Evidence-based Prevention Strategies
A Concept Paper
Purpose
Previous work on evidence-based practices has been devoted to treatment options. Since treatment was an ongoing activity, defining and implementing those practices that were most likely to produce optimal outcomes could theoretically be accomplished without delays or additional cost. However, the purpose for identifying evidence-based practices in prevention, which may likely not be an ongoing activity in this community, needs to be specified. Is the purpose to fund, or seek funding, or to implement prevention programs in the near future?
Definitions
Two different definition sets exist - either focused on the population or an individual.
Public Health Definition of Prevention
- Primary-prevents a condition from developing (example, polio vaccine).
- Secondary-prevents a condition that has developed from getting worse (example, insulin for diabetes).
- Tertiary-applies to a developed condition that cannot be prevented or improved. Instead, supports are provided to ensure the best possible quality of life (i.e., therapy for cerebral palsy).
1994 Institute of Medicine - 2001 National Institute of Mental Health
- Universal Prevention interventions for mental disorders are targeted to the general public or a whole population group that has not been identified on the basis of universal risk.
- Selective prevention interventions are targeted to individuals or a sub-group of the population whose risk of developing mental disorders is significantly higher than average. The risk may be imminent, or it may be a lifetime risk.
- Indicated prevention interventions are targeted to high-risk individuals who are identified as having minimal but detectable signs or symptoms foreshadowing mental disorder, or biological markers indicating predisposition for the mental disorder, but who do not currently meet DSM-III-R diagnostic levels.
Target
What is to be prevented?
- Behavioral problems in children
- Aggression in adolescents
- Adolescent suicide
- Mental illness
- Learning problems in children
- Substance abuse
- Juvenile delinquency or adult criminal behavior
- Violent behavior
Criteria
The Technical Assistance Fact Sheet 1 (April 2005) from Penn State outlines the various criteria that have been developed for establishing standards for evidence-based programs.
Resources
Preliminary potential resources have been identified.
- Samhsa Model Programs. Contains an excellent, though broad, listing of programs by "promising," "effective," and "model."
- Prevention Research Center, Pennsylvania State University, established in 1997 with a focus on longitudinal developmental research on risk to promote competence and prevent maladaptive outcomes for children, families, and communities.
- Priorities for prevention research at NIMH. by NIMH, National Advisory Mental Health Council, Workgroup on Mental Disorders Prevention Research
from Prevention & Treatment. 2001 June Vol 4(1) 17 [Article A]
- National Institute of Justice (1997). Preventing Crime: What Works, What Doesn't, What's Promising: A Report to the United States Congress. Department of Criminology and Criminal Justice, University of Maryland: College Park, MD.
- University of Colorado's Center for the Study and Prevention of Violence (CSPV) was one of the first groups to apply specific criteria in determining effectiveness. Developed "blueprints" with criteria and a program matrix for model and evidence-based programs to reduce or eliminate "problem behaviors."
- Cornell, DG (2000). Effective Practices in Youth Violence Prevention, Juvenile Forensic Evaluation Research Center.
- Working Together to Promote Learning, Social-Emotional Competence, and Mental Health for All Children. A Position Paper of the School Mental Health Alliance.
- Flay BR, et al (2005). Standards of Evidence: Criteria for Efficacy, Effectiveness and Dissemination. Prevention Science, (On-line, May 16, 2005).
- Hill M. Walker, Co-Director, Institute on Violence and Destructive Behavior, University of Oregon
- Drake RE, Merrens MR, Lynde DW (2005). Evidence-Based Mental Health Practice. W.W. Norton & Company: New York, NY.
