should people be using opioids? There is a time and a place for them. And what are the barriers to make opioid prevention actually happen? Some people still believe that they need opioids after surgeries, etc. And a lot of doctors are still very willing to prescribe a good long Dose of opioids for people. And there's a lack of education of patients about opioids when they're prescribed, especially after surgery. And P stands for promotion. What communications will occur from what sources, to whom and through what channels of influence? How are we going to get the message out about what opioids are, how they can be dangerous, how you can avoid the problems with them, yada, yada, yada. So Those are your 4P's product price, place and promotion. State the desired attributes and expected benefits of each target behavior. What you're doing, you know, what each person is doing in order to prevent opioid use, and what are the benefits to them for that implementation. And along with those desired attributes and behaviors, you know, it's not just not taking opioids. It's developing alternate ways of coping with pain and chronic pain and education of physicians about prescribing practices and physicians. One of the behaviors you want to see is them not prescribing as many opioids for as long a period of time, except for in, you know, medically necessary circumstances. Implementation. Engage partners, stakeholders and community members. We know what we want to do. We know how we're going to do it. Now we need to get everybody on board and ready to roll out. Assess individual and organizational ready for change using the stages of change model. Remember, pre contemplation. They don't think there's a problem. Contemplation. Yeah, they see there might be a problem. Not sure what to do about it yet. Preparation. They're getting ready to do something in action. They're ready to roll out the message. We want to have individuals and organizations, you know, your county commission, your law enforcement, your schools, your doctors. We want to have all of them in the action stage of change before we're ready to roll out. Then we provide education to the individuals, the stakeholders about what's going to happen and what we need to have happen in order to make this change occur in the community. Foster partnerships and coalitions to support broader reach and sustainability and ensure implementation of strategies. It's great to say, okay, we want to make sure that we are doing these three things. And people say, yeah, we're going to do those three things. That's great. Well, that's wonderful if they say they're going to do it, but we need to make sure that they're actually doing it. We need to make sure there's a change in behavior, include multiple types of activities that affect multiple settings, and go beyond awareness raising, beyond just giving them knowledge, to enhancing Protective factors and reversing or reducing risk factors. Include written material, videos, and interactive activities to help people learn the material based on their age, abilities and learning styles. Not everybody wants to watch a video. I know I don't want to watch videos. I want to read it. Give me something to read and have workshops. Have, you know, town hall meetings. Have a variety of different ways of intervening. Help participants apply the information and use the tools in session, at home and at work. Provide information in small chunks. If we're talking about, you know, depression prevention, for example, you're not going to give them everything about depression in one fell swoop. You're going to present them with information in small chunks that they can use and apply and then another small chunk that they can use and apply. Encourage adult participants to model the behavior so children can learn it. If you're teaching distress tolerance skills, for example, have special section and programming at the library for parents of young children. A lot of parents of young children go to the library as sort of a respite. I know I did when my kids were young. You know, let them go around the library and look at books and that sort of stuff. And mommy can just sit here where it's quiet for a few minutes. But that's a great place to reach parents of young children and administer a pre and post test if you're doing a formal intervention to provide feedback to participants about their mastery of the tools. Otherwise, you need to collect some sort of data from the community. Maybe if you're talking about depression, the incidence of depression, if you're talking about opioids, the incidence of opioid overdose, you know, you want to pick some sort of measure so you can figure out if your interventions are having an impact. Address all forms of physical and mental health issues alone or in combination in the local community by targeting modifiable risk factors and and strengthening identified protective factors. When you start looking at problems, especially mental health problems, but all problems, there are a lot of commonalities between the risk and protective factors. If we create a healthy community with strong social supports and community engagement and access to resources, and people who have healthy communication skills and coping skills, are physically healthy, we're a whole lot better off. That just eliminates or reduces significantly a lot of problems. You want to look for those trans diagnostic risk factors and protective factors, if you will, for the most bang for your buck. Prevention programs should be tailored to address risk specific to the population or audience characteristics such as age, gender and ethnicity to improve program effectiveness. A universal intervention. You're not just going to say everybody. You're at least going to separate it by age because what's appropriate for depression prevention in adults and the way you present it to adults is going to be different than the way you present it to 5 year olds. Family based prevention programs should enhance family bonding and relationships and include parenting skills, effective communication skills and health literacy. You don't necessarily need to call it parenting skills either. Sometimes you can just call it life management skills, setting boundaries, effective communication, behavior management, cooperation, all those things that you're going to be teaching. And prevention programs can be designed to intervene as early as the prenatal period. We know that prenatal conditions do affect the child when they are, when they're born, and it will continue to affect the child henceforth and forevermore. So if we can encourage the birth mother to be as healthy as possible, it's going to have a lot of positive impact on the child. And yes, the financial situation impacts a lot of the prevention programs, which is why I say we need to get communities and county commissions and city commissions on board. They hold purse strings and they can fund prevention programs and they can help you figure out ways to get information out to people where they don't have to take time off from work. But a lot of this will come down to the community's willingness to provide financial resources and what's available in the community for medical care and mental health care, etc. Prevention programs for elementary children should target improving academic and social emotional learning and physical health, including behavioral, self control, emotional awareness, communication skills, social problem solving, playing nice in the sandbox, academic support, especially in reading, self esteem and positive health behaviors. All of these can be taught in PE and health class and even some in reading if they're reading stories about emotional awareness and healthy communication. Prevention programs for middle or junior high school students should increase competence with study habits and academic support, goal setting, communication, peer relationships, coping and problem solving, self efficacy and assertiveness, health literacy again, and strengthening of personal commitments to healthy choices. When they, when students get into junior and high school, they are thinking, you know, think about Piaget. They are thinking on a more formal, operational, concrete to formal operational basis. They're able to more effectively set goals. Five year old is not going to be able to set long term goals. A 15 year old is going to be much more adept at that. Universal prevention programs at key transition points, such as transition to middle school or high school graduation can produce beneficial effects. Now remember, prevention isn't just for kids. We also want to look at other key transition points like when the kids leave and there's empty nest, if somebody gets divorced, that's a key transition point. If there's a death, that's a potential key transition point. Community prevention efforts that combine two or more evidence based interventions such as family and community based programs, can be more effective than a single program alone. We want to try to involve as many of the parts of that microsystem and exosystem as possible in order to keep a unified, consistent, ongoing message going. Community prevention programs reaching populations in multiple settings are most effective when they present consistent messages which can be facilitated by a community coalition. You've got representatives from your major stakeholders. Prevention programs should be long term with repeated interventions to reinforce original prevention goals. We all know that we can learn something and we can start doing it and we can even get a benefit from it. And then we may start backing off from it or forgetting and getting more lax in our approach. So periodic booster sessions serve to remind people that, okay, yep, exercise is important or good health is important. School and work based prevention programs should include teacher or supervisor training on management practices and motivational enhancement in order to effectively build self esteem and communication and all this other stuff in the classroom as well as in the workplace. Prevention programs are most effective when they employ interactive techniques such as peer discussions, role playing, and gamification. It can be, you know, role playing is obviously possible, but you can even gamify it where you team up, you know, half the class against the other half of the class, or this department at work against this department at work to encourage certain behaviors to start happening. Programs should be tailored to fit within cultural beliefs and practices of specific groups as well as local community norms. A systematic outcome evaluation is necessary to determine whether a program or strategy worked. You don't want to just keep throwing money and resources at an intervention and going well. We think it might be helpful. You want to have data which goes back to the beginning. You need to know what you're trying to achieve and figure out how you're going to measure it. If you're measuring truancy, if you're measuring school dropout, if you're measuring rates of depression in your community, you need to know this. It's important to remember though, when you're presenting these things that you need to attend to different learning styles. Some people are visual. They want to see it, they want to read it. They need to take it in through their eyes. Some people are verbal, they take it in by talking about it and listening. They prefer discussion groups and videos and tactile and Manipulative learners. You know, some things you can do with your hands, you know, like learning how to operate a VCR or DVD player. Other things are more abstract, like coping skills, so you can't touch coping skills. But by asking people to take this skill and apply it to a situation, they're manipulating it in their brain to apply it to something that's meaningful to them or asking them to teach it. When people teach something, they manipulate it in their mind in a way to they're trying to figure out how to communicate it, which helps. Tactile or manipulative learners really consolidate that information. On top of that, this is not an or thing, this is an and thing. You're going to have people who are active learners who learn and put together things as they go. They have those aha moments constantly. And then you're going to have reflective learners like me, who takes all the information. It's kind of like taking notes in our mind and, and then we collate it and we have that big aha moment at the end. But we need a few minutes to put it all together and see how it makes sense and go, oh, I get it now. You don't want to put reflective learners on the spot, but you want to check for understanding after they've had a time, time to process. You want to engage active learners as they're going and the format of learning another. And it's another layer. Some people are sequential learners and some people are global learners. Global learners are, you know, big picture learners. They want to know what the big concept is and then you know how you're going to go up to it. I'm a global learner. I want to look at the box when I do a puzzle. I want to read the wiki before I watch a movie. So I know generally what this is going to be about so I can put it into that container. Sequential learners, they don't need a container. They're happy to just start putting puzzle pieces together or go to a movie and see where it leads. It's important for both groups when you're teaching a diverse group of learners to always provide that unifying overview at the beginning so they know, okay, this is what we're going to learn about. That way they don't feel lost. The sequential learners could care less if you put that in there, but the global learners will really thank you. Barriers to learning. English language barriers are obviously big issues when a lot of the information that is put out, you know, by government agencies, etc. Is often only put out in English. That's a barrier. Figuring out how to get that translated. People with a low level of literacy There are a lot of people in the United States who have a very low level of literacy, and asking them to read something that is written at a high school or college level is a barrier. Poor health literacy. A lot of people don't know the basics about how to be healthy. They just have always kind of gone along and done whatever they want in order for them to learn these new strategies. We don't want to assume they have the foundational knowledge, so we may need to provide that foundational knowledge first. The presence of stress and pain can be a barrier to anybody learning. Ensuring that people are able to access interventions for that stress and pain before we start trying to dump more stuff on them. Health beliefs, including spiritual and cultural beliefs, are important to take into consideration when you're choosing your interventions and communicating with your community. What are their perceptions of the cause of this problem and of useful interventions for this problem? Cognitive, psychological and emotional challenges. If people are depressed, if they're anxious, if they have autism, if they have schizophrenia, if they have traumatic brain injury, these all can impact more or less their ability to learn new information, depending on how those things are controlled. If they're well controlled, probably not going to be a problem. But if it's not well controlled, then they may need more specific interventions. They may need you to go slower. With older people, if their cognitive function processing has slowed a little bit, which is normal in aging, they may need things presented a little bit more slowly and concretely. And physical and functional limitations may be barriers to learning. If you're trying to teach them physical stuff, they may not be able to do that. Tai Chi, for example, is, you know, a really good intervention for a lot of things. But if somebody has movement or balance issues, doing traditional Tai Chi where you're standing may be prohibitive. They can learn Tai Chi and the basics with it may be through chair based Tai Chi. Making sure that you take into consideration any physical or functional limitations of your population is going to be really important. The goals of communication and promotion are to increase risk perception, increase people's recognition of the risks that are applicable to them, to reinforce positive behaviors, to influence social norms. Let's get that community and even the culture to start embracing these healthier behaviors, to increase the availability of support and needed services for the individual in their family, in their peers, in their community, and to empower individuals to change or just improve their health conditions. You're not going to build Rome in a day if people are feeling like they're making positive changes, then, you know, that's what we want. We're not going to expect them to become super fit, healthy and happy in seven days. We want to see gradual improvement strategies using the radio or Sirius XM or whatever it is that people in your community listen to. You know, pay radio spots can be effective. Television, getting on the news and doing a health minute. Local magazines, flyers, brochures, the Internet, the employer intranet, you know, that one that nobody can access but the people who work there. Social media tools like Twitter, Facebook, YouTube, Instagram, digital billboards. We have those a lot around here in Tennessee. They're not, not the ones you see on the road, but you go into business establishments and they have televisions up that are just ad after ad. They're just, they're digital billboards. Health fairs. If you can get to health fairs, you can, you know, reach people who are interested in improving their health. Art fairs, those, you know, that's a little bit off the beaten path, but you can do a lot with, with art therapy, teaching people how to manage stress and distress. So if you have a booth at an art fair where you can teach them a skill or two, then you know, so much the better. School carnivals. A lot of people go to school carnivals just because they want to support the school. So they're sort of a captive audience. And cause walk runs, if the, you know, run for a cure or diabetes fundraisers or whatever it is out there. Generally these causes are for some sort of mental health or health condition. If you go to those and you provide prevention information and intervention information, then you're reaching a group of people who are already interested in that cause and you're providing them information that they would be interested in. Effective communication and promotion is relevant, useful and interesting. Features that appear on the CDC's homepage are a great place to find topics and content that can be repurposed for Facebook, Twitter, text messages. Review published research reports for social media worthy content and provide an interesting did you know Fact. Let people know about individual guidelines such as the physical activity guidelines for older adults. All of this can be in your social media account for your business. Make sure it's easy to understand and share and put relevant, intriguing information at the beginning. As a question, do you know how many people in your community struggle with depression? Use fewer characters than allowed to make sharing easy. Keep messages short but relevant. Figure out if somebody can understand what you're trying to communicate in less than two seconds. That's our attention span. Now, sorry and provide enough context so your message can stand alone. It doesn't need to have a lead up or explanation. Make sure it's friendly, conversational and engaging and is culturally responsive. Make your message action oriented. Use a specific call to action with verbs such as learn, watch or join and you don't want to just have Learn more and then take them to a page where there's six page article you know. Provide information in manageable chunks and there's a lot to be said for bullet points anymore. Include links to web content that offer more detail or supply a phone number or email address that people can reach out to use and use all caps sparingly and for emphasis only. All caps is screaming in text and social media, so try not to use it unless you really want to scream about something. When you're typing a public health partner's name in your post, like the CDC or the National Institute of Mental Health or whatever, add the symbol in front of it. This will trigger the tagging feature in Facebook automatically creating a link and displaying the post on the partner's page. That was something new that I learned. Examples of prevention programs that are out there Rural tobacco control and prevention, Rural HIVAIDS prevention and treatment toolkits. Both of these go to that financial aspect that you all were referring to. A lot of times in rural communities, they don't have the resources to implement programs in the same way that places like Nashville and New York might. The Northeast Louisiana Regional Prediabetes Prevention Project Reducing Obesity and Improving Fitness for People with Serious Mental Illness and Just Wellness Worksheets by samhsa. These are all intervention tools and programs that have been found to be very effective. As we move toward a capitated model of health care, prevention will become increasingly important. Capitation means that you are given X number of dollars, say $10 for every life that you are responsible for insuring. So if there are 100,000 people signed up for Medicaid in your county and you are the provider for Medicaid in your county, you get $10 for each one of those people. That means you get a million dollars. But you have to use that million dollars to provide every ounce of treatment necessary, which means it's really cost effective to engage in prevention practices. Prevention activities can be started as early as the prenatal period, integrated into school curricula, and are more effective if presented in multiple settings and formats in order to tailor them to the age, abilities and culture of the recipients. Are there any questions? I know I went through a lot of information, but when we're talking about implementing prevention programs. It is so important to recognize that this is not something that we can just do well, not something that we can do effectively as an individual practitioner. We need to reach out to the people that we might want to target and see what their needs and preferences and perceptions of the problem are. We need to involve community stakeholders in order to get the support that we need to create a meaningful program, and then we need to, again, make sure it's meaningful and produces results. You're not going to continue to get funding from the County Commission or the federal government unless you can prove you're meeting certain benchmarks. So it's always important to know what your goal is. If this podcast helps you help your clients or yourself, please support us by purchasing your ceus@allce.com or getting your agency to sponsor an episode. A direct link to the on demand CEUs for this podcast is@allce.com podcastceus that's allce.com podcastce to sponsor an episode of Counselor Toolbox and reach over 50,000 clinicians per week, go to allceus.com Sponsor thank you. Between writing notes, filing insurance claims and scheduling with clients, it can be hard to stay organized. That's why I recommend Therapy Notes. Their easy to use platform lets you manage your practice securely and efficiently. Visit therapynotes.com to get two free months of Therapy Notes by just using the promo code CEU when you sign up for a free trial at therapynotes. Com.
