THE STATE OF PREVENTION: VISIONQUEST 2 0 0 0

Prepared by: Adrienne Bitoy Jackson, Prevention Supervisor Behavioral Research and the Social Sciences (BRASS) Foundation, Inc.

The Field of Prevention as we know it is changing. This change is chaotic, kinetic and extremely challenging. However, from chaos can come great creativity and order. The changes did not occur overnight. They have been slow and consistent. Our field is being radically impacted by changes in technology, terminology, standardization of evaluation methods and performance criteria, political climate and regimes. New initiatives, the issue of managed care; access to and availability of information; marked variations in educational backgrounds, social class; and decreasing governmental appropriations/allocations also affect the field’s advancement into the 21st century.

Professional access to the Field of Prevention is changing. The Field is growing and developing exponentially. Universities and colleges offer specially designed programs, curricula and degrees that are applicable to our work. Many may be cost prohibitive or inaccessible because of location. In the past, access to this field was primarily attained through employment or related experience with a service provider of substance abuse prevention/treatment. Today, we find ourselves working shoulder to shoulder with youth development specialists, judicial advisers, home visitors, family advocates, health educators, officers of employee assistance, probationary and community policing programs, nutritionists, maternal and child advocates, visiting nurses and crisis intervention specialists.

All too often, this host of “new comers” to “prevention” seem to be doing the same things, with the same populations, in the same communities, at the same times, with the same results. This phenomenon occurs because of: 1) the myriad of public/private prevention systems, i.e. city, county, state and federal; privately funded organizations, educational systems and faith based operations; 2) the convergence/elimination of funding streams; and 3) pre-existing communication barriers. We are also affected by the need to integrate a responsive method addressing long range, strategic planning; ill- conceived and poorly forecasted public policies; and the lack of information sharing regarding the preceding causes. Despite this, we are asked repeatedly to intensify our efforts, make service gap identifications and eliminate duplication. We become fiscally responsible and costs are contained, but is it better?

The increase in frequency, intensity, and resources should result in effective collaboration, prevention teams/networks and resource redeployment. However, there seems to be little dialogue or agreement on how to proceed, or what quality assurances exist among us? This is frightening and can be organizationally threatening. It offers opportunities imagined, yet unrealized.

The Language of Prevention is also changing. Prevention specialists are being asked to explain, qualify and quantify clinical outcomes, indicators, observations and assessments that signify behavioral modifications in ATOD use or abuse. Daily, we venture more and more into the realm of Behavioral Sciences. Our programs are becoming experimental laboratories. We are witnesses to living outcomes and focus efforts to replicate their success. Unfortunately, experimentation takes time, and time is the one resource that is neither being adequately allotted nor realistically deployed. We grow increasingly impatient, but remain resolute. We know it works, but how do we prove it!

There have always been discussions about where the Field of Prevention fits into the scheme of things. This in itself is not new. There are multitudinous questions about the continuum of care; primary versus secondary or selective prevention. How treatment and prevention interact, integrate or interrelate? What is relapse prevention and when is aftercare? Debates rage on about whether or not preventionists should be certified; the use of indigenous workers and integrated management information systems, etc., etc., etc.

Unending theories exist as to whether we are a public health education model, a medical model, a community/human resources development model, or a mental health model. Dissertations are written on whether or not the most effective programming is school based, community centered, or family focused. Crucial to this dialogue is the issue of cultural sensitivity, consistency and competence in all aspects of the Field of Prevention. These dialogues continue. The response to all of the theories, discussions, questions, debates, etc. depends on your vantage point at the time. It is important that we realize that we are all of this and more, and continue to progress.

Whether we like it or not our field is expanding. The reality is there are just too many things for us to “prevent”. Where once our primary focus was on the prevention of alcohol, tobacco and other drug abuse (ATODA), we are now confronted with the need to prevent:

1. anti social behavior (crime, violence, gang involvement, elder or child abuse and neglect), 2. lack of educational readiness (poor academic performance, truancy and limited language

proficiency),3. teen pregnancy, STDs, HIV infection, and 4. the lack of family resources and supports (homelessness, unemployment and poverty).

It can be frustrating and disheartening. We do not know what the future will hold and there is so very much to do. Burnout, stress and turnover continue to be professional hazards. Overworked and under financed, we are faced with combating societal ills with only the five prevention strategies: information, education, community mobilization and professional development, creating alternatives and social policy advocacy, at our disposal. The question is, “Will these strategies be enough, and will our efforts be recognized and supported?”

The most important thing to remember is: that whatever works to improve/enhance the quality of life and remove the possibility of addiction is truly prevention. When done with the involvement and the input of the populations and/or communities it is designed to impact, it will be culturally sensitive, competent, quality assured and ultimately, effective. Efforts that allow local community neighborhood coordinating entities to actively identify and decide the type and level of prevention services must be continued, regardless of funding considerations.

Those who choose to work in this field must be afforded every access to training that enhances their capacity to provide prevention services, however it may be offered. Budgetary considerations for professional development should be a required part of every grant submission. These developing preventionists cannot hope to be effective, if they continue to labor in isolation without support or guidance from their peers.

As Prevention Specialists, we possess a knowledge that many of the others do not. We know intimately the effects of substance abuse on families in communities and the cost of years of productive life lost to society. It is our purpose, responsibility and obligation to continue to share this knowledge. The families with whom we work trust us to do this. We serve as their advocates.

We must assume a leadership role in the field’s changing design and definition. This is what makes us an essential element in the “change” equation. It is imperative that decision makers in the public and private arenas hear our recommendations on what changes should be made and the strategies for their implementation.

The Field of Prevention is changing and while there is always resistance to change; the one constant is that change is inevitable. But change merely for the sake of change is unconscionable and unnecessary. So is mediocrity. Perhaps it is time for a paradigm shift which examines who we really are, what we have accomplished and are trying to accomplish, and why.