Lessons learned on prevention

Over the last two years my team has looked into more than 30 preventative services for children, young people, and adults in the UK. Here are five lessons we have learned.

Lesson 1: Define prevention by what it is

Prevention is about addressing early signs before a situation might get more serious in the future.

For example, preventative services may be available for those older adults who are struggling in their daily living, but have not yet experienced serious needs, such as needing help to feed themselves.

In this case, prevention is defined in relation to more serious needs which are not yet experienced, but if they were experienced in the future, they would merit statutory social care.

Imagine you are asked to build a house, but all you know is what the house should not look like.

It is difficult to run a preventative service if there is no clear sense of who it is for. This requires describing the people who will be using the service by their characteristics, rather than by what they are not.

Lesson 2: Work out the number of service users in advance

Estimating the number of people who will be using a preventative service is a good upfront investment.

There is only one thing worse than waiting lists: opening a service and not finding anyone to use it.

A combination of surveys, and analysis of administrative information can give a sense of how many users will be happy to use a preventative service. If the estimate is that too few people seem interested, one wise decision is probably not to go ahead.

Lesson 3: Think outside the box to keep users engaged

In prevention, serious needs have not manifested themselves yet, at least not to a level that requires frequent contact with a practitioner like a school nurse, a social worker, or a probation officer.

Those who benefit from preventative services are not typically on contact lists alongside others in similar situations.

Identifying users of preventative services requires knocking on doors, approaching people who gather at social events, and observing kids playing at parks. Engaging with them starts by explaining that working on early signs now may pay off in the future.

Lesson 4: More, not less experienced staff

Supporting those with needs that might grow into serious problems in the future is more difficult than addressing clear cut problems now.

Anyone can decide what to do with a basket of apples that are about to go off. However, only someone who knows about apple trees can deal with a few unusually brown leaves in early spring.

In reality, the public sector spends less money on preventative services than on services for more serious needs. This explains why the staff running preventative services is usually at the early stages of their careers and receive lower salaries.

Spending and experience should be in line with the greater difficulty required for prevention.

Lesson 5: Analysis of actual results

Going back to where we started, the information that preventative services use to understand their results will be more useful if it explains what the services achieve, rather than what they avoid.

Measuring what has not happened is more difficult than measuring what has happened.

I discussed these five lessons at a conference organised by the European Union for Prevention Research in November 2016. If you have taken the time to read this blog, please leave comment with your thoughts.

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