PRIMARY PREVENTION PRIMARY PREVENTION MENTAL HEALTH MENTAL HEALTH PROGRAMSPROGRAMS

Current outcome research.Current outcome research. Durlak y Wells.Durlak y Wells. Recommendations:Recommendations:

- Precision of theory - Precision of theory

- Desingn - Desingn

- Program evaluation.- Program evaluation.

Commentators give recommendations to Commentators give recommendations to investigate some of the major questions investigate some of the major questions facing the feald:facing the feald:

- Who - Who

- What- What

- Where- Where

- When - When

- How of prevention - How of prevention

Recent ResearchRecent Research

No single study is perfect and No single study is perfect and contains every possible feature.contains every possible feature.

Collectively are notable in several Collectively are notable in several respects.respects.

In terms of methodology: researches In terms of methodology: researches have studied relatively larges have studied relatively larges samples.samples.

In terms of outcome studies have In terms of outcome studies have focusedfocused

- levesls of antisocial- levesls of antisocial

- aggresive behavior - aggresive behavior

- risk status- risk status

- subsequent development of - subsequent development of clinical disorders.clinical disorders.

Prevention in other areasPrevention in other areas Several commentators like Cowen or Several commentators like Cowen or

Kolbe Weissberg and Bell noted the Kolbe Weissberg and Bell noted the influence of interconnectedness of younginfluence of interconnectedness of young´s people physical psychological and ´s people physical psychological and social development.social development.

Weissberg and Bell wanted to include in Weissberg and Bell wanted to include in the review all types of preventions but this the review all types of preventions but this was a demanding task.was a demanding task.

Their suggestions raised an important Their suggestions raised an important point. Prevention research are very point. Prevention research are very parochial and categorical in nature. parochial and categorical in nature.

An examination of the reference lists of An examination of the reference lists of publish studies suggests that authors in publish studies suggests that authors in one field rarely acknowledge the work of one field rarely acknowledge the work of those in other areas. those in other areas.

In this case one well done studies can help In this case one well done studies can help as models in other areas and findings as models in other areas and findings drawn across areas can provide drawn across areas can provide convergent validity for theorical or convergent validity for theorical or conceptual instance.conceptual instance.

Their research presents findings from Their research presents findings from several well-done studies whose initial several well-done studies whose initial focus was not mental health per se, which focus was not mental health per se, which have achieved some positive mental health have achieved some positive mental health some positive mental health-related some positive mental health-related outcomes which were attained in addition outcomes which were attained in addition to the positive impact achieved on the to the positive impact achieved on the main trust on the interventionmain trust on the intervention

Prevention in other areas Prevention in other areas

Yoshikawa noted that the in three studies to Yoshikawa noted that the in three studies to asses long-term impact on serious adolescent asses long-term impact on serious adolescent behavior problems (antisocial and delinquency behavior problems (antisocial and delinquency behavior) obtained positive results.behavior) obtained positive results.

The effect sizes for these outcome data wich The effect sizes for these outcome data wich were collected during follow-up periods of 10 were collected during follow-up periods of 10 years. years.

And additional study And additional study of early childhood of early childhood intervention intervention conducted in turkey conducted in turkey has also been has also been successful in successful in preventing preventing adolescent adolescent delinquency.delinquency.

It is not possible to identify what specific It is not possible to identify what specific factors are responsible for these findings. factors are responsible for these findings. These early interventions have been These early interventions have been complex, multiyear, multicomponent complex, multiyear, multicomponent programs combining early childhood programs combining early childhood education with a variety of family support education with a variety of family support services.services.

Several elementary-level academic Several elementary-level academic interventions emphasizin peer tutoring or interventions emphasizin peer tutoring or organizational changes in school policies organizational changes in school policies and practices have also resulted in better and practices have also resulted in better peer relations , decreases in disruptive peer relations , decreases in disruptive behavior and improved self-concepts.behavior and improved self-concepts.

Some physical health Some physical health promotion programs promotion programs have also had have also had positive behavioral positive behavioral effectseffects

Specific issuesSpecific issuesStudy inclusion and classificationStudy inclusion and classification

Several commentators raised questions from some Several commentators raised questions from some of the criteria for inclusion in the methods of of the criteria for inclusion in the methods of classification or subdivision of studies and classification or subdivision of studies and disagreed about the research and saw it more as a disagreed about the research and saw it more as a single step or a hypothesis for future studies. single step or a hypothesis for future studies.

Trickett (1997) lamented the fact that there are no Trickett (1997) lamented the fact that there are no data on the ecological impact of mental health data on the ecological impact of mental health prevention and data analysis were limited to prevention and data analysis were limited to

individual level of analysis.individual level of analysis.

And this impression was the result of the decision And this impression was the result of the decision to analyze only outcome measures and assess to analyze only outcome measures and assess children and adolescents level of adjustment. children and adolescents level of adjustment.

Ecological ImpactEcological Impact

The data collected more frequently assessed changes in The data collected more frequently assessed changes in attitudes of parents or teachers, teacher-child attitudes of parents or teachers, teacher-child

interactions, and finally, any assessment of how the interactions, and finally, any assessment of how the psychological climate of the building was affected by the psychological climate of the building was affected by the

intervention. intervention.

It is often very difficult to determine whether prevention It is often very difficult to determine whether prevention programs are sustained over time, however, publication programs are sustained over time, however, publication

practices do not encourage the inclusion of such practices do not encourage the inclusion of such information as part of a study of results.information as part of a study of results.

PARENT PROGRAMSPARENT PROGRAMS

Three commentaries discussed the findings thatThree commentaries discussed the findings thatprograms exclusively devoted to parent training didprograms exclusively devoted to parent training didnot produce significant positive effects.not produce significant positive effects.

In our view, involving parents in training programs In our view, involving parents in training programs remains a challenge.remains a challenge.

PARENT PROGRAMS

Positive changes occurred among high-attendingPositive changes occurred among high-attendingparents, but only 9% of the target populationparents, but only 9% of the target populationattended any meetings, and only 55% of theattended any meetings, and only 55% of theparticipants attended at least 7 of the 15 scheduledparticipants attended at least 7 of the 15 scheduledsessions. sessions.

PARENT PROGRAMS

One recent group of investigators took several stepsOne recent group of investigators took several stepsto develop a culturally sensitive intervention for innerto develop a culturally sensitive intervention for innercity African American parents including seeking thecity African American parents including seeking theinput and support of parents and local communityinput and support of parents and local communityleaders when preparing and advertising the program.leaders when preparing and advertising the program.

PARENT PROGRAMS

These findings bring to mind Schinke's observation These findings bring to mind Schinke's observation that "...little is known about ways to galvanize familythat "...little is known about ways to galvanize familymembers into preventive action in a predictablymembers into preventive action in a predictablyeffective manner"effective manner"

PARENT PROGRAMS

COST ANALYSESCOST ANALYSES

Cost analyses of prevention programs are needed.Cost analyses of prevention programs are needed.Current data are very encouraging. Current data are very encouraging.

COST ANALYSES

Cost-benefit analyses have indicated that preventiveCost-benefit analyses have indicated that preventiveinterventions focused on physical health promotion,interventions focused on physical health promotion,early childhood education and childhood injury areearly childhood education and childhood injury arevery cost-effective, and can return $8, $13, or over $45very cost-effective, and can return $8, $13, or over $45in benefits for every dollar spent.in benefits for every dollar spent.

COST ANALYSES

We offer three cautions regarding cost analyses:We offer three cautions regarding cost analyses:

First, although money is not the only important First, although money is not the only important consideration, several analyses have only consideration, several analyses have only included costs and benefits that can be easily included costs and benefits that can be easily translated into monetary figures.translated into monetary figures.

COST ANALYSES

Prevention might not always save money in the longPrevention might not always save money in the longrun, but still be a worthwhile social investment if therun, but still be a worthwhile social investment if themany social and personal benefits preventionmany social and personal benefits preventionproduces are included in the analysis. produces are included in the analysis.

Much depends on the way cost analysis is Much depends on the way cost analysis is conducted.conducted.

COST ANALYSES

Second, support for prevention should not beSecond, support for prevention should not be contingent on the results of cost analyses becausecontingent on the results of cost analyses because that would impose a higher standard for preventionthat would impose a higher standard for prevention than for other types of programs.than for other types of programs.

COST ANALYSES

Third, positive results from a cost analysis do not Third, positive results from a cost analysis do not automatically translate into more acceptance of automatically translate into more acceptance of prevention at the decision-making and policy level.prevention at the decision-making and policy level.

Although a cost analysis is one important aspect ofAlthough a cost analysis is one important aspect ofprogram evaluation, it is necessary to consider theprogram evaluation, it is necessary to consider theadministrative, political, and personal factors thatadministrative, political, and personal factors thatinfluence program support and maintenance.influence program support and maintenance.

COST ANALYSES