Chapter 10 Flashcards
Common Prevention and Health Promotion Programs for Physical Health
- Signs to promote washing hands and prevent diseases (posters in schools, public washrooms, hospitals, etc.)
- Ads to promote movement and prevent chronic diseases (ads for older adults)
Adverse Childhood Experiences (ACEs)
Refer to potentially traumatic events that occur in childhood (before age 18) and have LT effects on health, wellbeing, and development
- These experiences can disrupt brain development, affect stress responses, and increase the risk of physical, emotional, and social problems in adulthood
- Can be (physical, psychological, emotional, sexual) abuse, neglect, household dysfunction, etc.
- You look at how many ACEs one may have had and how they have overcome them (to look into their resilience)
Impact of ACEs on development
Can have profound and lasting effects on adult development in multiple ways, influencing physical health, mental well-being, relationships, and even socioeconomic outcomes
Impacts of ACEs on Physical Health
- Higher risk of chronic illnesses (heart disease, diabetes, obesity, autoimmune disorders, cancer, etc.)
- Shortened lifespan due to stress-related health issues (stress hormones, cortisol)
Impacts of ACEs on Mental Health
- Increased risk of anxiety, depression, PTSD
- Poor stress management and emotional regulation
- Higher likelihood of substance abuse
- Higher likelihood of suicide attempts
Impacts of ACEs on Relationships and Social Life
- Difficulty forming healthy relationships
- Increased risk of toxic relationship patterns (repeating what they saw in childhood)
- Attachment issues & emotional dysregulation (struggle to manage emotions)
Impacts of ACEs on Career and Financial Aspects
- Lower educational and job achievement
- Increased workplace stress and burnout
Impacts of ACEs on Intergenerational Effects
- Risk of passing down trauma to future generations
- Parenting struggles due to unresolved trauma
Impacts of ACEs on Parenting and Intergenerational Effects
Higher risk of Perpetuating the Cycle, without intervention, individuals who experienced ACEs may unknowingly pass down similar patterns to their children (cycle of violence, parenting based on how you experienced parenting)
How to counter ACEs
Resilience and Healing can be acquired through therapy, strong support systems, and healthy coping strategies can help mitigate these effects
Approaches to Prevention
- Risk reduction model for prevention is an approach to prevention that reduces risks and promotes protective factors
- It considers influences both within and outside the person and considers across these different contexts risk and protective factors
Within and Outside Influences
- Individual factors (risk: health problems, protective: resilience)
- School/work context (risk: bullying, protective: behaviour management)
- Family/social factors (risk: no support, protective: family support)
- Life events and situations (risk: loss of employment, protective: achievements)
- Community and cultural factors (risk: restrictive/harmful norms, protective: strong supportive base)
Risk Factors for Development of Psychopathology in Children and Youth - Individual Factors
- Complications in pregnancy and/or birth
- Physical health problems or disability
- Difficult temperament
- Poor nutrition
- Intellectual deficit or learning disability
- Attachment problems
- Poor social skills
- Low self-esteem
- Impulsivity
- Attention deficits
Risk Factors for Development of Psychopathology in Children and Youth - School Content
- Bullying
- Peer Rejection
- Deviant peer group
- Inadequate behaviour management (no consistency with what they’re punished for)
Risk Factors for Development of Psychopathology in Children and Youth - Family/Social Factors
- Parental isolation
- Single parent
- Antisocial role models in family
- Exposure to family or community violence
- Harsh or inconsistent discipline
- Inadequate supervision and monitoring
- Parental abuse or neglect
- Parental psychopathology
- LT parental unemployment
- Criminality in family
- Conflict in family
- Poor parenting
Risk Factors for Development of Psychopathology in Children and Youth - Life Events and Situations
- Abuse
- Family disruption
- Chronic illness or death of family member
- Poverty
- Unemployment
- Homelessness
- Parental imprisonment
- War or natural disasters
- Witnessing trauma
- Migration
- High-density living
- Poor housing conditions
- Isolation from support services, including transport, shopping and recreational facilities
Risk Factors for Development of Psychopathology in Children and Youth - Community and Cultural Factors
- Socioeconomic disadvantage
- Social or cultural discrimination
- Isolation
- Exposure to community violence or crime (leads to chronic stress)
- Mitigated with support and social policy
What are some stressors associated with Poverty
- Economic stressors
- Social and Psychological stressors (Stigma, relationship stressors)
- Health-related stressors (Lack of access to HC, nutrition, sleep)
- Education and Development Stressors (Academic stressors, lack of academic support)
- Environmental stressors (lack of stable housing)
Protective Factors for Development of Psychopathology in Children and Youth - Individual Factors
- Easy temperament (adaptive, handle stress better)
- Adequate nutrition (helps with emotional regulation)
- Positive attachment
- Above-average intelligence (problem solving & adaptability)
- School achievement (boost confidence & motivation)
- Problem-solving skills (navigate difficult situations)
- Social competence
- Optimism (cope with adverse experiences)
- Positive self-esteem
Protective Factors for Development of Psychopathology in Children and Youth - Family/Social Factors
- Supportive, caring parents (fosters resilience)
- Authoritative parenting (warm & structured = emotional regulation)
- Family harmony (conflict free = stress & anxiety)
- Supportive relationships with another adult (aside from parents)
- Strong family norms and prosocial values (families that emphasize moral values in kids)
Protective Factors for Development of Psychopathology in Children and Youth - School context
- Prosocial peer group (positive behaviours encourage social and emotional growth)
- Required responsibility and helpfulness (builds self worth)
- Opportunities for some success and recognition of achievement (feeling valued leads to increased self esteem)
- School norms against violence (safe environment leads to less stress)
- Positive school-home relations (good relations between prevents & teachers)
Protective Factors for Development of Psychopathology in Children and Youth - Life Events and Situations
- Adequate income (less stress)
- Adequate housing (security)
Protective Factors for Development of Psychopathology in Children and Youth - Community and Cultural
- Attachment to networks within the community (ties with social support, ie. a group you’re connected to)
- Participation in church or other community groups (belonging and shared values)
- Strong cultural identity and ethnic pride (confidence and resilience against discrimination)
- Access to support services
- Community/cultural norms against violence (discourages violence, emotional security)
Designing and Evaluating Programs - Identify the target
- What do you want to prevent (anxiety, depression, emotional dysregulation)
- Children, adults, teens
Designing and Evaluating Programs - Determine how serious the problem is
- How many ppl are affected? what are the costs of the problem, in human suffering, health care costs, etc.?
- Behavioural regulation, schooling, mental health
Designing and Evaluating Programs - Review the research evidence about the problem
What do you know about how the risk factors develop? What variables make it more likely that a problem will develop?
Designing and Evaluating Programs - Identify high-risk groups
Determine which populations are most vulnerable (identify high risk groups: predispositions, ACEs)
Designing and Evaluating Programs - What is known about protective factors?
- These are the factors that have been shown to moderate risk (what decreases anxiety: physical movement)
- Family influences
Designing and Evaluating Programs - Design the intervention
- How will the target condition be prevented? Is there an evidence-based prevention program for this problem? If so, does it need to be modified for your community?
- Group work, videos to watch, online platforms
Designing and Evaluating Programs - Design the Study
- How will you know if the intervention is efficacious (a pilot study to see effectiveness, questionnaire before-after, long term follow ups, up to 5 years later)
- Questionnaires to evaluate, focus group
Prevention
- World Economic Forum estimated that, globally, the cost of mental disorders in 2010 was 2.5 trillion dollars
- By 2030 the cost is predicted to be 6 trillion dollars
- Importance of prevention: decrease cost
Benjamin Franklin
An ounce of prevention is worth a pound of cure
Three Main Types of Prevention Programs
1) Universal Preventive Interventions
2) Selective Preventive Instructions
3) Indicated Preventive Interventions
Universal Preventive Interventions
- Applied to everyone in a population
- Examples: anti-drunk driving campaigns, seatbelt promotion campaigns, flu season hand washing reminders
Selective Preventive Interventions
Targeted at people at elevated risk for a disorder (example: during an outbreak, requiring hospital visitors to wear masks)
Indicated Preventive Interventions
Focus on people who show early, subclinical signs or have direct exposure to a disorder (ex. quarantine for those exposed to a confirmed case)
Rethinking about Prevention - Traditional Prevention Categories
- Universal Prevention (everyone)
- Selective Prevention (at-risk groups)
- Indicated Prevention (early symptoms)
Rethinking about Prevention - Criticisms
- Relies heavily on disease model (focuses on preventing illness rather than promoting health)
- Proposed shift was to focus on promoting health and well-being
Rethinking about Prevention - What is Health
No universal definition, as it depends on context (younger ppl: fitness, energy, strength; older people: inner strength, ability to handle life challenges)
Mental Health Promotion
Activities to increase well-being and resilience
Programs for Prevention - Parenting groups
- Tripple P Parenting
- Incredible Years
Programs for Prevention - Violence Prevention
- Youth violence
- Bullying
Programs for Prevention - Internalized Disorders
- Anxiety and depression disorder
- Taming worry dragon (anxiety prevention/management)
Programs for Prevention - Other programs
- Trauma Prevention
- Substance use disorder (DARE)
Triple P Positive Parenting Program - Overview
- Developed by Matthew Sanders & colleagues (Australia)
- Widely used EB Program to help parents with knowledge, skills & confidence in helping kids develop healthily and build resilience
Triple P Positive Parenting Program - Goals
- Enhance parent knowledge, skills, and confidence
- Promote safe environments for children
- Encourage positive parenting practices (communication > punishment)
Triple P Positive Parenting Program - Key Feature
Multi-level system providing different levels of intervention based on need (provides different levels of intervention based on child (& presenting) need
Triple P - 5 Levels of Intervention
1) Universal Triple P: Media campaigns to normalize parenting challenges available to all
2) Brief support: 1-2 sessions for specific concerns, like behavioural
3) Mild to moderate problems: 3-4 sessions with a health provider
4) Standard Triple P: for severe behavioural problems, available in group and online for 10-12 sessions
5) Enhanced Triple P: Most intensive, includes parent mental health support (parent group & coaching + support & MH)
- Helps parents with different levels available to fit need
Triple P - Key Features more in depth
- Tailored for infants to teens (wide age range)
- Focus on boosting protective factors and supporting positive aspects, while reducing risk
- Self-regulation model (parents choose strategies that work for them)
- Requires intensive practitioner training (no need to actually be a psychologist, just training in Triple P strategies)
Triple P - Benefits
- Strong research support
- Fewer child behaviour problems
- Increased parental confidence
- Improved parental mental well-being
- Adapted for diverse ppns worldwide
The Incredible Years Program - Basic Program
- Covers different age ranges (minimum 12 sessions)
- Focused on parenting strategies and child behaviour management
The Incredible Years Program - Advanced Program
- 9 to 12 sessions
- Focused on parents’ interpersonal skills (their problem-solving, anger management, emotional regulation, communication)
The Incredible Years Program - Evidence-Based Success
- Tested with over 1000 diverse, socioeconomically disadvantaged families
- Shown to improve parenting skills, enhance children’s social competence, reduce conduct problems
The Incredible Years Program - Parenting Pyramid Key Levels
- Foundation (use liberally): listening, talking, play, involvement empathy build strong relationships
- Encouragement & Structure: Praise, rewards, clear rules, and follow-through reinforce positive behaviour
- Managing Misbehaviour: Ignoring, redirecting, and setting limits address minor issues
- Consequences (use selectively): time outs, loss of privileges, and logical consequences for serious behaviours
Importance of Evaluating Prevention Programs
- Prevention programs should be evaluated for effectiveness
- This is critical to ensure they genuinely protect healthcare workers and the public and the sacrifices (like quarantines or restrictions) are truly necessary and effective
- Ensures effectiveness (programs must truly protect HC workers & the public)
- Justifies Sacrifices (Measures like quarantines or restrictions should be necessary & beneficial)
- Improves future programs (data-driven evals help refine strategies for better outcome)
Preventing Physical Abuse of Children
- Intentional injury to a child
- Key Points: abuse linked to multiple diversities, higher risk of mental health disorders, poorer treatment response (trouble with therapy)
- Legal context: physical punishment allowed in Canada/US if not harmful (cultural context is important to take into account)
Programs that help prevent child abuse
- Home visits reduced abuse in poor, single teen moms
- Multimodal programs improved parenting skills
- Triple P Population Trial leads to fewer child maltreatment cases
Preventing Youth Violence - Bullying & Conduct Disorder
- Conduct problems are common reasons for referral (flagged early due to ppl not knowing what to do)
- Aggressive tendencies often start early and escalate (manage before it gets worse, worsens often when left untreated)
- Prevention more effective than later treatment (interviewing reduces LT issues, if physically violent with everyone in gr 1 can help manage issue before it gets worse)
Prevention of Violence
- Addressing the physical abuse of children
- Addressing youth violence (bullying and conduct disorder)
- Ex: Olweus Bullying Prevention Program (teacher-driven approach), Meta-analysis (bullying reduced by 20-23%), Kiva Finland Program (Multimedia-based, effective for cyberbullying, uses multimedia tools to effectively address cyberbullying & in-person bullying)
Preventing Conduct Disorder - Fast Track Program
- Launched in 1990 for high-risk kids (CPPRG)
- Multi-component intervention including child training (social skills, emotional regulation), parent training (discipline, monitoring, improve family dynamics), classroom curriculum (self-control, problem-solving to foster better behaviour)
Prevention of Internalizing Disorders
- Internalizing disorders, such as anxiety and depression, can significantly impact well-being if left unaddressed
- Early intervention programs help build resilience and coping skills to prevent these disorders
Prevention of Internalizing Disorders - Anxiety Disorders
- Coping Koala Program (a school-based designed to help children manage anxiety through cognitive-behavioural strategies)
- Taming Worry Dragons, a structured anxiety prevention and management program teaching children practical coping techniques (incorporates parents a lot, can do it 1-on-1 or in big groups (10 max) & engage with parents to check up and help find strategies with children and relay and adapt with parents)
Prevention of Substance Abuse
- Include skills development (social skills, problem-solving, decision-making, recognizing and resisting social pressure
- Involve youth, peer groups, school, home and community
- Programs should be sensitive to developmental stage and include adequate training and support
- Use of interactive programs is crucial for success (can take strategies & use them outside of program & when its done, LT)
Prevention of Problems in Those Exposed to Loss and Trauma
- Be cautious about well-intended programs and assumptions (the case of critical incident stress debriefing, must remember variability in how people effectively deal with grief and loss)
- Cogn. Bhvral Interventions (Indiv and group), can have positive impact for traumatized children/youth (provide knowledge about trauma and its sequelae, normalize reactions to extreme situations, emphasize skills to cope with emotional reactions, develop skills to reduce avoidance of trauma-related stimuli)
