Transcript Critical Health Psychology Needs Psychopolitical Validity

Strategies for
Community Well-Being
7/20/2015
Prilleltensky
1
Question
What do John Snow and Michael
Marmot have in common?
 A. Professor Prilleltensky’s heroes
 B. British epidemiologists
 C. pillars of the SPEC philosophy
 D. All of the above

7/20/2015
Prilleltensky
2
The Problems of DRAIN
Drain Approach
 Deficits-based
 Reactive
 Alienating
 Individual-focused
7/20/2015
approaches
Problems
 Too little
 Too late
 Too costly
 Too unrealistic
Prilleltensky
3
The Promise of SPEC approaches
SPEC Approaches
 Strengths-based
 Prevention
 Empowerment
 Community-focused
7/20/2015

Built to last
 Start early
 Give voice & choice
 Return $$$$
Prilleltensky
4
Organizations with a Strength-based
orientation
Perceive recipients of services and
community members as having
strengths
 Recognize that service recipients learn
to cope with difficult situations and
develop resilience
 Identify and build on individual and
community assets, resilience, and ability
to thrive in difficult situations

Organizations with a prevention
orientation
Work to prevent problems before they
occur
 Identify and reduce risk factors and
promote protective factors in individuals,
families, and communities.
 Take action to decrease the chances
that a particular problem will affect a
person, group, or an entire community

Organizations with an empowerment
orientation
Believe community members should
have voice and choice in issues and
decisions that affect their lives
 Aim to increase the power of
individuals, groups, and entire
communities
 Encourage the sharing of decisionmaking power and control over
resources with community members

Organizations with a community-change orientation

Believe that some of the problems that
individuals and entire communities face result
from community and living conditions
 Remove barriers to services and supports
 Work to address the root causes of the
problems people and communities face
 Promote social policies that enhance wellbeing
and people’s ability to thrive
 Create new systems or structures that enhance
citizen participation and wellbeing
How to do it?
Jobs and Roles
Roles for Agents of Change






Director: manager, controlling
Expert: diagnoses, tells others what to do
Consultant: influence derives from respect
Resource: trainer or researcher
Facilitator: process helper
Collaborator: joins in action
7/20/2015
Prilleltensky
10
Settings
Examples
Roles
Human Services
Community mental health agencies
Independent living centers
Department of community services
Department of public health
School board
Child and family services
Program developer
Program manager
Program evaluator
Human resources manager
Health promoter
Unit manager
Alternative settings Women’s shelters
Community economic development
corporation
Resource centre for persons with HIV/AIDS
Self-help group run by community members
Immigrant and refugee advocacy centre
Social advocate
Team leader
Community developer
Group facilitator
Board member
Social change
settings
Researcher
Organizer
Public speaker
Policy developer
Writer
7/20/2015
Public interest research group
Social policy institute
Social change movements
Trade and labour unions
Political parties
Prilleltensky
11
Review of I VALUE IT
I VALUE IT
 Inclusive host
 Visionary
 Asset seeker
 Listener and sense
maker
 Unique solution finder
 Evaluator
 Implementer
 Trendsetter
How to do it?
Strategies for Preventing
Child Abuse
Four Key Dimensions
 Strength-based partnerships (S & E of SPEC)
Promotion-prevention-early intervention
continuum (P of SPEC)
 Focusing the intervention at different ecological
levels (from micro to macro) (C of SPEC)
 Length and intensity of intervention (Research
evidence)
Dimension # 1 – Strength-based
and empowering partnerships
What Is a Strength-based and
Empowering Partnership?
 Most prevention programs are driven by professionals, the
recipients of the programs have little voice (they are “research
subjects” and “clients”)
 Those that follow a community development approach are
more likely to be driven by community members
 Partnerships emphasize the values of resident participation,
self-determination, collaboration with professionals, inclusion
and diversity, health promotion, etc. - not exclusively top
down or bottom up, but a blending of strengths and knowledge
Effect Sizes for Intensive Family
Preservation Programs on Out of Home
Placement Rates (S and E of SPEC)
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
No
Yes
Parent Participation
Social Support
Component
Source: MacLeod & Nelson (2000)
Question
Vaccinations for H1N1 is an example of
 A. indicated prevention
 B. selective prevention
 C. universal prevention

7/20/2015
Prilleltensky
18
Dimension # 2 –PromotionPreventionEarly Intervention Continuum
Proa ctive /Un iv e rs a l
Policie s & Pr ogr a m s
P rom ote W e llne s s


F a m ilie s
Fu nctionin g
W e ll

F a m ilie s
E xpe r ie n cing
Som e Prob le m s
Proa ctive /H igh Ris k
P olicie s & Pr ogra m s
Pre v e nt M a ltr e a tm e n t


F a m ilie s
A t-R is k of
M a ltr e a tm e n t

C h ild
M altre a tm e n t
O ccur s
R e active /In dica te d
P olicie s & Pr ogra m s
Pre v e nt D e te riora tion


Fa m ilie s
Re qu ir e I nte ns ive
Pr ote ction Se r vices
Meta-analysis
 A quantitative literature review / research
synthesis
 The main statistic that used in meta-analysis
is called an effect size
 Meta-analysis is also used to examine
moderators of effect size
Effect Sizes for Proactive and Reactive Interventions on Family
Outcomes at Post Intervention and Follow-up
0.6
0.5
0.4
Post
Follow-up
0.3
0.2
0.1
0
Proactive
Reactive
Source: MacLeod & Nelson (2000)
Dimension # 3 – Ecological View of
Family Wellness
Easy temperament
Physical health
Adequate birth weight
V alu es , R eso u rc es
P ro gr am s, Po lic ies
Child care
Good schools
Adequate housing
Cohesion
Access to health care
Good parenting
Mutual Support
Good mental healt
V alu es , R eso u rc es
P ro gr am s, Po lic ies
V alu es , R eso u rc es
P ro gr am s, Po lic ies
V alu es , R eso u rc es
P ro gr am s, Po lic ies
Employment
Justice
Safety nets
Quality educatio
Focusing the Intervention – From
Micro to Macro
 Family/parent support programs - home visitation
(Olds Prenatal/Early Infancy project, Healthy Families
America)
 Combined preschool/school and family/parent
support programs – Chicago Child-Parent Centers,
Better Beginnings, Better Futures
 Community-wide media campaigns
 Social policies
Home Visitation (Micro)
 Olds’ nurse home visitation program, Healthy Families
America, Parents As Teachers are examples
 Recent reviews of the literature and commentaries (Daro,
2004; Santos, 2005; Zercher & Spiker, 2004) have suggested that
the impacts of home visitation programs are varied and modest
overall
 Geeraert, Van de Noortgate, Grietans, & Onghenea (2004)
found an overall ES of . 29 for mostly home visitation programs
post intervention
 Sweet and Appelbaum (2994) found an ES of .32 for abuse
and .24 for child abuse potential for home visitation programs
Multi-component Programs (More
Comprehensive) - CPC
 Chicago Child-Parent Center program provides
several programs for low-income children beginning
at age 3 (Reynolds & Robertson, 2003)
 Programs include home visitation, parent resource
centers, parenting skills training, vocational training,
social support, preschool education, continued
educational assistance to children up to 2nd or 3rd
grade
Multi-component Programs (More
Comprehensive) - CPC
 Examination of court petitions for child
maltreatment by age 17 showed significantly lower
rate of child maltreatment in the CPC group (5%)
than the comparison group (10.5%)
 Parental involvement in school and school
mobility were significant mediators of prevention
effects, demonstrating the importance of a more
comprehensive, ecological program
Multi-component Programs –
Better Beginnings, Better
Futures
 Better Beginnings, Better Futures is a multicomponent prevention program in 8 low-income
Ontario communities (Peters et al., 2000)
 There are child-focused, family-focused, and
community-focused programs in each community
Impacts on Child Maltreatment: Number of Open
CAS Cases in Highfield Community over Time
35
30
25
20
15
10
5
Source: Peters et al. (2002)
19
97
19
95
19
93
19
91
19
89
19
87
0
Community-wide Education
Programs (Macro)
Examples include:
 the universal Triple P Positive Parenting Program in
Australia that uses print and electronic media
(Sanders, Cann & Markie-Dadds, 2003) and which is
now being in implemented in South Carolina as well
 the Parenting the First Year newsletter in Wisconsin
(Riley, 1997)
 Prevent Shaken Baby Syndrome (Dias et al., 2005)
Triple P program (Positive Parenting Program
-- Prinz, Sanders, 2009. Prev Science (2009), 1-12

5 levels of intervention (for universal,
selective, and indicated levels of
prevention)
– Media
– Group
– Brief consultation
– Intensive consultation
– Home visits
7/20/2015
Prilleltensky
30
Triple P program (Positive Parenting Program
-- Prinz, Sanders, 2009. Prev Science (2009), 1-12
– Population: 18 counties with 85,000
families with kids younger than 8 years old.
– Programs delivered through existing social
service systems
– 5 core principles:
•
•
•
•
•
7/20/2015
Ensuring a safe, engaging environment
Promoting a positive learning environment
Using assertive discipline
Maintaining reasonable expectations
Taking care of oneself as a parent
Prilleltensky
31
Triple P program (Positive Parenting Program
-- Prinz, Sanders, 2009. Prev Science (2009), 1-12
– Key skills taught
•
•
•
•
•
•
•
•
7/20/2015
Parent-child relationship enhancement
Encouraging desirable behavior
Teaching new skills and behaviors
Managing misbehaviors
Preventing problems in high-risk situations
Self regulation skills
Parental mood management and coping skills
Partner support and communication skills
Prilleltensky
32
Triple P program (Positive Parenting Program
-- Prinz, Sanders, 2009. Prev Science (2009), 1-12
– Outcomes
• Fewer child maltreatment cases over two years
as compared to control groups
• Fewer out of home placements
• Fewer child maltreatment injuries
• In a community of 100,000 results translate into
688 fewer cases of maltreatment, 240 fewer out
of home placements, and 60 fewer children
with injuries requiring hospitalization or
emergency room treatment
7/20/2015
Prilleltensky
33
Community-wide Education
Programs – Wisconsin Program
(Macro)
 Evaluation of the Parenting the First Year newsletter in
Wisconsin (Riley, 1997) using a sample of over 1000
mothers with 14 month old infants
 Compared with those who did not receive the newsletter
(the control group), those who received the newsletter had
significantly lower rates of spanking or slapping their
children
 Across the 40,000 families who received the newsletter,
this adds up to the prevention of over 1 million instances of
babies being struck
Community-wide Education
Programs – Western New York
Program (Macro)
 Program to reduce violent shaking of babies in all
hospitals in 8 counties through parental education
(Dias et al., 2005)
 about 65,000 parents signed consent forms
confirming their reading and understanding of the
material out of 94,000 births over a 5 year period
 Incidence of abusive head injuries decreased by
47% from the 6 year baseline period, and no
comparable reduction was seen in two adjacent
comparison communities
Social Policy Intervention
(Macro)
Can social policies prevent child maltreatment?
The case of Sweden
 Physical punishment of children abolished in
secondary schools in Sweden in 1928
 On July 1, 1979, Sweden enacted a law that
outlawed corporal punishment of children (the first
country to do so)
 A variety of family and parenting support programs
have been put in place to reinforce this policy
Social Policy Intervention (Macro)
 Rates of prosecution have not increased since the
law was enacted (Durrant, 1999)
 Rates of out-of-home placements have steadily
decreased since the law was enacted (Durrant,
1999)
 Rates of youth involvement in crime, alcohol
and drug use, rape, and suicide have decreased
(Durrant, 2000)
 Mothers’ use of physical punishment has
decreased substantially since the law was enacted
(Durrant, 2000, 2003)
Social Policy Intervention
(Macro)
 The percentage of Swedish parents who agreed with the
statement “A child has to be given corporal punishment
from time to time” decreased from 42% in 1968 to 26% in
1981 (Durrant, 2003)
 Swedish parents more likely than U.S. parents to agree
with “law prohibiting parents from spanking their children
at all” in 1981 – 76% of Swedish parents vs. 27% of U.S.
parents (Durrant, 2003)
 In 1981, 11% of U.S. boys and 15% of U.S. girls
reported never being spanked compared with 56% of
Swedish boys and 64% of Swedish girls (Durrant &
Janson, in press)
Dimension # 4 - Length and Intensity
of the Intervention
 Length and intensity for parents
 Length and intensity for children
Effect Sizes for Preschool Interventions on Child and
Family Outcomes at K-8 by Length and Intensity of the
Intervention for Children
0.45
0.4
0.35
0.3
0.25
0.2
0.15
0.1
High
Low
0.05
0
Intensity
Length
Source: Nelson, Westhues, & MacLeod (2002)
Length and Intensity of the
Intervention
 In the Chicago Child-Parent Center (CPC) program
evaluation, those children with 4-6 years of
participation had a lower rate of child maltreatment
(3.6%) vs. those with less extensive participation
(6.9%) (Reynolds & Robertson, 2003)
Theme 1: Beyond the Individual - The ecological perspective
From person to community
7/20/2015
Prilleltensky
42
Theme 2: Beyond individualism
and self interest
-- Values for a Just and Caring
Society
From personal blame to social
responsibility
7/20/2015
Prilleltensky
43
Theme 3: Beyond programs-Social policies for a just and
caring society
From single programs to
universal social policies
7/20/2015
Prilleltensky
44
Theme 4: Beyond child
protection -- Promotion and
prevention programs
From reaction to proaction
7/20/2015
Prilleltensky
45
Theme 5: Beyond child welfare -Partnership and Community
From experts to collaborators
7/20/2015
Prilleltensky
46
Theme 6: Beyond model
programs -- Implementation and
diffusion
from demonstration to
institutionalization
7/20/2015
Prilleltensky
47
How to do it?
Strategies for Preventing
Crime
Question
Building jails is an example of
 A. collective, proactive interventions
 B. collective, reactive solutions
 C. personal, reactive solutions
 D. disempowering, proactive
interventions

7/20/2015
Prilleltensky
49
Crime: Direct Expenditures
http://www.ojp.usdoj.gov/bjs/glance/expgov.htm
7/20/2015
Prilleltensky
50
Principles for effective
prevention programs









Are comprehensive
Use varied teaching methods
Provide sufficient dosage
Are theory driven
Promote positive relationships
Are appropriately timed
Are culturally relevant
Use outcome evaluation
Have well trained staff
7/20/2015
Prilleltensky
51
DRAIN Approaches to Crime
Prevention are not effective
http://www.surgeongeneral.gov/library/youthviolence/

Deficit oriented
– Milieu treatment with other problem youth
– Grade retention

Reactive
– Firearm training
– Gun buy back

Alienating
– Boot camps
– Adult court
– Scared straight

Individual focused
– Counseling and casework
– Drug abuse resistance education
7/20/2015
Prilleltensky
52
SPEC approaches to crime prevention are
promising www.surgeongeneral.gov/library/youthviolence/

Strength-based
– Skills training
– Social problem solving

Prevention
– Parent training
– Home visiting
– Early education
7/20/2015
Prilleltensky
53
SPEC approaches to crime prevention are
promising www.surgeongeneral.gov/library/youthviolence/

Empowerment
– Positive youth development
– Marital and family therapy
– Cooperative learning

Community change
– Building school capacity
– Wraparound social services
7/20/2015
Prilleltensky
54
High/Scope Perry Preschool
 Age 19 - twice as many program participants as control
children were employed, attending college, or receiving
further training; high school graduation rates were 30%
higher; and arrest and teen pregnancy rates were 40% lower
 Age 40 - Compared with participants in the control group,
participants in the Perry Preschool project were less likely
to be arrested five or more times and more likely to be
employed, earn $20,000 or more, and have a savings
account
 For every dollar invested in the 30-week program, there
was a $14 return in savings from lower education, criminal
justice, and welfare costs and higher tax revenues
7/20/2015
Prilleltensky
55
From Dennis Winters, Sept. 2007
http://www.partnershipforsuccess.org/uploads/200709_Wintersprez.pdf
7/20/2015
Prilleltensky
56
Chicago Child-Parent Centers (CPC)
Age 17 – CPC preschool participants had
significantly lower rates of court petitions for child
abuse than no CPC comparison group
 Age 24 - CPC participants had significantly higher
rates of high school completion, participation in 4year colleges, years of schooling completed, and
employment and significantly lower rates of
depressive symptoms, felony arrests, convictions and
incarcerations
For every dollar invested in the program, there was a
$7 return in savings from lower education and
criminal justice costs and higher tax revenues
7/20/2015
Prilleltensky
57
Better Beginnings, Better Futures: Goals
Prevention
 To reduce the incidence of serious, long-term emotional and
behavioural problems in children living in high risk
neighborhoods
Promotion
 To promote the optimal social, emotional, behavioral,
physical and educational development in children
Community Development
 To strengthen the ability of disadvantaged communities to
respond effectively to the social and economic needs of
children and their families
7/20/2015
Prilleltensky
58
Better Beginnings, Better Futures:
Outcomes
 Significant positive impacts on teacher ratings of
child behavior problems
 Significant positive impacts on parent ratings of
child behavior problems
 Significant positive impacts on teachers and parent
ratings of prosocial child behavior
 At Grade 6, parents’ ratings of prosocial behavior
and teacher ratings of self-control were
significantly higher for Better Beginnings children
and teacher ratings of hyperactivity-inattention
were significantly lower
7/20/2015
Prilleltensky
59
ROI in Crime Prevention: Focus on
School Graduation
from Moretti, 2007

One percent increase in male high school
graduation would save as much as $ 1.4
billion, or about $ 2,100 per additional
graduate, per year
 One additional year of high school costs $
6,000 per student, much less than $ 2,100 in
benefits per year after graduation
 Completing high school would increase
annual earnings of graduate by $ 8,040
7/20/2015
Prilleltensky
60
Incarceration rates for men, by level of education (1960, 1970
and 1980) (Moretti, 2007)
White Men
Black Men
High school
dropout
0.83
3.64
High school
graduate
0.34
2.18
Some college
0.24
1.97
College +
0.07
0.66
7/20/2015
Prilleltensky
61
Reduction in crime as a result of one year
increase in schooling (Moretti, 2007)
Murder
 Assault
 Vehicle theft
 Arson
 Burglary
 Larceny

7/20/2015
30%
30%
20%
13%
6%
6%
Prilleltensky
62
Reduction in numbers of crime as a result of
1% increase in high school graduation
(Moretti, 2007)
Murder
 Assault
 Vehicle theft
 Arson
 Burglary
 Larceny

7/20/2015
400
37000
14200
470
9400
35000
Prilleltensky
63
Savings in crimes prevented as a result of 1%
increase in male high school graduation
(Moretti, 2007)
Murder
 Rape
 Robbery
 Assault
 Burglary
 Larceny/theft
 Car theft
 Arson

7/20/2015
$ 1.12
$ 139
$ 8.6
$ 368
$ 9.3
$7
$ 18
$ 18
Prilleltensky
billion
million
million
million
million
million
million
million
64
Extra high school graduates per 100 students in
successful programs (Levin & Belfield, 2007)





Perry Preschool Program
First Things First (school reform)
Chicago Child Parent Center
Project Star (class size reduction)
Teacher Salary Increase
7/20/2015
Prilleltensky
19
16
11
11
5
65
Benefit : cost ratio for successful programs
(Levin & Belfield, 2007)
Perry Preschool Program
2.31
 First Things First (school reform) 3.54
 Chicago Child Parent Center
3.09
 Project Star (class size reduction)1.46
 Teacher Salary Increase
2.55

7/20/2015
Prilleltensky
66
Common elements of successful high school
graduation programs (Levin and Belfield,
2007)
 Small school size
 High levels of personalization
 High academic expectations
 Strong counseling
 Parental engagement
 Extended time school sessions
 Competent and appropriate personnel
7/20/2015
Prilleltensky
67
Lifetime public savings per new high
school graduate in 2004 dollars
Based on extra tax payments, public
health savings, criminal justice system
savings, and welfare savings,
 White male
$ 262,000
 Black male
$ 268,500
 Hispanic male
$ 196,300

7/20/2015
Prilleltensky
68
Percent reduction in negative outcomes
as result of programs (Belfield, 2007)

Special education placement
– ABC
– PPP
– CPC
– Head Start

- 8%
- 43%
- 32%
- 28%
Likelihood of dropping out
– ABC
– PPP
– CPC
7/20/2015
- 32%
- 25%
- 24%
Prilleltensky
69
Percent reduction in negative outcomes
as result of programs (Belfield, 2007)
Juvenile court petition (CPC)
 Treatment for addiction (PPP)
 Drug use (ABC)
 Teen parenting (ABC)
 Teen parenting (PPP)
 Teen parenting (CPC)




-9%
-12%
-21%
-19%
-11%
-7%
ABC: Abecedarian,
PPP: Perry Preschool,
CPC: Chicago Child Parent Center
7/20/2015
Prilleltensky
70
Conclusions

Prevention should go beyond the parent
child dyad and include systemic,
community-based, long term
interventions as well.
7/20/2015
Prilleltensky
71
How to do it?
Strategies for Community
and Social Change
Changing society from within
government

Amelioration

–
–
–
–
– Support full
employment
– Eliminate poverty
– Universal health
insurance
– Universal family
support
Population health
Public education
Prevent epidemics
Provide basic
necessities
– Improve services
7/20/2015
Transformation
Prilleltensky
73
Changing society from outside
government


Amelioration
– Demand more
services
– Increased
participation in local
politics
– Funds for charity,
research, and
demonstration
projects
7/20/2015
Prilleltensky
Transformation
– Fight exploitation
– Sustainable
communities
– Promote culture of
equity
– Raise consciousness
about inequality
74
Strengths and limitations of
government social interventions

Strengths
–
–
–
–

– Ameliorative
– Conservative
– Regressive
Breadth
Depth
Length
Sustainability
7/20/2015
Limitations
Prilleltensky
75
Social Change Movements

Roots
– Suffering and deprivation
– Consciousness raising
– Congealing events
– Political opportunities
7/20/2015
Prilleltensky
76
Social Change Movements

Antecedents
– Multiple sources of support
– Congruence of interests
– Communication networks
– Organizational effectiveness
– Resource mobilization
7/20/2015
Prilleltensky
77
Social Change Movements

Collective action strategies
– Recruitment of large number of people
– Media campaigns
– Coalitions
– Lobbying and political influence
– protest
7/20/2015
Prilleltensky
78
Strengths and limitations of
social change movements

Strengths

– Transformative
– Participatory
– Integrative
7/20/2015
Limitations
– Unaccountable
– Contradictory
– Transitory
Prilleltensky
79
Kerala: A Community
Strengths Story
Kerala: A state in Southwest
India. The name "Kerala"
probably means "land of
coconuts."
Population: 31.8 million
Kerala's population is the same
as Canada's.
Indicator
Kerala
India
Low income
countries
USA
Per Capita GDP 566
$
460
420
34,260
Adult Literacy
Rate (%)
91
58
39
96
Males (f)
68
63
59
74
Females (f)
74
64
Infant Mortality
per 1,000
12
65
80
7
Birth Rate Per
1,000
17
29
40
16
Life Expectancy
in Years
80
Processes
Well-Being in Kerala
Personal
Empowerment
Outcomes
Personal
Well-Being
Infant
mortality
Literacy
Nutrition
Life expectancy
Social
Movements
Relational
And
Organizational
Well-Being
Social support
Sense of
cohesion
Government
Action
Community
Well-Being
Tenancy laws
Nutrition in school
Distribution
Of resources
Land reform