• By Kevin Mount
  • Posted on Saturday 30th May, 2009

Show me the money and I’ll show you what works

In an unmistakably symbolic gesture, Society for Prevention Research president Zili Sloboda yesterday sacrificed her conference address to spotlight the Obama administration's response to the Institute of Medicine's argument for investment in US mental health. Sloboda gave way first to Mary Ellen O’Connell, study director of the March report, who laid out the key findings and recommendations that set out a research agenda for the next decade. She stressed the scale of the problem (the report estimated that between 14% and 20% of US children suffer from some type of mental health disorder). She also highlighted the social costs and the financial burden placed on society by a population experiencing poor mental health – an estimated $247 billion in "heavy-end services," plus additional costs for education and social welfare and personal costs to individuals. But there was some good news, she said. Since the last Institute of Medicine report in 1994 there had been an explosion in the number of randomized control trials supporting a broad range of interventions to improve children’s mental health. These trials and the results of increasingly vigorous epidemiological and etiological research were beginning to identify the reasons problems developed, and what could be done to stem the tide. Prevention was the acknowledged key. Kathy Stack, a senior policy maker from the US Office of Management and Budget, had some bad news. “Policy makers rarely pay attention to the strong evidence base you’ve created,” she said.[See : "Show me the money and I’ll show you what works"]She also had the latest on a bold step being taken by the White House. The Institute of Medicine had reported that one of the biggest challenges to be faced over the next ten years was large-scale implementation and sustainability of evidence-based interventions. The new administration’s response has been to throw money at the problem. Apparently convinced by the weight of evidence supporting Nurse Family Partnership, and particularly by the potentially huge cost-benefit returns, the Federal Government has announced spending of $124million in discretionary funds on home-visitation programs. And it was to be no short-term fix, Kathy Stack said. Even in the midst of the current economic crisis, funding would rise to $8.6billion over the next ten years. States were being invited to apply to one of two funding tiers. The top tier funded only those home visitation programs supported by the highest standards of evidence, such as Nurse Family Partnership. Second tier funding extended to interventions that had a strong body of evidence but perhaps lacked randomized controlled trial or quasi-experimental robustness. They were also eligible but only on condition that further tests of effectiveness and cost-benefit would be carried out. Home visitation is not the only focus of the attempts to get evidence-based interventions more widely adopted and to promote new lines of attack. A similar investment of $110million is being made to prevent teenage pregnancy. So while prevention scientists try to improve the science of taking evidence-based interventions to scale (focusing on issues of dissemination, fidelity and sustainability), the White House is taking a blunter approach, but one that will create a wave that scientists and service providers will no doubt want to ride. • For more about Preventing Mental, Emotional and Behavioral Disorders Among Young People, see for example, Pull down the silos - it's time to pool resources and Has the time come for the "preventionist"?

Back to Archives