Most of us working in prevention recognize how difficult it is to describe a single prevention system that provides the spectrum of services needed by our communities. In this our fourth and last Prevention Nugget to address Building Prevention Systems, we will look to see how we might work together to build an infrastructure of prevention that combines the elements described in the graphic i.e., Consumers who will ‘demand’ effective services; Prevention Professionals who are trained and certified to work effectively with populations; Evidence-based Services that have been shown through research to be effective; and the Prevention Delivery System that coordinates the service structures so they meet the needs of the population.
The service delivery system that provides evidence-based prevention and harm reduction services consists of several parts and these are not always visible and often not integrated. Furthermore, as we mentioned in an earlier Nugget, they may not be considered or labeled prevention services. In addition, they may be coordinated by a community coalition of stakeholders but are these coalitions permanent structures that can continue to provide support and leadership over time.
In most communities today, prevention services are delivered in many settings. Indeed, as we see in our graphic, it is difficult to identify all the prevention programming that is available in a community. This may be due to what we discussed in earlier Nuggets, that some services may be delivered by professionals who may not consider themselves as prevention professionals and therefore the services may not be labeled as ‘prevention’.
Systems of other behavioral and health services may also not be integrated and, indeed, in many communities they may be fragmented and duplicative. The issue of fragmentation of services has a long history, certainly from the 1960s (e.g., Sowder, W.T., 1961). One of the major efforts in the United States to create health care system that was patient centered and that provided full health care services was the passage of the Affordable Care Act. Under this plan, group health medical centers would be created as a core administrative unit or hub to coordinate health care (see graphic from Reid et al., 2010).
In this model, the Hub integrates health services from an array of health-based organizations. It also maintains a centralized record system for each patient that is shared across providers. The movement toward computerization has assisted in creating these changes (Pearce et al, 2013) providing the potential for comprehensive, non-redundant patient-centered care. Could such a model be replicated for prevention services? We can take the graphic to the left and create a ‘hub’ or for many communities--a partnership or coalition that becomes a prevention implementation and delivery system.
Such a system would benefit from a centralized system that would provide data, not necessarily on individuals but on the utilization and outcomes from prevention programming, a monitoring system.
Such a system would include credentialed prevention professionals and service providers who would assure the implementation of evidence-based services and is guided by stakeholders representing diverse groups within the community.
Such a system would be informed by on-going needs assessments and prioritizations of service needs, a comprehensive planning process and a monitoring and evaluation data system.
Such a system would need to be organized, supported, and overseen by governmental agencies at the county and State levels
Although community-based, these systems then could be linked through a centralized national system to form community-based prevention systems across the country.
Prevention Service Delivery System: Communities for Healthy and Safe Families
1. Delivery system is central -
On its own through a built inter-related system at three levels: a. national b. state c. local
and/or integrated within existing system a. health care service b. social/family service c. regulatory services (e.g., availability/accessibility to psychoactive substances; ‘under-the-influence’ laws)
2. In what local/existing systems can the evidence-based prevention services to be delivered?
a. family-based prevention interventions/services
b. school-based prevention interventions/services/policies
c. workplace-based prevention interventions/services/policies
d. environment-based prevention interventions/services/policies
e. media-based prevention interventions
3. Who is to receive prevention services? And what service systems do they use? What is the reach of services needed to achieve equity across populations?
a. formal
b. informal
4. System of trained professionals
a. Education/training systems
b. Credentialling
5. System to assure quality of service delivery (related to need, implementation, receptivity, outcomes) and to update evidence-based services to meet community needs
6. Funding systems
References
Davis, K., Abrams, M., and Stremikis, K. (2011). How the Affordable Care Act Will Strengthen the Nation's Primary Care Foundation. Journal of General Internal Medicine, 26(10), 1201–1203.
Pearce, C. M., de Lusignan, S., Phillips, C., Hall, S., & Travaglia, J. (2013). The computerized medical record as a tool for clinical governance in Australian primary care. Interactive journal of medical research, 2(2), e26.
Reid, R.J., Coleman, K., Johnson, E.A., et al. (2010). The group health medical home at year two: cost savings, higher patient satisfaction, and less burnout for providers. Health Affairs, 29, 834–843.
Sowder, W.T. (1961). Fragmentation of Health Services. Archives of Environmental Health, 3, 637-640.