2 Discussions - w9

Disseminating Effective Community Prevention Practices: Opportunities for Social Work Education

J. David Hawkins, 1

Valerie B. Shapiro, 1

and Abigail A. Fagan 2

Abstract In the United States, about 17% of adolescents meet diagnostic criteria for mental, emotional, and behavioral (MEB) disorders. Six million young people receive treatment services annually for mental, emotional, or behavioral problems. These problems affect one in five families and cost $247 million annually. Some strategies for preventing MEB disorders in young people have been developed, tested, and found to be effective in preventing the onset, persistence, and severity of psychological disorders, drug abuse, and delinquency. Unfortunately, tested and effective prevention policies, programs, and practices are not widely used. This article highlights recent advances in prevention science and describes some opportunities and challenges in advancing the use of science-based prevention in communities. The chapter concludes by exploring the potential role of social work education in developing a workforce ready to increase community access to effective prevention strategies.

Keywords prevention, prevention science, Communities That Care, social work education, Community Youth Development Study, workforce development, training, curriculum content

Much progress has been made over the past 30 years in the

development and testing of prevention policies, programs, and

practices. Effective policies, programs, and practices for pre-

venting mental, emotional, and behavioral (MEB) problems

in young people have been identified through controlled studies

using rigorous experimental designs (O’Connell, Boat, &

Warner, 2009). A variety of effective prevention programs

have been found to produce benefits to individuals and society,

which far exceed their costs (Allen, 2005). Lists of these

programs are available on the Internet (colorado.edu/cspv/

blueprints; ncadi.samhsa.gov/features/ctc/resources.aspx). Yet

in the allocation of resources, effective prevention strategies

are often overlooked in the favor of strategies to cope with the

‘‘downstream consequences’’ of disorder (Woolf, 2006).

Systems for treating MEB disorders are sustained through an

existing infrastructure that provides funding, access, and

workforce training. The translation of effective preventive

approaches to widespread practice now requires the develop-

ment of a sufficient infrastructure for prevention (Cullen &

Jonson, 2009; O’Connell et al., 2009; Woolf, 2006).

Balas and Boren (2000) speculated on reasons that advances

made through research might fail to be successfully

institutionalized in widespread practice. They suggested that

(a) scientific research is often intentionally isolated from the

complicated realities of individuals, service providers, and

communities to maintain the integrity of the scientific process;

(b) scientific theories tested with specific populations may fail

when generalized to understudied populations and settings; (c)

tested and effective practices may be difficult for potential

users to access; (d) tested policies, programs, or practices may

be too poorly articulated, cumbersome, or costly for wide-

spread replication with fidelity; (e) attention is not given to the

needs, values, and priorities of the individuals and communities

that might use the new programs or practices; and (f) there is a

lack of attention to understanding mechanisms for sustainable

systems change and community infrastructure development

needed to support effective policies, programs, and practices.

Some of the problems identified by Balas and Boren have

been addressed by prevention scientists. Standards for effec-

tiveness and dissemination research trials developed by the

Society for Prevention Research (2004) emphasize that preven-

tion policies, programs, and practices should be tested within

real-world settings by practitioners. Further, these standards

emphasize the need for research samples to be clearly

1 School of Social Work, University of Washington, Seattle, USA 2 Department of Criminology and Criminal Justice, University of South

Carolina, Columbia, USA

Corresponding Author:

J. David Hawkins, Social Development Research Group, School of Social Work,

University of Washington, 9725 3rd Ave. NE, Suite 401, Seattle, WA 98115,

USA.

Email: jdh@u.washington.edu

Research on Social Work Practice 20(5) 518-527 ª The Author(s) 2010 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/1049731509359919 http://rswp.sagepub.com

518

described to inform generalizations to diverse populations. The

concerns of Balas and Boren are further addressed by standards

requiring that prevention program developers create manuals,

training, and technical assistance to support the high-quality

use and replication of prevention technologies. Those who con-

duct effectiveness and dissemination trials following these

standards cannot work in isolation from the individuals and

organizations that must implement new prevention programs

and policies when taken to scale. Nevertheless, several

challenges to the widespread adoption of tested and effective

preventive interventions raised by Balas and Boren remain.

Community infrastructures are needed which can support the

installation of tested and effective prevention policies, pro-

grams, and practices while attending to the needs, values, and

priorities of the individuals, organizations, and communities

using these new preventive interventions.

What Makes Prevention Unique?

Prevention science is based on the premise that to prevent men-

tal health problems, substance abuse disorders, or crime before

these problems occur, it is necessary to identify and alter the

predictors of such problems (Coie et al., 1993). ‘‘Risk factors’’

are characteristics of individuals or environments that predict

an increased likelihood of an undesirable outcome. Promotive

factors are characteristics of individuals or environments that

predict a decreased likelihood of an undesirable outcome.

‘‘Protective factors’’ predict a decreased likelihood of an unde-

sirable outcome in the presence of risk exposure (Rutter, 1985).

Longitudinal studies in the United Kingdom, New Zealand,

Scandinavia, Canada, and the United States have identified

risk, promotive, and protective factors for a wide range of

adolescent MEB problems. These studies have identified risk,

promotive, and protective factors in neighborhoods, schools,

peer groups, and families, as well as in individuals themselves

(Catalano, Kosterman, Hawkins, Newcomb, & Abbott, 1996;

Catalano, Park, Harachi, Haggerty, Abbott, & Hawkins,

2005; Huang, Kosterman, Catalano, Hawkins, & Abbott,

2001; Lonczak et al., 2001; O’Connell et al., 2009). Prevention

science seeks to alter malleable risk, promotive, and protective

factors in individuals and environments in hopes of changing

the probability that future problems will occur.

Prevention is distinct from treatment (O’Connell et al.,

2009). Prevention occurs when communities, groups, or indi-

viduals who do not meet criteria for the diagnosis of illness,

disorder, or crime receive services or interventions that reduce

the chances of developing a disorder or criminal behavior in the

future (O’Connell et al., 2009). This helps explain why the

development of unique infrastructure is important to the disse-

mination of effective prevention. Preventive interventions seek

to reach and affect those who do not necessarily interact with

clinically trained professionals or meet criteria for the funding

streams that have traditionally supported treatment or interven-

tion services for those with mental, emotional, or behavior

problems. Preventive services may be provided to an entire

population (universal prevention), to those at risk for problems

because of exposure to risk factors, who have not yet experi-

enced a problem (selective prevention), or to those who have

shown early signs or symptoms of mental, emotional, or

behavioral problems but who have not yet developed a diagno-

sable disorder or criminal behavior (indicated prevention).

Interventions initiated in response to mental disorders, drug

abuse/dependence, or delinquent/criminal behavior, including

treatment, punishment, and incapacitation, intended to prevent

the reoccurrence of the problem or promote recovery are not

truly preventive, as discussed here, because the undesirable

outcome has already occurred (Mrazek & Haggerty, 1994;

O’Connell et al., 2009).

Another reason that the development of a unique infrastruc-

ture is important to the dissemination of effective prevention

practice is the fact that many of the same factors predict a

diverse array of outcomes, including criminal behavior,

violence, depression, substance abuse, teenage pregnancy,

dropping out of school, and other behavior problems in adoles-

cence and young adulthood (Howell, 2009; O’Connell et al.,

2009). Because many of the same risk factors predict a number

of different negative outcomes, it is possible to prevent these

different problems by addressing their shared predictors. This

creates a disconnect between existing service delivery systems

that are designed to intervene and treat specific problems such

as crime, mental disorders, or substance abuse and those

needed to support prevention programs. For example, a low

commitment to education and academic failure are predictors

of later delinquency and drug abuse, but juvenile courts and

drug treatment agencies often have little influence on interven-

tions to increase school success in the communities they serve.

Yet specific methods of classroom management and instruction

can prevent future drug use and delinquent behavior by increas-

ing academic success and enhancing students’ commitment to

schooling/education (Wilson, Gottfredson, & Najaka, 2001).

Schools must be involved in prevention efforts if the relevant

risk factors are to be addressed. As this example illustrates,

changing risk and protective factors in communities requires

coordination by multiple existing service and community

structures such as police, city planners, schools, families, and

businesses. New prevention infrastructures are needed to

ensure that all the relevant stakeholders who represent the

entire range of institutions and organizations that affect risk,

promotive, and protective factors are involved in planning and

implementing preventive interventions.

In sum, diverse stakeholders need to be part of local preven-

tion infrastructures promoting effective prevention in each

community. Prevention infrastructures need to exist locally

because risk, promotive, and protective factors vary in intensity

and prevalence in different communities (Hawkins, Van Horn,

& Arthur, 2004; Van Horn, Hawkins, Arthur, & Catalano,

2007), and the specific risk, promotive, and protective factors

that are elevated or depressed vary across communities (Fagan,

Hawkins, & Catalano, 2008). These profiles of risk, promotive,

and protective factors may also vary over time as conditions

change and problems are addressed. Communitywide efforts

to prevent MEB problems before they arise need to address the

Hawkins et al. 519

519

specific levels of risk and protective factors in each community

at a given time. Further, the resources available for prevention,

the values and priorities of community members, and the per-

ceived fit and acceptability of various preventive interventions

are likely to differ across communities. Having diverse stake-

holders participate in the prevention infrastructure ensures that

communities can effectively build on local strengths, address

local needs, and recognize local preferences while planning,

promoting, and implementing tested and effective prevention

strategies. Community prevention infrastructures are needed

which foster local ownership and self-determination while

using the advances of prevention science to prevent community

problems (Hawkins, Catalano, & Arthur, 2002).

Community Coalitions as Prevention Infrastructures

Coalitions of diverse stakeholders representing a variety of

agencies and organizations concerned with the healthy devel-

opment of young people have been advocated as infrastructures

for advancing prevention in communities. Coalitions have been

a popular mechanism for communitywide change in substance

use prevention and other areas (Roussos & Fawcett, 2000).

Given the multiple sources of risk and protection, the overlap

in risk and protection for multiple problems, and the variation

in local risk exposure, a community-driven, communitywide

effort to reduce health-risking behaviors has been advocated

to reduce health-risking behaviors community wide (Woolf,

2006).

However, a number of prior efforts to activate coalitions of

community stakeholders to prevent problems have been unsuc-

cessful. Several well-intentioned community-based coalition

efforts have failed to make any significant difference in the

lives of young people. Scientific evaluations of coalitions

focused on preventing problems ranging from drug abuse to

teen pregnancy have found no positive effects on these out-

comes (Collins, Johnson, & Becker, 2007; Flewelling et al.,

2005; Hallfors, Cho, Livert, & Kadushin, 2002; Roussos &

Fawcett, 2000; Wandersman & Florin, 2003; Yin, Kaftarian,

Yu, & Jansen, 1997; Zakocs & Edwards, 2006). Even

well-funded initiatives such as the Robert Wood Johnson

Foundation’s Fighting Back project and the federal Center for

Substance Abuse Prevention’s State Incentive Grants have

failed to produce significant effects on young people’s health

or behaviors in available evaluations (Collins et al., 2007; Hall-

fors et al., 2002).

Evaluations of these failed coalition initiatives have

concluded that to produce a significant impact on intended out-

comes, coalitions should follow some basic guidelines (Collins

et al., 2007; David-Ferdon & Hammond, 2008; Feinberg,

Greenberg, Osgood, Sartorius, & Bontempo, 2007; Flewelling

et al., 2005; Hallfors et al., 2002):

� Set clearly defined, focused, and manageable goals; � Ensure that efforts allow for adequate planning time;

� Base decisions on empirical data about what needs to change in the community and on evidence from scientifi-

cally valid studies of what works to address those needs;

� Implement policies, practices, and programs that have been tested and shown to be effective;

� Carefully monitor prevention activities to ensure imple- mentation quality.

A new generation of community coalition–based approaches

has emerged with a dual focus on both community mobilization

and the use of scientific evidence regarded as essential for the

success of community-based prevention. When community sta-

keholders from diverse organizations and backgrounds come

together to achieve clear and common goals, use scientific

advances regarding what works to prevent problem behaviors,

and monitor their activities for quality assurance, positive out-

comes can be achieved. By pooling information and resources

and selecting tested and effective policies and programs that

address local needs, community coalitions can ensure the

adoption of tested and effective prevention activities, enhance

community buy-in for these initiatives, and increase the likeli-

hood of their sustainability.

There is now clear evidence that coalition-based efforts that

meet these conditions can increase the likelihood of positive

and widespread benefits for community youth. Recent evalua-

tions of two community-based, coalition-driven models have

demonstrated effectiveness in reducing children’s involvement

in problem behaviors. Although their specific implementation

processes differ, both the PROmoting School–community–

university Partnerships to Enhance Resilience (PROSPER)

project (Spoth, Greenberg, Bierman, & Redmond, 2004) and

the Communities That Care (CTC) operating system (Hawkins,

Catalano, & and Associates, 1992; Hawkins, Catalano, &

Arthur, 2002) rely on broad-based coalitions of community

stakeholders who work together to carefully implement and mon-

itor prevention strategies that have scientific evidence of effec-

tiveness. The PROSPER model is initiated by local university

Cooperative Extension Service agents, who partner with school

district personnel to advocate for the use of tested and effective

family- and school-based programs. Prevention activities are

overseen by a coalition of stakeholders that typically includes

representatives from substance use and mental health agencies,

parents, youth, and other local leaders (Spoth et al., 2004).

In the CTC system (Hawkins et al., 1992), the community

coalition is composed of key leaders and stakeholders from all

sectors of the community, including schools, law enforcement,

health and human service agencies, youth-serving agencies,

local government, business, religious groups, youth, and par-

ents. The coalition identifies local prevention needs by con-

ducting a school-based survey of the community’s youth and

a review of ongoing community prevention services. The coali-

tion then selects prevention activities from a menu of tested and

effective preventive interventions to fill gaps in prevention

services, implements and tracks these activities and their out-

comes, and makes implementation changes as needed to ensure

results.

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520

The PROSPER and the CTC system have both been tested in

well-designed randomized experiments and have been found to

reduce adolescent problem behaviors. The evaluation of the

PROSPER model was conducted in 28 communities in Iowa and

Pennsylvania in which communities were randomly assigned

either to receive PROSPER or not. Eighteen months after the

study began, fewer middle school students in the 14 PROSPER

communities reported having used gateway or illicit drugs for

the first time. Students in the PROSPER communities also

reported less marijuana and inhalant use in the past year com-

pared to students in the control communities (Spoth et al., 2007).

The CTC system has been evaluated in two studies, one con-

ducted by the Prevention Research Center at The Pennsylvania

State University (Feinberg et al., 2007) and one conducted by

the Social Development Research Group at the University of

Washington (Hawkins et al., 2008). The Pennsylvania project

involved 120 communities funded to create CTC coalitions that

enacted tested and effective prevention programs, and a group

of comparison communities in which CTC was not enacted.

CTC communities experienced significant reductions in com-

munitywide alcohol and cigarette use as well as in delinquent

behaviors compared with controls (Feinberg & Greenberg, in

press; Feinberg et al., 2007).

The most recent CTC evaluation, the Community Youth

Development Study (CYDS), involved 24 matched communities

across seven states, which were randomly assigned to either

implement the CTC system or to conduct prevention services

as usual. Students in both CTC and control communities were

followed in a longitudinal panel from Grade 5 to Grade 8. By the

spring of Grade 8, 4 years after the CTC process began, panel

students in CTC communities were 33% less likely to have tried smokeless tobacco, 32% less likely to have initiated tobacco use, 32% less likely to have ever used alcohol, and 25% less likely to have initiated delinquent behavior. By the spring of eighth grade,

current alcohol use in the panel was reduced by 23%, current smokeless tobacco use was reduced by 48%, and recent binge drinking was reduced by 37%. Eighth-grade panel students from CTC communities were 31% less likely than controls to engage in a variety of delinquent acts.

Both the PROSPER and the CTC systems have produced

significant, communitywide reductions in behavior problems

among young people while many other coalitions initiatives

have not. It can be challenging to faithfully implement these

coalition-based approaches because they involve multiple

components enacted over several years by groups of diverse

individuals (Wandersman & Florin, 2003). Given the positive

outcomes found from controlled experimental trials of these

recent coalition-driven systems, it is important to understand

what skills are required of individuals to successfully imple-

ment them. Both PROSPER and CTC require a community

coordinator in each participating community to facilitate the

work of the prevention coalition. The skills of these coalition

coordinators will be important determinants of the success of

efforts to replicate these outcomes in communities nationwide

(Allen, 2005; Kegler, Norton, & Aronson, 2007; Riggs,

Morgan, & Pentz, 2008; Watson-Thompson, Fawcett, &

Schulz, 2008). In our work with communities implementing

CTC, we have identified the following skills and capacities that

community coordinators should have:

� Community-mobilizing skills for activating and organizing coalitions of diverse community stakeholders.

� An understanding of the basic premises of prevention sci- ence, including risk and protective factors and effective

prevention programs.

� Ability to collect, analyze, interpret, and present epidemio- logic data on empirically identified risk and protective fac-

tors and MEB problems in the community.

� Group process facilitation skills needed to build stake- holder consensus around priorities and actions.

� Ability to locate, read, comprehend, and critique research reports on the effects of preventive interventions.

� Knowledge of universal, selective, and indicated effective prevention policies, programs, and practices.

� Knowledge of the various systems, agencies, and organiza- tions that affect youths and could be activated for preven-

tion programming.

� Skills to facilitate implementation and integration of pre- vention strategies into existing systems, agencies, and

organizations.

� Appreciation of the need to implement prevention strate- gies with fidelity; that is, in adherence to the theoretical

rationale and key components specified by developers.

� Ability to manage systems for monitoring fidelity of implementation.

� Process and outcome evaluation skills. � Ability to communicate the economic benefits of tested and

effective preventive interventions relative to their costs.

� Ability to identify and secure resources to support and sus- tain coalition and prevention work.

This is an extensive list of skills and capacities needed to suc-

cessfully coordinate the work of community prevention coali-

tions. It is difficult to find candidates who have them all. The

2009 Institute of Medicine (IOM) report identified workforce

development as one of three infrastructure challenges to the

effective widespread dissemination and implementation of

the advances of prevention science (O’Connell et al., 2009). The

Annapolis Coalition on Behavioral Health Workforce Education

(Hoge & Morris, 2003) asserted that ‘‘the public health perspec-

tive on the value of prevention, early identification and early

intervention are honored in training programs more in word than

deed’’ (p. 2). The Annapolis Coalition recommended that clini-

cal training programs be expanded to include specific competen-

cies in prevention (Hoge, Huey, & O’Connell, 2004). There is a

need for purposive training of prevention practitioners.

Social Work’s Advantageous Position for Providing Prevention Training

Social work has a long history of leadership in prevention work

(Siefert, 1983) and is well positioned to respond to this

Hawkins et al. 521

521

contemporary need. Social work originally emerged as a dis-

tinct profession through primary prevention efforts in the set-

tlement house movement (Van Pelt, 2009). The Sheppard-

Towner Act of 1921 established governmental responsibility

for the health of children and was passed, based in large part

on an advocacy campaign led by social workers. This legisla-

tion established national and local infrastructures to carry out

data collection activities and to mount preventive interven-

tions. Yet in 1981, Bloom decried the lack of emphasis on pre-

vention training in social work education programs (Bloom,

1981). Subsequently, the Council on Social Work Education

was awarded a 3-year National Institute of Mental Health

(NIMH) grant to ‘‘promote the development of curriculum and

teaching materials on primary prevention in mental health. The

ultimate objective of the project was to increase the supply of

manpower equipped to plan and deliver preventive mental

health services’’ (Nobel, 1981, p. v).

Reimbursement structures for services, the lure of private

practice, and an emphasis on ‘‘casework’’ and treatment for

disorders in the1980s inhibited the widespread inclusion of cur-

ricula focused on prevention in social work training programs

at that time (Roskin, 1980). Advances in prevention science

over the last two decades have clearly established what works

in preventing MEB disorders, creating a greater demand for

preventive services skills and resulting in new practice roles.

The Council for Social Work Education has recognized this

need for a trained prevention workforce by making the

‘‘Advanced Social Work Practice in the Prevention of Sub-

stance Use Disorders’’ (Council on Social Work Education,

2009), the first concentration area for which it has developed

advanced practice training competencies to build on the Educa-

tional Policy and Accreditation Standards of 2008.

Social work could be a natural home for prevention training.

Social work has a tradition of preparing students to consider

environmental predictors of health and behavior problems as

potential targets for preventive solutions (Roskin, 1980). Social

workers use an ecological model to consider multiple individ-

ual and contextual factors in assessment, intervention, and

evaluation, as well as the role of power and resources in under-

standing policy, institutions, and interpersonal dynamics (Rus-

sell, Champika, Wagoner, & Dawson, 2008). Social work

training already provides significant content in policy develop-

ment and agency administration (Moore, Davis, & Mellon,

1985). Social workers are exposed to the great variety of

service systems and agencies that are included in prevention

coalitions. At any given time, 58% of social work students are in field placements learning applied practice skills. Further-

more, the solution-focused and strength-based methods that

social work trains students to use in their casework and

community-organizing activities are necessary in the work of

prevention (Roskin, 1980). Social work is poised to respond

to the 2009 IOM report’s call to develop a workforce to

advance the prevention of MEB disorders (O’Connell et al.,

2009). To what extent will social work provide leadership in

the preparation of professionals in the prevention of MEB prob-

lems? In the remainder of this article, we suggest ways in which

social work education might seize the opportunity to develop a

skilled workforce prepared to empower local coalitions to uti-

lize advances in prevention science to reduce the prevalence of

undesirable outcomes in the communities they serve. Our ideas

about skill development for prevention through social work

education require varying degrees of change. They are pre-

sented in hope that various approaches to infusing training for

preventive practice into social work education programs will be

considered, debated, and adopted to fill a growing need.

Opportunities for Development of the Prevention Workforce

We see three strategic opportunities through which schools of

nonsocial work can advance workforce development for effec-

tive prevention policies, programs, and practices. These are

through general undergraduate education, preservice training

in social work at the bachelor’s, master’s, and doctoral levels,

and continuing education training for workers already in

practice.

General Undergraduate Education

The federal Substance Abuse and Mental Health Services

Administration (SAMHSA) broadly defines their workforce

to include professionals, paraprofessionals, community mem-

bers, and families who work to promote resilience and recovery

(Hoge, Morris, Daniels, Stuart, Huey, & Adams, 2007). This

notion reflects the importance of consumer advocacy in system

transformation and the expanding role of paraprofessionals in

service delivery (Brennen, 1967; Clark, Power, Le Fauve, &

Lopez, 2008; Lincourt, 2005). It is important to empower stu-

dents earning associate and bachelor’s degrees with knowledge

of the advances of prevention science and skills needed to

become informed consumers of prevention services, committed

frontline paraprofessionals (such as mentors and tutors),

engaged community members, citizen advocates, and contribu-

tors to the advancement of prevention through their chosen

professions.

What does this look like in general undergraduate educa-

tion? Teaching undergraduates to use scientific principles to

inform opinions and decisions (Gambrill, 2006), helping them

to develop content knowledge and critical thinking skills

(Nickerson, 1986) in regard to the effective prevention of social

problems, and developing an ideal of social justice fostered

through the universal promotion of well-being (Kenny, Horne,

Orpinas, & Reese, 2008) should increase their support and

advocacy for prevention, encourage enrollment and retention

in effective preventive interventions, and facilitate recruitment

into the social work profession (Wittman, 1965). Social work

faculty should reach across disciplines and institutional bound-

aries to orient non-social work students to a way of thinking

that will foster the adoption of science-based solutions to social

problems. In a course, we offer at the University of Washing-

ton, titled ‘‘Advances in Prevention Science: Bridging the Gap

from Science to Service,’’ undergraduate students from diverse

522 Research on Social Work Practice 20(5)

522

disciplines learn, often for the first time, that many significant

social problems can be prevented before these problems occur.

The students learn to ask ‘‘what is the scientific evidence that

this policy, program, or practice works?’’ in formulating an

opinion as to how to ameliorate social problems. They learn

how to read scientific reports, evaluate evidence, and use their

power as engaged citizens and allied professionals to shape

debate and advocate for the implementation of effective pre-

vention strategies in their communities. These students are the

future coalition members, interventionists, and consumers of

community-based preventive initiatives and are crucial to the

successful development of infrastructure to support the diffu-

sion of tested and effective preventive policies and programs.

Preservice Training

Preservice training provides an opportunity for future social

workers to learn the skills needed for effective prevention prac-

tice. Bachelors of Social Work (BSWs) could be the interven-

tionists who implement effective prevention programs. Masters

of Social Work (MSWs) could be prepared for roles as commu-

nity coordinators who mobilize entire communities to use

effective strategies to prevent MEB disorders. Prevention train-

ing for these roles can be incorporated into social work educa-

tion through (a) integrating prevention into the foundation

curriculum, (b) offering elective courses and/or advanced

concentrations, and/or (c) developing interdisciplinary

collaborations.

Foundation Curriculum

Adding prevention content to foundation coursework is the most

direct way to broaden social workers’ perception of their roles

(Roskin, 1980) and ensure that classroom training is aligned with

prevention practice demands (Volland, Berkman, Stein, &

Vaghy, 1999; Wilkinson, Rounds, & Copeland, 2002). Refram-

ing students’ expectations of social work roles to include those

who prevent problems (Conyne, Newmeyer, Kenny, Romano,

& Matthews, 2008) as well as treat them will encourage students

to learn skills for community mobilization, and for the design,

implementation, and evaluation of preventive interventions

(Wilkinson et al., 2002). Skills needed for prevention work build

upon skills developed in other courses, but the utility of these

skills for prevention often goes unnoted without sufficient con-

crete examples of application (Conyne et al., 2008).

In the foundation curriculum, students already learn to

assess empirical studies of interventions to determine whether

the design, measures, and analyses are adequate to allow

conclusions regarding intervention efficacy or effectiveness.

Students would benefit from additional examples using preven-

tive interventions and should learn skills to monitor the fidelity

of implementation in these courses. In teaching research

courses to MSW students, we have found that about three fifths

of students begin the course with the assumption that research

is ‘‘extremely useful or relevant’’ to social work practice, but

only about a third anticipate that research will be as useful or

relevant to the role they will have when they complete their

MSW. Social work students need to learn and appreciate

research methods as a practice skill relied upon in their preven-

tion and intervention work.

When students are introduced to the historical and intellec-

tual foundations of social work practice, they learn the philoso-

phical orientation that underlies public intervention to promote

community and social welfare. They should additionally learn

about the history of prevention in social work, from the com-

munity transformation efforts of the Settlement Movement and

the institutionalization of health promotion practices through

the Children’s Bureau (Kemp, Almgren, Gilchrist, & Eisinger,

2001), to the current mandates for evidence-based practice.

In foundation policy classes, students already develop skills

to analyze a policy for use as both a tool and target for social

change. In addition, students should understand how welfare

policy can be an investment in prevention (i.e., Esping-Ander-

sen’s Child Centered Social Investment Strategy calls for a

reorientation from welfare state ‘‘social spending’’ to ‘‘social

investment’’—Esping-Andersen, Gallie, Hemerijk, & Myers,

2002). They should study exemplars of effective policies for

the prevention of social problems, for example, how changing

the minimum drinking age from 18 to 21 reduced drinking and

driving accidents among 18- to 21-year-olds in the United

States (Wagenaar & Toomey, 2002).

In courses in which students learn about ‘‘human beha-

vior in the social environment,’’ students should be exposed

to the longitudinal and epidemiologic studies that have

identified risk and protective factors predictive of undesir-

able outcomes (Mason & Nakkula, 2008; Siefert, Jayaratne,

& Martin, 1992). Content should include individual, inter-

personal, and structural/systemic factors that interact and

predict diverse MEB outcomes. Students should develop

skills to collect, organize, interpret, and report epidemiolo-

gic data on risk and protective factors and on the incidence

and prevalence of MEB problems as a foundation for

data-based prevention practice.

In foundation practice classes, students begin to learn the

micro-practice skills of communicating with diverse stake-

holder groups, using screening protocols to select individuals

appropriate for interventions, and appraising strategies for

appropriateness with diverse populations in specific contexts.

Students also begin to learn the macro-practice skills of enga-

ging stakeholders and assessing resources, building consensus

for social priorities, and using effective outreach and education

campaigns to access hard-to-reach populations. In addition,

students need to understand the distinction between prevention

and treatment and the assumptions and characteristics of uni-

versal, selective, and indicated prevention approaches.

Infusion of prevention content into the curriculum requires

appropriate field education experiences (Conyne et al., 2008;

Zins, 2001). Currently, prevention practicum opportunities

appear most plentiful in school districts and with sovereign

tribes. It is noteworthy that at our own university, prevention

is not listed as an area of work on the checklists field sites used

to communicate placement opportunities to prospective

Hawkins et al. 523

523

students. When a meaningful number of bachelor’s and mas-

ter’s level social workers have opportunities to engage in pre-

vention work in their field placements, social workers will

begin to be adequately trained in prevention.

Advanced Electives or Specialization in Prevention

In some schools of social work, there may be opportunities for

advanced practice courses in prevention that build upon the

foundation already discussed. In such courses, students could

learn how to promote community readiness; mobilize coali-

tions; use risk and protective factor profiles to select new pre-

vention policies, programs, or practices to address identified

community needs; set explicit goals for change; and implement

preventive interventions that achieve coalition goals. Students

could learn how to secure or promote reallocation of resources

to support and sustain prevention work, and could study and

learn to apply theories of organization change and diffusion

of innovations (Rogers, 1995). They would also benefit from

understanding basic principles of benefit-cost analysis and

communicating the impact of preventive interventions in

economic terms.

Even where the core curriculum is unchanged, social work

educators could create freestanding courses and programmatic

tracks to prepare students specifically for prevention work. The

University of Michigan has offered ‘‘Preventive Intervention in

Social Work,’’ a course which conveys the history of preven-

tion in social work, the current knowledge base in prevention,

ethical issues in the design and implementation of prevention

strategies, and basic epidemiological methods (Siefert et al.,

1992). At the University of North Carolina, prevention course-

work was designed for the Maternal and Child Health Leader-

ship Program in order to connect the prevention agenda with

the mission and values of social work (Wilkinson et al.,

2002). Other universities have established freestanding multi-

disciplinary prevention training programs outside schools of

social work, such as the program at the University of Wisconsin

(a joint affiliation of the schools of education, human

development, nursing, and social work), or within colleges of

education, such as Harvard University, the University of Penn-

sylvania, and the University of Virginia, which each grant a

degree in some variant of prevention science (Britner &

O’Neil, 2008; Mason & Nakkula, 2008) for graduate students.

In partnership with the Southwest Prevention Center, the Uni-

versity of Oklahoma has developed an online master’s degree

program in prevention expected to enroll its first cohort in

2010 (http://swpc.ou.edu/services/masterdegree.htm).

Critics of these programs suggest that programs outside of

social work schools and departments may be difficult or costly

for social work students to access. It can be difficult to align the

credits from these programs with accreditation standards for gra-

duation, certification, and licensing. Moreover, elective preven-

tion programs and courses are likely to be enrollment challenges

for social work students if prevention content is absent from the

core curriculum in social work because students may not

appreciate the prevention training program’s relevance or utility

to their profession. Clearly, prevention training programs exter-

nal to social work should include mentoring and some course-

work in prevention in social work education programs in order

to integrate social work and prevention (Conyne et al., 2008).

Public Health Social Workers

Some universities have institutionalized relationships between

schools of public health and schools of social work to cross-

train cohorts of prevention workers (Institute for the Advance-

ment of Social Work Research [IASWR], 2003). Over the past

30 years, joint programs have expanded from an initial pilot in

Minnesota (Hooyman, Schwanke, & Yesner, 1981) to the cur-

rent 21 programs. Interdisciplinary trainers claim that the ben-

efits are mutual in helping social workers learn applied

epidemiology, and public health students learn participatory,

empowering, and culturally responsive techniques that aid in

diffusion of macropractice preventive interventions (Ruth,

Geron, Wyatt, Bachman, & Chiasson, 2006). Elizabeth Clark,

the executive director of National Association of Social Work-

ers (NASW), wrote that ‘‘public health social work might be

the future of social work. Recent political changes are expected

to affect the future delivery of health care, possibly leading to

more emphasis on preventive health care and integrated health

care and wellness services. The ability of public health social

workers to bridge prevention and intervention, individual and

community, and practice and policy will be increasingly valued

in our changing society’’ (Van Pelt, 2009, p. 30). The IASWR

(2003) reports several challenges to the implementation of this

model, including a lack of student identification with the term

‘‘public health social worker,’’ a lack of social work integration

into the American Public Health Association (APHA), and ten-

sions between the social work commitment to the vulnerable

and the public health commitment to the broad population, all

of which may be addressed by interdisciplinary mentoring and

field placements. The only published outcome study of gradu-

ates of these dual degree programs indicated that graduates

were slightly underutilized for their skills sets, felt somewhat

‘‘homeless’’ with regard to professional identification and had

significant financial consequences of the dual degree training,

though they reported that they would choose the same training

again. Participants in the dual degree program saw social work

as the ‘‘soft,’’ though valued, side of their training (Ruth et al.,

2006). Critics of the integration of public health content into

social work fear it will medicalize the profession (Siefert

et al., 1992).

At the doctoral level, required coursework often is more

flexible and interdisciplinary training is strongly encouraged.

At the University of Michigan and the University of Washing-

ton, institutional training grants support the development of

prevention scientists through the NIMH Prevention Research

Training Program. While those trained at the doctoral level

may have limited direct practice roles in prevention, they will

need to be well trained in prevention science in order to train

bachelor’s and master’s level social workers to provide

preventive services. They also may become prevention

524 Research on Social Work Practice 20(5)

524

program developers, researchers, state and federal program

administrators, and federal agency personnel. Preparation at

this level varies substantially by institution and needs to be

made more available.

In-service Training/Technical Assistance

Workforce training for prevention could also reach profession-

als already practicing in the field of social work through

in-service training and technical assistance. In fact, most clin-

icians develop their prevention skills on the job postgraduation

(Conyne et al., 2008). Technical assistance can be very respon-

sive and relevant to practice demands but has been found to be

more successful when built upon a training foundation that

allows practitioners to take advantage of it (Chinman et al.,

2005). Therefore, training and technical assistance programs

should be integrated. Social work departments have an oppor-

tunity to provide training to professionals through certificate

and continuing education programs. Nearly every jurisdiction

that issues social work licenses requires continuing education

courses for license renewal. Social work continuing education

requirements are rigorous across all 50 states (Daniels &

Walter, 2002), but continuing education opportunities for

practitioners working at the community level continue to be

sparse. Schools could offer such individuals a coordinated

series of prevention courses resulting in a postgraduate certifi-

cate in prevention practice. It could be worthwhile to extend

collaborations with APHA to provide continuing education

credits for public health social workers.

Schools of social work could also provide training to front-

line prevention practitioners who have not received graduate

training. Schools of social work could expand upon an emer-

ging infrastructure by partnering with the Association for

Addiction Professionals to become approved providers of train-

ing for Certified Prevention Specialists, a designation offered

by the International Certification and Reciprocity Consortium

(IC&RC) to credential frontline prevention workers in 40 of

50 American states and in 9 foreign countries (Hayden,

2005). Credentialing requires a minimum of 2,000 hr of prac-

tice experience, 120 hr in supervision, and 100 hr of education,

with a 40-hr continuing education requirement every 2 years.

The coursework content and the credentialing exam include

(a) planning and evaluation, (b) education and skill develop-

ment, (c) community organization, (d) public policy and envi-

ronmental change, and (e) professional growth and

responsibility. Although this training is now done exclusively

by the service sector, academic schools of social work should

become involved in training Certified Prevention Specialists

to facilitate the transfer of research to practice and bring

advances in prevention science to the field.

The Challenge Ahead

We are aware of the challenges of placing a serious emphasis

on prevention practice in social work education. A case study

from the Risk and Prevention training program at the Harvard

Graduate School of Education suggests that success is predi-

cated on finding like-minded faculty, communicating to admin-

istration and recruits the importance and uniqueness of the

program, ensuring eligibility for licensure, and translating the

training to professional opportunities upon graduation (Mason

& Nakkula, 2008). Others have suggested focusing first on

bachelor’s and doctoral training, so as to more quickly build

a quorum of agency staff ready to carry out prevention work,

change agency norms, and simultaneously prepare the next

generation of faculty with skills to teach prevention content

in master’s training programs (Siefert et al., 1992).

The advances in prevention science over the past two

decades have created the need for a national workforce that

is trained to move evidence-based prevention from efficacy and

effectiveness trials into widespread national application.

Schools and departments in other professions and disciplines

are assessing their capacity to seize this opportunity. We urge

schools and departments of social work to respond to this need

by leading the training of the prevention workforce of the 21st

century.

Authors’ Note

This article was prepared for the Los Angeles Conference on Interven-

tion Research in Social Work, School of Social Work, University of

Southern California, October 22–23, 2009. The authors wish to

acknowledge the contributions of the communities participating in the

Community Youth Development Study.

Declaration of Conflict of Interest

The authors declared no conflicts of interest with respect to the author-

ship and/or publication of this article.

Funding

The authors disclosed receipt of the following financial support for the

research and/or authorship of this article: A research grant from the

National Institute on Drug Abuse (R01 DA015183-01A1) with co-

funding from the National Cancer Institute, the National Institute of

Child Health and Human Development, the National Institute of Men-

tal Health, the National Institute on Alcohol Abuse and Alcoholism,

and the Center for Substance Abuse Prevention, and a training grant

from the National Institutes of Mental Health (T32 MH20010).

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