SCOPE Thought Piece, Question #8: Should prevention efforts be piecemeal or strategic within risk areas to maximize effectiveness? How about across risk areas? What suggestions do you have for schools and campuses looking to develop and apply a strategic prevention curriculum, including content, timing, dosage, audience and more?

Andra Teten Tharp, Ph.D.

*The findings and conclusions contributed to this Thought Piece are those of the author and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Comprehensive prevention programs combine prevention strategies at multiple levels of the social ecology and are considered a best practice in prevention (Nation et al., 2003). Comprehensive prevention approaches may also strategically target shared risk factors to have an impact on multiple risk behaviors. As it is unlikely that individual-level prevention strategies used in isolation will have a population level impact (Dodge, 2009), comprehensive approaches are increasingly being developed and implemented. Comprehensive approaches have the potential for broad reach and impact, such that each constituent prevention strategy makes an additive and synergistic contribution to the overall effect. The development of comprehensive approaches is complicated by two issues: 1) a limited menu of what works to prevent problem behaviors in many levels of the social ecology (e.g., effective policies), and 2) the potential to create contradictory messages that undermine the utility of the approach by combining strategies that have different theoretical underpinnings and prevention aims. Instead, prevention strategies and messages that comprise a comprehensive approach should be complimentary, cohesive, and consistent.

An example of a cohesive and comprehensive prevention program being led by the Centers for Disease Control and Prevention is Dating Matters: Strategies to Promote Healthy Teen Relationships (www.cdc.gov/violenceprevention). It includes: school-based strategies aimed at building skills that support healthy relationships and decrease factors that put youth at risk for violence; parent programs that enhance parenting skills and communication; training for teachers to enable them to recognize and respond to the risk factors and warning signs of dating violence; tools for working with organizations and neighborhoods to ensure policies support healthy relationships and keep youth safe; and, social media and other communication strategies to promote messages that support healthy relationships.

 

In the development of this comprehensive approach, CDC built a multi-tiered approach based on the best available evidence on what works to prevent dating violence. As such, Dating Matters includes evidence-based prevention programs that have a consistent prevention aim and message, as well as CDC-developed strategies that fill gaps in prevention programming and are consistent with the evidence-based programs. Like Dating Matters, comprehensive approaches in areas of prevention that have a developing evidence base will employ a combination of evidence-based and evidence-informed strategies; thus necessitating evaluation to confirm that the strategies are all contributing to the effectiveness of the overall approach.

Prevention must be developed and implemented strategically to maximize the opportunity for decreasing unhealthy and unsafe behaviors. Carefully selecting and planning how a comprehensive prevention programs will be implemented on campus will lead to greater efficiency, cohesion, and impact.

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