Primary prevention

Best Practice Guidelines on Prevention Practice, Research, Training, and Social Advocacy for Psychologists

Preventive interventions have been shown to successfully aid the development of children, youths, and adults and avert maladjustment in individuals at risk for negative outcomes. Continued scientific advancement of preventive interventions is crucial to further the health of U.S. children, youths, and families. This article presents 15 best practice guidelines on prevention practice, research, training, and social advocacy for psychology. These guidelines articulate clear standards and a framework for moving the profession toward improving the well-being of a greater number of individuals and communities. The guidelines are intended to assist psychologists in evaluating their preparation for engaging in prevention work and in furthering their understanding through increased knowledge, skills, and experience in prevention.

Ambivalence related to potential lifestyle changes following preventive cardiovascular consultations in general practice: a qualitative study

BACKGROUND

Motivational interviewing approaches are currently recommended in primary prevention and treatment of cardiovascular disease (CVD) in general practice in Denmark, based on an empirical and multidisciplinary body of scientific knowledge about the importance of motivation for successful lifestyle change among patients at risk of lifestyle related diseases. This study aimed to explore and describe motivational aspects related to potential lifestyle changes among patients at increased risk of CVD following preventive consultations in general practice.

METHODS

Individual interviews with 12 patients at increased risk of CVD within 2 weeks after the consultation. Grounded theory was used in the analysis.

RESULTS

Ambivalence related to potential lifestyle changes was the core motivational aspect in the interviews, even though the patients rarely verbalised this experience during the consultations. The patients experienced ambivalence in the form of conflicting feelings about lifestyle change. Analysis showed that these feelings interacted with their reflections in a concurrent process. Analysis generated a typology of five different ambivalence sub-types: perception, demand, information, priority and treatment ambivalence.

CONCLUSION

Ambivalence was a common experience in relation to motivation among patients at increased risk of CVD. Five different ambivalence sub-types were found, which clinicians may use to explore and resolve ambivalence in trying to aid patients to adopt lifestyle changes. Future research is needed to explore whether motivational interviewing and other cognitive approaches can be enhanced by exploring ambivalence in more depth, to ensure that lifestyle changes are made and sustained. Further studies with a wider range of patient characteristics are required to investigate the generalisability of the results.

The use and misuse of some positively valenced community concepts

Considers the usage of four somewhat amorphous, but positively valenced, community mental health terms: primary prevention in mental health (and closely related notions such as wellness enhancement and positive psychology); resilience; charter schools; and empowerment. Use of these concepts often reflects a need to align with currently popular, "in"-terminology, rather than an intrinsic connection between what is being written about and a tight definition of the concept in question. Usages built primarily around a concept's positive valence and glitter tend to: (a) break down communication; (b) confuse rather than clarify; and (c) ultimately retard a field's growth and progress.

Social, community, and preventive interventions

Psychology can and should be at the forefront of participation in social, community, and preventive interventions. This chapter focuses on selective topics under two general areas: violence as a public health problem and health promotion/competence promotion across the life span. Under violence prevention, discussion of violence against women, youth violence, and child maltreatment are the focal points. Under health and competence promotion, attention is paid to the prevention of substance abuse and HIV/AIDS. We highlight a few significant theoretical and empirical contributions, especially from the field of community/prevention psychology. The chapter includes a brief overview of diversity issues, which are integral to a comprehensive discussion of these prevention efforts. We argue that the field should extend its role in social action while emphasizing the critical importance of rigorous research as a component of future interventions.

The ontogenesis of primary prevention: lengthy strides and stubbed toes

Reviews evolution of the concept of primary prevention in the past 40 years and cites progress in overcoming significant early deterrents (e.g., loosely anchored, overinclusive definitions; weak supporting empirical base) to this development. Highlights the growing trend to define the concept specifically around the yoked notions of risk, and the goal of forestalling major psychological dysfunction. This de facto shift in definitional emphasis has obscured primary prevention's early vision of promoting health and wellness. Stresses need for a comprehensive, multilevel, proactive approach targeted systematically toward the enhancement of psychological wellness in all people, from the start.

Prevention in Sweden and Cuba: Implications for policy research

Sweden and Cuba, each in its own way, have made radical and comprehensive changes in their economic, educational, and social systems. In the process, they have corrected many contradictions about health promotion, which has, in turn, enhanced the effectiveness of their primary prevention programs. There is much for health care planners and public policy strategists to learn from these two social and economic experiments.

Children of disturbed parents: the interface between research and intervention

This paper provides a review of high-risk studies and preventive interventions with children who have an increased likelihood of developing psychopathology because they are the offspring of emotionally disturbed parents. The research implications for preventive interventions are summarized in terms of selection of participants, goals for prevention, intervention methods, and intervention research methodology. Next, several preventive intervention programs are reviewed and evaluated for their responsiveness to the research literature. The review revealed that, despite theoretical and methodological diversity in the research literature, the findings provide many suggestions for the design of preventive interventions. On the other hand, intervention programs were most often found to have not used research findings in program design. This review concludes with suggestions for needed research and guidelines for future preventive interventions.

Enhancing leadership skills for community self-help organizations through behavioral instruction

Group members with skills to lead effective meetings are valuable resources of any community organization. The effects of a behaviorally based textbook and training procedures designed to teach members of community self-help groups to chair effective meetings were analyzed. Measures were collected during regularly scheduled meetings on chairperson performance, member participation, and the closure of discussion topics. The results showed that the use of specified chairperson activities increased after training for each of two chairperson trainees. Further, outcome data suggest that more decisions were made. These findings suggest that the chairperson training procedures may enhance the leadership and decision-making resources of community self-help groups.

Creating and using social technologies for community empowerment

Powerlessness appears to be associated consistently with widespread problems of living. Recently, enhancing community empowerment has been suggested as an important emphasis for human service professionals. This manuscript illustrates a role for human service professionals in creating and using social technologies to facilitate empowerment . Seven case studies are presented that represent seven frequently cited goals of empowerment efforts. Finally, the ethics of the empowerment strategy are analyzed and other implications of designing and using empowerment technologies are considered.

A diagnostic axis relevant to psychotherapy and preventive mental health

Concepts commonly useful to therapists in deciding upon the direction of psychotherapy are collated into a diagnostic axis, using the language of skills. It is argued that this skills axis has more therapeutic relevance than a symptom-cluster scheme, is less pejorative than personality disorder labels, lends itself to scientific grounding, would promote clarity in outcome research, and could be usefully applied to preventive mental health.

Training counseling and problem-solving skills with university students

Often nonprofessionals lack specific instruction in relevant counseling and problem-solving skills. The effects of training procedures on counseling and problem-solving behaviors were examined experimentally with university students. The procedures involved the use of behavioral specifications, rationales, situational examples, study guides, and practice plus feedback on performance. Following training, the average percentage of occurrence of counseling and problem-solving behaviors increased to 89%. Generalization data in sessions with actual clients and expert ratings of the overall quality of counseling provided evidence of generalization to other settings and other evaluative dimensions of counseling and problem-solving performance.

Training counseling skills: an experimental analysis and social validation

A community development perspective suggests the value of using local resources to solve local problems. Two low-income staff of a community service center served as nonprofessional counselors after receiving a training program consisting of written instructions, practice, and performance feedback. The effects of the 40-hour training program were positive for both counseling and problem-solving skills. There was also evidence of generalization of counseling performance across clients, problems, and time. In addition, expert judges' ratings of performance were obtained as a measure of social validity. These findings suggest that the training procedures are effective in enhancing the counseling and problem-solving skills of low-income nonprofessionals.

Toward a clarification of primary prevention

The ambiguity of the concept of primary prevention and a vague fear that primary prevention may violate civil liberties are two of the important barriers blocking the implementation of primary prevention. Progress toward overcoming these barriers may be possible by distinguishing between the different but overlapping meanings of primary prevention. In this paper four models of primary prevention are proposed to aid definitional accuracy and to help identify and avoid those types of preventive interventions which threaten civil liberties.

Social workers in primary prevention: action and ideology in mental health

Primary prevention and a public health model have been among the distinguishing innovations of the community mental health movement. Social work practice, however, has historically been involved in community intervention and environmental manipulation to offset social and psychological jeopardy. Given a long tradition of commitment to activity and techniques which are now hailed as mental health's "third revolution," this study explores the role of social work in primary prevention. Data are from a survey of three community mental health centers in which professional staff completed the Gottesfeld Critical Issues of Community Mental Health questionnaire, a time-distribution form, and a prevention questionnaire. In addition, all staff working in primary prevention were interviewed in depth. The total sample of this study of mental health professionals was 84. This study points to some interesting contradictions found between social work action and ideology in primary prevention. Also, social workers are compared with other professionals in order to isolate some primary prevention tasks and attitudes that appear unique to each.

Primary prevention in community mental health centers: a survey of current activity

About half of the current activity in consultation and education services of community mental health centers can be classified as primary prevention. Using a framework that distinguishes between institutional-level interventions (caretaker training and program consultation) and individual-level interventions (dealing with developmental or situational crises) data are presented from 43 community mental health centers on (a) specific target populations that are tapped by primary-prevention activities and (b) content of the activities. Illustrative activities are described and explanations of current trends are posited. Current programming trends in primary prevention reflect the "state of the art" today and the findings in this paper have implications for the future promotion of primary prevention activity.

[Prevention of behavior disturbances in small children within the scope of public health care]

Four approaches in secondary prevention are described: the personal initiative of the parents, a risk strategy based on social indicators, crisis intervention, and systematic screening. With the exception of the risk strategy, which--at least in a Swiss urban setting--appears to be rather ineffective, these approaches could make a significant contribution, but cannot be considered as sufficient by themselves. Primary prevention in the form of structured group work stimulating the parents to display own activity is an important part in a combined strategy. Some conditions for such a strategy to be successful are mentioned. The necessity of team work and of personal continuity is stressed. Well baby clinics provide the optimal organisational base on which to build the necessary cooperation between professionals of different fields and appropriate lay organisations.