Handbook of Youth Prevention Science

Beth Doll, William Pfohl, Jina S. Yoon

• Publisher: Routledge
• Year: 2012
• ISBN:
  9781135239626
• Edition: 1
• Topic: Pedagogía
• Subtopic: Educación general

The Handbook of Youth Prevention Science describes current research and practice in mental health preventive interventions for youth. Traditional prevention research focused on preventing specific disorders, e.g. substance abuse, conduct disorders, or criminality. This produced "silos" of isolated knowledge about the prevention of individual disorders without acknowledging the overlapping goals, strategies, and impacts of prevention programs. This Handbook reflects current research and practice by organizing prevention science around comprehensive systems that reach across all disorders and all institutions within a community. Throughout the book, preventive interventions are seen as complementary components of effective mental health programs, not as replacements for therapeutic interventions.

This book is suitable for researchers, instructors and graduate students in the child and adolescent mental health professions: school psychology, school counseling, special education, school social work, child clinical psychology and the libraries serving them. It is also suitable for graduate course work in these fields.

1
The Current Status of Youth Prevention Science

Beth Doll, University of Nebraska–Lincoln
Jina Yoon, Wayne State University

Youth prevention science is the empirically rigorous examination of practices that prevent psychosocial disturbances or promote psychological wellness in children and adolescents. These include careful examinations of the outcomes of policies and preventive interventions; and developmental investigations of the correlates, moderators, and mediators of youth disturbance or competence that provide the conceptual and theoretical underpinnings for preventive interventions. In its earliest incarnation, the prevention of psychosocial maladjustment in youth was termed the “mental hygiene” movement, drawing parallels between practices to strengthen psychological wellness in youth and community practices that promote physical health by cleaning the water and containing community waste and sewage (Hosman, Jane-Liopis, & Saxena, 2005). However, many prominent preventionists maintain that the science of youth prevention did not truly emerge until 1986 when the National Mental Health Association (NMHA) published its Commission Report recommending that youth prevention efforts be strengthened (Commission on the Prevention of Mental/Emotional Disabilities, 1987).

Albee (1996) believes that the origins began at least 10 years earlier. His own commitment to prevention science began when he worked with the 1960 Joint Commission on Mental Illness and Health, tasked with evaluating the United States’ mental health needs and resources and making recommendations for a national mental health program. He became convinced that, “No amount of research on treatment, even if resulting in success, can reduce incidence (rate of new cases)” (Albee, 2005, p. 313). He dates the birth of modern prevention science to the 1960s and 1970s when ambitious social programs were implemented to counteract the effects of poverty, prejudice, and other socially toxic stressors in the United States. A classic example of such social programs is the early intervention with pre-school children that began in the United States during the 1960s (Gettinger, Ball, Mulford, & Hoffman, this volume; Odom, Butera, Horn, Palmer, Diamond, & Lieber, this volume). By 1977, during Jimmy Carter’s presidency, education and social engineering were identified in a report of the President’s Commission on Mental Health as important strategies to prevent social disturbances and promote psychological wellness. This socioecological perspective on youth prevention science was shared by the NMHA’s commission when it specifically recommended comprehensive, multi-agency community programs to ensure that all babies were healthy and wanted, prevent adolescent pregnancy, integrate promotion of psychosocial competence into school programs, and help children and adults cope effectively with adversity (Commission on the Prevention of Mental/Emotional Disabilities, 1987).

Definitions of Prevention Science

Discussions of youth prevention research are inevitably complicated by inconsistent use of terms caused, in part, by the imperfect fit of borrowed medical terms to the sociopsychological phenomenon of youth prevention (U.S. Department of Health and Human Services, 1999). For example, primary prevention, secondary prevention, and tertiary prevention are classic terms attributed to the Commission on Chronic Illness (1957). Primary prevention refers to the prevention of diseases before they develop, secondary prevention refers to prevention of diseases’ worsening or recurrence, and tertiary prevention describes reductions in the functional impact of diseases subsequent to their development. These terms were widely adopted by mental health professionals to describe youth prevention programs, such as the Primary Mental Health Project (Cowan, 1994). Still, prevention researchers and practitioners were troubled by the terms’ implicit assumption that a disease was being prevented. Critics of the terms detailed multiple respects in which medical models were a poor fit for social, emotional, and educational prevention efforts. Four principal arguments were emphasized in these debates:

First, a focus on preventing diseases implies that health is the absence of disease. Critics of medical models argued, instead, that authentic definitions of social and psychological health must describe the characteristics of wellness and competence in addition to diagnostic criteria of pathology. Some researchers used the term “primary prevention” as an umbrella term to describe health promotion as well as disease prevention, but others did not follow suit, arguing that the terms had been contaminated by their emphasis on disease.

Second, a focus on preventing disease suggests that the purpose of services is to cure or eliminate disorders so that the youth can proceed through life “disease-free.” Critics of medical models endorse an alternative purpose of strengthening youths’ functional competence to meet the demands of their daily lives regardless of whether pathological symptoms of disorders are reduced or eliminated (Albee 1996; Biglan, 2004). Others broaden the purpose of youth prevention to include influencing “problems” that impair youths’ capacities to succeed in their daily lives and not just preventing “mental disorders” as defined within the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision, American Psychiatric Association, 2000).

Third, a focus on preventing disease requires that the presence or absence of a disorder be reliably identified. Diagnostic reliability, difficult enough within physical medicine, is often elusive within psychological disorders (Kaplan, 2000). Diagnostic criteria included in the DSM frequently require subjective judgments about the strength of a symptom from imprecise descriptions of the person or members of their family. Moreover, diagnoses do not always lead to effective treatment; they are not always correct; and they are not essential when problems are the result of risky behaviors or environmental risk rather than mental disorders.

Fourth, researchers concur that investigations describing the correlates, occurrence, or non-occurrence of a disorder are not sufficient to support a mature prevention science. Instead, effective prevention strategies require understanding the causes and mechanisms underlying negative life outcomes so that it is possible to alter or shift these mechanisms and increase the likelihood of positive outcomes (U.S. Department of Health and Human Services, 1999).

In the face of these and other criticisms, the Institute of Medicine convened a Committee on the Prevention of Mental Disorders and charged them with the task of reviewing the status of mental health prevention research (Mrazek & Haggerty, 1994). That committee’s report recommended that the term “prevention” be reserved for services provided before a mental disorder is present, and proposed the alternative terms of universal, selective, and indicated prevention which they had adopted with some modification from the earlier work of Gordon (1983). Within their spectrum of mental health services, universal prevention described preventive interventions provided to everyone in a community or group; selective prevention described services provided to those members of a group who were at higher-than-average risk for a mental disorder; and indicated prevention described services provided to group members at high risk for a mental disorder and who already evidenced some symptoms of a disorder, although without meeting the disorder’s full diagnostic criteria. (In current terminology, some researchers also use the word “targeted” instead of “indicated.”) Although the committee intended to provide a common language across prevention researchers and practitioners, its recommendations were widely criticized because the definitions continued to presuppose medical models of prevention and failed to acknowledge the importance of wellness promotion (Albee, 2004; Kaplan, 2000; Weissberg, Kumpfer, & Seligman, 2003). The American Psychological Association’s Task Force on Prevention endorsed a broader definition that incorporated both. Alternatively, Weisz, Sandler, Durlak, and Anton (2005) attempted to reconcile the wellness promotion and disease prevention models of mental health prevention by proposing a mental health intervention framework that included wellness promotion, universal prevention, selective prevention, indicated prevention, and therapeutic intervention.

At the same time as these definitional debates have raged within youth prevention science, schools have been rapidly moving to adopt a population-based model of prevention actualized into a three-tier approach in which the first tier is universal services, the second tier includes selective services to youth who evidence early signs of emotional or behavioral problems, and the third tier includes indicated services for students with significant emotional and behavioral problems (Dwyer & Van Buren, this volume; Osher et al., this volume; Walker et al., this volume). These tiers of intervention are frequently framed within a Response-to-Intervention model in which youth are identified for progressively more intense services based on data showing that their response to less intensive interventions was inadequate (Cooney, Kratochwill, & Small, this volume). Because these data can be used to describe either negative markers of maladjustment or positive indicators of student competence, educational three-tier approaches can be framed as preventing disabilities or promoting developmental competence. The three-tier approaches are represented within the U.S. Individuals with Disabilities Education Act as strategies to prevent educational disturbances and interrupt premature identification of students for special education services.

These definitional debates are not esoteric but are grounded in the very real dilemma that funding mechanisms outside of education are often wedded to the medical models of youth prevention, at least in the United States, despite the consensus among youth prevention scientists that prevention practices and research must emphasize socioenvironmental perspectives (Albee, 2004). The emphasis on promoting competence and diminishing the impact of environmental adversity is strikingly different from National Institute of Mental Health’s commitment to a program of well-controlled research designed to systematically examine the impact of preventive interventions on the emergence of psychopathology (Mrazek & Haggerty, 1994). NIMH funding explicitly excludes programs to promote psychosocial wellness and focuses instead on biological models of causation and particularly on neurobiological causes of specific mental disorders. Moreover, priorities in mental health funding in the United States continue to emphasize programs to treat psychopathology over prevention programs (Cooney et al., this volume). At the same time, social-environmental frameworks are highly compatible with public education’s mission to promote the success of all youth. One likely outcome is the emergence of at least two competing frameworks for youth prevention science—one operating within population-based agencies such as public schools and another dominant within health service agencies. Dwyer and Van Buren (this volume) make a more optimistic prediction—that with time, researchers will come to understand that the two perspectives (environmental supports for wellness and biological contributions to psychopathology) are not truly competing.

Conceptual Foundations for Youth Prevention

Since 1980, developmental research has shed light on the complex phenomenon of child and adolescent mental health and their developmental competence (Bumbarger, Perkins, & Greenberg, this volume). In particular, cumulative knowledge from developmental psychopathology and epidemiology research has contributed to the conceptual foundations for youth prevention science. In the United States, epidemiological research in developmental psychopathology has significantly altered estimates of the prevalence of mental disorders in youth. Whereas pre-1980 estimates of childhood mental illness suggested that between 5% and 7% of school-aged children met the criteria for one or more mental disorders described by the Diagnostic and Statistical Manual of Mental Disorders (4th Edition; American Psychiatric Association, 1996), epidemiological studies funded by the National Institute of Mental Health consistently identified between 18% and 22% of their community samples as meeting the criteria for psychopathology (Doll, 1996; U.S. Department of Health and Human Services, 1999). The functional impact of these mental disorders on children’s developmental success has not been fully described by researchers, but the relevance of psychological health and wellness to subsequent adult success is amply documented.

The striking prevalence of psychopathology among youth is particularly alarming, given that early signs of maladjustment often proceed to later difficulties in educational, social, and occupational roles during adolescence and adulthood. Results of these epidemiological studies emphasized the importance of very early intervention to promote psychological wellness and prevent long-term disturbances. When prevention research identifies the early warning signs that place children at a higher risk of failure, early preventive interventions can be more effective and less costly than therapeutic interventions provided once children meet diagnostic criteria for a disorder. Moreover, epidemiological evidence for incidence, prevalence, and severity of youth problem behaviors provides important direction so that communities can “systematically prioritize child and adolescent problems in terms of their cost and the likely benefits of preventing each of them” (Biglan, Mrazek, Carnine, & Flay, 2003, p. 433). As such, epidemiological research strategies are critical in evaluating the effectiveness of prevention efforts and ensuring that prevention approaches are guided by evidence.

As a second contribution, the field of developmental psychopathology has documented a number of individual characteristics and contextual variables that are responsible for the different forms and severity of developmental maladjustment (Mash & Dozois, 2003). One important finding from this research is that socioecological features of children’s lives are as important as individual child characteristics in predicting children’s healthy development or the incidence and severity of psychopathology (Coie et al., 1993; Doll & Lyon, 1998; Werner, 2006). For example, children’s exposure to poverty, family violence, parental psychopathology, or community violence significantly increases their chances of developing a debilitating mental illness, while their access to caring adults, high-quality parenting, and effective community support services can protect some children from psychopathology. These findings further suggest that evidence-based social and mental health services should emphasize the creation of strong and effective caretaking systems (i.e., family, school, and community) as much as the remediation of individual characteristics. Moreover, coordinated prevention efforts across families, schools, and communities are likely to be more effective than isolated, stand-alone programs (Greenberg et al., 2003; Kumpfer, Alvarado, Tait, & Turner, 2002; Wandersman & Florin, 2003).

A third important perspective of developmental psychopathology is the recognition of ongoing reciprocal influence of multiple factors in explaining youth outcomes. Such concepts as heterotypic continuity, multi-finality, and equi-finality highlight the multi-factorial, longitudinal nature of developmental maladjustment that is further complicated by mediating and moderating influences. As we learn more about the risk and protective factors associated with certain forms of psychopathology, community prevention strategies and approaches are likely to become more specific and tailored. Although it is chal...

Table of contents

• Contents
• Figures and Tables
• 1 The Current Status of Youth Prevention Science
• 2 Placing Prevention into the Context of School Improvement
• 3 School Mental Health
• 4 Screening for Mental Health and Wellness
• 5 Implementing Universal Screening Systems Within an RtI-PBS Context
• 6 Building Conditions for Learning and Healthy Adolescent Development
• 7 Assessment for Integrated Screening and Prevention Using the Resiliency Scales for Children and Adolescents
• 8 Social Support
• 9 Peer Support as a Means of Improving School Safety and Reducing Bullying and Violence
• 10 The Developmental Implications of Classroom Social Relationships and Strategies for Improving Them
• 11 Factors Influencing Teacher Interventions in Bullying Situations
• 12 Development, Evaluation, and Diffusion of a National Anti-Bullying Program, KiVa
• 13 Promoting the Well-Being of School Communities
• 14 Promoting Student Resilience
• 15 Stimulating Positive Social Interaction
• 16 A Hybrid Framework for Intervention Development
• 17 Check & Connect
• 18 Prevention and Early Intervention for Preschool Children at Risk for Learning and Behavior Problems
• 19 Partnering to Achieve School Success
• 20 Dissemination of Evidence-Based Programs in the Schools
• 21 Prevention, Early Childhood Intervention, and Implementation Science
• 22 Taking Effective Prevention to Scale
• 23 Youth Policy and Politics in the United States
• Editors
• Contributors
• Index