Conceptual Model

Primary, Secondary & Tertiary Prevention

Edgardo Prez
MD, MPH, FRCPC, CHE, CPHQ
CEO and President
Homewood Health Centre
Professor of Psychiatry,
Universities of McMaster, Ottawa,
and Toronto
Director, The Centre for
Organizational Health

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A Conceptual Model
Primary Prevention
Secondary Prevention
Tertiary Prevention

Cooper, 1997

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Primary Prevention
a. Primary preventionTo protect individuals in order to avoid
problems prior to signs or symptoms of
problems. Includes those
activities, programs, and practices that
operate on
a fundamentally non-personal basis and
alter the set of opportunities, risks, and
expectations surrounding individuals.
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Primary Prevention
b. Secondary preventionIdentifies persons in the early stages of
problem behaviors and attempts to avert
the ensuing negative consequences by
inducing them to cease their problem
behavior through counseling or treatment.
It is often referred to as early intervention.

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Primary Prevention
c. Tertiary preventionStrives to end problem behavior and/or to
ameliorate their negative effects through
treatment and rehabilitation. This is most
often referred to as treatment but also
includes rehabilitation and relapse
prevention.

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An Intervention Strategy for Workplace

Primary
eliminate or reduce sources of stress

Secondary
prompt detection and management

Tertiary
treatment, rehabilitation and recovery of those with
illness due to stress

Cooper, 1997

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Goal: Preventing Stress at Work

A Comprehensive Approach
Organizational Practices+Stress Management
=A Healthy Workplace
reduced stress disorders
satisfied and productive workers
profitable and competitive organization

Stress at Work, NIOSH 2001

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Basic Mental Health Needs

in the Workplace
respect and
appreciation
feeling heard or
listened to
freedom to speak up
sense of confidence
and self-worth
freedom from chronic
feelings of hostility
and anger

a sense of belonging
to a meaningful and
supportive work
group
freedom from chronic
symptoms or
distress, anxiety and
depression
periods of relative
calm and peace of
mind

Best Advice on Stress Risk Management in the Workplace

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Primary Intervention

redesign the task

flexible work schedule
participative management
social support and
feedback
build cohesive teams
fair employment policies
share the rewards
address issues of
demand/control

address issues of
effort/reward
clearly define roles and
responsibilities
provide opportunities to
participate in decisions
affecting their jobs
workload in line with
workers capabilities and
resources

Cooper, 1997

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Secondary Intervention

developing self awareness

individual coping skills (e.g., relaxation techniques)
health promotion
life style modifications
stress education
stress management training
role of the Employee Assistance Program

to improve adaptability of the individual to the environment

Cooper, 1997

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Preventing Job Stress: Getting Started

Step 1: Identify the problem
group discussion
data regarding the employee perception
objective measures (e.g., absenteeism, performance
problems)
Step 2: Design and Implement Interventions
Step 3: Evaluate the Interventions
short and long term
employee perceptions
objective measures

NIOSH, 2001

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Partners in Stress Risk Management

A Combined Forces Approach to Stress Abatement
Senior Management
and Unions
EFAP
Committee(s)

Combined Forces
Steering Committee

Health
and Safety
Committees

(Working Committee)
Education,
Awareness

Training
Work Force
(All Levels) and Families
Best Advice on Stress
Risk Management

Culture + Practices
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Tertiary Intervention
counselling services
system to manage return to work
role of the Employee Assistance Program

Cooper, 1997

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Continuum of Intervention
Employer
Executives

Primary
Intervention

Secondary
Intervention

Tertiary
Intervention

Employees

Human Resources
Occupational Health
Supervisors

HBH
Employee
Assistance
Program

Unions

Mental Health
Consultants

In-patient Treatment
Specialized Treatment Programs
Disability Treatment Program
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