SCOPE Thought Piece, Question #1: What are the critical challenges facing the prevention field?

Beth DeRicco, Ph.D.

What prevention field?  Campus, school and community are different and face some similar and some not so similar challenges, including:

  • Competing priorities;
  • Lack of skills, knowledge;
  • Lack of appropriate training;
  • Terminology;
  • Reactive rather than proactive approach.

All of these issues lead to some concerning challenges – who defines what “prevention” is and for whom?  There are some commonalities (e.g. evidence informed practice, process and outcome focus, concern with “primary, secondary and tertiary” models, focus on the social ecological model, etc.), however a critical and complex issue is terminology and paradigm; we think we understand each other when we are working and planning together, but do we really?

Our processes and paradigms have affected our collaborations and created tensions that need not be present.  For example, when we talk about the “3-in-1 framework, the social ecological model, or “it takes a village,” are we using different language to say the same thing? Creating an infrastructure supportive of prevention priorities means a focus on:  funding, education of professionals in appropriate modalities and methodologies (e.g. community organizing, policy development, evaluation, review and revisions, management and supervision, etc.), and the big “G” and little “g” government support of these efforts, among other things.

For example, prevention professionals working on campuses come to the field with a variety of previous experience and professional training. Preparation programs offer little opportunity to prepare new professionals (with the exception of health education and health promotion which offers limited opportunity) for their work in and alcohol and other drug (AOD) prevention; more specifically, our preparation programs are overwhelmingly content focused rather than process focused.  Just as an effective professional trainer can master content on many topic areas and needs to focus on effective training, presentation and facilitation skills (among others), a good prevention specialist needs to understand key processes, as well as critical content areas – content knowledge is important, however not to the exclusion of a focus on process. The turf issues related to this are immense and begin at the educational preparation level and move to how we organize and conceptualize our programs.

Perhaps the most important aspect of our current thinking in prevention that challenges our efforts and outcomes relates to a reactive rather than proactive approach, which leads to a deficit base rather than an asset-focused model.  Our prevention efforts result from “problem” analyses and deficit health behavior, rather than strategic interventions that promote well being and pro-health choices.  This deficit, rather than asset-based thinking makes it difficult to really focus on healthy behavior, and no funder or other key stakeholder really allows us this luxury.  We need to catch people doing good and reward that, instead of trying to mitigate unhealthy behavior choices.  Think about how we are taught to interact with children – it is better to reward the positive than punish the negative.  However, we plan and implement our (health promotion) prevention efforts from a deficit based model.  Our focus on deficits seems wrongheaded, and contrary to other teachings.

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