NEED ASSESSMENTNEED ASSESSMENT

The concept of need within the context of The concept of need within the context of

public healthpublic health

• Needs assessment is the proces of Needs assessment is the proces of

evaluating the problem and solutions evaluating the problem and solutions

identified for a specific target population.identified for a specific target population.

• To present the problem of addictions in To present the problem of addictions in

Primorsko-goranska County we used social Primorsko-goranska County we used social

indicators, utilization of services and survey indicators, utilization of services and survey

techniques for identifing health needs.techniques for identifing health needs.

NEED ASSESSMENTNEED ASSESSMENTEpidemiology of addictionEpidemiology of addiction

Drug prevention system in RijekaDrug prevention system in Rijeka

CCurrenturrent public healthpublic health problems olf schoolproblems olf school children and children and

youthyouth

Risk and protective factors in adolescentsRisk and protective factors in adolescents

Health promotion in family practiceHealth promotion in family practice

Presenter: Đulija Malatestinić, PhD

Epidemiology of Epidemiology of

addictionaddiction

Treated drug addicts, morphine (opiate) type addicts, new cases Treated drug addicts, morphine (opiate) type addicts, new cases (first recorded) and new morphine (opiate) type addicts in (first recorded) and new morphine (opiate) type addicts in

Primorsko-goranska county 1997-2007.Primorsko-goranska county 1997-2007.

0

100

200

300

400

500

600

700

1997. 1998. 1999. 2000. 2001. 2002. 2003. 2004. 2005. 2006. 2007.

Treated drug addicts Treated morphine (opiate) type addicts

First recorded drug 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

Cigarettes 51,0 10,1 6,0 32,9

Beer 22,7 19,3 31,3 26,7

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

• 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

Addictions in 14 year olds

Drug prevention Drug prevention

system in Rijekasystem in Rijeka

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.

Center for Drug Prevention

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.

Population

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).

Primary Prevention

Youth counseling (Mobile counseling thought the

County).

Outpatient treatment.

Prison group therapy.

Therapeutic communities (NGOs).

Resocialization of addicts (CZZS, NGOs).

Secondary and terciary prevetion

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.

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.

WHAT MAKES YOUNG PEOPLE VULNERABLE TO RISK BEHAVIOUR

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%

COUNSELING AT SCHOOL MEDICINE DOCTOR (SCHOOL YEAR 2006/2007)

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%

THE MAIN REASONS FOR VISITING YOUTH FRIENDLY SERVICES – OPEN DOOR COUNSELLING

( REPRODUCTIVE HEALTH)

Risk and protective Risk and protective

factors in adolescentsfactors in adolescents

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

Child at risk

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

Risk continuum

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.

Major risk behaviors

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.

Efective parenting

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)

Community safety

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.

Prevention models

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

Efective prevention

HHealth promotionealth promotion

in family practice in family practice

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 case health

promotion in family practice.

SWOT analysis

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.

Strenghts

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.

Weaknesses

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.

Opportunities

Health promotion in family practice could

produce an overwork of family doctor and

nurse, or neglection of disease treatments.

Threats