Parents Anonymous and Primary Prevention

["Robert Caldwell" <caldwel9@xxxxxxxxxxxxx>]

On Monday Karen Wade wrote about the excellent organization, Parents
Anonymous, Inc.  While I have the highest respect for the work PA
does, a comment at the end of Ms. Wade's message  shows some
confusion about the terms Primary  and Secondary prevention.  Ms.
Wade wrote,  "Some parent participants have abused their children,
others are at risk to abuse because of stressors in their lives which
may be perceived as overwhelming.  Thus, Parents Anonymous, Inc. is
both a primary and secondary prevention model."

As they are currently used in the field of child abuse and neglect, 
primary and secondary prevention have the following definitions:

PRIMARY PREVENTION
Primary prevention of child abuse and neglect is any action aimed at
preventing either condition from occurring for the first time in a
family. Thus, these actions must be delivered to non-abusive and
non-neglecting families with the intention of helping them remain
non-abusive and non-neglecting. Such programs are often directed at
large, unselected groups of the general population, for example, all
families living in a certain geographical area, or all families
delivering their babies at a certain hospital.  There are no
eligibility requirements for these programs beyond having a child or 
being in a position where one interacts with children.

SECONDARY PREVENTION
Secondary prevention of child abuse and neglect also refers to any
action aimed at preventing either condition from occurring for the
first time in a family.  The difference from primary prevention is 
that secondary prevention programs are directed at populations of 
families who have been determined to be "at-risk" for abusive or 
neglectful behavior, or have circumstances in their life that present 
challenges to positive parenting behaviors and optimal child 
development.  The determination of the riskiness of a family is often 
made by an examination of demographic characteristics of the family 
(e.g., age of parents, income, education, etc.) or by a some 
questionnaire or checklist of risk factors (e.g., unwanted 
pregnancy, substance abuse, parents victims of childhood abuse or 
neglect).  Because these actions are directed at selected, specific 
families (as opposed to families in general) they often are closer to 
mental health or social work services rather than the educational or 
public health approaches of primary prevention.  It is important to 
note, that in both primary prevention and secondary prevention, the 
condition to be prevented (i.e., child maltreatment) has not yet 
happened in the family.  Once child maltreatment has occurred
the inclusion of the family in a prevention program is inappropriate. 

Once child maltreatment has occurred, the family is in need of (and is 
eligible for) treatment services.  These services are sometimes 
called TERTIARY PREVENTION since good treatment can (and does) 
prevent the maltreatment from happening again.

Under these definitions, PA would be a combination of Secondary and 
Tertiary prevention approaches.  This is important to be clear about 
since there seems to be both psychological and financial pressure to 
market treatment interventions as prevention programs.  Since there 
is so little money specifically earmarked for prevention, it is 
important that we ensure that this money actually go to prevention 
and not to (worthy) treatment programs who call themselves 
prevention programs. 

This confusion about what is primary and secondary prevention is not
at all unique to Parents Anonymous.  In legislatures, service
agencies, and the halls of academia there seems to be a tendency to
embrace the language of prevention but not its substance.  This is 
my plea to those on this list to think carefully about the use of 
these terms.
%#%#%#%#%#%#%#%#%%#%#%#%#%#%#%#%#%#%#%

Robert A. Caldwell, Ph.D.     
Department of Psychology
Michigan State University
East Lansing, MI 48824-1117
U.S.A.

Phone:(517) 353-4548 (office)
      (517) 432-2476 (FAX)

URL: http://pilot.msu.edu/user/caldwel9

%#%#%#%#%#%#%#%#%#%#%#%#%#%#%#%#%#%#%