• By Kevin Mount
  • Posted on Wednesday 25th March, 2009

Pull down the silos - it's time to pool resources

The year-long inquiry that has culminated in the publication this week of the National Academies report on the future of prevention science should help to set the agenda for the coming decade.The core message of Preventing Mental, Emotional and Behavioral Disorders Among Young People is that prevention should be at the heart of future research, policy and practice. The last 15 years have seen it emerge as a discipline in its own right; the main hope for the next decade is that it should be integrated into all that is done on behalf of children.Many of the recommendations are aimed at US Federal and State Government, headed by the call for a government entity to lead on the implementation of evidence-based approaches.Just as there are national goals for children’s educational performance in the US, so the Academies make the case for national benchmarks against which aspirations to prevent disorders can be judged and funded. Regular and reliable measurement of the incidence of mental, emotional and behavioral disorders, to see how they change, is also advocated.The committee calls on the White House to align education, justice and health resources, not simply to break down the silos of central government but also to support integration at state level and promote links between professional organizations. Better connections between state, county and community on preventing disorders are natural secondary target. Parents, children, schools, child welfare, justice and health systems and community leaders are encouraged to engage in the conversation about stopping problems before they occur.In the same strategic spirit, the report explicitly calls upon federal and state agencies to withdraw funding from programs that are not underpinned by robust evidence.In recommending the next cycle of research, the National Academies recommend that the National Institutes of Health, the primary science funder in the US, to work with other funders to develop a ten-year plan to research the promotion of child well-being, and the reduction of mental, emotional and behavioral disorders. One ambition would be a better balance between studies of prevention and investigations into intervention.Other prominent research recommendations include the study of what is required to take effective prevention programs to scale – Type 2 translation questions, which the committee refer to as implementation or dissemination research. Much more attention, the authors suggest, should be given to screening programs that identify children at risk of mental, emotional and behavioral disorders, similarly to the interacting roles of genes and biology in their development, and to the advance in economic analysis of prevention programs.ReferencesNational Research Council and Institute of Medicine of the National Academies, Preventing Mental, Emotional and Behavioral Disorders Among Young People, The National Academies Press, Washington, D.C., 2009Institute of Medicine, Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research, The National Academies Press, Washington, D.C., 1994

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