A Reflection on Prevention Systems: A European perspective

Prevention science over the past years has accumulated evidence on the effectiveness of drug prevention interventions (Sloboda et al. 2014). In Europe this improvement has been a consequence of priorities defined by EU drug strategies since 2015 and the subsequent action plans and projects. In the EU Drugs Action Plan 2009 - 2012 EU governments agreed to develop a European consensus on minimum quality standards and put in place a common framework. The first milestone in this development was the publication of Minimum Quality Standards in Drug Demand Reduction in the European Union (EMQS)(2015). Four other EU funded projects laid the groundwork on this subject:

1. European Drug Prevention Quality Standards (EDPQS) Phase I (2010) reviewed the drug prevention standards in EU member states and delivered a set of quality standards in prevention, recognized by EUDA (FKA EMCDDA)
2. Minimum Quality Standards in Drug Demand Reduction (EQUS) (2011)
3. EDPQS Phase II (2015) delivered a set of tools to promote EDQPS
4. UPC-Adapt with the aim to adapt an international curriculum (UPC) for the training of drug prevention professionals to the European context.  

The main output was the prototype of what is now known as the EUPC, the European Prevention Curriculum.

Despite this progress, there is still a lack of implementation and dissemination of quality standards and evidence-based interventions in daily practice. Wide implementation of prevention interventions that are evidence-based and anchored in quality standards cannot rely on the engagement with practitioners alone, but require:

1. A complex systems-approach

The drug use phenomenon involves multiple domains (welfare, health, justice etc.) and the users represent a diverse risk profile (health problems, criminality etc.). To deliver successful drug use prevention interventions it is essential to provide comprehensive responses incorporating multiple stakeholders in an integrated way. The approach commonly adopted at the moment is often focused at the micro level  and fails to take into consideration the whole system.

2. A competent workforce

A workforce with the core competencies is essential  for the implementation of prevention in line with quality standards as well as for the implementation of evidence-based interventions in general. The Council’s conclusions (2015)  highlighted that it is important that “those developing prevention interventions have competencies and expertise on prevention principles, theories and practice, and are trained and/or specialized professionals.” Despite this, in many countries many professionals are still not updated on knowledge and competences required to apply quality standards and evidence-based interventions

3. Adaptation

 The quality standards must be adapted to align with individual country prevention systems.Prevention systems and quality standards are designed at EU or national level and are often scaled at local level with insufficient consideration for the peculiarities of the local population and systems. To increase their implementation, there is a need for a deep understanding of the structures and systems in which they are integrated (service delivery, culture, staff organization)(Ritter et al. 2008)

4. Sustainability measures

It is essential to have mechanisms in place to facilitate sustainability ofactivities that promote the dissemination  of best practice strategies. Long term actions require the creation of organizational sustainability. Focus groups findings from EDPQS projects, showed that prevention trainers and professionals tend to work in a way that excludes other professionals and stakeholders. There appears to be a lack of interdisciplinary collaboration with the other professionals in the field, who often find themselves implementing prevention strategies without support coming from colleagues with an appropriate expertise in prevention.

5. A supportive policy environment and structures

Sustainable prevention strategies require the active participation of all responsible government ministries and departments as well as all levels of society including the non-governmental sector (UNODC, 2013). Changes in prevention systems also require sustainable funding and strong supportive regulatory systems.

The ASAP-Training project (2019-2021) analysed European prevention systems and linked the analysis to the professionalization of the European prevention workforce, using the model offered by the European Drug Agency (EUDA). The model suggests that a prevention system comprises 5 main components (See accompanying image):

1. Organization,
2. Research and quality control,
3. Interventions.
4. Workforce; and
5. Target populations

which are complemented by a set of mediators and moderators that influence the interaction of these components. ‘Mediators consist of the elements whose modification through policies can change the overall impact of the prevention system, such as administrative organization, intersectoral cooperation, interaction with academia and implementation. Moderators (e.g. social capital, or alcohol and tobacco policies), on the other hand, are those factors that cannot be easily modified but nevertheless are here hypothesized to influence the overall delivery of prevention.’ (EMCDDA, 2019, pp.: 11)

During this project, a questionnaire was developed to gather information about European prevention systems through interviews with national, regional and local prevention stakeholders.

The most notable findings are that in all responding countries, large scale epidemiological research has been used to inform policy development; manualized prevention programmes are available, and measures for type of preventive service measures are in place. There are similarities in the European countries when it comes to perceived competencies and skills of the decision makers and prevention practitioners. The lack of educational requirements for the workforce engaged in prevention, the perceived lack of the wide use of standards, the often-lacking certification systems, and systematic collections of information about the programmes and organizations are also characteristic features of the responding countries. Seemingly a lot of important support systems, organizations, funding mechanisms are in place, but it is unclear to what degree the whole country is covered and to what extent the target groups are reached.

The profiling showed the lack of publicly available registry of prevention programmes and/or programme- service providers. Another important lesson learnt from the analysis of the available data is the lack of specified education of those who are responsible for prevention-related decision-making and/or the implementation of preventive interventions. Structures and mechanisms to ensure the sustainability of quality prevention activities should be strengthened through financial commitment and measures geared at ensuring professional development. Based on the analysis carried out so far, elements of these improvements can be identified (appropriate utilization of quality standards, strengthening the link between certification system and financing, targeted education programmes for prevention professionals, development and availability of programme/service registries).

References:

UNODC, International standards on drug use prevention, 2013 EMCDDA, Drug prevention: exploring a systems perspective, 2019

https://www.euda.europa.eu/publications/technical-reports/drug-prevention-exploring-systems- perspective_en