Transcript Baby Blues - Nastavni Zavod za javno zdravstvo PGŽ

NEED ASSESSMENT
The concept of need within the context of
public health
• Needs assessment is the proces of evaluating
the problem and solutions identified for a
specific target population.
• To present the problem of addictions in
Primorsko-goranska County we used social
indicators, utilization of services and survey
techniques for identifing health needs.
NEED ASSESSMENT
Epidemiology of addiction
Drug prevention system in Rijeka
Current public health problems olf school children and
youth
Risk and protective factors in adolescents
Health promotion in family practice
Presenter: Đulija Malatestinić, PhD
Epidemiology of
addiction
Treated drug addicts, morphine (opiate) type addicts, new cases
(first recorded) and new morphine (opiate) type addicts in
Primorsko-goranska county 1997-2007.
700
600
500
400
300
200
100
0
1997.
1998.
1999.
2000.
Treated drug addicts
First recorded drug addicts
2001.
2002.
2003.
2004.
2005.
2006.
2007.
Treated morphine (opiate) type addicts
First recorded morphine (opiate) typeaddicts
Source: Registry of Treated Phychoactive Drug Addicts, Teaching Institute of Public Healt of Primorsko-goranska County
Psychoactive substance abuse among Croatian adolescents
in Primorsko-goranska County
Percentages of examinees
Psychoactive
substance
never or once
occasional
several time
on month
several time a
week and
every day
32,9
26,7
Cigarettes
Beer
51,0
22,7
10,1
19,3
6,0
31,3
Wine
22,8
26,5
33,7
17,0
Alcholic beverages
25,0
27,5
36,3
11,2
Sedatives
86,6
8,1
3,3
2,0
Marihuana
80,2
10,4
5,2
4,1
Cocaine
97,8
0,8
0,4
1,0
Amphetamine
94,9
2,6
1,4
1,0
LSD
97,8
0,8
0,4
1,0
Opiates
98,5
0,4
0,5
0,7
Inhalants
96,3
1,9
0,5
1,2
N= 1 670
Source: Roviš D, Mataija Redžović A. Adolescent risk behaviour. In: Primorsko- goranska County, editor.
Social Map of Primorsko-goranska County, Rijeka, 2007.
Risk behaviour in 14 year olds
• new types of risk behaviour – bullying, gambling
• up to 20 % children has low self-esteem
• half is exposed to social violence
• 12-25% was rejected by peers
• more than half claims that their friends smokes,
drinks and takes drugs
• family communication is extremely poor
Addictions in 14 year olds
• 16–19% smokers
• experimenting with cigaretes (50-50%) starts before 7
grade
• smokers in family (father, mother, brother, sister...)
• 25-30% activly consumes alcohol
(6 or more occasions in a year)
• Consumes alcoholic beverages, drunkedness – 7. grade
critical
• drinking out of sight
• 5-7% experimenting with marihuana
• 2-3% experimenting with ecstasy
• 9-11% inhalant gateway drug –, before 7. grade
Drug prevention
system in Rijeka
Center for Drug Prevention
 The Drug prevention Centre was funded in 1995. and is
serving as a key instituting regarding prevention and
outpatient treatment.
 Form 2005 it acts as integral part of Public Health
Institute.
 It collects POPMPIDOE forms and runs Register of
Addicts of Primorsko-goranska county.
 It is divide in two offices –for prevention and outpatient
treatment.
 It runs programs from primary, secondary and tertiary
prevention.
Population
 It actually has approx. 600 addicts in program.
 A large number of addict is in the Rijeka prison (60-70%
of prison population).
 A population between 18 -28 years.
 First age of consumption is 16, and treatment at 26.
Primary Prevention
 Life skills training program (two year program for 3000
elementary school children).
 “Ready-steady-healthy” (a prevention program for
finishing classes of elementary school).
 News letter “RIZIK” (Risk) – providing examples of best
practice in field of health promotion and working with
young.
 Peer-to-peer education (carried out by Department for
school medicine in secondary school).
 Efficient Parental skills (carried out by Department for
school medicine in secondary school).
 Civil sector (ASK RI, Kibernetika,Terra).
Secondary and terciary prevetion
 Youth counseling (Mobile counseling thought the
County).
 Outpatient treatment.
 Prison group therapy.
 Therapeutic communities (NGOs).
 Resocialization of addicts (CZZS, NGOs).
CURRENT PUBLIC HEALTH
PROBLEMS OF SCHOOL CHILDREN
AND YOUTH
 The problems of psychosocial etiology:
•uncertanity and anxiousness, depression;
•unsuccess in school;
•adolescent crisis;
•bullying, violence.
 Risky sexual behaviour.
 Abuse of legal and illegal substances that may cause
addiction.
 Chronic illness.
 Eating disorders (bulimia or binge eating, anorexia).
 Overwight, obesity and reduced physical activities.
WHAT MAKES YOUNG PEOPLE VULNERABLE
TO RISK BEHAVIOUR
 lack of experience,
 low risk perception,
 lack of the social skills,
 life style,
 early age of the first sexual intercourse, promiscuity,
and no protection used,
 insufficient education,
 hedonism as a important part of young identity,
 no relevant programmes for especially risky or
marginalized populations.
COUNSELING AT SCHOOL MEDICINE DOCTOR
(SCHOOL YEAR 2006/2007)
 problems of mental health
19,0%
 bullying, violence
12,1%
 eating disorders (bulimia, anorexia)
3,0%
 overwight
16,1%
 obesity
4,2%
 problems with reproductive health
27,5%
 abuse of supstances that may cause addiction
18,1%
THE MAIN REASONS FOR VISITING YOUTH FRIENDLY
SERVICES – OPEN DOOR COUNSELLING
( REPRODUCTIVE HEALTH)
 Use of contraception
29,4%
 Advice an sexual behaviour
16,5%
 Problems with PMS
12,5%
 Amenorea
6,2%
 Symptoms of STD
23,4%
 Infection with chlamidia trachomatis
12,0%
Risk and protective
factors in adolescents
Child at risk
 Numerous psychological, social, economic stressors
represent “tripping point” for children and their
families that results in increase of negligence, child
abuse, juvenile pregnancies, violence among young,
juvenile delinquency, drug abuse, children on the
streets, homelessness, poverty, inadequate child care
etc.
 “Child at risk” – used to describe young at risk for
developing specific psychosocial problems due to
serious obstacles (family, school and community
problems) to become a responsible and productive
grow-up individuals
Risk continuum
 Low risk – the one that carries minimal damage to
wellbeing of child
 High Risk - the one that carries serious damage to
wellbeing of child (delinquency, violence, sexual
abuse, psychological abuse, drug abuse, prostitution,
exclusion from education system, work and family,
homelessness.)

McWhirter, Ben-Rabi i Kahan-Strawczynski
 American survey (Drayfoos, 1997) shows prevalence of
problem behavior among 14-17 year old young:
- 30 % of young engaging multiple risk behaviors
leading to high risk with extremely negative
consequences
- 35 % of young experiment with activities that
strongly influence their future
Major risk behaviors
 Major risk behaviors should be addressed by most
nations strategies and plans:
 drug and alcohol abuse,
 early sexual relationships,
 school abandoned and school problems,
 juvenile delinquency,
 violence and school violence.
Efective parenting
 Research ”Communities that care..” was carried out
2002-2005 in Istra by ERF
 Max 50% parents according to their opinion always
knew about where their child is going out, their friend,
free time or money spending habits.
 Parents says they have a serious talk about risk
behaviors with their children 4-5 times a year
 Their children see this conversations only 2-3 time a
year
 Regarding sanctions, parents are most tolerant to
alcohol use, irresponsible sexual behavior and school
missing.
Community safety
 Community safety
 95,5% young feel safe in their community
 Alcohol and drug availability
 82,2% young says it easy to buy alcohol

(3% don’t know)
 44,0% young says it easy to buy marihuana (14,3%
responds “don’t know”)
 19,0% young says it easy to buy hard drugs (26,8 %
don’t know)
Prevention models
 Prevention concepts have moved their focus from
pathology oriented to strengths of individual and their
surrounding
 Modern dominating prevention models:
 (1) Risk and protective factors.
 (2) Resilience and risk.
 (3) Promotion of mental health and prevention of
mental and behavioral disorders.
 (4) Developmental strengths.
 (5) Positive development.
Efective prevention
 For effective prevention it is necessary to:
 Point multiple interventions at multiple factors at the
same time (engage all risk factors and special needs
and protection in surrounding)
 Direct interventions towards many systems (to all
systems that young person participates in and
interacts)
 Organize multy layer prevention interventions
(individual level and macro levels)
Efective prevention
 All accounted to be effective should include:
 Programs based on theoretical knowledge,
 Authentic and reliable - trustworthy interventions,
 Build in evaluation,
 Sampling strategies
 Keeping the users in the program
 Ability to replicate the program
 Abilities to spread the programs
 Total level of trust in results
 Usefulness of results for prevention theory and
practice
Health promotion
in family practice
SWOT analysis
SWOT analysis (acronym for Strenghts ,
Weaknesses, Opportunities and Threats)
... is a diagnostic and prognostic instrument
helping us to analyse and implement
certain
project,
in
our
promotion in family practice.
case
health
Strenghts
 Human resources
 MD, general practitioner/family medicine
specialist, nurse in team, patronage nurse
as team collaborate. All them are basically
educated for health promotion.
 Space capabilities (doctor´s office, file
room, waiting room, small surgery room).
 Well organised family practices net,
especially in cities.
Weaknesses
 Organisation of practice – mostly oriented toward
curative medicine. Health promotion takes place
during patients´ individual visits or through
periodically lessons in collaboration with local
community.
 Lack of time for health promotion because of team
members overworking with treatments of patients and
administrative work.
 Financing system. Family practices are financed
mostly through flat rate “per capita”, only in small part
preventive chekups are financed. It´s necessary to plan
additional financial resources for health promotion in
family practice.
Opportunities
 Additional education perspective (smoking cessation
treatment, obesity treatment, asthma control school
etc.) The example of such education is Professional
Course of Health Promotion and Addiction Prevention
in frame of the Tempus project.
 Positive attitudes of local community – Rijeka is
involved in Healthy Cities Movement, Primorsko
Goranska County upholds health promotion projects.
 Patients show growing interest for helthy life styles.
 Organistion of practice could be not only weak point,
but also an opportunity for health promotion. Patients
in waiting room could get inspirative thematic
materials, which could encourage them for discussion
with other patients.
Threats
 Health promotion in family practice could
produce an overwork of family doctor and
nurse, or neglection of disease treatments.