• By Kevin Mount
  • Posted on Friday 27th March, 2009

Prevention for all? Same over here!

The US National Academies' call for government action on Preventing Mental, Emotional and Behavioral Disorders Among Young People is beginning to be echoed by the international community of “preventionists”.No great surprise, since the obstacles to more effective prevention in the US are similar to those faced by the scientific and practitioner communities in the UK and continental Europe and Australasia, North American experts have re-affirmed the strengths of the National Academies’ approach. For example, David Hawkins, founding Director of the Social Development Research Group at the University of Washington, Seattle, and co-originator of the Communities that Care operating system, has welcomed the continuing distinction between prevention and treatment and the promotion of mental health as an empirically valid strategy. Hawkins drew attention to the importance of systematic epidemiology to measure mental health and behavioral outcomes in states and communities. “The broad challenge,” he said, echoing the call for a White House Office of Prevention, “is to get prevention into the mainstream.” Mark Greenberg at Penn State University's Prevention Research Center emphasized the challenges ahead. “The Committee has rightly focused on dissemination and sustainability. At present, only a small percentage of those who could benefit from evidence-based preventive interventions or services receive them. An even smaller percentage receive high quality interventions.”That sentiment is shared in the UK. Stephen Scott, Director of Research at the National Academy for Parenting Practitioners in London. He commented: “We need to address how to engage with the most needy families, since many still shun services. "There may be hard questions to face about whether society can insist, for the sake of the children, that parents attend parenting courses. I welcome the fact that the publication rightly calls for more joined up services and higher quality front-line staff.”  As the National Academies report acknowledges, several European countries have been making significant advances in the integration of prevention into systems at federal, state and local levels. Norway, for example, has adapted Parent Management Training from a US program and implemented it across the country. A national center co-ordinates the training, supervision and support of local providers.The Netherlands has invested in the training of health promoters and prevention workers who operate across health, justice and education sectors. Half of their work concerns the prevention of mental ill-health.In Finland the idea has been to train existing children’s services professionals. By the end of 2006, there were 650 fully trained clinicians and 80 qualified trainers to deal with parental depression, drug and alcohol problems, and families coping with chronic ill-health.Arguably, outside the US more attention goes toward securing better outcomes for all children; inside, the priority tends to be those at highest risk of impairments to health and development. Triple P’s originator Matt Sanders, Professor of Clinical Psychology and Director of the Parenting and Family Support Centre at the University of Queensland, Australia, welcomed the National Academies’ recognition of the value of a public health perspective. “Parenting interventions have the greatest potential for reducing conduct and other disorders at a population level. When they are offered to all, approaches such as Triple P are de-stigmatized, normalized and can be made to fit with a range of delivery options. It allows us to tailor the level of support to parents’ needs.”Stephen Scott has come to similar conclusions. “If we are to see a change in our culture, we also need to engage the media in a public campaign to raise standards of care and education for children." It has been an eventful week in Washington. The economic crisis continues to dominate the world headlines, and against that background the National Academies report may seem to pale into insignificance. But 20 years on, it may be that the work of a small group of prevention experts stands out as the more lasting contribution to the sum of human well-being.Mark Greenberg, Director of the Prevention Research Center at Penn State University sums up the result this way:“This Committee has done an exemplary job in reviewing the state of prevention research and practice and elucidating the next steps in a broad public health agenda. Central to this endeavor is the re-assertion of a clear definition of prevention that separates it from treatment from both a conceptual and practical standpoint.  “Working closely with practitioners and policy-makers we must build a reliable and effective system to broadly disseminate effective interventions. In doing so, we will build a new model of the science of effective dissemination.”See: Preventing Mental, Emotional and Behavioral Disorders Among Young People, The National Academies Press, Washington, DC, 2009

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