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NEED ASSESSMENT The concept of need within the context of public health • Needs 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 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, Ph. D

Epidemiology of addiction Epidemiology of addiction

Treated drug addicts, morphine (opiate) type addicts, new cases (first recorded) and new morphine Treated drug addicts, morphine (opiate) type addicts, new cases (first recorded) and new morphine (opiate) type addicts in Primorsko -goranska county 1997 -2007. 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 N= 1 670 Source: Roviš Psychoactive substance abuse among Croatian adolescents in Primorsko-goranska County 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, 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 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 Drug prevention system in Rijeka

Center for Drug Prevention § The Drug prevention Centre was funded in 1995. and 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 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 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 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 CURRENT PUBLIC HEALTH PROBLEMS OF SCHOOL CHILDREN AND YOUTH

§ The problems of psychosocial etiology: • uncertanity and anxiousness, depression; • unsuccess in § 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 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, 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 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 Risk and protective factors in adolescents

Child at risk § Numerous psychological, social, economic stressors represent “tripping point” for children 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 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. ) § Mc. Whirter, 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 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 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 § 95, 5% young feel safe in their community § Alcohol and 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 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 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 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 Health promotion in family practice

SWOT analysis (acronym for Strenghts , Weaknesses, Opportunities and Threats) . . . is 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 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 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. 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 Threats § Health promotion in family practice could produce an overwork of family doctor and nurse, or neglection of disease treatments.