The dilemma of primary prevention in mental health services: Rationalize the status quo or bite the hand that feeds you

That primary prevention has been ‘inappropriately marginalised’ is seen to be an inevitable outcome of reliance on government support. Policy makers and service providers can never be expected to give prevention a higher priority than direct service. Preventionists have developed two strategies for doing their work. One, based on the logical positivist ideal, seeks specific causal models for specific disorders. This sort of prevention research, while it will always remain less well funded than direct services, tends not to challenge the status quo belief in individual responsibility, or the acceptable methods of mainstream science, and thus will tend to be more acceptable than other forms of prevention research and services. An alternative, based on a social constructivist paradigm engages in social action research through collaboration with a variety of grass roots organizations and people outside the mainstream of power. This latter approach, brings to preventionists ideas from feminists, ethnic minority leaders, neighborhood organizers, and self and mutual help group leaders. It is a sensible way to use the resources available to those professionals interested in social change oriented prevention.     

Academic on a mission: Run and run and run

Challenges the distinctions we make between research/scholarship and practice. Recognizes and values the complimentarity of teaching, research, practice, and public policy. Tells how I have tried to approach creating opportunities to integrate those activities in my role as a community psychologist in an academic setting. Describes some of the lessons I have learned from my two decades of practice. This article is a very close approximation to my Distinguished Contribution to Practice in Community Psychology award address at APA in Toronto, August 1996. That talk included numerous overheads, which reason demands I omit. I thank Jim Sorenson and George Albee who, each in their own way, showed me that university professors can be passionate about their work and extend their reach beyond the perimeters of the campus. I thank Heather Barton, Krista Hopkins, Jennifer Heigel, and Anne Salassi for being such good ambassadors and for my most meaningful source of professional satisfaction: turning students on to careers as community psychologists and preventionists. I thank the Virginia prevention community for two decades of working together toward a common mission and the College of William and Mary for supporting my life’s work. Finally I thank John Morgan for his friendship and his affirming introduction, State Michaels for her help with the original talk, and Beverly Peterson for always being there. I am deeply honored.     

Mobilizing positive reinforcement in communities to reduce youth access to tobacco

A community intervention to mobilize positive reinforcement for not selling tobacco to young people was evaluated. The intervention had five components: (a) mobilization of community support, (b) merchant education, (c) changing consequences to clerks for selling or not selling to those under 18, (d) publicity about clerks’ refusals to sell, and (e) feedback to store owners or managers about the extent of their sales to adolescents. A multiple baseline design experiment was conducted, in which two small Oregon communities received the intervention, while two others continued in baseline. Outlets’ willingness to sell was assessed repeatedly by teenage volunteers. The intervention significantly reduced the proportion of stores willing to sell. Mobilizing socia and material reinforcement for stores not selling tobacco to young people is a viable means of reducing such sales. It may be especially valuable in communities where laws against sales to minors go unenforced. This paper supported in part by the National Cancer Institute Grant CA38273.     

Empowerment praxis in community coalitions

Community coalitions address a wide variety of community problems, espousing a community development processes that promotes individual and collective self-determination. They offer a promising venue for the study of empowerment of individuals and organizations. This study utilizes data from members of 35 community coalitions organized for the prevention of alcohol and other drug problems to address the following questions: What individual characteristics are related to the psychological empowerment of coalition members? What organizational characteristics are related to the collective empowering of members? What organization characteristics are related to a coalition being organizationally empowered to succeed in achieving its objectives? At the individual level, psychological empowerment was most strongly related to individuals' participation levels, sense of community, and perceptions of a positive organizational climate. At the group level, the strongest predictors of collective empowering (our operationalization of the empowering organization) were net benefits of participation, commitment, and positive organization climate. Psychological empowerment and positive organizational climate were the two predictors of organizational effectiveness (the empowered organization). Implications and limitations of these findings are discussed.     

An Ounce of Prevention: A Model for Working with Couples At-Risk for Battering

Literature on preventing spousal battering before it starts is virtually non-existent. This article describes a prevention of abuse program that targets couples at-risk for battering. At-risk couples and the process of engaging them in couples counseling are described. The prevention model is based on a Bowenian approach that focuses on partner differentiation and reducing emotionality and promoting rational thinking. It is assumed that increasing differentiation decreases the risk of spousal battering. The various techniques used to facilitate differentiation are presented as well as a case example illustrating a successful prevention of abuse experience.     

In Praise of a Cumulative Prevention Science

Durlak and Wells (1997) provide a pivotal appraisal of prevention research on children and adolescents. Their meta-analytic approach has the advantages of reducing scientific misjudgments based on single studies, and providing a more balanced evaluation of impact of various interventions; it provides an opportunity for hypothesis finding, helps set methodological standards, allows assessment of working classifications in the field, and an evaluation of the maturity of the prevention field itself. New developmental tasks for the field include incorporating and pursuing the leads produced by these findings, conducting similar research syntheses with other populations and outcomes, and using the results as an impetus to increased operational precision and parsimony.     

Primary Prevention Mental Health Programs: The Future is Exciting

Current outcome research on primary prevention mental health programs is encouraging and the future is exciting. Data continue to accumulate regarding the efficacy of preventive intervention. Exemplary programs can prevent multiple problems across different outcome domains suggesting the need for collaboration among preventionists across disciplines and research areas. The commentators on our review (Durlak and Wells, 1997) offered many useful suggestions to improve the next generation of research. Most recommendations fall broadly under the rubric of increasing the precision of theory, design, and program evaluation. If current recommendations for improving future research are followed, the next reviewers of primary prevention mental health programs for children and adolescents will have a more complete and useful database for analysis.     

Adolescent AIDS Prevention in Context: The Impact of Peer Educator Qualities and Classroom Environments on Intervention Efficacy

Peer-led, school-based interventions show promise for preventing AIDS among adolescents, but little is known about the processes underlying effective peer education or the conditions that promote its efficacy. This study examined the implementation in one school of an effective, peer-led AIDS prevention program for inner-city 7th-grade participants (n = 123) and identified the qualities of peer educators (n = 15) and classroom environments (n = 5) that contributed to improvement in participants' postintervention AIDS-related attitudes. The Peer Educator Rating Scale was developed to assess two dimensions of participants' perceptions of peer educators: positive regard and perceived similarity. Participants reported greater positive regard for more highly individuated and less shy peer educators, and participants' positive regard for peer educators in turn was associated with lowered AIDS risk as measured by perceptions of peer norms regarding sexual activity and self-efficacy for peer communication regarding sexual topics and condoms. Participants' perceived similarity was not associated with any postintervention improvements in AIDS-related knowledge and attitudes. Participants' classroom membership was associated with improvements in all 5 knowledge and attitude scales, and exploratory classroom-level findings indicated that classroom intervention environments perceived as more organized by participants showed slightly greater overall improvements across AIDS-related knowledge and attitudes scales. Consistent with individual-level findings regarding participants' positive regard for peer educators, the two classrooms with the greatest positive regard for their peer educator teams showed the most student improvement. Implications for further research and the design of future prevention and promotion programs for adolescents are discussed.     

School-Based Secondary Prevention for Children with Disruptive Behavior: Initial Outcomes

First through fourth graders from 22 suburban elementary schools were screened for cross-setting disruptive behavior as eligibility criteria for participation in a longitudinal secondary prevention study aimed at reducing the risk for serious externalizing behavioral disorders. Three hundred nine subjects participated in either a multicomponent competence enhancement intervention (MCEI) or an information/attention control (IAC) condition over a 2-year period. Following baseline measurements, initial intervention effects were assessed at the end of intervention Year 1, at the beginning of intervention Year 2 (fall of the next school year), and at the end of intervention Year 2. Multisource assessments were not supportive of the efficacy of the MCEI over the IAC condition. Children in both groups rated themselves as improved over time in terms of increased adaptive skills and decreased school problems and internalizing symptoms. Teacher and parent ratings of externalizing behavior did not yield evidence of positive change, but teachers noted improved problem solving and observers noted a decrease in behavioral interference in both groups over time, possibly as a result of maturation.     

On the Semantics and Operations of Primary Prevention and Wellness Enhancement (Or Will the Real Primary Prevention Please Stand Up?)

Compared two recent, major reviews of primary prevention program evaluation research (i.e., Durlak and Wells' meta-analysis of 177 such studies and the Institute of Medicine (IOM) Report's summary of research studies of preventive intervention programs) with respect to specific studies included and input sources used. Whereas the IOM Report defined the goal of primary prevention as reducing the occurrence of new cases of mental disorder, Durlak and Wells' broader definition included both that goal and the promotion of psychological wellness. Overlap in journal sources used by the two reviews was modest and overlap in the actual primary prevention program evaluation studies included was minimal (7%). These findings bespeak somewhat different views of primary prevention and suggest a need for the complementary development of both the above approaches as alternatives, individually and collectively, to mental health's past established restorative ways.