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PRESENTERPRESENTER
ROBERT K. CONYNE, Ph.D.ROBERT K. CONYNE, Ph.D.
PROFESSOR EMERITUSPROFESSOR EMERITUS
COUNSELING COUNSELING PSYCHOLOGISTPSYCHOLOGIST
UNIVERSITY OF CINCINNATIUNIVERSITY OF CINCINNATI
LEARNING OBJECTIVESLEARNING OBJECTIVES
TO UNDERSTAND MENTAL TO UNDERSTAND MENTAL HEALTH PREVENTION HEALTH PREVENTION CONCEPTS CONCEPTS
TO DIFFERENTIATE TO DIFFERENTIATE KNOWLEDGE AND SKILLSKNOWLEDGE AND SKILLS
TO LEARN A MODEL FOR TO LEARN A MODEL FOR PREVENTIONPREVENTION
PERFORMANCE PERFORMANCE OBJECTIVESOBJECTIVES
DESCRIBE KNOWLEDGE DESCRIBE KNOWLEDGE AND SKILLS NEEDEDAND SKILLS NEEDED
KNOW WHAT TO INCLUDE KNOW WHAT TO INCLUDE IN PROGRAMSIN PROGRAMS
IDENTIFY EFEECTIVE IDENTIFY EFEECTIVE PREVENTION PROGRAMSPREVENTION PROGRAMS
Epidemiology: MentalEpidemiology: Mental IllnessIllness
AdultsAdults: (under 55): (under 55)20% of U.S. adults per year 20% of U.S. adults per year (44 million)(44 million)
Children/AdolescentsChildren/Adolescents20% of 9-17 years old per 20% of 9-17 years old per year year (U.S. Surgeon General)(U.S. Surgeon General)
SUBSTANCE ABUSESUBSTANCE ABUSE 1962: 4 MILLION TRIED 1962: 4 MILLION TRIED
ILLEGAL DRUGSILLEGAL DRUGS 1999: 87.7 MILLION…1999: 87.7 MILLION… USERS OVER AGE 12USERS OVER AGE 12::
-1979: 25.4 MILLION-1979: 25.4 MILLION
-1992: 12 MILLION-1992: 12 MILLION
-1999: 14.8 MILLION-1999: 14.8 MILLION
LITERACYLITERACY
20 MILLION ILLITERATE 20 MILLION ILLITERATE ADULTS (13%)ADULTS (13%)
20 MILLION MARGINALLY 20 MILLION MARGINALLY LITERATELITERATE
---------------------------------------------- 4 MILLION OF THESE PEOPLE 4 MILLION OF THESE PEOPLE
ARE REACHEDARE REACHED
COST OF MENTAL ILLNESSCOST OF MENTAL ILLNESS
19961996::
--DIRECT COST: DIRECT COST: $69 BILLION.$69 BILLION.
--INDIRECT COST: INDIRECT COST: $78.6 $78.6 BILLIONBILLION
(Surgeon General)(Surgeon General)
ONE POPULATION: AFRICAN ONE POPULATION: AFRICAN AMERICANSAMERICANS
POVERTY: 1999, 22%POVERTY: 1999, 22% HOMELESS: 40% OF HOMELESS HOMELESS: 40% OF HOMELESS
POPULATIONPOPULATION INCARCERATION: HALF OF INCARCERATION: HALF OF
ALL STATE & NATIONAL ALL STATE & NATIONAL PRISONERSPRISONERS
AFRICAN-AMERICANS AFRICAN-AMERICANS (CONTD)(CONTD)
ACCESS: 20% FEWER ARE ACCESS: 20% FEWER ARE COVERED BY EMPLOYER-COVERED BY EMPLOYER-BASED HEALTH INS.BASED HEALTH INS.
USE: ONLY ONE-HALF USE: ONLY ONE-HALF THAT OF WHITES; THAT OF WHITES; EMERGENCY USE HIGHEMERGENCY USE HIGH
INCIDENCEINCIDENCE
TO REDUCE DEVELOPMENT TO REDUCE DEVELOPMENT OR RATE OF DEVELOPMENT OR RATE OF DEVELOPMENT OF:OF:
NEW CASES OF A DISORDER NEW CASES OF A DISORDER OR PROBLEMOR PROBLEM
TO REDUCE INCIDENCETO REDUCE INCIDENCE
DECREASEDECREASE::STRESS + EXPLOITATIONSTRESS + EXPLOITATION
INCREASE:INCREASE:COPING SKILLS +SELF-COPING SKILLS +SELF-
ESTEEM+ESTEEM+SUPPORTSUPPORT
(Albee, modified, 1982)(Albee, modified, 1982)
PRIMARY PREVENTIONPRIMARY PREVENTION Intentional interventionIntentional intervention To reduce incidence ofTo reduce incidence of Adjustment problems inAdjustment problems in Currently normal populations, plusCurrently normal populations, plus Promotion of mental health Promotion of mental health
functioning (functioning (Durlak & Wells, 1997)Durlak & Wells, 1997)
DEGREE OF RISK DEGREE OF RISK (Institute of Medicine, 1994)(Institute of Medicine, 1994)
UniversalUniversal: for all: for all SelectiveSelective: Based on risk markers: Based on risk markers IndicatedIndicated: Based on specific risk: Based on specific risk
indicators and showing early signs, indicators and showing early signs, but no mental disorderbut no mental disorder
WHY PRIMARY WHY PRIMARY PREVENTION?PREVENTION?
TOO MANY PROBLEMS/NOT TOO MANY PROBLEMS/NOT ENOUGH HELPERSENOUGH HELPERS
TOO MUCH AFTER-THE-FACTTOO MUCH AFTER-THE-FACT LIMITED REACHLIMITED REACH DE-CONTEXTUALIZEDDE-CONTEXTUALIZED STRESSORS/STRENGTHS STRESSORS/STRENGTHS
IGNOREDIGNORED
PRIMARY PREVENTIVE PRIMARY PREVENTIVE COUNSELING (COUNSELING (Conyne, 2004)Conyne, 2004)
APPLICATION OF BROAD APPLICATION OF BROAD RANGE OF COUNSELINGRANGE OF COUNSELING
HEALTHY AND/OR AT RISK HEALTHY AND/OR AT RISK TARGETSTARGETS
TO AVERT FUTURE PROBLEMS TO AVERT FUTURE PROBLEMS ANDAND
TO PROMOTE GROWTHTO PROMOTE GROWTH
PREVENTIVE COUNSELING PREVENTIVE COUNSELING PRECEPTSPRECEPTS
BEFORE-THE-FACTBEFORE-THE-FACT HEATHY PEOPLE/AT RISKHEATHY PEOPLE/AT RISK DEVELOP COMPETENCEDEVELOP COMPETENCE REDUCE INCIDENCEREDUCE INCIDENCE GROUP AND COMMUNITY GROUP AND COMMUNITY
FOCUSEDFOCUSED
PRECEPTS (Cont’d)PRECEPTS (Cont’d)
ECOLOGICAL FOCUSECOLOGICAL FOCUS CULTURALLY VALIDCULTURALLY VALID SOCIAL JUSTICE VALUESOCIAL JUSTICE VALUE COLLABORATIVE PROCESSCOLLABORATIVE PROCESS EMPOWERINGEMPOWERING
PREVENTION SKILL SETSPREVENTION SKILL SETS
Primary prevention perspectivePrimary prevention perspective Personal attributes & behaviorsPersonal attributes & behaviors Ethical skillsEthical skills Marketing skillsMarketing skills Multicultural skillsMulticultural skills Group facilitation skillsGroup facilitation skills
PREVENTION SKILL SETPREVENTION SKILL SET (Cont’d)(Cont’d)
Collaboration skillsCollaboration skills Organizational & setting dynamic Organizational & setting dynamic
skills skills Trends & political dynamic skillsTrends & political dynamic skills Research & evaluation skillsResearch & evaluation skills
(Conyne, 2004) (Conyne, 2004)
PREVENTIVE COUNSELING PREVENTIVE COUNSELING MODEL (Conyne, 2004)MODEL (Conyne, 2004)
PURPOSIVE STRATEGIESPURPOSIVE STRATEGIES
TARGETSTARGETS
METHODSMETHODS
PREVENTIVE COUNSELING PREVENTIVE COUNSELING MODEL MODEL (Cont’d)(Cont’d)
PURPOSIVE STRATEGIESPURPOSIVE STRATEGIES::
SEEK SEEK SYSTEMSYSTEM CHANGE CHANGE
SEEK SEEK PERSONPERSON CHANGE CHANGE
MODELMODEL (Cont’d)(Cont’d)
TARGETTARGET IndividualIndividual GroupGroup FamilyFamily OrganizationOrganization CommunityCommunity
MODELMODEL (Cont’d)(Cont’d)
METHODSMETHODS
DIRECTDIRECT: Education, : Education, OrganizationOrganization
INDIRECTINDIRECT: Consultation, Media: Consultation, Media
EFFECTIVE PREVENTION EFFECTIVE PREVENTION PROGRAMSPROGRAMS
TARGETEDTARGETED
LIFE TRAJECTORIES LIFE TRAJECTORIES CHANGEDCHANGED
NEW SKILLS EMERGEDNEW SKILLS EMERGED
EFFECTIVE PREVENTION EFFECTIVE PREVENTION PROGRAMSPROGRAMS (CONT’D) (CONT’D)
SOCIAL SUPPORT SOCIAL SUPPORT DEVELOPEDDEVELOPED
NATURAL SUPPORT NATURAL SUPPORT SYSTEMS IMPROVEDSYSTEMS IMPROVED
NEW CASES REDUCEDNEW CASES REDUCED
EFFECTIVENESS CRITERIAEFFECTIVENESS CRITERIA
WHAT’S BEING PREVENTED?WHAT’S BEING PREVENTED? WHAT’S BEING PROMOTED?WHAT’S BEING PROMOTED? IS IT BEFORE-THE-FACT?IS IT BEFORE-THE-FACT? DOES IT INVOLVE HEALTHY DOES IT INVOLVE HEALTHY
AND/OR AT RISK PERSONS?AND/OR AT RISK PERSONS? IS THERE SYSTEM CHANGE?IS THERE SYSTEM CHANGE?
CRITERIACRITERIA (Cont’d) (Cont’d) IS IT FEASIBLE?IS IT FEASIBLE? USE EXISTING RESOURCES?USE EXISTING RESOURCES? IS IT COLLABORATIVE?IS IT COLLABORATIVE? STRESSORS & STRENGTHS?STRESSORS & STRENGTHS? IS THE METHOD SPECIFIED?IS THE METHOD SPECIFIED? INTERVENOR ROLES? INTERVENOR ROLES? ARE THERE RESULTS?ARE THERE RESULTS?