This is the third Prevention Nugget to address Building Prevention Systems. As indicated before, there are four Prevention Nuggets on this topic addressing: Consumers of Prevention Services, the Services Delivered, and the Prevention Professionals who implement and monitor these services, and the Service Delivery System.
To review, the key elements of the system are the consumers who may or may not seek prevention services; prevention professionals who deliver the services who vary not only in their training but also may not be certified as prevention professionals; the services that are delivered that may or not be evidence-based; and the service delivery system that may be prevention focused, for example, community coalitions, schools, county boards, and in some cases, law enforcement, but there is generally no prevention structure that is identifiable. Furthermore, funding for prevention services is primarily from public funding, often federal or State, or from foundations and is not based on documented need (as we say in the Prevention Nugget on Consumers of Prevention Services).
Now what about the professionals who plan for and deliver evidence-based prevention programming? Who are they? There is not an accepted professional classification as Prevention Professional. During COVID we talk about health professionals. What comes to mind? We think of physicians, nurses, emergency medical technicians (EMTs), licensed practical nurses (LPNs), physical therapists, and a number of other groups that form the health workforce. Each of these groups have well-defined competencies that inform their training. All are credentialled, licensed, and regulated. They all belong to a professional association that represent them and advocate for them.
As we want professionals delivering prevention services to have the same knowledge, skills and competencies to deliver evidence-based interventions and policies, we therefore need to use a variety of methods to reach and to train these prevention workers, so they deliver the most effective interventions with the highest quality. So where are ‘prevention professionals’ currently trained? They are trained in universities through degree programs although it is only within the past few years that universities have included prevention science into their programs. They are trained through continuing education programs delivered through university systems from community colleges to large major universities. But again, these trainings are not consistent in their content, competencies, or certification. And then more common, are trainings offered by a number of not-for-profits and government sponsored groups. Again these trainings are not consistent in their content.
Professionalizing a Prevention Workforce
Sociologists have defined professionalization as having a systematic body of knowledge, skills, and competencies that have their basis in theory and research.
A profession has the authority to define the problems or issues it is to address and how to treat or address them.
A profession as a group, has sanctions regarding credentialing and training, that is who is to be admitted into the profession and how they are trained.
Professions have their own codes of ethics based on principles of service to others, and
Professions have their own culture and settings that includes what institutions or systems are necessary to carry out their functions.
We have a lot in place all ready.
1. For the authority, we have a systematic body of theory knowledge, skills, and competencies that has been acknowledged internationally based on prevention science. A major advancement has been the recognition that there is a science to the development and implementation of prevention interventions. Prevention science has been documented by the U.S. and EU Societies for Prevention Research. This science-based knowledge and skills help prevention professionals build the case for evidence-based (EB) prevention and includes:
Epidemiology describes the substance use problem, the people affected, and the causes and consequences;
Prevention definitions and principles explain learning and behavior and how prevention works;
Prevention research methods help us to understand how EB prevention interventions and policies have been evaluated and shown to be effective so prevention professionals can select the best intervention for their population;
Monitoring and evaluation approaches that gives us the tools to assess and improve our interventions as we progress.
In addition, prevention professionals need to have the skills necessary
To implement evidence-based (EB) prevention;
For advocacy or persuasive communications to support EB interventions;
To select the most effective intervention and policies best suited for the community;
To monitor and evaluate EB interventions and policies.
2. For professional standards, we have the Society for Prevention Research Standards document, the European Drug Prevention Quality Standards, and the International Standards on Drug Use Prevention. But also, there is the Universal Prevention Curriculum that was developed in 2014 through 2018 by our group, Applied Prevention Science International, with funding from the U.S. Department of State, that has been updated in content and adapted for virtual implementation (Foundations of Prevention Science and Practice).
3. Further, the field is working on having authority to define problems and their treatment working with new concepts of vulnerability within a risk and protection framework. But again, there is no single internationally accepted guidance for prevention professionals to use regarding evidence-based prevention interventions and policies, although the criteria for being evidence-based among leading resources are quite similar. We look at both the UNODC International Standards for Drug Use Prevention as our major reference for evidence-based prevention strategies, and registries such as BluePrints and the European Monitoring Centre for Drugs and Drug Addiction Portal for manualized prevention programs.
4. For ethics, we look to the International Certification and Reciprocity Consortium’s Prevention Think Tank Code of Ethics and the European Drug Prevention Quality Standards which stresses an ideal of service to others.
But, missing from our list of elements of a profession are:
5. Regarding the credentials needed to supervise, coordinate, and implement prevention programming, there is no international credentialing and licensing system in place to oversee the training that prevention professionals require to implement prevention interventions with children, adults, and communities.
6. Also, there is no international culture of prevention that would include the needed institutions and infrastructure to carry out the field’s functions. While there may be prevention programs within a variety of settings throughout communities, there is no obvious prevention center of operations in most places.
So we see we have pieces in place but more needs to be done. It is important to have an international body bring all of what we have in place listed above 1-4 and to pursue items 5 and 6.