Thomas Edison State University Three Different Levels of Prevention Discussion Open and read uploaded fileBasically you will answer both questions complete

Thomas Edison State University Three Different Levels of Prevention Discussion Open and read uploaded fileBasically you will answer both questions completely. You must use one or more of the articles given provided in the uploaded file only when answering both questions. Please cite APA in text citation properly for both questions and absolutely no plagiarism. This week discussion is: Levels of prevention
Please answer both questions completely. You must use one or more of the articles given
below only when answering both questions. Please cite APA in text citation properly for both
questions and absolutely no plagiarism.
1. Why is it important to understand the three different levels of prevention? Use the
resource given by Romano (2015) in the uploaded file only to answer this question.
2. What level of prevention do you believe is most prevalent in the U.S. healthcare system?
Why do you believe your opinion to be true (give some facts)?
Articles are here below, you can locate these resources over the internet. Please remember you
must use one or more of the articles given below only when answering and/or supporting both
? Romano, J. L. (2015). Recommendations for developing, implementing, and evaluating
prevention interventions. In Prevention psychology: Enhancing personal and social wellbeing. (pp. 131–142). American Psychological Association This reading is in the
uploaded file, you must use this for question one
? Fostering Multiple Healthy Lifestyle Behaviors for Primary Prevention of Cancer: Cancer
and Psychology Special Issue,” by Spring, King, Pagoto, Van Horn, & Fisher,
from American Psychologist, (2015).
? The Role of Psychologists and the Psychological Profession in Health Promotion and
Addiction Prevention” by Pacic-Turk, & Boskovic, from Journal of Public
Health (2011).
? Eight Ways to Stay Healthy after Cancer: An Evidence-Based Message” by Wolin, Dart,
& Colditz, from Cancer Causes & Control: CCC (2013).
The American Psychological Association (APA, 2014) “Guidelines for Prevention in
Psychology” (see Appendix A) present aspirational goals for the development and
implementation of prevention interventions. Among the “Prevention Guidelines” are those that
recommend that psychologists develop and implement prevention interventions that are theoryand evidence-based, are culturally relevant, attend to ethical issues in the design and
implementation of prevention, address prevention of problem behaviors, and promote healthenhancing behaviors. In addition to addressing prevention at the individual and personal levels,
the “Prevention Guidelines” recommend that prevention psychologists apply prevention
knowledge and skills to broader social conditions and use data and knowledge to inform public
policy decisions. Although the APA (2014) “Prevention Guidelines” provide a broad foundation
on which to develop and implement prevention interventions, this chapter offers specific
recommendations for development, implementation, and evaluation at different stages. The
development and implementation of prevention interventions can be challenging (Embry, 2004;
Julian, Ross, & Partridge, 2008), but the challenges can be mitigated and the interventions
strengthened by attending to activities and processes at different stages of prevention initiatives.
Both the “Prevention Guidelines” and the more specific recommendations in this chapter apply,
regardless of the setting or population of a prevention initiative.
Therefore, this chapter recommends activities to be conducted by prevention specialists at early,
intermediate, and later stages of a prevention intervention. In addition, the chapter attends to
three topics important to prevention program implementation and evaluation: assessment of
prevention program fidelity across 16 community-based programs, lessons learned from the
transfer of a university-based prevention program to the community, and considerations of
prevention activities in medical settings.
These topics are instructional for prevention specialists, as they highlight dimensions of program
implementation fidelity, challenges associated with the transfer of a university-based program to
a community agency, and prevention activities for psychologists and other mental health
professionals in medical settings, settings that have much potential for the practice of prevention
Form an Advisory Group
The first step in developing a prevention intervention is to assemble a group of major
stakeholders, as an advisory group, from the institution or community that will ultimately
implement the intervention. Ideally, this group is represented by different constituents and
represents the demographic characteristics of the institution or community. In a community
setting, major stakeholders might include community institutions and services from law
enforcement, education, medical and social service agencies, government and policymaking
bodies, faith communities, and the business community.
The advisory group should also be representative of the diversity within the community that is
relevant to the prevention intervention (e.g., age, socioeconomic status, race/ethnicity, and sexual
orientation). An advisory group will serve its purpose well if it is inclusive and represents
differing opinions and perspectives. Once formed, the group may choose to develop a more
formal needs assessment to better meet the prevention need. The advisory group can serve as a
standing committee to provide guidance and be regularly consulted about program development,
implementation, and evaluation.
Assess Community Needs
What problems most need to be prevented, or what behaviors most need to be promoted? A
comprehensive needs assessment should measure individual and community or institutional
needs that are risks in light of the identified problem or problems as well as behaviors that serve
as protections against the problem. Too often the emphasis in prevention revolves around
preventing problems, but protections that help to mitigate problems are equally important. The
Search Institute’s list of developmental assets and deficits are examples of community
characteristics that may either contribute to problems in a community or offer protections to a
community (Benson, 2006). Examples of community protections against problem behaviors for
children and adolescents might include (a) increased levels of communitywide enforcements to
reduce the sale of alcohol to minors; (b) extension of recreational building hours in community
centers and other structures, especially during the summer, to engage youth in structured or
unstructured play and sports activities; (c) increased physical exercise opportunities and health
nutrition classes for adults and seniors living in the community; and (d) parenting classes for
expectant and new parents. For example, in a school setting, a building-wide message might
promote respectful behaviors by students and staff. Similarly, in medical settings, materials that
promote prevention of illness should be readily available, and in languages that are
representative of the community.
Consult With Experts and Access Relevant Resources
During the prevention intervention development phase, stakeholders may wish to consult with
prevention experts at universities and colleges, school districts, and government agencies. Given
the increased attention to prevention during the recent decades, it is likely that others have
developed and are further along with a similar prevention application. In addition, it is
recommended that prevention specialists be aware of relevant resources to assist them in
designing a prevention intervention. Appendix B lists resources that can be readily accessed to
inform the prevention specialist. Many of these resources were generated by U.S. government
agencies to strengthen prevention initiatives. For example, the National Registry of EvidenceBased Prevention Programs, cited several times throughout this book, is an excellent resource for
prevention interventions that may meet school and community needs. In addition, Focus on
Prevention (Substance Abuse and Mental Health Services Administration, 2010) is an excellent
resource and practical guide for developing and implementing alcohol, tobacco, and illicit drug
use prevention programs, although the recommendations therein also apply to other problem
behaviors. Focus on Prevention, published by the U.S. Department of Health and Human
Services, offers comprehensive guidance and a strategic prevention framework with an
overarching theme of sustainability and cultural competence across areas such as capacity,
assessment, and evaluation for communities and institutions in the development of prevention
initiatives. Therefore, it is recommended that prevention specialists become familiar with
materials, resources, and other’s experiences in preventing similar problems or promoting similar
behaviors. Organizations, such as government agencies and universities, may welcome the
opportunity to collaborate with a community or school to develop and implement a prevention
program. Such a partnership offers value because it brings different types and levels of expertise
to the problem, and the collaboration may enhance funding opportunities to support and sustain a
prevention initiative.
Consider Theoretical Frameworks for Prevention
As recommended in Chapter 2 of this volume, it is important that prevention interventions be
anchored in one or more theoretical frameworks that support the activities being implemented. A
theoretical foundation supporting the intervention will assist in the interpretation of process,
outcome, and impact data collected about the intervention. The theoretical framework will also
assist developers in making needed adjustments to an intervention based on data collected, and
therefore, help to sustain modifications to the original intervention.
Choose Prevention Activities
Prevention specialists should develop a plan to sustain the intervention over a multiyear period,
taking into account the needs and resources of the community or institution. Prevention
interventions are more likely to be sustained after the initial enthusiasm lessens if plans are in
place to institutionalize and sustain the interventions within a community or institution for as
long as the need exists. Appendix B lists resources that identify possible prevention activities,
depending on the nature of the prevention intervention.
Select Evaluation Criteria
The prevention specialist should determine the types of assessments and data collection
strategies that will be needed and used. Once the specialist has identified evaluation assessments,
they should be explained to the advisory group. The measures should assess, as much as
possible, process information about the intervention (e.g., number of participants, attendance,
program fidelity), outcome data (e.g., change in participant attitudes and behaviors), and impact
data (e.g., systemic changes that have been demonstrated within an institution: e.g., school,
workplace, or community). For example, schools may report a positive change in the incidents of
bullying, and communities may demonstrate a reduction in juvenile crime. Focus on Prevention
(Substance Abuse and Mental Health Services Administration, 2010) gives guidance on
evaluation strategies, including using both qualitative and quantitative assessments, attending to
the cost-effectiveness of an evaluation plan, and keeping the prevention advisory group of
stakeholders apprised about evaluation decisions and evaluation data.
Plan Implementation and Evaluation
Once a set of prevention goals, objectives, activities, and evaluation measures has been selected,
the prevention specialist (in consultation with the advisory group) develops plans to recruit
participants, select implementation strategies, and delineate an evaluation plan. In this stage of
the process, it is also important to identify major organizations and/or individuals that will have
primary responsibility for implementation. The prevention initiative is now ready for
Data Collection
Depending on the evaluation plan, individual, community, and institutional data may be
collected before the start of prevention intervention and at various points during and after
implementation. Quantitative and qualitative process and outcome data will provide important
information to stakeholders as they review and evaluate the initiative. Eventually, the community
or institution will assess the impact of the intervention, but it may take some time to fully
measure the impact on a community or institution such as a school or workplace. Data should
answer questions such as the following: (a) What is working well? (b) What implementation
problems are encountered? (c) What changes, if any, should be made? (d) How is program
fidelity maintained? and (e) What are the strengths and challenges of program leadership and
organization? Collecting evaluation data throughout the prevention intervention will help
stakeholders make future decisions about the prevention initiative, especially planning for a
sustained prevention intervention over the long term. Evaluation data, even preliminary data,
should regularly be shared with stakeholders, and necessary adjustments made to the prevention
Make Adjustments as Needed
Once a sufficient amount of data about the prevention intervention has been collected,
stakeholders and the advisory group can begin planning for needed changes to enhance the
intervention, if it is to be sustained. During this stage, the advisory group and other stakeholders
make decisions about the continuation of the intervention and suggest ways that it can be
strengthened. Suggestions might be made in terms of intervention activities, whether intervention
fidelity was upheld, leadership for the intervention, intervention personnel, data that are
important to collect that were not initially collected, and future funding for the initiative. It is
highly likely that the topics of prevention that are currently important to communities and
institutions will also be important in the future. Therefore, if at all possible, prevention initiatives
should be planned for multiple implementations over longer periods, rather than a one-time,
short-term intervention.
Prevention program fidelity is important to consider during implementation. Fagan et al. (2008)
studied program implementation fidelity of 16 different prevention programs in 12 communities.
The authors examined implementation fidelity of communities that participated in the
Community Youth Development Study and Communities That Care (CTC) initiative. Fagan et
al. reported that few studies assessed all four dimensions of implementation fidelity: (a)
adherence, (b) dosage, (c) quality of delivery, and (d) participant responsiveness. Adherence and
dosage (i.e., the extent to which prevention activities are delivered as recommended) are most
often measured. However, the quality of delivery of prevention activities and response of
participants to an intervention are less often measured. Fagan et al. stressed the importance of
assessing all four dimensions of fidelity to adequately measure the effectiveness of a prevention
In the Fagan et al. (2008) study, implementation data were collected over a 2-year period from
communities that participated in CTC (Hawkins & Catalano, 1992). CTC is a community-owned
and community-operated system to prevent problems such as substance abuse, delinquency, and
violence. The 12 CTC communities implemented different types of prevention interventions,
including after-school tutoring and mentoring programs, parent training programs, and schoolbased drug prevention curricula, as well as addressing schoolwide systemic changes. The CTC
system includes several components: assessing community readiness to participate in a
prevention intervention, developing a community coalition, assessing prevention needs, selecting
evidence-based prevention policies and practices, implementing the prevention initiative, and
monitoring fidelity and impact. The CTC fidelity monitoring system is designed to be easily
understood and used by members of the community.
The four dimensions of fidelity implementation across the communities were measured.
Adherence and dosage rates were very high across the 2 years of program implementation.
However, dosage rates of the school-based components were lower than the parent training and
after-school prevention activities. The quality of delivery and participant responsiveness were
also high across the implementation period, with average scores over 4.0 on a 5-point scale
across each fidelity dimension. As might be expected, program attendance was higher for the inschool activities than for the after-school activities and parent training sessions.
Fagan et al. (2008) reported that despite high levels of implementation fidelity, several
challenges were faced during implementation of the prevention activities. The biggest challenges
were lack of time to deliver required material and lack of participant responsiveness. However,
these challenges declined during the second year of the study, suggesting that staff became more
skilled as they implemented the activities. Despite the high levels of program fidelity, four
programs were not maintained into the third year. Three of these programs were either afterschool or parent training, and they were discontinued because of difficulties recruiting
participants. The fourth program was a schoolwide one in which schools were to conduct a needs
assessment and develop interventions and action plans to address schoolwide problems.
Although previous research cited by Fagan et al. (2008) showed mixed reviews of fidelity
implementation when implementing prevention activities in communities, this was not the case
in their fidelity study. Fagan et al. found that all four dimensions of fidelity were high across
prevention activities that were replicated in the selected communities. Further, the measures of
fidelity increased and challenges decreased over the 2 years of the study. Thus, on the basis of
the results of this study, communities can successfully replicate prevention activities with high
implementation fidelity. Although communities will face challenges when doing so, Fagan et
al.’s findings bode well for communities that wish to replicate high-cost demonstration projects
and maintain high levels of implementation fidelity.
Prevention programs are sometimes initiated at a university with external funding, with the goal
of transferring the program to a community setting, where it will be sustained. The example
below describes such a transfer, which can be instructive for others desiring to transfer a
university-based research prevention intervention to an applied setting in the community.
Baptiste et al. (2007) described a process of transferring a university research-based HIV/AIDS
prevention program to a community agency. The Collaborative HIV/AIDS Adolescent Mental
Health Project (CHAMP) is a university-led (University of Illinois at Chicago) research project
that focuses on factors related to HIV/AIDS risks of youth living in high-prevalence urban areas,
with the goal of developing and implementing prevention interventions to protect youth against
HIV. Eventual community implementation of HIV/AIDS prevention interventions was a key
element of CHAMP, but it was also understood that transferring research and scientific
knowledge from university settings to community intervention settings does not necessarily
happen naturally or with ease. Therefore, the transfer of CHAMP to a community agency
(Habilitative Systems Incorporated; HSI) is instructive. HSI is a Chicago-based human
development agency offering an array of services across the city; goals of their client services
include allev…
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