Prevention professionals work in a variety of systems to provide services to the public; these include systems of public health, health care, mental health, education, social services, and law enforcement to name some of them. But why isn’t there a community-wide prevention system that focuses on the full spectrum of services, ranging from health promotion and prevention through treatment and harm reduction where needed?
This is the first Prevention Nugget to address the concept of Building Prevention Systems and providing an infrastructure that reaches out to those in need. There will be four Prevention Nuggets on this topic addressing: Consumers of Prevention Services, Evidence-based Services, the Prevention Professionals who implement and monitor these services, and Delivery Structures that support these services and professionals.
What Would a Prevention Service Delivery System Look Like?
We are all familiar with a health care services delivery system, but when and how do we access prevention services?
When we look at a health care services delivery system, we see four major components: consumers who seek care, health professionals who deliver the care, and effective care delivered within a structure or context provided by a health care provider organization such as a health maintenance organization, home health care organization, or clinics. Effective health care systems feature two important elements--having trained and qualified health care professionals and medical care services that have been found to be effective. The provider organization is also key, as it usually is a delivery structure that is identifiable as a place where this effective health care is delivered by these qualified health care professionals. Funding generally comes from private health insurance, public funding, or out-of-pocket.
Now let’s look at the existing prevention service delivery system. The key elements of the system are the consumers who may or may not seek prevention services; prevention professionals who vary not only in their training but also may not be certified as prevention professionals. And the prevention services that are being delivered may or may not be effective or evidence-based. Furthermore, although provider organizations may exist, for example, community coalitions, schools, county boards, and in some cases, law enforcement, there is generally no prevention structure that is identifiable. And funding for prevention services is primarily from public funding, often federal or State, or from foundations.
Consumers of Prevention and Harm Reduction Services
We can look at any population and establish that there at least 8 consumer groups that exist relative to psychoactive substance use. Each of the groups would require difference services (Refer to www.apsintl.org Prevention Nugget: Prevention, Treatment and Harm Reduction: How Are These Defined in Today’s Prevention Work? Posted January 24, 2022). These 8 groups include:
Using data from the National Household Survey on Drug Use and Health and research studies to help put numbers to each of these groups, it is estimated that most people need prevention or harm reduction services (approximately 110,000,000) compared to those who need treatment services (approximately 3,000,000).
This suggests that within any geographic area from small communities to large cities an array of services should be made available and that these services should be evidence-based and integrated. Looking at prevention, however, we know that the etiology of problem or unhealthy behaviors, such as substance use, is the result of many ‘causes’ and represents a process rather than one event.
Referring back to the Etiology Model depicted to the right [Prevention Nugget, October 5, 2020: What is the Etiology Model,] we can see that there are several pathways or trajectories toward engagement in substance use and other problem behaviors. Being at risk or susceptible and being protected are the potential outcomes of how we interact with our environments and groups, such as our families, our school teachers and peers. This interactive process shapes our beliefs, attitudes and ultimately our behaviors, and represents part of how we are socialized into our small ‘s’ and large ‘s’ societies. Ideally, these processes should be prosocial and positive for all of us to realize our full potential as members of our communities, but we know this isn’t always the case. The next Prevention Nugget on this topic will look at Prevention Professionals who provide these services.