Checking up on the power of prevention

摘要

You have decided on some prevention projects and you know what it is you want to achieve. Let's say, you want to try to reduce the number of young people who feel they can't cope, or the number of adults who need social care when in theory you think it could be prevented. The big question is how do you know your project is working? Or even likely to work? In Hertfordshire, we have been working with the council and voluntary sector services on how to demonstrate the effectiveness of prevention, ranging from drug testing on arrest for acquisitive and violent crime, to safety training for motorcyclists and mentoring young people with learning disabilities into employment. Not one project has been simple, but through various means we found they all had value. The most straightforward way of doing this is to review the evidence and use it as a yardstick against your own practice. Not everything has good and reliable evidence that something works, but there are some things which do, for example, preventing recurring falls in older people. The evidence continues to support assessing multiple risk factors (from gait stability to hazards at home) and multiple points of intervention (removal of hazards, plus strength training, plus eye tests). Begin by getting your public health team to hone down on what your project is trying to achieve, then assess the evidence of what works. By comparing how what you do sits with the evidence and making any changes to what you do are essential steps. If there is no good quality published evidence, there are two reactions: first, you have to commission an external evaluation or you can't prove anything. Wrong. Evaluation is a good discipline to practice, but doesn't always mean commissioning external evaluations.