Identifying and implementing effective prevention strategies

Not all prevention initiatives are equally effective. In order to find the ones which will yield results, one must examine carefully the scientific evaluation of the initiative. There are a lot of evidence-based programmes to choose from, so there is no need for policymakers to invent new ones before trying something that already exists. This section of the conference focused on the characteristics of a successful programme, and how it should be implemented.
Giovanna Campello, UNODC Prevention, Treatment & Rehabilitation Section: The UNODC prevention standards
Giovanna Campello, Director of the Prevention, Treatment and Rehabilitation Section at the United Nations Office on Drugs and Crime (UNODC), works with over 100 experts from many different countries to create standards for effective prevention initiatives. At the conference, she presented some of the main themes within evidence-based substance use prevention.
– Prevention based on scientific evidence is synonymous with prevention that actually works. We recommend only studies that are relevant and have a good methodology.
Campello says she often receives evaluation studies that highlight participant satisfaction in a certain initiative. She says that such data is irrelevant. Personal opinions, happiness, or the feel-good factor, tradition, and moral values shouldn’t play any role. Only strategies where the effectiveness has been demonstrated through scientific research should be taken into account.
– Evidence-based prevention is cost-effective. One dollar invested today will yield 10 dollars in the future. This is a conservative estimate, but one that is easy to remember, Campello says.
”One dollar invested [in prevention] today will yield 10 dollars in the future.”
Evidence-based prevention initiatives vary in methodology, but they have certain characteristics in common. “The earlier the better” is usually a good standard. Some initiatives are directed towards parents even before the child is born. Successful school initiatives usually help to strengthen the child’s emotional intelligence and intervene in early-onset mental problems.
– All of this should be done non-judgementally and on a voluntary basis. There is a lot we can do without waiting for the adolescent to start using substances. If you use evidence-based programmes, interventions, and policies, you are preventing drug use and other risky behaviours.
Also, Campello stresses that it is never too late. There are effective strategies to be implemented also when the recipient is older and problematic substance use may already have started.
Effective programmes focus on practising social skills and learning to cope with negative emotions. They also aim to change perceptions of risks associated with substance use, dispel misconceptions about the normative nature of substance abuse, and emphasise appropriate consequences.
What does not work are strategies which include non-interactive methods as the primary delivery strategy, such as only information-giving. Other examples of poor practices include fear arousal, single or unstructured sessions, focusing only on building self-esteem, addressing only ethical or moral decision-making or values, and using people in recovery as testimonials.
– These could function as a checklist for policymakers to compare their programmes and ask if there is anything that could be improved.
Kristine Amlund Hagen, The Norwegian Centre for Child Behavioural Development (NUBU): Experiences with implementing knowledge-based programmes
The Norwegian Centre for Child Behavioural Development (NUBU) started over 20 years ago as a research project in response to a societal need for better help for children with problem behaviours, director Kristine Amlund Hagen says.
In her speech Experiences with implementing knowledge-based programmes, Kristine Amlund Hagen shared NUBU’s experiences from implementing these programmes. The correct way to implement a programme is by going through certain phases in the right order: an efficacy trial, an effectiveness trial in real life, a look at which factors provide sustainability, going to scale or scaling up a programme, and implementing sustaining programmes systemwide.
With over 20 years of experience in the implementation of programmes, NUBU has learned as an institute that evaluation is important.
– You have to know whether the programme you are implementing actually works. And as Giovanna Campello said, it is not enough that the participants are happy. There is actually low or no correlation between treatment satisfaction and effectiveness. The most expensive programme is the programme that does not work.
”There is actually low or no correlation between treatment satisfaction and effectiveness. The most expensive programme is the programme that does not work.”
Another lesson learned is that co-morbidity is common. If a child enters the programme for reasons related to behavioural problems, there is a high probability that the same person is struggling with other issues as well such as anxiety, depression, school refusal, or drug use.
Effective methods have common features: solid empirical support that meets a societal problem, the right competence, resources, and political will.
However great an initiative may be, the programme will not have the desired effects, if a scrupulous and feasible plan for implementation is lacking. Good implementation standards entail that the programme is perceived as useful by the professionals working in the field; they need to have confidence and believe in the principles and stick to them faithfully. The project also needs good leadership, management, and reach, and it helps if there is a sense of urgency.
– When implementing effective programmes we usually say: you pay now or you pay later. If you pay later, you pay a much higher cost. Most of the socioeconomic analyses that have been conducted find that spending time and resources on effective programmes saves a lot of money, now and down the line.
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