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Evidence-based Strategies for Prevention

There are three ways to categorize prevention strategies: according to effectiveness, according to how they’re intended to help (their methodology), and according to whom they’re intended to help (their audience/clientele).  Let’s take a look at all three classification systems.

Classification by Effectiveness
 

The first (and most recently developed) way to classify prevention strategies is by whether they’ve been proven effective.  Strategies that have been so proven are called evidence-based practices, or EBPs.  For referral to lists of EBPs, see our Resources page.  Other strategies are either unproven or disproven.

Though this classification system is the newest of the three (It’s only been in the last decade or so that preventionists have realized effectiveness cannot be assumed), the label “EBP” is fast becoming one of the most influential factors in the strategy selection process.  A strategy may be effective, but if it’s under-researched, funders are less likely to approve it.  This selectivity is a double-edged sword in that it ensures the effective application of resources, but it dampens innovation.

Classification by Methodology

The second classification system, classification by methodology, divides all prevention strategies into two groups: individual or environmental.  Both types ultimately hope to change individuals’ behavior; however, the means by which they attempt to change behavior are slightly different.  Whereas individual prevention strategies try to change people’s behavior by changing their minds, environmental prevention strategies try to change people’s behavior by changing their environment.

To illustrate the difference between individual and environmental prevention, consider this situation.  Suppose a community is experiencing high rates of car crashes related to underage drinking.  The community can respond in numerous ways.  It can educate its students about the dangers of drinking and driving: it can enrolling them in an online curriculum like AlcoholEdu or a classroom curriculum like DARE.  It can engage students’ emotions by hosting a recovering alcoholic as a speaker or by dramatizing a car crash at an assembly.  It can also increase enforcement of alcoholic beverage laws by increasing the number of compliance checks at alcohol retailers, patrol cars on the streets, and penalties for social hosting.  Some of these strategies are individual, and some are environmental.

AlcoholEdu, DARE, a speaker, or a mock car crash are all individual strategies: they attempt to change students’ thoughts and feelings about DUI.  The enforcement efforts are environmental strategies in that they don’t attempt to change anyone’s thoughts or feelings about DUI so much as counterbalance them with their existing thoughts and feelings about the need to avoid being fined or arrested.

Currently environmental prevention strategies are dominating the world of prevention since they are generally more economical.

Classification by Audience/Clientele

The last classification system mentioned above is by audience or clientele.  According to this classification system, there are three types of prevention: universal, selected (targeted), or indicated.

Universal prevention is for everyone.  It’s the type of prevention people need regardless of whether they’re healthy or sick, well or unwell, not at risk or at very high risk.  An example would be a smoke-free area: it prevents everyone, smokers and non-, from inhaling toxic chemicals that negatively affect their health.

Selective prevention is for people who are at risk of experiencing a particular problem.  (For a cogent discussion of risk and protective factors, click on SAMHSA’s “Prevention and Behavioral Health” tutorial.)  An example of selective prevention would be Head Start, “a federal program that promotes the school readiness of children ages birth to five from low-income families.” (1)  This program recognizes that being in poverty increases a child’s risk of failing to obtain a good education.

Last but not least there’s indicated prevention.  Indicated prevention is for individuals who have shown signs of a problem but who have not yet been diagnosed with it.  An example might include the screening of a student who has been found in possession of illicit drugs.

Sometime identifying whether a prevention strategy is universal, selective, or indicated can be challenging.  The confusion here usually results from the fact that, when it comes to universal strategies, “everyone” doesn’t always mean “everyone in the entire world” or “everyone in the entire community.”  Sometimes it means “everyone to whom it applies.”  A better explanation might include, “everyone to whom it applies, regardless of whether they’re at risk of the problem we’re trying to prevent.”  To elucidate this discussion, take a look at the chart and accompanying discussion below.

Source: "Substance Abuse Prevention Skills Training: A Behavioral Health Workforce Development Curriculum," Center for the Application of Prevention Technologies, Center for Substance Abuse Prevention, Substance Abuse and Mental Health Administration

Classification Overlap

The fact that there are multiple ways of understanding and categorizing prevention strategies means that any given strategy can be described three different ways and designated with three different labels. The chart below gives several examples.  It lists ten strategies for reducing underage drinking and describes them according to each classification system.

Sources:
a. 
National Registry of Evidence-Based Prevention Practices
b. “ODMHSAS Evidence Based Strategies Matrices,” Oklahoma Department of Mental Health and Substance Abuse Services
c.
 “Don’t Do It!  Ineffective Prevention Strategies,” The Colorado Department of Education

 

1. http://eclkc.ohs.acf.hhs.gov/hslc/hs/about