study guide Flashcards
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
behavioral issues include but are
not limited to ________________
- Substance misuse
- Alcohol and drug addiction
- Mental health disorders and substance use disorders
- Serious psychological distress
- Suicide
The _________________ and ____________________ co-exist and influence the field of prevention in behavioral health
public health approach and Behavioral Health Continuum of Care
Key Characteristics of Public Health Approach
Promotion and prevention – The focus is on promoting wellness and preventing problems.
* Population-based – The focus is not on one individual but on the population that is affected and that is at risk.
* Risk and protective factors – These are the factors that influence the problem.
* Multiple contexts – Understands that the individual is influenced by different environments, such as the family, neighborhood, school, community, culture, and society.
* Developmental perspective – Considers the developmental stage of life of the populations at risk (e.g. adolescence, older adults)
* Planning process – Public health utilizes a deliberate, active, and ongoing planning process.
Social Determinants of Health (Def’n)
the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.
What are the domains of social determinants of health?
- Access and quality of Education
- Access and quality of Health Care
- Neighborhood and Built Environment (where someone lives, works, plays, etc)
- Social and Community Context
- Economic Stability
What questions does the public health approach ask in developing prevention intervention and strategies?
What substance misuse and other behavioral health problems need to be addressed?
Who will the interventions focus on—the entire population or a specific population group?
When in the lifespan—at what specific developmental stage—is the population group that the interventions focus on? (e.g., adolescence, young adulthood)
Where should the interventions take place?
Why are these problems occurring? This refers to the risk and protective factors that contribute to the problems.
How do we do effective prevention? This refers to a planning process—the Strategic Prevention Framework—that will be used to determine what interventions will be most effective for a specific population group.
Prevention needs to take place in ____________________
multiple contexts that influence health and where risk and protective factors can be found—in individuals, families, communities, and society.
Recovery (def’n)
process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.
Wellness (def’n)
not merely the absence of disease, illness, and stress, but the presence of purpose in life, active involvement in satisfying work and play, joyful relationships, a healthy body and living environment, and happiness.
What are the 8 dimensions of wellness?
Emotional
Financial
Social
Spiritual
Occupational
Physical
Intellectual
Environmental
According to ________________ , there are how many dimensions to wellness?
SAMHSA (Substance Abuse and Mental Health Services Administration) states 8 dimensions of wellness
History of Substance Misuse SITUATION and prevention STRATEGIES being used: 1950s
NATIONAL SITUATION - Drug use intensified. Heroin addiction alone hit an all-time high, particularly in urban areas.
PREVENTION STRATEGY - Scare tactics through films and speakers
History of Substance Misuse SITUATION and prevention STRATEGIES being used: 1960s
NATIONAL SITUATION - People began using drugs to have psychedelic experiences. Drug use was associated with the counterculture. By the end of the decade drug use was considered a national epidemic.
PREVENTION STRATEGY - Scare tactics through films and speakers; information about substance use through films and speakers
History of Substance Misuse SITUATION and prevention STRATEGIES being used: 1970s
NATIONAL SITUATION -
Alcohol and drug misuse were recognized as major public health problems. The War on Drugs campaign was developed to reduce illegal drug trade. Throughout the decade, society grew more tolerant of drug use.
PREVENTION STRATEGIES - Drug education using curricula based on factual information; affective education using curricula based on communication, decision-making, values clarification, and self-esteem
History of Substance Misuse SITUATION and prevention STRATEGIES being used: 1980s
NATIONAL SITUATION - “Just Say No” campaign, part of the War on Drug effort, encouraged youth to resist peer pressure by saying “no.” Partnerships developed as the public became increasingly involved in addressing the problems of substance misuse.
PREVENTION STRATEGIES - Parent-formed organizations to combat drug use; social skills curricula, refusal skills training and parenting education
History of Substance Misuse SITUATION and prevention STRATEGIES being used: 1990s
NATIONAL SITUATION - Research examined the factors that protect people or put them at risk for a variety of problems, including alcohol and drug use. The value of professionalism and training in this area grew.
Community coalitions received funding to address alcohol and drug misuse problems.
PREVENTION STRATEGIES - Community-based approaches to prevention; environmental approaches; media campaigns; culturally sensitive programs; evaluation of prevention programs; professional training programs
History of Substance Misuse SITUATION and prevention STRATEGIES being used: 2000-2010
NATIONAL SITUATION - Understanding of the connections between substance misuse and mental health disorders/health evolved. “Behavioral health” encompassed both substance use and mental health problems.
PREVENTION STRATEGIES - Application of evidence-based models; comprehensive programs targeting many contexts (family, school, community); data- driven decision- making through a strategic planning process
History of Substance Misuse SITUATION and prevention STRATEGIES being used: 2010 - present
NATIONAL SITUATION - Greater emphasis is placed on prevention and treatment for everyone. Behavioral health was integrated with primary care under the Affordable Care Act of 2010. Increased prescription of opioid medications resulting from misinformation spread by pharmaceutical companies starting in the late 90s led to widespread opioid misuse, and in 2017, the opioid crisis was declared a public health emergency. The COVID-19 pandemic and spread of highly potent synthetic opioids containing fentanyl have contributed to the most significant substance use and overdose epidemic ever faced in the U.S.
PREVENTION STRATEGIES - Use of evidence-based practices; strategic planning process; improved access to health insurance with better benefits for mental health and substance misuse treatment and support.
Expansion of harm reduction approaches* to prevent death, injury, disease, overdose, and other harms associated with substance use/misuse and mitigate the impacts of the overdose epidemic.
Risk Factors (def’n)
certain biological, psychological, family, community, or cultural characteristics that precede and are associated with a higher likelihood of behavioral health problems
Protective Factors (def’n)
characteristics at the individual, family, or community level that are associated with a lower likelihood of problem outcomes
Socio-Ecological Model (def’n)
a multi-level framework that considers the different contexts in which risk and protective factors exist, including the Individual level, the Relationship level, the Community level and the Societal level
allows us to look at how the different levels/contexts interact with each other and choose prevention strategies that operate at multiple levels for the greatest impact
In prevention, it is important to address the constellation of factors across what levels of the Socio-Ecological model?
All/most levels (individual, relationship, community, and societal) in order to influence individuals, targeted populations, and general population
What does the Developmental Perspective consider and look at?
considers the developmental stage of life of the individuals that are the focus of interventions to improve health and prevent disease
looks at risk and protective factors and their potential consequences and benefits according to defined developmental periods.
Why is it important to understand the developmental perspective in substance misuse prevention?
● Interventions should be appropriate for the specific developmental stage of the population that they focus on.
● Prevention efforts that are aligned with key periods in young peoples’ development are most likely to produce the desired, long-term positive effects.
● People are more vulnerable to substance misuse and other behavioral health problems when they have experienced untreated, unresolved trauma.
Social Development Model
looks at the factors and contexts that contribute to the development of prosocial and antisocial behavior in children and adolescents
suggests that multilevel developmental influences, such as key contexts (family, school, and community), the child’s social and emotional skills, and the parenting skills of the child’s caregivers, as well as the strength and quality of the child’s social attachments, all jointly influence whether or not the young person engages in behaviors such as drug use or delinquency
The Stages of Change Model describes _____________
the process people go through in modifying a problem behavior.
What are the 5 stages of change according to the Stages of Change model?
- Pre-contemplation
- Contemplation
- Preparation/Determination
- Action
- Maintenance
What is the Pre-Contemplation stage in the stages of change model?
The person does not see the behavior as a problem/does not see a need for change/has no intention to change.
What is the Contemplation stage in the stages of change model?
The person has some awareness of the need/desire to change behavior and is actively weighing the pros and cons of the behavior.
What is the Preparation/Determination stage in the stages of change model?
The person believes that the behavior can be changed and that he/she can manage the change and is taking steps to get ready to make the change.
What is the Action stage in the stages of change model?
The person has begun to make the behavior change and has developed plans to maintain the change.
What is the Maintenance stage in the stages of change model?
The person has maintained the new behavior consistently for over 6 months and has made the new behavior habitual.
Sometimes, relapse can happen during behavior change. What does this look like?
person has a “slip”- reverts back to a previous pattern of behavior. The person may become discouraged but should recognize that most people making a behavior change have some degree of reoccurrence
What are 3 types of individual behavior change strategies?
Education-based programs - focus on helping people develop the knowledge, attitudes, and skills they need to change their behavior
School and community bonding activities - address the risk factor of low attachment to school and community. Specific interventions can include mentoring and alternative activities
Communication and Public Education - uses the media because of the significant role it plays in shaping how people think and behave
Quantitative Data
Indicates how often a behavior/event occurs or to what degree it exists.
● It can provide the answers to “How many?” and “How often?”
● It is typically described in “numbers.”
● It can be used to draw general conclusions about a population, such as the level of youth alcohol use in a community.
Qualitative Data
explains why people behave or feel the way they do
● It can help provide the answer to “Why/Why not?” or “What does it mean?”
● It is usually described in “words.”
● It can be used to examine an issue or population in more depth to understand underlying issues, such as the way in which community norms contribute to the level of youth alcohol use.
Mixed Method approach
collects both quantitative and qualitative data to provide a more in-depth understanding of the behavioral health problems being assessed.
What are examples of methods for obtaining quantitative data?
random sample surveys and archival sources
What are examples of methods for obtaining qualitative data?
key informant interviews and focus groups
_______________ + _________________ = CAPACITY
Resources + Readiness
● The RESOURCES (programs, organizations, people, money, expertise, etc.) a community has to address the problem
● How READY the community is to take action and commit its resources to addressing these problems
- Raising community awareness of a behavioral health problem can increase readiness of partners and the community to address the problem/take preventive action
Stakeholders (def’n)
the people and organizations in the community who have something to gain or lose by your prevention efforts
Effectiveness of prevention intervention
Refers to whether an intervention was evaluated and found to be effective under a particular set of circumstances.
Evaluation of prevention intervention (def’n)
the systematic collection and analysis of information about an intervention to improve its effectiveness and make program decisions
Cultural Competence (def’n)
describes the ability of an individual or organization to interact respectfully and effectively with people of different cultures.
** AKA cultural responsiveness, cultural appropriateness or cultural humility **
To produce positive change, prevention practitioners must ________________________________________.
understand the cultural context of their community of focus, and have the willingness and skills to work within this context. This means drawing on community-based values, traditions, and customs, and working with knowledgeable persons of and from the community to plan, implement, and evaluate prevention activities.
According to SAMHSA’s Center for Substance Abuse Prevention (CSAP), what are the principles of cultural competence to guide prevention planning?
- Include the population/community of focus in all aspects of prevention planning
- Use a population-based definition of community (that is, let the community define
itself) - Stress the importance of relevant, culturally-appropriate prevention approaches
- Employ culturally-competent evaluators
Promote cultural competence among program staff and hire staff that reflect the community they serve
Process of building cultural competence involves ___________________________.
- CULTURAL KNOWLEDGE - Knowledge of some cultural characteristics, history, values, beliefs and behaviors of a different group
- CULTURAL AWARENESS - Openness to the idea of changing cultural attitudes
- CULTURAL SENSITIVITY - Knowledge of cultural differences without assigning values
to the differences - CULTURAL COMPETENCE - Ability to bring together different behaviors, attitudes, and policies and work effectively in cross-cultural settings to produce better results
Culture affects how people interact with each other and their surroundings. Culture also affects how people think, feel, and act with regard to alcohol, tobacco, and other drug use. This means that effective prevention programs will appreciate and respect all cultures and _______________________________
- Recognize and accept that cultural differences exist and affect delivery of services.
- Accept that diversity within cultures is as important as diversity between cultures.
- Respect the unique, culturally defined needs of various populations.
- Recognize that concepts such as “family” and “community” are different among cultures and even for groups within cultures.
- Understand that people from different racial and ethnic groups and groups within cultures are served best by individuals who are part of or in tune with their culture.
- Recognize that valuing and drawing on the strengths of each culture makes everyone stronger.
Cultural Considerations in Prevention Planning (Using SPF Framework) : ASSESSMENT
● Identify sub-populations in your community that face behavioral health disparities
● Identify data gaps and work to fill them
● Share and solicit input about assessment findings with community members, including sub-populations facing behavioral health disparities
Cultural Considerations in Prevention Planning (Using SPF Framework) : CAPACITY
● Build the capacity of prevention practitioners to address disparities, and to provide culturally and linguistically appropriate services
● Develop partnerships that will help engage members of sub-populations facing health disparities in prevention planning efforts
Cultural Considerations in Prevention Planning (Using SPF Framework) : PLANNING
● Ensure the community is represented in the planning process, including members of the focus population
● Identify and prioritize risk and protective factors associated with health disparities
● Include reduction in health disparities as a long-term outcome in your logic model
● Select effective prevention program that have been developed for and evaluated
with an audience similar to the focus population
Cultural Considerations in Prevention Planning (Using SPF Framework) : IMPLEMENTATION
● Implement prevention programs that focus on populations experiencing behavioral health disparities
● Involve members of the focus population in the design and delivery of programs
● Adapt/tailor evidence-based practices to be more culturally relevant
Cultural Considerations in Prevention Planning (Using SPF Framework) : EVALUATION
● Evaluate whether selected prevention programs are having an impact on reducing behavioral health disparities
● Keep track of all adaptations made to interventions/prevention programs
● Conduct follow-up interviews with participants to better understand evaluation
findings
Cultural competence applies to organizations and health systems, just as it does to professionals. What does a culturally competent organization need to do?
● Continually assesses organizational diversity
● Invests in building capacity for cultural competency and inclusion
● Practices strategic planning that incorporates community culture and diversity
● Implements prevention strategies using culture and diversity as a resource
●Evaluates the incorporation of cultural competence
What are the steps to forming an effective coalition?
- Starting a Coalition
- Building a Coalition
- Needs Assessment
- Developing an Action Plan
- Evaluation of Coalition Activities
- Sustaining Planning
- Cultural Responsiveness
What is involved in starting a coalition (first step in forming effective coalition)?
● Identify the problems (e.g., underage drinking) and related behaviors (deaths and injuries related to underage drinking)
● Identify risk and protective factors related to the identified problems and related behaviors
● Determine community readiness
● Determine a need for a new coalition or revising an existing coalition
● Determine the potential goals and objectives
● Identify membership – i.e., key stakeholders by their skills, expertise, participation, diverse population represented
● Set final goals and objectives by consensus.
● Assess and build capacity
What is involved in building a coalition (second step in forming effective coalition)?
● Determine coalition structure
● Develop a mission or purpose statement for the coalition.
● Recruit members to include all major stakeholders, and represent multiple sectors.
● Determine a decision-making process – consensus or group vote.
● Facilitate prevention planning and implementation strategies.
What is involved in needs assessment (3rd step in forming effective coalition)?
● Identify behavioral health problems based on quantitative and qualitative data.
● Assess community assets and resources.
● Conduct an analysis of resource gaps.
What is involved in Developing an Action Plan (4th step in forming effective coalition)?
● Identify evidence-based policies, programs, and strategies for the focus populations.
● Develop a work plan, timeline, and measures.
What is involved in Evaluating Coalition Activities (5th step in forming effective coalition)?
● Develop a logic model
● Develop a data collection plan and identify a data collection tool.
What is involved in Sustainability Planning (6th step in forming effective coalition)?
● Incorporate sustainability planning into all strategies to ensure sufficient resources to achieve coalition goals
● Include plans to sustain financial resources, in-kind resources and human resources to produce and maintain positive prevention outcomes over time.
What is involved in Cultural Responsiveness (7th step in forming effective coalition)?
Ensure cultural responsiveness throughout the coalition development process.
What are the different levels of involvement of stakeholders in coalition prevention activities?
● No involvement
● Networking
● Cooperation
● Coordination
● Collaboration
Norms (def’n)
patterns of belief or behavior in a particular group, community or culture, accepted as normal and to which an individual is expected to conform.
Health Communication Targets
Knowledge, Attitudes, Behavior
What are Public Awareness Campaigns?
A comprehensive effort that includes multiple components (messaging, grassroots outreach, media relations, government affairs, budget, etc.) to help reach a specific goal.
What are the 6 principles of ethics for prevention specialists?
- Nondiscrimination
- Competence
- Integrity
- Nature of services
- Confidentiality
- Ethical obligations for community and society
Nondiscimination (def’n)
Prevention professionals shall not discriminate against service recipients or colleagues based on race, ethnicity, religion, national origin, sex, age, sexual orientation, gender identity, education level, economic or medical condition, or physical or mental ability.
What are the key concepts of nondiscrimination?
● Avoiding/preventing discrimination
● Complying with anti-discrimination laws and regulations
● Promoting cultural responsiveness
Competence (def’n)
Prevention professionals shall master their prevention specialty’s body of knowledge and skill competencies, strive continually to improve personal proficiency and quality of service delivery, and delegate professional responsibility to the best of their ability.
Key concepts of Competence
● Assessing your qualifications, working within your existing skill set and only within the prevention domain
● Building your knowledge and skills
● Using best prevention practices
● Addressing personal impairment
● Addressing the unethical conduct of colleagues
Integrity (def’n)
To maintain and broaden public confidence, prevention professionals should perform all responsibilities with the highest sense of integrity.
Key concepts of integrity
● Providing accurate information
● Giving credit for ideas, information and materials
● Avoiding deception
● Supporting impaired colleagues and service recipients
Nature of Service (def’n)
Practices shall do no harm to service recipients. Services provided by prevention professionals shall be respectful and non-exploitive.
Key Concepts of Nature of Service
● Involving the focus population in all aspects of planning
● Protecting participants from harm
● Maintaining appropriate boundaries
Informed Cosent (def’n)
The process of obtaining consent from participants that includes a full description and explanation of the activity presented in a way participants can understand, and ensures that participants provide their consent willingly, free from coercion or undue influence.
Key Concepts of Confidentiality
● Knowing and complying with confidentiality laws and regulations
● Protecting confidential information from disclosure
● Releasing confidential information (when a participant provides written consent OR under specific extenuating circumstances)
Passive Consent (def’n)
requires a signature from only those individuals who do not agree to participate in the research activity and/or their legal representative.
Active Consent (def’n)
requires a signature from all participants in a research project and/or their legal representatives.
Confidentiality (def’n)
Confidential information acquired during service delivery shall be safeguarded from disclosure, including—but not limited to—verbal disclosure, unsecured maintenance of records, or recording of an activity or presentation without appropriate releases.
Ethical Obligations for Community and Society (def’n)
In accordance with their consciences, prevention professionals should be proactive on public policy and legislative issues. The public welfare and the individual’s right to services and personal wellness should guide the efforts of prevention professionals to educate the general public and policy makers.
Key Concepts of “Ethical Obligations for Community and Society”
● Advocating for Prevention
● Protecting the health of others
● Promoting your own wellness
What are the the 5 elements of culture?
- norms
- values
- beliefs
- symbols
- practices
What is epidemiology?
the study of the distribution and determinants of the health and wellness of populations
e.g. in behavioral health field, epidemiologists study the patterns of use and abuse and the factors associated with an increased or decreased risk of developiong substance abuse problems
What is sustainability?
The ability or likelihood of a coalition, program, or activity to continue over a period of time
What is pharmacology?
the science or study of drugs, including their composition, uses, and effects upon living organisms
What are the 3 key areas in which to build capacity?
- Engage and build relationships with stakeholders
- Strengthen collaborative groups
- Increase community awareness
Addiction/Stages of Addiction
Compulsive physiological need for and use of a habit-forming substance (i.e. marijuana, nicotine, alcohol) characterized by tolerance and by well defined physiological symptoms upon withdrawl
Advocacy
Taking action to support an idea or cause.
What are the goals of advocating?
● Educate community members, the media, and elected officials in order to raise awareness
● Increase understanding of key issues
● Mobilize support in order to create positive change
Archival Data (def’n)
Data that have already been collected by an agency or organization which are in their records or archives
Adverse Childhood Experiences (ACEs)
potentially traumatic events that occur in childhood
ACEs can include _______________, __________________, and _________________. They are linked to:
violence, abuse, and growing up in a family with mental health or substance use problems
- Linked to chronic health problems, mental illness, and substance misuse in adulthood
Capacity (def’n)
The various types and levels of resources that an organization, coalition, or community has at its disposal to meet the implementation demands of specific interventions
Capacity includes ________________________ and _______________________.
● the resources/assets a community has to address its problems (e.g., programs, organizations, people, money, expertise)
● how ready the community is to take action to address its problems
