BOX 7-2

Systems Framework Premises

I. Each system is a goal-directed collection of interacting or interdependent parts, or subsystems.

II. The whole system is continually interacting with and adapting to the environment, or suprasystem.

III. There is a hierarchical structure (suprasystem → system → subsystems).

IV. Each system is characterized by the following:

A. Structure: Arrangement and organization of parts, or subsystems

1. Organization and configuration (e.g., traditional vs. nontraditional; greater variability [no right or wrong and no proper vs. improper form])

2. Boundaries (open vs. closed; regulate input and output)

3. Territory (spatial and behavioral)

4. Role allocation

B. Functions: Goals and purpose of system and activities necessary to ensure survival, continuity, and growth of system

1. General

a. Physical: Food, clothing, shelter, protection from danger, and provision for health and illness care

b. Affectional: Meeting the emotional needs of affection and security

c. Social: Identity, affiliation, socialization, and controls

2. Specific: Each family, group, or aggregate has its own individual agenda regarding values, aspirations, and cultural obligations

C. Process and dynamics

1. Adaptation: Attempt to establish and maintain equilibrium; balance between stability, differentiation, and growth; self-regulation and adaptation (equilibrium and homeostasis)

a. Internal: Families, groups, or aggregates

b. External: Interaction with suprasystem

2. Integration: Unity and ability to communicate

3. Decision making: Power distribution, consensus, accommodation, and authority

Primary prevention relates to activities directed at preventing a problem before it occurs by altering susceptibility or reducing exposure for susceptible individuals. Primary prevention consists of two elements: general health promotion and specific protection. Health promotion efforts enhance resiliency and protective factors and target essentially well populations. Examples include promotion of good nutrition, provision of adequate shelter, and encouraging regular exercise. Specific protection efforts reduce or eliminate risk factors and include such measures as immunization, seat belt use, and water purification.

Secondary prevention refers to early detection and prompt intervention during the period of early disease pathogenesis. Secondary prevention is implemented after a problem has begun, but before signs and symptoms appear, and targets those populations that have risk factors. Mammography, blood pressure screening, scoliosis screening, and Papanicolaou tests are examples of secondary prevention.

Tertiary prevention targets populations that have experienced disease or injury and focuses on limitation of disability and rehabilitation. Aims of tertiary prevention are to keep health problems from getting worse, to reduce the effects of disease and injury, and to restore individuals to their optimal level of functioning. Examples include teaching how to perform insulin injections and disease management to a patient with diabetes, referral of a patient with spinal cord injury for occupational and physical therapy, and leading a support group for grieving parents.