Health promotion and drug prevention within the public health system …evidence based approach...

Health promotion Health promotion and drug prevention and drug prevention

within thewithin the public health systempublic health system

…evidence based approach

Darko Roviš, prof.

Public Health Institute of Primorsko-goranska county

Krešimirova 52A, 51 000 Rijeka

Public Health InstitutePublic Health Institute

Actively working in health promotion since 1905

Departments: Social medicine Health ecology Epidemiology Microbiology School and university medicine Drug prevention and outpatient treatment

Office for Drug Office for Drug prevention prevention

Department for Drug prevention and outpatient treatment

Office for Office for Outpatient Outpatient treatmenttreatment

Health promotion and Health promotion and drug prevention drug prevention programsprograms::

• Universal Universal • SelectiveSelective• Indicative Indicative

Specific drug treatmentSpecific drug treatment::

• PPsychotherapysychotherapy in p in penal systemenal system• Family support groupsFamily support groups

Outpatient treatment:Outpatient treatment:

• DDrug free approachrug free approach• MMaintainence aintainence • DDetox programetox program

Community involvementCommunity involvement

• Drug prevention committeesDrug prevention committees• HealthHealthyy cities cities • University programsUniversity programs

Office for Drug Office for Drug prevention prevention

Fiorello la guardie 23, RijekaFiorello la guardie 23, Rijeka

Team of Two psychologists, defectologist, and teacher Formed in 2005.

Health promotion and drug prevention:

Life Skills Taining Ready- Steady-Healthy Youth Counselling Bulletin – Rizik

- M- Major and still rising problem for Croatiajor and still rising problem for Croatiaa- D- Drug rate of rug rate of 250 /100 000 250 /100 000 populationpopulation- - EU countries EU countries 200-800 / 100 000 200-800 / 100 000 population population

Total number of addict

Opiate addict

New addict

New opiate addict

Drug abuse and

addiction

Drug abuse and adiction Drug abuse and adiction in Rijeka countyin Rijeka county

TREATED DRUG ADDICT

1995. year– 17 addict






1 148 Criminal Acts 707 Other Offences

Why do we talk of addicts when we are discussing children ?

44% highschool children regularly or occasionally consume alcohol 51-64 % 2nd grade students engage in ” Binge drinking” – ESPAD 2007 2002. - 50 interventions of ER service

SubstanceSubstance use use ……

1/3 tried marihuana more than once

25-40 %

smokes often

Majority thinks it is “normal” to drink and smoke

Drinking 10 times or often (last 30 day)

1st and 2nd grade students

First time hard liker?

• bullying, gambling

• Up to 20 % of children low self-esteem

• ½ exposed to social violence

• 12-25% peer rejection

• ½ go out where other are smoking, drinking drug using

• Fammily and school communication poor

Research on 8th grade PGZ

Starting from early age…

Based on

Possible solutions

1

Based on

How to direct our efforts to produce wanted effect ?

Less mental & behaviouralproblems and drug abuse in communities and thepopulation !

Evidence basedEvidence based

evidence-basedresearch-basedscience-basedblueprint programsmodel programspromising programseffective programs

Science based programsScience based programs

Based on evidence, Tested in practiceMethodologically clear designSignificant reduction of negative outcomes and

related risks

Based on theoryDetail evaluated

Evidence based aproach in Evidence based aproach in RijekaRijeka

High quality implementation of best evidence based model programs.

Careful pilot program design following the principles of effectiveness

Quasi experimental evaluation design

ComprehensivenessVariety of teaching methodsSufficient lastingTheory basedBuilding positive, strong and stabile

relationshipsTimeFollowing developmental psychopathology Social-cultural appropriatenessEvaluationEducation

Principles of effectivenessPrinciples of effectiveness

Developing a prevention model on a community level

Package of multiple interventions that target Children in different age groups Children, families, social network, community Risk and protective factors Common and disorder-specific factors

Use of variety of intervention methods

Building evidence-based interventions

Prevention programs at PHI

Youth Counseling

Life Skills Training

Ready SteadyHealth

BulletinRIzik

Family self help group

Support group in

Penal system

Health youth

Narodni Zdravstveni List

Educating Educators

Junior in the house

LIFE SKILLS TRAINING

Series of workshopsfor 6th and 7th grade

Pilot program for 3rd and 4th garde

2005/06- 31 school- 1657 students 2006/07 - 38 school- 150 assistants- 3168 students

2007/08 - 39š school-165 assistants -3427 students

2008/09- 44 school-180 assistants- over 3500 students

Life Skills Training• Universal prevention level (smoking, alcohol, drugs, violence)• Evidence based• Experience in implementation and evaluation (SAD, EU, Australia)

• Based on theory (Risk reduction model)• Aim: reduce the increase in substance use in adolescents

Protective factorsProtective factors

• High Sef-esteem • Good social and communication skills• Good decision making skills• Good problem solving skills • assertivness • Coping with stress and anxiety,• Goal setting • Resistance to peer pressure

Risk factorsRisk factors

• Early first contact with cigarettes, alcohol, drugs

• Lack of self-control• Poor assertiveness

(Dr.Gilbert J. Botvin)

Workshops

Self image and self esteem Decision making

Smoking Alcohol

MarihuanaMedia

Anxious emotionsFacing anger

Communication skills Social skills Asertivness

Conflict resolution

Activitiesin 2007/08

MATERIALS

Prepared and printed materials for 6th and 7th grade

– Student manual for 6th grade– Teacher manual for 6th grade

– Student manual for 7th grade– Teacher manual for 7th grade

– Student questioners– Evaluation forms for teachers

EVALUATION AND SUPEVISION• Pre-test• Re-test• Post-test

• Evaluation forms filled after each workshop

• Supervision workshop in February 2008

EDUCATION• 2 X two day education for teachers and

school coordinators – October 2008– February 2009

Activities in 2007/08

Evaluation...

Evaluation...

Reduction higher than 50 % Evidence that program WORKS Corresponds to results form USA,EU Troubles for the firs generation

Life Skills Training

• 4 Rijeka school + 1 County school• Total: 300 učenika• Piloting for two years

• 8 workshops held 1 x month

• Sef-esteem• Decision making• Smoking • Media advertisement

• Coping with stress• Communication skills• Social skills • Assertivens

… for 3rd and 4th grade (8-9 years)

Ready

• Pilot program u 2007/08 based on risk reduction model• 5 workshops with 8th graders (14 years)• Evaluation questionery• Scholl staff + parents engagement• Deliver the program to school services

ThemesAdolescenceCoping skills

Drugs –one way streetPeer pressure

Health lifestyles

SteadyHealthy

Health promotion and drug prevention within the public health system …evidence based approach...

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