Primary Level

Primary Level

What is Primary Prevention?

Primary Prevention involves system-wide efforts to prevent new cases of a condition or disorder. For example, giving children vaccinations against common diseases such as measles and chicken pox is done to prevent initial occurrences of these diseases. As a system-wide Primary Prevention effort in schools, positive behavior support consists of rules, routines, and physical arrangements that are developed and taught by school staff to prevent initial occurrences of problem behavior. For example, to prevent injuries to students caused by running in hallways, schools may develop Primary Preventions by 1) establishing and teaching the rule,"walk in the hallways;" 2) creating a routine in which staff station themselves in the hallways during transition times to supervise the movement of pupils; or 3) altering the physical arrangement, such as making sure that an adult is with any group of students when they are in the hallways.

What are we trying to prevent?

It goes without saying that we want to prevent the major"behavioral earthquakes" that we hear about in the news: violent acts against teachers or other students, theft, bullying behavior, drug use, and the like. However, research has taught us that efforts to prevent these serious problems are more successful if the"host environment"_the school as a whole_supports the adoption and use of evidence-based practices. Practices that meet these criteria include teaching and rewarding students for complying with a small set of basic rules for conduct, such as"be safe," be responsible," and"be respectful." These rules translate into sets of expectations that differ according to various settings in the school. Thus, on the playground"be safe" means stay within boundaries and follow the rules of the game. In hallways and on stairs, it means to keep your hands and feet to yourself and to walk on the right side. Some parents and educators believe that students come to school knowing these rules of conduct, and that those who don't follow them simply should be punished. However, research and experience has taught us that systematically teaching behavioral expectations and rewarding students for following them is a much more positive approach than waiting for misbehavior to occur before responding. It also establishes a climate in which appropriate behavior is the norm. Finally, the use of Primary Prevention strategies has been shown to result in dramatic reductions in the number of students being sent to the office for discipline in elementary and middle schools across the United States and Canada. In effect, by teaching and encouraging positive student behavior (i.e., positive behavior support), we reduce the"white noise" of common but constant student disruption that distracts us from focusing intervention expertise on the more serious problems mentioned above.

How is Primary Prevention implemented in schools?

As with any effort to create change in an organization, the first step is to gain consensus on several issues:

1) Is there a problem that we need and want to address?
2) What is the nature of this problem?
3) What are we going to do about it?

The most efficient way to establish consensus is to arrange a meeting of the entire school staff (teachers and aides, administrators, office and cafeteria workers, custodians, counselors, etc.) to discuss these questions. If the majority of staff respond proactively to these questions (e.g.,"Yes, student behavior is a problem and we want to do something about it;""The rates of office disciplinary referrals from classrooms and the cafeteria have increased 50% since the last quarter;""We will implement a school-wide disciplinary plan based on positive behavior support"), the next step is to conduct further assessments, as necessary, and then to agree on a set of strategies to address the problem(s). Typically, all of this can be accomplished in a facilitated one-day meeting of the entire school staff. An important rule for establishing consensus is that at least 80% of all staff must agree on the problems and the strategies to address them, and make a commitment to implement the strategies as planned. Obviously, some Primary Prevention strategies will be easier to implement than others. This is why it is important for all staff in the school to have input and to agree on which strategies will be implemented and commit to use these.

What if Primary Prevention doesn't work?

Primary Prevention, through positive behavior support, does work for over 80% of all students in a given school (based on a criterion of the number of students who have one or fewer office discipline referrals per month). But obviously, it will not work for everyone. For a variety of reasons, some students do not respond to the kinds of efforts that make up Primary Prevention, just as some children are not completely protected by vaccinations. Putting into place systematic Primary Prevention strategies offers two advantages: First,it reduces the"white noise" caused by large numbers of office discipline referrals for minor problems. As we suggested earlier, this volume of referrals obscures and distracts our attention from more serious problems. Second, having a system for documenting the occurrence of problem behaviors (e.g., office discipline referrals) provides a way to determine which students need more intensive intervention. For example, the criterion for considering the need for moving into secondary prevention for a student or group of students might be 4 or more office discipline referrals in a month. Without Primary Prevention, of course, the number of students meeting this criteria and needing additional help will be much larger.

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