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Chapter 9

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Colleen Loomis

Chapter 9: Prevention and Promotion: Key Concepts Cholera epidemic -Outbreak in 1832 killed more than 55,000 people in Great Britain -Snow developed a new approach to thinking about epidemics -Map of London, spoke to families that had outbreak, found that almost all the people who died had gotten their water from the broad street pump -Snow is considered one of the fathers of epidemiology 1. Even if you don’t know how to cure a problem, you may still be able to prevent it 2. Second, you don’t need to know the cause or a problem to prevent it; you just need to understand something about the mechanisms through which the problem is transmitted or sustained 3. Third, you can often prevent a problem through changing some aspect of human behaviour 4. Fourth, while individual behaviour change can contribute to prevention, complete prevention of a problem often relies on public action. Introduction: Prevention and Promotion are all around you -The majority of prevention work was not created by psychologists, but by teachers, social workers, police who implemented specific behaviours What is prevention? -Common sense concept that derives from Latin work meaning to anticipate or before something to come -The idea that prevention concepts could be systematically applied to mental disorders has a very recent history -George Albee 1959 – looked at # of Americans who could benefit from mental health counseling each year -Then he looked at # of mental health clinicians the country could produce -His analysis showed that there could ever be a sufficient # of clinicians trained to provide all the needed mental health services for the population -Another issue raised by Albee – Concerns how scarce treatment resources are distributed -Series of epidemiological studies show a strong relationship between socio- economic status, ethnicity, and service received. Most patients would receive more medicine than psychotherapy and the ones that did get therapy (preferred) were similar to the therapists; male, Caucasian, successful -Psychologists working in 1950s: -Psychotherapy may not work -Even if it does work, we can’t provide it to everyone that needs it -Even if we could provide it, its not equally available for all groups Concepts for Understanding Prevention and Promotion -Caplan: Primary, Secondary, and Tertiary Prevention Primary Prevention: Given to entire populations when they are not in a condition of known need or distress. The goal is to lower the rate of new cases. Examples: Vaccinations, fluoridating water, and providing decision making, problem solving, and skill building programs to children in pre school; prevention benefiting society. Secondary Prevention: Given to populations showing early signs of a disorder or difficulty. Another term: Early intervention. This concept is of current notions of being at risk: people who are shy or withdrawn, those who are beginning to have academic difficulty, or adults who are getting into conflicts with coworkers on the job. Propose some method of determining who is at risk. -Treatment given because of early identification and tertiary prevention as rehabilitation services. (Redefined from Klein and Goldston 1977) Tertiary Prevention: Populations who have a disorder, with the intention of limiting the disability caused by the disorder, reducing its intensity and duration, and thereby preventing future reoccurrence. This type of effort when applied to individuals is referred to as rehabilitation. -Prevention is on a community level The IOM Report: Universal, Selective, and Indicated Measures -US Institute of Medicine Universal Preventive Measures: Interventions are designed to be offered to everyone in a given population group, and are administered to populations that are not in distress (similar to primary prevention). Selective Preventive Measures: Designed for people at above-average risk for developing behavioral or emotional dis
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