By Max Hammond
For Carter County Times
Carter County’s Pathfinder Initiative has gained the partnership of West Virginia University (WVU). Alfgeir L. Kristjansson, PhD, MSc., a WVU professor and researcher, recently visited Carter County and briefed approximately 30 key community stakeholders from churches, schools, healthcare, law enforcement, recreation, non-profits, and local, county, and state government – including State Representative Patrick Flannery, and County Judge Executive Brandon Burton – on Monday, July 28 at the Olive Hill Police Station.
Kristjansson, spoke about the Integrated Community Engagement (ICE) Collaborative based on the Icelandic Prevention Model of which he is the principal investigator (PI).
Dr. Kristjansson, who is originally from Iceland, is a professor of public health at West Virginia University (WVU) School of Public Health; center principal investigator and co-director for the West Virginia Prevention Research Center (WVPRC); and adjunct faculty at Reykjavik University in Iceland. He earned his PhD in Social Medicine from the Karolinska Institute in Sweden in 2010 and was a post-doctoral fellow in Health Behavior at Columbia University in New York City between 2010-2012. Dr. Kristjansson has published widely on substance use prevention and the Icelandic Prevention Model, as well as more generally on adolescent behavioral development and the well-being of children, youth and families.
Currently, he is the principal investigator (PI) of several US-based federally funded studies, including the Young Mountaineer Health Study in WV funded by NIAAA, and the Integrated Community Engagement (ICE) Collaborative funded by the Centers for Disease Control and Prevention (CDC) via the WVPRC. He has published over 130 peer-reviewed manuscripts within public health, health education, preventive medicine, and multidisciplinary journals focused on adolescents.
According to Kristjansson, the Substance Abuse and Mental Health Service Administration (SAMHSA) recently estimated that 48,500,000 people in this country suffer from substance abuse disorder at any given time and most of the country is heavily impacted by substance abuse disorder.
Kristjansson opined that the system of prevention and the way our society addresses drug addiction emphasizes care instead of prevention. He explained three approaches used to combat substance abuse: primary prevention, secondary prevention, and tertiary prevention and care.
Primary prevention focuses on preventing the problem before it starts, secondary prevention focuses on trying to change behaviors after the problem has begun, and tertiary prevention focuses on taking care of people after the problem has become severe. Kristjansson says there is too much focus on tertiary prevention, waiting for the problem to come “downstream” instead of “damming the problem upstream.”
According to Kristjansson, currently more than 90 percent of resources are spent on tertiary care. He stated that almost all the money, manpower, time, and what he called the professional umbrella is focused on tertiary care; basically, helping people who are already very sick which is the downstream side of prevention.
“We’re waiting at the end of the river, and we do almost nothing until people are in dire need to come to treatment,” Kristjansson said.
Although he realizes the importance of tertiary care, such as drug treatment, to ensure the health and safety of drug users, he said more needs to be done “upstream” to reduce the need for treatment.
Kristjansson is an advocate for focusing on the health and wellbeing of all children, not just those who are already in trouble, and believes that primary prevention is a much more effective method for fighting substance abuse.
ICE is based on The Icelandic Prevention Model (IPM) and is a community-based approach designed to prevent adolescent substance use by influencing environmental risk and protective factors related to substance use within the community, school, peer, and family contexts. It emphasizes collaboration among different stakeholders, including researchers, policymakers, practitioners, and community members.
The IPM is an evidence-based approach that has shown success in reducing adolescent substance use in Iceland and is gaining recognition internationally. The model was developed by the Icelandic Centre for Social Research and Analysis (ICSRA), and is a community-based approach focused on reducing youth substance use by addressing environmental risks and protective factors within the family, school, peer, and leisure-time contexts.
Although the IPM has been implemented around the world, Carter County, thru the Pathfinder Initiative, is the first county in eastern Kentucky to adopt the program and has benefited from the mentorship of Kentucky’s first IPM program, Franklin County’s “Just Say Yes Program.”
Dr. Kristjansson spent several days touring the county and meeting with representatives from Carter Caves and the Olive Hill Center for Arts and Heritage, along with Mayor Troy Combs of Grayson, Senator Robin Webb and the Carter County Board of Education.
Unlike other prevention programs the ICE/IPM method is data-driven and evidence-based. The students of East and West Carter middle and high schools will have an opportunity to be heard through an anonymous survey distributed by the Pathfinder Initiative. The results of this survey will guide the implementation of the program and efforts to create greater opportunities for the students.
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