Today, I am sitting in a room, at this moment, with the 20 most published preventions scientists in the United States who are collectively responsible for many of the major prevention programs on NREPP, the Blueprints, etc. We are discussing the exact reverse of a movement toward prevention credentialling. Today and the next day we are working on helping 50 neighborhoods in America become "Promise Neighborhoods" rather like the Harlem Children's Zone.
Some thoughts about both issues.
2) Our challenge as a country is to make prevention of substance abuse and related problems as accessible and easy to use as car seats, safety belts and child injury prevention items available at drug stores, discount stores, on line, etc. We need to it common knowledge what to do as parents, teachers, and communities to:
The prevention of these problems is possible, despite most websites saying not. The recent Institute of Medicine Report on the Prevention of Mental, Emotional and Behavior Problems details how, and I am sitting next to two of the authors of that report today. Sadly, few people know that these costly problems are preventable by simple strategies, which do not involve the delivery of complex programs.
If prevention specialist operated like county extension agents instead of service delivery agents to kids, etc., we could significantly advance the agenda for prevention for everyone. If we frame prevention being delivered by prevention specialist as a "requirement" of policy, then we are likely to lag significantly in prevention outcomes as a country.
As humorous note, none of the prevention scientists in the room with me today who populate the NREPP list could be certified prevention specialists, after reading statute from the state of New York.
Below I have copied my previous posting on prevention credentialing....
May I present an iconoclastic view of prevention credentialing?
In terms of the objective of population-level prevention—prevention for everyone—this idea makes little or no sense to me. For example, let's say that only accredited personnel should do prevention. Does that mean that a parent cannot teach their child things that would prevent substance abuse, mental illness, bullying, injury, etc? Does that mean that an elementary teacher should be prohibited from implementing simple behavior management strategies that are documented to prevent substance abuse, ADHD, mental illness, delinquency, school failure, hard drug use, alcohol abuse?
A population level approach to prevention embraces the idea that every parent, every teacher, every neighbor, etc. can and should engage in behaviors and actions that prevent the rising prevalence of substance abuse, mental illness, obesity, anti-social behavior, etc. We have robust evidence to show that this is how child-maltreatment is prevented—by 20% or more of the population of parents learning to implement small strategies that reduce parent-child conflict.
Further, actual empirical data suggest that requiring prevention services to be delivered by credentialed personnel might have the reverse effect intended: reducing the breadth, reach, effectiveness and support for prevention by citizens and political leaders. In the history of substance abuse prevention (alcohol, tobacco and marijuana specifically), alcohol and marijuana use was specifically reduced mostly by the parents movement in the late 1970s through 1992. When the parent-to-parent movement was deemed "not research based" and stopped getting funding and support, marijuana use and alcohol use increased. This policy essentially took away the ability of parents to act in their own behalf—unless they attended some 6 to 16 week parenting course run by an "expert." The tobacco control movement was dominated by advocacy and true community mobilization rather than the certification or accreditation of tobacco prevention specialists. The tobacco-free movement has been far more successful.
The danger of this movement toward only prevention credentialing can be further illustrated by a story of a recent workshop I gave to one states' accredited prevention specialists—several hundred such folks and I did the same exercise with my colleagues at the Society for Prevention Research.
For both groups, I gave them a challenge. I said, "Imagine that each of you have $100 cash. How long will it take you to go outside this room and successfully buy alcohol, tobacco, marijuana and some hard drugs?" In both groups, most people said 15 minutes, maybe 30 minutes.
Then I said, "let's reverse that. Let's say a bunch of parents and teachers have $100 cash, and they are all wanting to prevent alcohol, tobacco, marijuana, and hard drug use among the children in their care. Imagine they want some preventions strategies they can use right now. What would you tell them to do after taking their $100 cash."
The rooms went dead silent. I prodded and poked them. "Hey, you folks are the experts in your state or nation. Let's help these people."
In ones and twos, people suggested seeing a counselor or buying an evidence-based program for their school. If this is what we have to offer as credentialed prevention providers or prevention scientists folks, we are in deep caca.
Alcohol, tobacco, illegal drugs and prescription drugs are "retail products" that can be had almost instantly. We need to liberate prevention from the jail of a wannabe therapeutic model. We need to make practical prevention for substance abuse and mental illness as easy to get as injury control devices—bike helmets, car seats, electric plugs, stair gates, etc. Any person can get those within minutes in most communities or overnight by FEDEX or UPS if they live some very rural place.
In preparing to write this, I did a literature search in PsychInfo and Medline (PubMed) for prevention accreditation or credentialing. There are no experimental studies of the effects of such a policy. There is one very curious and telling qualitative study, however, of credentialed prevention specialist in the military. In that setting, the prevention specialists report the greatest job satisfaction when they are meeting one-on-one with people. Hmmmmm...that doesn't sound like a way to make prevention accessible to all or to achieve population level prevention for everyone. It sounds more like one-to-one therapy.
There is clearly a role for knowledgeable people to advise organizations, businesses, health-care systems, policy makers, elected officials, etc. about prevention systems to achieve population level results or group results. That is much more than knowing lists of prevention strategies. That is about large-scale human change.
If prevention credentialing is some sort of generic state professional certification to deliver prevention programs to children, youth and adults outside parents, teachers, and regular community people, then we are likely to harm the very thing we want to achieve: wide-spread use of and support of prevention for every child, youth and adult in America.
PS. This is not to say that people might not need to learn some kind of prevention strategy that works or that existing professionals (e.g., teachers, nurses, doctors, etc.) might not learn some specific tools to disseminate.
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Posted Saturday, January 30, 2010