How to promote effective evidence-based prevention when no one is listening?

Good intentions but ineffective or even harmful prevention measures? In this blog post, Sanela Talič from the Institute for Research and Development UTRIP, Slovenia, shares her critical insights to current and past developments in the field of prevention research. She makes a strong point to implement existing prevention programs that have proven effective and calls for an increased collaboration between the different stakeholders and experts in the field.

The topic of my second blog was encouraged by recent events and conferences in Europe and some insider information from our allies – Slovenian NGO’s active in the field of prevention. Overall, 10 years of intensive prevention work have resulted in only few sympathizers who actually understand the basic principles of prevention. Often, we receive very valuable information about prevention in schools from them. So, let me start from the beginning…

Want me to draw it to you? Would that help you understand?

Recently, I had some presentations at different conferences and workshops and every time I was talking about whether prevention can be effective or not. I strongly believe that a general negative impression of the effectiveness of prevention is due to the financing and implementation of interventions and/or actions that have been proven to be ineffective and/or even harmful. In my presentations, I always use the famous Olive of Prevention.

The Olive of Prevention (Source: preventionhub.org, last accessed 2015)

This concept has been implemented by Harry Rutter, a senior clinical research fellow at the London School of Hygiene and Tropical Medicine. Then, this olive was adapted to the prevention field by Andrew Brown, an Alcohol Programme Implementation Manager and consultant focused on substance misuse policy for adults with multiple needs. This olive offers a great and simple description of the status of prevention. Also, this simple picture of the olive reminded me of something that happened often when I was a kid. Were you as a kid ever in a situation in which your parents were mad at you because you didn’t follow their instructions as they intended? And they went like: »What didn’t you understand? Want me to draw it to you? Would that help?«. Well, the same happens with our prevention olive. It couldn’t be more simple to understand that evidence-based, effective prevention has nothing to do with general opinion that prevention doesn’t work.

In the meantime …

It was like »déjà vu«. I received an email from one of our prevention colleagues with the invitation for parents of 13-year-old children to a lecture of one of the famous criminal officers in Slovenia. The title of his performance was »Illegal drug abuse prevention«. I still have fresh memories of his performance in our school two years ago when I had the opportunity to listen to this incredible source of shocking information. For the first time, I realized that our school kids are dying because of drugs. That we, as parents, should introduce a police search in our homes meaning that we should be checking the pockets of our kid’s pants, school bags and even their eyes for symptoms of illegal drug use every day. And if they (our kids – teenagers, who are going through turbulent physical and mental development) started to eat more than usual, it is a sign that they are using cannabis. The guy was incredible. You should have seen and heard the parents! Mouth open, shocked looks, sighs of helplessness … all of these gave him additional motivation. And just when you think that nothing else can surprise you… reactions of parents… like a Mexican wave. One father suggested that the kids should visit a person with a substance use disorder (not someone with a former substance dependence, someone with a current one) in order to frighten the children, because that is the only way we can prevent our children from taking drugs. The whole group of parents applauded to this idea and at the same time a group of mums sitting behind me realized that they can be very happy…. As long as their children stick to alcohol and/or cigarettes… that is something that they (mums) can live with, but »real drugs« (cannabis, heroin, cocaine) – oh, no, not that one. Yes, our society is too tolerant towards the use of alcohol, although various reports indicate that the harm caused by alcohol use is huge.

Ironically, two days after that event I had scheduled a meeting with the principal aimed at promoting the »real prevention programs« targeted at risk behaviours specific for teenagers. Instead, I had a more important job to do: to close the school doors for that cowboy… And now he strikes again but in another school.

What is and what isn’t prevention? Instead of »What is effective and what is ineffective prevention?«

These  events raised some issues to consider and think about. What are we doing wrong in our country? For so many years we have been advocating for effective prevention and still we face these awful prevention attempts. One of the definitions of »drug prevention« says: »The primary objective of drug prevention is to help people, particularly but not exclusively young people, to avoid or delay initiation into the use of drugs, or, if they have started already, to avoid developing disorders (e.g. dependence)«1. We know from the evidence how we can fulfill these goals, but still we spend so much of our presentation time on approaches that aren’t effective, instead of focusing on the »real« prevention. There will always be hopefuls who will one day wake up and say »I want to do prevention«. That’s ok. If they follow the scientific standards and engage in trainings and/or education. Otherwise, they should avoid abusing the term »prevention« and respect the complexicity of prevention science and collaborate with experienced preventionists to understand the processes.

 

About the author:

Sanela Talič is the Head of Prevention at Institute for Research and Development UTRIP, Slovenia. She is the national coordinator and master trainer for the school-based prevention programs “Unplugged” and “Effekt” and the family-based prevention program “Strengthening Families Program”. Currently she is a PhD student of prevention science at the University of Zagreb. You can contact her via email: sanela[at]institut-utrip.si.

Bibliographic references

  1.  UNODC (2015) International Standards on Drug Use Prevention. Vienna: United Nations Office on Drugs and Crime, p. 1. []

2 thoughts on “How to promote effective evidence-based prevention when no one is listening?

  1. Thank you Sanela, I really enjoyed reading your post!
    We are struggling in Estonia with the same problems – what people think is prevention compared to what actually works in prevention. And also what they define to be ‘evidence-based’ compared to if it actually is ‘evidence-based’ or ‘science-based’ or just “good intention”.
    And how to change those attitudes and raise awareness so that our children would not be affected negatively. But it is comforting to know that we are facing the same problems all over Europe.

  2. Thanks Sanela for raising this issue, which is a very sensitive one. I have also been (and probably most of us have) in a position where I have had to listen to somebody describing their “preventive” work, praising it as “highly effective” even though it was neither properly evaluated nor in line with recommendations for evidence-based working. It’s a difficult situation, as you can’t just stand up and challenge or criticise (and thereby humiliate) this person publicly, and also it could be a very stupid thing to do so without knowing the full story behind them and their project. So, at least for the duration of their presentation, I also just sit there, feeling frustrated but optimistically hoping that there is more (evidence) to their activity than they were able to present, and that others in the audience are also having critical thoughts rather than just accepting these claims to “effectiveness” at face value.

    Where possible, I try to bring up such issues indirectly at a later point in the discussion, when the link to that particular presentation is no longer so evident. But even then, that may not always work out as intended. For example, it has happened to me that I say explicitly that scare tactics and standalone media campaigns are not recommended, and the people who presented exactly such approaches earlier in the day appear to agree with me the most, which I find very confusing. Perhaps what happens is that people are so convinced of the validity of their own preventive approach, they don’t even consider the possibility that I may actually be talking about THEM, and consequently re-interpret what I’m saying to mean that it supports, rather than challenges, their work. Perhaps they think that they are using scare tactics and standalone mass media campaigns in a “good” way, and obviously don’t agree with these approaches being used in a “bad” way.

    I’m also conscious of the need not to devalue, talk down to or make fun of people who are clearly passionate about prevention, willing to invest a lot of time and energy in it, and often have many, many years of experience (far more than me!). With this mind, I would be very much interested to know, rather than to speculate, what people praising non evidence based approaches are thinking (especially when confronted with information that conflicts their own preventive approach), but it’s a very difficult topic to address, and there are not many possibilities to do so in a safe environment.

    To link this back to early-career issues, I think part of our problem is that we’re simply not a position where we can actually speak honestly with the people involved. Therefore, I think it’s important to reach out to and engage those people who are also unhappy about the state of prevention (or at least open to the idea that prevention efforts can be improved) but actually in a better position of influence. While we ourselves may not be able to say/do much directly, these people have the power – to reject funding, to organise a training course, etc, or as you say, “to close the school doors”! (In fact, I’m curious what was the school principal’s role in all this, and his reaction to your feedback…)

    A colleague and I always joke that our goal is to get to a stage where there is such a wide consensus and understanding regarding evidence-based prevention that if somebody does present an activity that’s actually unlikely to work, people just start booing and throwing tomatoes and rotten eggs. To conclude, I think you outline some really important points which we need to address before we can get to that scenario, so thanks very much for speaking up and sharing this thought-provoking post!

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