Prevention Services in Healthcare
What is Prevention Science?1
Prevention science focuses on developing evidence-based policies to reduce risk factors and strengthen protective factors to improve the health and well-being of individuals, families, and communities. Prevention science is based on various disciplines, including epidemiological, social, psychological, behavioral, medical, and neurobiological sciences, to identify the determinants of societal, community, and individual problems. Promoting health equity and reducing disparities by studying how social, economic, and racial inequalities and discrimination affect healthy development and well-being are fundamental principles of prevention science.
The policies, programs, and practices associated with prevention science have been demonstrated to decrease the incidence and prevalence of individual and community vulnerabilities as well as promote good health in many ways, including:
- Protecting from chronic disease, promoting regular physical activity and good nutrition;
- Disrupting pathways to substance use disorder across the lifespan;
- Strengthening the community’s overall capacity to mitigate undesirable conditions and enhancing access to support services; and
- Promoting resilience, social competency, and self-regulation to reduce impulsive, aggressive, and off-task behavior.
Mental health conditions typically evolve through a series of clinical stages, however progression from one clinical stage to another is not inevitable, and cessation of a mental health condition can be achieved through appropriate interventions. Three differing levels of preventative interventions can be utilized to determine the proper steps taken to avoid future developments:
- Primary prevention focuses on preventing the development of a mental health condition before its occurrence.
- Secondary prevention focuses on detecting and treating a mental health condition at its earliest possible stage to reduce its duration and severity. In general, secondary prevention refers to early intervention.
- Tertiary prevention focuses on reducing the impact of an established condition on a person’s functioning, quality of life and longevity utilizing treatment and supportive psychosocial services.
1What is Prevention Science? – npsc. https://www.npscoalition.org/prevention-science
BCBSAZ Health Choice Prevention Administrator
John Gould, M.Ed.
Primary prevention focuses on preventing mental health conditions before they occur within a given community or individual. This level of prevention aims to decrease risk factors and increase protective factors to prevent the initiation of a mental health condition. The following are examples of basic prevention strategies:
- Information Dissemination: Social media, brochures & pamphlets;
- Education: Parenting classes, youth groups and organizations;
- Problem Identification: Community assistance programs, prevention screening & referral;
- Community-Based Processes: Community needs assessments, multi-agency collaboration;
- Environmental: Retail compliance checks; policy & regulation influencing;
- Alternative: Community service activities, social & recreational events.
It is important to note that decreasing substance abuse decreases the number of mental health conditions in a community.
Risk factors are personal, psychological, or broader social-ecological variables associated with an increased risk of developing a mental health condition. Most conditions are multi-factorial and result from a combination of risk factors working simultaneously or cumulatively over time, rather than a single risk factor operating in isolation. The following are examples of potential risk factors:
- Individual: Difficult temperament, low self-esteem, anxiety, insecure attachment, poor social skills;
- Family: Parent-child conflict, parental depression/anxiety, poor parenting, child abuse;
- Community: Peer rejection, poverty, violence, traumatic events.
Protective factors reduce a person’s likelihood of experiencing a mental health condition. Protective factors may help to improve mental health and quality of life for individuals or act as a safeguard in preventing their exposure to risks, thus reducing the risk that they will become ill. Reducing people’s exposure to risk factors and increasing their exposure to protective factors makes it possible to reduce the occurrence of mental health conditions across the community. The following are examples of potential protective factors:
- Individual: Emotional self-regulation, high self-esteem, good coping skills, engagement & connection
- Family: Structure (limits, rules, monitoring, predictability), supportive relationships, clear expectations;
- Community: Developmental support, opportunities for engagement, positive norms, physical & psychological safety.
Community-based efforts to address mental health-related problems are most effective when matched to their population’s level of risk. Prevention programs and practices can be grouped according to three levels of risk: Universal, Selective, and Indicated.
- Universal prevention efforts focus on general audiences not identified based on mental health-related risk.
- Selective prevention efforts focus on audiences with known risk factors for a mental health-related problem.
- Indicated prevention efforts focus on audiences already experiencing a mental health-related problem.
Strategies at all three levels should be included in the overall community approach to prevention. For example, a comprehensive plan for addressing the nonmedical use of prescription drugs among youth might consist of a school-based substance misuse prevention curriculum for all middle school students (universal), support groups for youth with a family history of substance misuse disorders (selective), and counseling and referral to other services, as needed, for youth who are currently misusing prescription drugs (indicated).
Utilizing evidence-based interventions is crucial to the implementation and success of primary prevention programming. It is of vital importance to note that the success of any primary prevention program will also depend on the effort that evidence-based interventions are strictly implemented to complete fidelity. Unfortunately, this is not always the case due to competing demands, insufficient professional development, insufficient supervision and support, and limited resources, resulting in many programs failing to utilize evidence-based interventions adequately or not implementing the evidence-based interventions as intended. In addition, there has been and continues to be the development and implementation of evidence-based prevention strategies to combat systemic and structural inequalities in areas like neighborhoods, education, and criminal justice.
Secondary prevention seeks to identify a mental health condition at the earliest onset so that prompt intervention can occur when an individual is already exhibiting a mental health disorder. Early detection and rapid action are the main goals of secondary prevention.
Generally, secondary prevention is synonymous with screening. For example, screening patients for depression or suicide risk can lead to the early intervention ― and prevention — of a more extreme result. The following are examples of secondary prevention initiatives:
- Suicide hotlines
- LGBTQIA+ support programs
- Crisis centers
- Grief & loss support groups
- Trauma recovery
- Veteran & veteran family support groups
- Foster care programs
A mental health disorder may already exist in these examples, but mitigation is possible before the condition escalates. The potential for undesirable outcomes can be alleviated with the support of trained social workers or suicide prevention specialists.
Tertiary prevention focuses on the treatment and management after a mental health disorder or crisis has occurred. In this context, the main objective is to facilitate advanced patient recovery and reduce further risk of relapse. The following are examples of tertiary prevention initiatives:
- Community mental healthcare clinics
- Relapse prevention programs
- Chronic pain management
- Peer-led support groups
- Individual & group therapy
- School counseling programs
- Pharmacologic treatment
In these examples, tertiary prevention aims to support the individual experiencing a mental health disorder and assist in recovery so that the condition does not worsen, leading the individual to a healthier lifestyle in the future.
*ADHS Public Health Prevention
*CADCA Building Drug-Free Communities
*GOYYF Substance Abuse Prevention
*NIDA Substance Use Prevention
*NIMH Suicide Prevention
*NIAAA Alcohol Abuse & Alcoholism
*Office of National Drug Control Policy (ONDCP)
*Prevention of Substance Use & Mental Health Disorders
*Youth Mental Health Promotion & Prevention
*AHCCCS Substance Abuse Prevention Logic Model Training
*AHCCCS Statewide Substance Abuse Prevention Strategic Plan
*APPC Prevention Systems Change Framework
*Arizona Prevention Data Dashboards
*Arizona Suicide Prevention Action Plan 2022-2023
*CADCA E-Learning Trainings
*Collective Impact Forum
*Evidence-Based Practices Resource Center
*Guide to SAHMSA’s Strategic Prevention Framework
*Pacific Southwest PTTC Trainings & Credentialing
*US National Data & Statistics
*988 Suicide & Crisis Lifeline
Call or Text 988
*The Arizona Opioid Assistance & Referral (OAR) HelpLine
*Substance Abuse and Mental Health Service Administration (SAMHSA) Treatment Locator
*Arizona Health Care Cost Containment System (AHCCCS) – State of Arizona
*Governor’s Office of Youth, Faith & Family (GOYFF) – State of Arizona
*Grants.GOV – US National
*National Institutes of Health (NIH) – US National
*Office of National Drug Control Policy (ONDCP) – US National
*Substance Abuse and Mental Health Services Administration (SAMHSA) – US National
*Arizona High Intensity Drug Trafficking Area (HIDTA)
*Substance Abuse Coalition Leaders of Arizona (SACLAZ)
*United States Drug Enforcement Administration (DEA) Phoenix Division