Domain I: Planning and Evaluation Flashcards
The Behavioral Health Continuum of Care
is a _____________________
classification system that presents the scope of behavioral health interventions and services, including: promotion of health, prevention of illness/disorder, treatment, and maintenance/recovery.
Continuum of Care: Prevention
focuses on interventions that occur prior to the onset of a disorder and which are intended to prevent the occurrence of the disorder or reduce risk for the disorder.
Continuum of Care: Promotion
involves interventions (e.g., programs, practices, or environmental strategies) that enable people “to increase control over, and to improve, their health.”
What are the three types of Prevention interventions?
Universal - focus on the “general public or a population subgroup that have not been identified on the basis of risk.”
Selective - focus on individuals or subgroups of the population “whose risk of developing behavioral health disorders is significantly higher than average.”
Indicated - focus on “high-risk individuals who are identified as having minimal but detectable signs or symptoms” that foreshadow behavioral health disorders, “but who do not meet diagnostic levels at the current time.”
What is included in Treatment according to the Behavioral Health Continuum of Care model?
case identification and standard forms of treatment (e.g., detoxification, outpatient treatment, inpatient treatment, medication-assisted treatment).
What is included in Recovery according to the Behavioral Health Continuum of Care model?
standard treatment, Long Term treatment, & After Care/Rehabilitation
What is included in Maintenance according to the Behavioral Health Continuum of Care model?
interventions that focus on participation in long-term treatment to reduce relapse/reoccurrence, and aftercare including rehabilitation and recovery support.
behavioral health (def’n)
“a state of emotional/mental well-being and/or choices and actions that affect health and wellness”
used to describe the service systems surrounding the promotion of mental health, the prevention and treatment of mental health disorders and substance use disorders, and recovery support
What are the 6 CSAP prevention strategies?
- Dissemination of Informatiom
- Prevention Education
- Alternative Activities
- Community based processes
- Environmental Approaches
- Problem Identification & Referral
** see study guide book for what occurs during each strategy **
Environmental strategies are prevention efforts aimed at ____________________________________
changing or influencing community conditions, standards, institutions, structures, systems and policies. Environmental strategies enhance public health by altering the physical, social, legal, and economic conditions that influence behavior.
Data collected during the assessment step of the SPF helps to answer what questions?
● What are the problems and related behaviors that are occurring in the community?
● How often are the problems and related behaviors occurring?
● Where are the problems and related behaviors occurring?
● Which populations are experiencing more of the problems and related behaviors?
● What are the risk and protective factors that influence problems and related behaviors in the community?
Strategies focused on changing the community environmental context that influence individual behavior include:
● Enhance access/reduce barriers — Improving systems and processes to increase the ease, ability and opportunity to utilize systems and services (e.g., access to treatment, childcare, transportation, housing, education, cultural and language sensitivity).
In prevention efforts, this strategy can also be “turned around” to ‘reduce access/enhance’ barriers, for example, reducing access and enhancing barriers to purchasing alcohol, tobacco products or marijuana for people under 21.
● Change consequences (incentives/disincentives) — Increasing or decreasing the probability of a specific behavior that reduces risk or enhances protection by altering the consequences for performing that behavior (e.g., increasing public recognition for desired behavior, individual and business rewards, taxes, citations, fines, revocations/loss of privileges).
● Change physical design — Changing the physical design or structure of the environment to reduce risk or enhance protection (e.g., parks, landscapes, signage, lighting, outlet density).
● Modify/change policies — Formal change in written procedures, by-laws, proclamations, rules or laws with written documentation and/or voting procedures (e.g., workplace initiatives, law enforcement procedures and practices, public policy actions, systems change within government, communities and organizations).
● Various Communication Strategies
Prevention professionals use __________________ to plan prevention initiatives.
SAMSHA Strategic Prevention Framework (SPF)
What is the SPF?
5 step planning process that guides the selection, implementation, and evaluation of evidence-based, culturally appropriate, sustainable prevention activities
The SPF begins with ___________________ and depends on ________________________
a clear understanding of community needs; the involvement of community members in all stages of the planning process.
What are the 5 steps of the SPF?
- Assessment - Collect data to define behavioral health problems and needs within a geographic area.
- Capacity - Mobilize and/or build capacity within a geographic area to address identified needs.
- Planning - Develop a comprehensive, data-driven plan to address problems and needs identified in the assessment phase.
- Implementation - Implement evidence-based prevention programs, policies, and practices.
- Evaluation - Measure the impact of implemented programs, policies and practices.
** Sustainability and cultural competence should be integrated into all steps of the SPF.
In the SPF, the first step ASSESSMENT helps communities ______________________________
better understand the extent and nature of behavioral health problems present in the community
- AKA needs assessment
What should be considered to prioritize results from Assessment?
Magnitude - Which problem/behavior is most widespread in the community?
Severity - Which problem/ behavior is most serious?
Trend - Which problem/ behavior is getting worse or better?
Changeability - Which problem/behavior are you most likely to influence with your prevention efforts?
What are the types of resources that need to be assessed to address the problem?
● Fiscal resources – such as grants and donations, and tangible, physical resources such as meeting space and supplies
● Human resources – such as trained staff, consultants, volunteers, stakeholders, partners, local champions
● Organizational resources – such as vision and mission statements aligned with the prevention effort, and organizational policies, organizational budgets, and technology
● Community resources – such as previous efforts to address the problem, local policies and regulations, community awareness of the problem
What are the 9 stages of readiness according to the Community Readiness Model?
STAGE 1 – Community Tolerance/No Knowledge: The community or leaders do not generally recognize that there is a problem. Community norms may encourage or tolerate the behavior in social contexts.
STAGE 2 – Denial: There is some recognition by some members of the community that the behavior is a problem, but little or no recognition that it is a local problem.
STAGE 3 – Vague Awareness: There is a general feeling among some in the community that there is a local problem and that something ought to be done, but there is little motivation to act.
STAGE 4 – Preplanning: There is clear recognition by many that there is a local problem and something needs to be done. There may be a committee to address the problem, but no clear idea of how to progress. No action to address problem/beginning stage of acknowledging the necessity of dealing with the problem
STAGE 5 – Preparation: The community has begun planning and is focused on practical details. Leadership is active and energetic. Decisions are being made and resources are sought and allocated. Pros/Cons of prevention activities , actions, and/or policies may not be based on collected data
STAGE 6 – Initiation: Data are collected that justify a prevention program. Action has begun. Staff are being trained. Stereotypes exist of risk factor knowledge
STAGE 7 – Institutionalization/Stabilization: Several planned efforts are underway and supported by community decision makers. Staff are trained and experienced. No in-depth evaluation for effectiveness; No perceived need for change or expansion
STAGE 8 – Confirmation/Expansion: Programs have been evaluated and modified/Support for expansion and/or improvement in efforts to deal with the problem; Leaders support expanding funding and scope. Data are regularly collected and used to drive planning.
STAGE 9 – Professionalism/High Level of Community Ownership: Universal, selective, and indicated efforts are in place for a variety of focus populations. Staff is well trained and experienced. Effective evaluation is routine and used to modify activities. Community involvement is high.
What are the 3 ways to increase resources and improve readiness?
1) Engage diverse community stakeholders
2) Develop and strengthen a prevention team
3) Raise community awareness of the problem to be addressed
What are the 3 tasks involved in planning prevention program/intervention according to the SPF?
- Prioritize risk and protective factors associated with the identified priority
- Select prevention interventions that are evidence based, most likely to influence the identified risk factors (conceptual fit), and feasible and relevant to the focus population (practical fit).
- Develop a comprehensive, data-driven prevention plan
Planning stage of SPF: Prioritizing Risk and Protective Factors
IMPORTANCE and CHANGEABILITY can be used to help decide which risk or protective factors to address with prevention interventions
- Importance - how much/how strongly a risk or protective factor impacts the targeted behavioral health problem in a community
- Changeability refers to 3 issues:
● Whether the community has the capacity to change a particular risk or protective
factor
● Whether a suitable evidence-based intervention exists to address a particular problem
● Whether change can be brought about in a reasonable time frame
3 criteria for Selecting effective interventions with good “fit” (planning stage of SPF)
● Effectiveness: Is the intervention effective?
● Conceptual fit: Will the intervention(s) impact the selected risk or protective
factor?
● Practical fit: Is the intervention appropriate to the community, and/or the specific population or subgroup of focus?
Questions to ask to assess conceptual fit
● Does it address the targeted problem?
● Does it address the risk/protective factors and conditions associated with the
problem?
● Does it focus on a relevant population and/or context?
Questions to ask to assess practical fit
● Is it feasible? Does the community have the resources needed for the
intervention?
● Is there synergism? Does the intervention add to or reinforce other prevention interventions?
● Is the community ready? Will stakeholders and the community support the intervention?
● Is the intervention culturally relevant? Will the cultural groups that are the focus of the intervention be receptive to it? Are they involved in the planning and implementation?
A comprehensive prevention plan (planning stage of SPF) includes:
● A description of the priority problem and why it was selected
● A list of the prioritized risk factors and how they were prioritized
● A description of community resources, resource gaps, readiness, cultural issues, and how challenges will be addressed
● A description of the interventions chosen to address the selected risk factors
● A logic model with short- and long-term outcomes
● An action plan with timetables, roles, and responsibilities for implementing interventions.
Tasks that encompass the implementation stage of the SPF
- Deliver programs and practices
- Balance fidelity with planned adaptations
- Establish implementation supports and monitor implementation
What does DELIVERING PROGRAMS AND PRACTICES (part of implementation stage of SPF) do?
● Increase community awareness of the problem and of the intervention(s) selected to address it.
● Introduce the intervention to stakeholders to obtain their buy-in and expand partnerships.
● Select settings where the intervention will be implemented, and provide resources and support as needed.
● Develop and carry out an action plan detailing what is to occur, who is responsible, and a timeline.
What should be done in order to establish implementation supports and monitor implementation (part of implementation stage of SPF)
● Build leadership and administrative support in the settings where the intervention is happening
● Provide training for the people implementing the intervention if they do not have the necessary skills
● Monitor the delivery of the program and make mid-course corrections as needed. Your evaluation activities can help you to monitor implementation of the intervention.
Fidelity (def’n)
the degree to which an evidence-based prevention program is implemented as its developer intended.
Adaptation (def’n)
how an intervention is changed and customized to meet local needs and circumstances.
modifications made to a chosen intervention such as audience, setting, and/or intensity of program deliver
Why is it important to balance fidelity and adaptation when implementing a prevention intervention?
changes to an intervention can compromise its effectiveness.
Guidelines for adaptation of an intervention
● Select programs with the best practical fit to local needs and conditions
● Consult with the program developer
● Retain core components of the original intervention
● Add, rather than subtract
