Prevention Program Development and Evaluation: An Incidence Reduction, Culturally Relevant Approach

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Robert K. Conyne

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  • Dedication

    In my experience it takes considerable dedication to work in the field of prevention. It's often an uncertain enterprise, as this question underscores: How can you tell if you've actually prevented something from occurring? So you have to be “true to your school,” the school of prevention, that is.

    Certainly dedication to prevention is required by practitioners, but teachers, scholars, and researchers all need a healthy dose of it, too. All of us are swimming against some strong tides—and making progress, too, as we seek to find verifiable ways to lessen new cases of human suffering and to promote healthy functioning.

    Therefore, I dedicate Prevention Program Development and Evaluation to all of you who have been involved, and to those who are joining the prevention effort. Keep the faith, be true to your school, and take encouragement from Matthew Arnold's 1866 poem “Thyrsis”:

    Why faintest thou!

    I wander'd till I died.

    Roam on!

    The light we sought

    Is shining still. (Lancashire, 2008)

    Copyright

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    List of Tables, Figures, and Learning Exercises

    Preface

    “Stayin’ Alive,” the Bee Gees’ huge disco hit of 1977 (before the time of many of you!), can save lives due to its catchy tune and 103 beats per minute, the latter being perfectly in sync with the proper performance of chest compressions in cardiopulmonary resuscitation (CPR). A study reported at the annual meeting of the American College of Emergency Physicians by Dr. David Matlock of the University of Illinois College of Medicine at Peoria indicated that medical students and physicians who were trained in CPR while listening to the tune were able to maintain the proper CPR rhythm and also were able to reproduce it accurately weeks later. This finding is important because correctly delivered CPR can triple survival rates for cardiac arrest (Layton, 2008).

    The proper delivery of CPR is a simple, but powerful, example of a prevention strategy. Indeed, prevention is coming to be understood as a necessity in physical health, mental health, and education. Note the following injunction, which concluded a newspaper article about the rise of suicides among middle-aged whites, particularly women, in the United States (Crane, 2008): “One thing on which the experts agree: The study should prompt more prevention efforts [italics added].”

    In addition to becoming an essential ingredient in contemporary education and mental health, prevention is very much an everyday experience. Accumulating research attests that our mothers and everyday proverbs have been right all along—cautioning us to “look before we leap,” “save for a rainy day,” and “be prepared.”

    Applied to mental health, we understand the maxim that “an ounce of prevention is worth a pound of cure.” Attending to both person-centered and system-centered programs can help people reduce the impact of stressors in their lives while using their strengths to build a better future. This approach can help them avoid dysfunction and reduce the costs of treatment. Yet too many helping professionals know neither how to teach prevention nor how to deliver it.

    The minimal presence of prevention training in most academic programs continues to contribute to this deficit although, on the positive side of the ledger, the numbers of programs now offering prevention training show signs of increasing (Conyne, Newmeyer, Kenny, Romano, & Matthews, 2008). Drawing from the transtheoretical stages of change model (Prochaska & DiClemente, 2005), Adams (2008) suggested that prevention in counseling psychology may be moving from a contemplation stage (thinking about applying prevention) to the preparation stage, where people are beginning to incorporate it into practice and training. If so, then hooray, it's sure been a long time coming (Conyne, 2000)! Although it is encouraging that movement is occurring, plenty of space exists for implementing and maintaining prevention.

    Certainly, one of the ways that prevention can be practiced lies within treatment approaches. In fact, a cogent argument can be launched that a major purpose of treatment (e.g., individual psychotherapy or counseling) is for clients to learn how to prevent reoccurrence of the problems (and of related concerns) that brought them to seek professional help in the first place. From this perspective, all treatment includes prevention, without dichotomy. I subscribe to that viewpoint. As I've pointed out previously,

    It is now possible to think and act in terms of viewing prevention and treatment along the same helping dimension, viewing them as collaborative partners, not as rivals. This is a far healthier position and is more apt to support both prevention and remediation. (Conyne, 2004, p. xv)

    At the same time, though, prevention can be approached outside of treatment, as an end in its own right. Programs that are focused on prevention can be developed and delivered in an effort to forestall the emergence of new problems. This approach garners the attention of this book. Here, we are concerned with prevention programs—in and of themselves—and how to create them.

    From that perspective, then, it can be noted that even as prevention is beginning to gain increased acceptability, it continues to lag behind problem remediation approaches. Uncertainties in how to develop and evaluate prevention programs—indeed, as I have said, the very subject of this book—are major factors in holding back prevention. Students and practitioners are left with the question: How do we “do prevention”?

    Prevention Program Development and Evaluation: An Incidence Reduction, Culturally Relevant Approach seeks to address this problem. It is intended to provide direction for instructors, trainers, students, and practitioners in how to design and evaluate effective preventive interventions in mental health, education, and community settings by giving specific attention to the reduction of incidence (reducing new cases of a disorder), while giving credence to processes of collaboration, participation, and cultural relevance. Training workshops I conduct on prevention in mental health (both in the United States and abroad), the publication of new resources in prevention, accumulating evidence-based practice, and the increasing profile now given to prevention in counseling psychology (e.g., through the Prevention Section of the Society of Counseling Psychology) and other fields all suggest to me that interest and increasing importance are being placed on prevention as a concept and as a practice.

    The rationale for this book is that program development and evaluation needs to be yoked more closely to prevention in order for prevention programs to become more frequently provided. This connection also will help prepare students and trainees to become more adept at prevention.

    In this book, I attempt to describe how to develop and evaluate prevention programs and interventions guided by an incidence-reduction conceptual framework that was first suggested by Albee, which I have adapted over time (see Conyne & Newmeyer, 2008; Conyne, Newmeyer, & Kitchens, 2007). Although the book describes the entire program development and evaluation sequence, the purpose is to highlight it with regard to prevention programs.

    Defining the problem identification step within program development and evaluation from the incidence reduction perspective of prevention commands the lion's share of attention. In addition, the incidence reduction lens is sharpened by incorporating processes of community, collaboration, and cultural relevance. I have successfully used this approach in teaching prevention and in training workshops, which both students and practitioners have found to be beneficial.

    As implied above, many forces are serving to open up the teaching and practice of prevention. These include multicultural counseling and diversity, positive psychology, ecological approaches to counseling, group work, social justice, and culturally relevant practice. This expansion will continue noticeably, I believe. Why? Prevention and how to do it will become more mainstream as awareness builds that remediation is but one important approach to mental health and educational delivery and it needs to be complemented by other approaches. We are learning that in addition to the important and necessary work of helping people who already are dealing with problems, we also must figure out how to reach people “before the fact” in ways that are empirically sound and responsive to cultural characteristics. This is the essence of prevention.

    Courses at both the undergraduate and graduate levels are being expanded to include prevention. When the curriculum can handle it, specialized courses are appearing that demand specialized texts. Otherwise, infusion occurs across existing courses, and prevention resources are included as supplements.

    Some excellent (but few in number) sources exist in the area of prevention, including the examples that follow. Stellar prevention programs were identified and described in an American Psychological Association publication, 14 Ounces of Prevention (Price, Cowen, Lorion, & Ramos-McKay, 1988). The forthcoming edited volume, Realizing Social Justice: The Challenge of Preventive Interventions, edited by Kenny, Horne, Orpinas, and Reese (2009), effectively examines how prevention connects with social justice. Major contributions have appeared in issues of The Counseling Psychologist: Romano and Hage (2000) discussed the relationship between prevention and counseling psychology; prevention guidelines were suggested (Hage et al., 2007); and culturally relevant prevention was considered by Reese and Vera (2007). A future special issue of the Journal of Primary Prevention, cited above, will feature methods of teaching primary prevention (O'Neil & Britner, in press).

    Reviewers suggested that I comment specifically on how this new text differs from my 2004 text, Preventive Counseling (which abridged my original 1987 text). For years, these other texts were the only ones available to address prevention within counseling and counseling psychology. I intended them to “open the door” to prevention for counselors, to introduce them to its concepts and basic strategies. As such, these texts were basic primers in the field and, I think, crossed a new threshold. This new text very clearly builds on them while focusing on the essential process of program development in prevention. As I've pointed out earlier in this preface, how to plan and evaluate prevention programs now needs to be addressed, and that is what I have sought to do in this text. Providing an expansive and concrete way to apply incidence reduction within planning is an innovation that should advance prevention practice. In addition, I've incorporated the newest material available, particularly sources dedicated to cultural sensitivity and relevance, and to social justice.

    Actually, the publication of a new book is no unique or special event anymore when you realize that today—meaning on this day, as every day—more than 3,000 books will be published (The Fischbowl, 2007)! Even so, at least book authors think their books are distinctive, as I confess I do.

    I wrote this book for five types of courses: (a) human service courses at the undergraduate level; (b) existing prevention courses or courses in program development and evaluation; (c) introductory courses in graduate fields of helping, for example, Theories of Counseling, where this book could serve as a supplement; (d) practice-stage courses centered around practicum and internship, where students are providing supervised service; and (e) doctoral seminars. Beyond academic courses, due to its practical focus, this book will be of value to the large number of practicing counselors, psychologists, social workers, and others who are offering prevention programming without benefit of specific training.

    Prevention Program Development and Evaluation addresses another key step for implementing prevention. Linking theory with practice, I have tried to show some of the nuts and bolts involved with converting the magnificent goal of prevention—which now enjoys considerable supportive research—to its execution within training programs and by helpers in the field.

    The book contains a number of instructional resources and learning aids. Seven lighthearted figures are included to buoy readers as they move through the book. Each chapter is introduced by an overview, includes learning exercises (25 in all), and ends with a summary. Interspersed are five explanatory tables that summarize essential aspects of the overall prevention program development and evaluation process.

    To make learning come increasingly alive, I strongly encourage readers in Chapter 7 to select their own prevention topic that they can work with as they proceed through Chapters 79; better yet, I suggest they form a team. Periodic process checks are presented as learning exercises to help a team assess its important work. The final chapter in this book provides readers with opportunities to apply their prevention analytical skills as they examine program descriptions against evaluative criteria.

    The book concludes with an extensive and comprehensive set of classic and contemporary references in the prevention and program development fields and eight appendices that will be useful in applying information contained throughout the text. I have found in teaching and training that these kinds of organizers, exercises, resources, and summaries sensitize learners to what makes for good prevention programs.

    I hope that this book will enable readers to climb another rung on the prevention ladder. Increased knowledge and skill in program development will enable personnel to launch prevention programs more frequently and effectively in mental health, educational, and community settings—thus contributing more fully to reducing the scope of social problems and to improving human satisfaction and fulfillment.

    Acknowledgments

    For decades I taught two specialized courses that I developed—preventive counseling, and program development and evaluation (this course with Lynn Rapin)—that students said should be linked together because they were so mutually reinforcing.

    The present book attempts to provide that linkage. It is intended to serve as a guide for those interested in developing and evaluating prevention programs.

    As with any book, many people are to be credited (but only I can take any blame). Early collaboration with Doug Lamb, Neal Gamsky, Jim Clack, Lynn Rapin, Betty Rademacher, Don Cochran, Fran LaFave, Bob Silver, Betty Harding (dec.), and other terrific professional staff and the paraprofessional student advisors at the Illinois State University (ISU) Student Counseling Service in the 1970s provided a dynamic crucible for developing campus-based preventive interventions, such as the environmental assessment project. In ISU's Counselor Education Program I first developed a fledgling preventive counseling elective course in 1975. The belief directing this course was, and remains, that counselors, psychologists, social workers, and other helpers need to function first as “preventionists,” and that prevention should infuse all interventions. The basic structure of the course has been carried forward ever since, both at ISU and for 25 years in the Counseling Program at the University of Cincinnati (UC), where it moved from special topic, to elective, to required status—incorporating many twists and turns as research, training, and practice evolved. Also at ISU, Lynn and I developed the foundation for our program development and evaluation course, which was used there within counseling service consultation and training sessions. That course, too, later became a staple of the UC Counseling Program, and its contents formed the center of many consultation projects either of us assumed.

    None of this academic activity would have been possible without the tolerance and support of my fellow faculty at both institutions, who fortunately gave me the benefit of the doubt to keep moving ahead. For instance, Ray Eiben (dec.) at ISU (in the middle 1970s) and Geof Yager at UC (early 1980s) first supported the initial special topics versions of the preventive counseling course in their respective Counseling Programs—in both cases, I think, wondering why they should do that—actions that were instrumental in allowing the course to develop, take hold, and then flourish. Thanks to them and to all of my colleagues at both institutions.

    Scores and scores of students who took the preventive counseling course were my enthusiastic critics, always pushing me to become clearer, and they also were my collaborators all along the way; for instance, the preventive checklist contained in this book expanded after every class offering due to specific input from these students. A former UC counseling student, Mark Newmeyer, graciously volunteered to comment on a portion of this book manuscript; I thank him for his feedback and for assisting me several times in teaching both the preventive counseling and the program development and evaluation courses. Likewise, I thank Jeri Crowell and Gail Kiley, two other former UC Counseling Program students, for the multiple times they volunteered to assist me in teaching those courses. And I am especially pleased and thankful for the creative contribution of my brother, John Conyne, for his cartoons. I owe them all my gratitude.

    My acquisitions editor at SAGE, Kassie Graves, stretching back to my book Failures in Group Work, deserves singular appreciation for her wisdom and her support of my work. The full range of SAGE staff also have been invaluable in producing this book, including Veronica Novak (editorial assistant), Sarah Quesenberry (production editor), and Teresa Wilson (copy editor). The observations and recommendations made by reviewers of this book, all prevention experts themselves and fellow travelers in the “prevention mission,” were comprehensive and insightful, and I want to acknowledge each of them: Andy Horne, Mary Lee Nelson, James O'Neil, John Romano, Paul Richard Smokowski, Elizabeth Vera, and Michael Waldo. The Prevention Section of the American Psychological Association's Society of Counseling Psychology (similar to the American College Personnel Association Commission VII's prevention task force and the APA Division 17 Prevention Interest Group of the 1970s) provides a fount of innovative ideas and a wonderful sense of mutual support, and it has been an honor for me to be involved. The late Bob Toal first exposed me to community psychology at Purdue University during my doctoral program, for which I am ever grateful. Rudy Moos from Stanford was a strong early influence from afar on my thinking about social ecology in prevention, as were Jim Banning and Jim Hurst in the area of campus ecology. Rick Price, with whom I completed a year (years ago) as a postdoctoral scholar in community psychology at the University of Michigan, taught me much about prevention's value, strategies, and research, and I thank him for his mentorship.

    And finally my family deserves special mention for allowing me the time to stare at my computer screen attempting to untangle my cobwebbed thoughts by writing—to my wife and colleague, Lynn; my daughter, Suzanne; my son, Zack; and our dog, Lucy (who always lies at my feet as I plod along, providing an unquestioned supportive foundation)—thank you!

  • Appendix A. Ten-Step PPD&E Model

    Appendix B. Laying the Groundwork (Steps 1–8) for Community, Collaboration, and Cultural Relevance

    Appendix C. Implement and Evaluate (Steps 9–10)

    Appendix D. PPD&E Step 9: Design the Prevention Program Plan

    Appendix E. PPD&E Step 10: Design the Prevention Program Evaluation Plan

    Appendix F. Basic Incidence Reduction Formulae

    A. Original Albee Incidence Reduction Formula

    B. Adapted Incidence Reduction

    C. Adapted Incidence Reduction Formula: PLANNING Version

    Appendix G. PPD&E Step 9b: Identify the Problem

    Adapted Incidence Reduction Formula for Problem Identification in Prevention Program Development and Evaluation

    I. Contributions to Environmental Deficits (Numerator Factors)

    Reduce Environmental Deficits

    Physical Environment Stressors

    • What Physical Environmental Stressors (natural and built environment, context, events, circumstances, situations) affect the lives of people in this population?
      • What organic physical, mental, or emotional behaviors are affected by physical environmental stressors? (e.g., Down syndrome, lead poisoning, depression, obesity, attention deficit, alcoholism)
      • How do they inhibit functioning, and what is their strength?
      • What physical stressors are present that could affect any in the population?
      • How could physical stressors be reduced by population members and/or by preventive intervention?

    Social Environment Stressors

    • What Social Environmental Stressors exist that can lead to psychological and emotional disorders?
      • What could be done by population members and/or by preventive intervention to reduce negative effects of the social environment?
      • How can negative behaviors be reduced?

    Cultural Stressors in the Environment

    • What is there about the environmental Culture that may support exploitation and affect the lives of people in this population?
      • Identify any abuse: Oppression? Exploitation? Marginalization? Violence?
      • Describe how any oppression and exploitation are expressed in terms of ethnicity, race, gender, sexual orientation, age, religious orientation, spiritual affiliation, socioeconomic status, and physical/mental ability.
      • How could this oppression and exploitation be reduced by population members and/or by preventive intervention?
    II. Contributions to Personal, Interpersonal, Group, and System Strengths (Denominator Factors)

    Increase Protective Strengths

    Personal Strengths

    • How is Self-Esteem evidenced?
      • What competencies tend to be shown?
      • What could be done by population members and/or by preventive intervention to enhance self-esteem?
    • How is Well-Being evidenced?
      • What competencies tend to be shown?
      • What could be done by population members and/or by preventive intervention to enhance well-being?
    • How is Resilience evidenced?
      • What competencies tend to be shown?
      • What could be done by population members and/or by preventive intervention to enhance their resilience?
    • How is Self-Efficacy evidenced?
      • What competencies tend to be shown?
      • What could be done by population members and/or by preventive intervention to enhance their sense of personal self-efficacy?

    Interpersonal Strengths

    • How are Interpersonal and Coping Skills evidenced?
      • What competencies tend to be shown?
        • Interpersonal skills
        • Coping skills
      • What could be done by population members and/or by preventive intervention to enhance their interpersonal skills?
    • How is Engagement evidenced?
      • What competencies tend to be shown?
      • What could be done by population members and/or by preventive intervention to enhance their ability to become engaged?

    Group Strengths

    • How is Collective Efficacy evidenced?

      What could be done by population group members and/or by preventive intervention to enhance their sense of collective efficacy?

    • How is use of Support Systems (friends, groups, families, communities, organizations, mentors …) evidenced?

      How could support systems and their use be enhanced?

    System Strengths

    • How is Ecological Competence evidenced?
      • How ecologically competent are population members?
      • What can population members do and/or what can preventive intervention do to increase ecological competence?
    • How is Advocacy evidenced?

      What can population members do and/or what can preventive intervention do to foster advocacy?

    • Summation and Integration: Based on your above assessment, what factors should be reduced and which ones increased to effect positive preventive activity?

    Appendix H. Useful Web Sites

    Development Services Group, Inc., is in the process of developing a resource manual for supplemental assistance in obtaining indicator information. These materials will be completed and distributed in the near future. In the meantime, the following online sources contain indicator information:

    If you or any member of your community team are aware of any Web site addresses (or other sources) that you find helpful and believe should be added to the resource guide, please feel free to contact DSG with your suggestions (call 1-877-5-TITLE-5 [584–8535]).

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    Author Index

    About the Author

    Robert K. Conyne, PhD, professor emeritus from the University of Cincinnati, is a licensed psychologist, clinical counselor, and Fellow of the Association for Specialists in Group Work (ASGW) and the American Psychological Association and three of its divisions. He has 36 years of professional experience as a university professor, department head, and program director, and as a psychologist and counselor. He has provided consultation and training over decades both within the United States and within several international contexts, including frequent assignments in China. Current work finds him volunteering as an American Red Cross disaster mental health specialist and serving as a military family life consultant. Bob has received many awards, including the Eminent Career Award from the ASGW; the Lifetime Achievement Award in Prevention, Society of Counseling Psychology of the APA; the Distinguished Alumni Award of Distinction from Purdue University; and designation as a Soros International Scholar providing service in Kyrgyzstan to the American University of Central Asia. He is the 2009 president of the APA's Division of Group Psychology and Group Psychotherapy. With over 200 scholarly publications and presentations, including 10 books in his areas of expertise (group work, prevention, and ecological counseling), along with broad international consultation in these areas, Bob is recognized as an expert in working with people and systems and across cultures. With colleague (and wife) Lynn S. Rapin, PhD, he also helps people plan and prepare psychologically for their upcoming retirement, using the holistic approach they developed, “Charting Your Personal Future.” This new book on prevention program development builds on his basic text, Preventive Counseling (2004). His most recent offering is Group Techniques: How to Use Them More Meaningfully (2008, with former students Jeri Crowell and Mark Newmeyer), which demonstrates how to help group members by using an ecological orientation. When not working, Bob and Lynn—as often as possible with their children, Suzanne and Zack, who are now grown—can be found enjoying life at their northern Ontario cottage with their dog, Lucy.


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