Prospects for the Prevention of Mental Illness:
New Developments and New Challenges
Risk Factors are not
predictive factors
due to protective
factors
Carl C. Bell, MD
Committee Charge
Review promising areas of research
 Highlight areas of key advances and
persistent challenges
 Examine the research base within a
developmental framework
 Review the current scope of federal efforts
 Recommend areas of emphasis for future
federal policies and programs of research

Committee Members

KENNETH WARNER (Chair), School of Public Health, University of Michigan
THOMAS BOAT (Vice Chair), Cincinnati Children’s Hospital Medical Center
WILLIAM R. BEARDSLEE, Department of Psychiatry, Children’s Hospital Boston
CARL C. BELL, University of Illinois at Chicago, Community Mental Health Council
ANTHONY BIGLAN, Center on Early Adolescence, Oregon Research Institute
C. HENDRICKS BROWN, College of Public Health, University of South Florida
E. JANE COSTELLO, Department of Psychiatry and Behavioral Sciences, Duke
University Medical Center
TERESA D. LaFROMBOISE, School of Education, Stanford University
RICARDO F. MUNOZ, Department of Psychiatry, University of California, San Francisco
PETER J. PECORA, Casey Family Programs and School of Social Work, University of
Washington
BRADLEY S. PETERSON, Pediatric Neuropsychiatry, Columbia University
LINDA A. RANDOLPH, Developing Families Center, Washington, DC
IRWIN SANDLER, Prevention Research Center, Arizona State University

MARY ELLEN O’CONNELL, Study Director

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IOM: Reducing Suicide
Report where the
notion that risk factors
were not predictive
factors due to protective
factors developed.
Categories of Adverse
Childhood Experiences
Psychological abuse
Physical abuse
Sexual abuse
Violence against mother
Living with household members who were
substance abusers
Living with household members who were
mentally ill or suicidal
Living with ex-offender household members.
RESULTS
More than half of respondents
(52%) experienced > 1
category of adverse childhood
exposure
6.2% reported > 4 exposures.
RESULTS
Persons who experienced 4 or more
categories of childhood exposure,
compared to those who had experienced
none had:
7.4 fold increase for alcoholism
10.3 fold increase for drug abuse
4.6 fold increase for depression
12.0 fold increase in suicide attempts.
RESULTS
Persons who experienced 4 or more categories
of childhood exposure, compared to those who
had experienced none had
2.2 fold increase in smoking
2.2 fold increase poor self-rated health
3.2 fold increase in > 50 sexual
intercourse partners
2.5 fold increase in sexually
transmitted disease.
RESULTS
Persons who experienced 4 or more categories
of childhood exposure compared to those who
had experienced none had
2.2 fold increase in ischemic heart disease
1.9 fold increase cancer,
3.9 fold increase in chronic lung disease
(bronchitis and emphysema),
1.6 fold increase in skeletal fractures,
2.4 fold increase in liver disease.
Facts about Depression & Suicide
20,000 out of 100,000 people get depressed
 5,000 out of 100,000 people attempt suicide
 11-20 out of 100,000 people complete
suicide.
 Something must be protecting the 19,980
people who are depressed and the 4,980
people who have attempted suicide.

Trauma is Ubiquitous
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Bell & Jenkins (1985) found that 25% & 30% of inner-city
Chicago youth, ages 7-15, had seen a shooting & stabbing.
Using structured telephone interviews in a national sample of
4,008 adult women, Resnick et al (1993) found a lifetime rate of
exposure to any type of traumatic event of 69%.
Kessler et al (The National Comorbidity Survey - 1995) found
that more 50% of nearly 6,000 subjects, ages 15 – 54, had
experienced a traumatic event during their lifetime & most
people had experienced more than one.
Breslau et al (1998) examined trauma exposure & the diagnosis
of PTSD in a community sample of 2,181 individuals in the
Detroit area and found that the lifetime prevalence of trauma
exposure was 89.6%.
Exposure To A Traumatic Event Does Not Automatically
Put A person On A Path To Develop PTSD: The Importance
of Protective Factors To Promote Resiliency
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Kessler et al (1995) found 8% of males and 20% of females
Breslau et al (1992) found 10% of males and 14% of females
who were exposed to trauma had a lifetime prevalence rate of
PSTD)
Exposure to a traumatic stress does automatically mean a
victim of trauma is predisposed to develop PTSD.
Most people affected by a trauma event will adapt in a period
of 3 – 6 months following trauma (Riggs et al, 1995) and only a
small proportion will develop long-term psychiatric disorders
(Bryant, 2006; Bryant 2006).
Paradigm Shift
“Risk factors are not predictive
factors because of protective
factors.”
Child Welfare: CANS Psychiatric Symptoms
Integrated Assessment, FY06
30
25
25.4
20
17.9
17.7
15
16.7
10
5
0
Trauma
Attach
Anger
Depress
%
N=1375
The Impact of Trauma Experiences on Risk
Behaviors
2
Risk Average (z)
1.5
1
0.5
0
-0.5
-1
-1.5
-2
-2
-1.5
-1
-0.5
0
0.5
1
1.5
Traumatic Experience Score (10,25,50,75,90 Pctl)
2
Risk of Symptoms & Strengths
2
STR
STR
STR
STR
STR
Risk Average (z)
1.5
1
90th
75th
50th
25th
10th
Pctl
Pctl
Pctl
Pctl
Pctl
=
=
=
=
=
1.27
0.72
-0.01
-0.73
-1.38
0.5
0
-0.5
-1
-1.5
-2
-2
-1.5
-1
-0.5
0
0.5
1
1.5
Traumatic Experience Score (10,25,50,75,90 Pctl)
2
The Contribution of
Prevention Science

The scientific foundation has been
created for the nation to begin to create
a society in which young people arrive
at adulthood with the skills, interests,
assets, and health habits needed to live
healthy, happy, and productive lives in
caring relationships with others.
Disorders Are Common and Costly
 Around
1 in 5 young people (14-20%)
have a current disorder
 Estimated $247 billion in annual costs
 Costs to multiple sectors – education,
justice, health care, social welfare
 Non-monetary costs to the individual
and family
Dr. David Satcher’s
Children’s Mental
Health Conference
suggested our
Nation focus on:
• Children in Child
Protective Services
•Children in
Juvenile Justice
Facilities
•Children in
Special Education
Preventive Opportunities Early in Life
 Early
onset (¾ of adult disorders had
onset by age 24; ½ by age 14)
 First symptoms occur 2-4 years prior to
diagnosable disorder
 There are common risk factors for
multiple, different problems and
disorders
NIMH Prevention Spending - 2008
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Prevention (RCDC FY2008) = $208,278,505
695 grants in this pile but only 60 (8.6%) were prevention grants.
Prevention Effectiveness Research (RCDC FY2008) = $34,281,125
107 grants in this category and about 32 (29.9%) were prevention grants.
Prevention Health Services Research (RCDC FY2008) = $28,970,981
100 grants here but only 15 (15%) were prevention grants (liberal
definition).
Dissemination and Implementation Research = $23,746,062
67 of these grants and 6 (9%) were prevention grants.
Dissemination and Implementation Research in Prevention = $4,703,195
18 grants and 6 (33%) were prevention grants & some PI's were in the
above category.
Effectiveness Research (RCDC FY2008) = $76,805,163
217 grants and 32 (14.5%) were prevention grants.
Health Services Research (RCDC FY2008) = $94,273,008
328 grants and 16 (4.9%) were prevention grants & some PI’s were in the
above category.
Research Funding Illustration
Key Core Concepts of Prevention
1.
Prevention requires a paradigm shift
2.
Mental health and physical health are inseparable
3.
Successful prevention is inherently interdisciplinary
4.
Mental, emotional, and behavioral disorders are
developmental
5.
Coordinated community level systems are needed to
support young people
6.
Developmental perspective is key
Explosion in Randomized Trials
24
Resource silos
Activity-driven
Different language
Different goals
How are we functioning?
Common
language
Evidence based
Outcome
driven
Maximize
resources
We need Synergy and a Integrated System
Common Risk Factors for
Multiple Problems

Poverty

Coercive processes in families

Lack of self-regulation
Aggressive social behavior that is
developmentally appropriate
Risk Factors Are Not Predictive Factors
Due To Protective Factors

The Critical Role of Self-Regulation


Neuroscience and behavioral
research are converging on the
importance of self-regulation for
successful development
Children who do not develop the
capacity to inhibit impulsive
behavior, to plan, and to regulate
their emotion are at high risk for
behavioral and emotional
difficulties
Prevention Window
Defining Prevention and
Promotion
 Prevention
should not include the
preventive aspects of treatment
 Prevention and promotion overlap,
but promotion has important distinct
role
 Mental health not just the absence of
disorder
Mental Health Promotion Aims to:
Enhance individuals’ ability to achieve
developmentally appropriate tasks
(developmental competence)
Enhance individuals’ positive sense of
self-esteem, mastery, well-being, and
social inclusion
Strengthen their ability to cope with
adversity
Prevention AND Promotion
Preventive Intervention Opportunities
Generic Features
of Preventive Interventions
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Reduce or minimize toxic biological and
psychological processes
Richly reinforce self-regulated, prosocial
behavior
Teach prosocial skills and values
Foster acceptance
Evidence that Some Disorders Can
be Prevented
 Risk
and protective factors focus of
research
 Interventions are tied to these factors
 Multi-year effects on substance
abuse, conduct disorder, antisocial
behavior, aggression and child
maltreatment
Evidence that Some Disorders Can
be Prevented
 Indications
that incidence of adolescent
depression can be reduced
 Interventions that target family
adversity reduce depression risk and
increase effective parenting
 Emerging evidence for prevention of
clinical schizophrenia
Nurse-Family Partnership*
 Pregnancy through infancy
 Focus on
 Prenatal care
 Maternal smoking
 Mothering
 Contraception
 Work life
* Funded in part by NIDA
Nurse-Family Partnership
 Evaluated in three randomized trials for
poor, teenager single mothers,
 Significant effects on
 Abuse and neglect
 Children’s behavioral development
 Mother’s economic wellbeing
 Time to next baby
 Children’s arrest as adolescent
Adjusted rates of arrests,
15-year olds, Elmira
0.4
PC-NP & C-NPI = .005
0.35
0.3
0.25
0.2
0.15
0.1
0.05
0
Comparison
Nurse P
Nurse P&I
CPS CRADLE TO CLASSROOM
Collaborative initiative with Chicago Public
Health Department, six hospitals, & other
agencies for pregnant & parenting teens
Trains teens in the development of parenting
skills and accessing community resources
Provides teens access to prenatal,
nutritional, medical, social, and child care
services
Provides counseling to new mothers around
issues of domestic violence
CPS CRADLE TO CLASSROOM
 Some 2000 teenagers in 54 Chicago schools that
offer this program had babies in 2002. All 495
seniors graduated, and 78% of them enrolled in 2or 4-year college programs.
 Only 5 of the women had a repeat pregnancy while
still in school; 4 were graduating seniors, and the
other, a junior, stayed in school. Eighty-five teen
fathers also participated in the program, learning
parenting skills under the supervision of a male
mentor at each school.
 The program's annual budget was $3.7 million
Positive Parenting Program—
Triple P*
 A community-wide system of parenting
supports that includes
 brief media communications,
 brief advice for specific problems, and
 more extensive interventions when needed
 Multiple randomized trials showing benefit
 Including an RCT in 18 counties in South
Carolina
* Funded in part by NIDA
Substantiated Child
Maltreatment
Before Triple P
After Triple P
Rates per 1,000 Children (0-8 Years)
16
12
8
4
0
Triple P Counties
Control Counties
Child Out-of-Home
Placements
Rates per 1,000 Children (0-8 Years)
Before Triple P
After Triple P
4.500
4.000
3.500
3.000
2.500
2.000
1.500
1.000
.500
.000
Triple P Counties
Control Counties
Effect size = 1.22, p <.01, showing Triple P decreased
medical injuries in counties using Triple P, compared
to control counties not receiving Triple P increasing.
Strengthening Families 10-14
(Spoth et al., 2001)*
 Group-based parenting program for parents of early
adolescents
 Effects up to six years later
 Reduced tobacco, alcohol, & drug use—including
methamphetamine use
 Reduced delinquency
 Cost-effectiveness (Aos et al., 2004)
 Savings of $7.82 per dollar invested
 Total savings of $5,805 per youth
* Funded by NIDA
The Family Check-Up*
 Provides parenting support to families of adolescents via
a family resource center in middle schools
 Effects as much as five years later
 Reduced substance use
 Fewer arrests
 Better school attendance & academic performance
 Cost-effectiveness (Aos et al., 2004)
 Savings of $5.02 per dollar invested
 Total savings of $1,938 per youth
* Funded in part by NIDA
New Beginnings Program (NBP)
Small group program for divorcing
families
 Emphases on learning new skills and
applying them in the family

Marijuana Use -- Last 12 Months
79
80
70
56
Percentage
60
50
40
28
30
16
20
13
8
10
0
0-2
3-9
10 +
Number of Use
Control
NBP
CMHC’s Work in McLean County, Illinois
 The twin cities of Bloomington/Normal and
Peoria, Illinois are located in McLean and
Peoria counties, respectively, 135 -160
miles South of Chicago.
 The two cities have a combined population
base of 227,000 residents (Brinkhoff,
2005), approximately 25 percent of whom
are African-American (Children and Family
Research Center, 2003).
CMHC’s Work in McLean County, Illinois
Of the counties in this Central Illinois area
(Fulton, Marshall, McLean, Peoria,
Tazwell, and Wollford), McLean and
Peoria are the only two with a substantial
African-American population – 10.2% and
37.6% respectively, with all the rest having
less than 1% (Children and Family
Research Center, 2003).
CMHC’s Work in McLean County, Illinois




In 1999, the Illinois Department of Children and Family
Services learned there was a problem in child protective
services in McLean & Peoria counties in Illinois
In 1999, the average rate of removal of children from
their families was 4/1,000.
In 1999, in McLean and Peoria counties in Illinois, the
average rate of removal of children from their families
was 35 - 40/1,000.
By 2000, in McLean and Peoria counties in Illinois, the
official rate of removal of children from their families was
25/1,000.
CMHC’s Work in McLean County, Illinois
In early 2001, CMHC’s Executive
Administrative Team began a
comprehensive assessment of the child
protective services in McLean and Peoria
counties.
CMHC’s Work in McLean County, Illinois
 The assessment included windshield surveys
(the process of driving through the community
and noting community strengths, e.g. a youth
recreational club, and deficits, e.g., a crack
house) across the city and interviews with DCFS
consumers, key informants from the State’s
Attorney’s Office, DCFS employees, elected
officials, community activitists, case workers,
and other social service agency workers.
CMHC’s Work in McLean County, Illinois



Completed in late 2001, the assessment
revealed IDCFS was quite active in taking
custody of children felt to be in danger in
McLean and Peoria County.
There were three private (purchase of service –
POS) agencies in McLean County that received
children taken into custody.
Investigations were neither comprehensive nor
complete, and African-Americans had become
extremely distrustful of IDCFS procedures.
CMHC’s Work in McLean County, Illinois



Parents and alleged perpetrators reported they
were not being informed of their rights or the
results of the investigation consistently.
Additionally, when children were taken into state
custody, children and their parents were not being
prepared for placement.
The McLean and Peoria offices were making
placement decisions before collecting all required
information, and without considering all possible
alternatives to placement.
CMHC’s Work in McLean County, Illinois


When investigations raised concerns about
domestic violence, African-American children
were quickly taken into custody despite the
dearth of domestic violence treatment
services needed to rehabilitate the family.
The same occurred in cases involving alcohol
& substance abuse, there were few treatment
services available to address the issue
CMHC’s Work in McLean County, Illinois

In addition, inconsistent application of policies
governing investigations and case
management further compounded the
problem. Lastly, the assessment found that
the documentation in investigative and
service case files did not always provide
evidence that investigators and caseworkers
were receiving regular supervision. Further,
services to intact families needed substantial
improvement.
CMHC’s Work in McLean County, Illinois

Both the McLean County & the Peoria County
field offices experienced a significant amount
of turnover of child welfare service workers &
supervisors. Moreover, since there was only
one field supervisor and one clinical services
manager for both offices, the constant
demand to train new staff negatively
impacted the way cases were handled at both
sites.
Triadic Theory of Influence

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Sociological theories of social control and social bonding
(Akers et al., 1979; Elliott et al., 1985)
Peer clustering (Oetting & Beauvais, 1986)
Cultural identity (Oetting & Beauvais, 1990-91)
Psychological theories of attitude change & behavioral
prediction (Fishbein & Ajzen, 1975; Ajzen, 1985)
Personality development (Digman, 1990)
Social learning (Akers et al., 1979; Bandura, 1977, 1986)
Integrative theories (e.g., Jessor & Jessor's, Problem Behavior
Theory; Brook’s Family Interaction Theory, Hawkins’ Social
Development Theory)
See Petraitis, Flay and Miller (1995).
Cultural/
Attitudinal
Stream
Social/
Normative
Stream
Intrapersonal
Stream
Community Psychiatry
Health Behavior Change
Field Principle
Operationalization
Rebuilding the village
Build community collaborations to
support troubled families
Providing access to modern technology
Transport evidence-based assessment
and treatment to the community
Increasing connectedness
Organizational/staff development
Increasing social and emotional skills
Organizational/staff development
Increasing self-esteem
Actualize quality assurance systems to
monitor IDCFS practices
Reestablishing the adult protective shield Actualize quality assurance systems to
monitor IDCFS practices
Minimizing trauma
Take a system approach to the problem
& ensure that each stakeholder has
support
Strategies and Interventions
Urban Services

Family Advocates
The purpose of the Family Advocate is to provide
advocacy and case management services to children and
their families who are involved in the child welfare system.
The Family Advocate ensures the delivery of culturally
competent services through on-going support and guidance
to children and their families.
The program was implemented in August 2002 in which
the Advocates completed departmental trainings
(Foundation, Child Protection Investigations, and Child
Welfare Specialists) along with becoming CERAP certified.
Partnerships with Faith Based Community.
Strategies and Interventions
DCFS

Citizen Quality Assurance Panel



While waiting for this panel to be operationalized, CMHC
has been performing this task.
The Citizen Quality Assurance Panel - voluntary Citizen
Review Panel established using the National Association of
Roster Reviewers’ guidelines for independent reviews.
Review cases regarding safety decisions that were made
during the investigative process or when families request a
special review of their opened intact or permanency cases
based on services identification and delivery, the lack of
reasonable efforts made by the IDCFS/POS agency, and
other identified permanency issues.
Outcomes in McLean County
FY00 through FY02
Reported Abuse and Neglect by Race
150
140
130
120
110
100
90
80
70
60
50
40
30
20
10
0
149
43.3
31.1
37.4
25.1
FY00
FY02
EuropeanAmerican
(- 19.3%)
AfricanAmerican
(- 1.5%)
Hispanic
(- 13.6%)
Outcomes in McLean County
FY00 through FY02
Children Removed by Race
40
35.05
35
EuropeanAmerican
(- 57.2%)
AfricanAmerican
(- 61.3%)
Hispanic
(0%)
30
25
20
13.58
15
10
5
3.69
1.16
1.58
1.16
0
FY00
FY02
Evidence that Depressive
Disorders Can be Prevented

Clarke et al. (2001) found that a
group program for adolescent
offspring of depressed parents
could reduce the incidence of
depression to a level no higher
than for adolescents whose
parents were not depressed.
Foster kids and adoptees from overseas
orphanages show this disrupted pattern involving
low daytime cortisol, and associated with neglect
Relation between Neglect and Morning
CortisolLevels
Severity neglect in low, average, and high morning cortisol groups
3
2.5
F(2,
p <p.05
F(2,114)
114)= =4.27,
4.27,
<
Severity of Neglect
2
.05
1.5
1
0.5
0
Low
Average
High
Morning Cortisol Level
Bruce, Fisher, Pears, & Levine (2008)
Multidimensional Treatment Foster
Care for Preschoolers (MTFC)

Training of foster parents in
behavioral parenting practices

24/7 support of foster parents

RCT comparing MTFC with Regular
Foster Care (RFC)

Reduction in caregiver stress

Increase blunted diurnal HPA axis
activity for RFC and return to stable
Diurnal activity for MTFC children
The Good Behavior Game*
Classrooms are divided into teams, and
each team can win rewards if the entire team
is “on task” (e.g., fewer than a specified
number of rule violations during the game
period) or otherwise acting in accordance
with previously stated teacher expectations
 Rewards include extra free time, stars on
charts, and special team privileges.
* Funded in part by NIDA
The Good Behavior Game*
 Classroom teams in elementary school earn
small rewards for being on-task and cooperative
 Randomized trial in Baltimore Inner City
Schools
Had preventive effects even
 into young adulthood
Substance abuse disorders
Antisocial personality
* Funded in part by NIDA
A Good Behavior Game Result
Aban Aya*
 Chicago high poverty African-American
neighborhoods
 School/community intervention
 Social skills training
 In-service training of school staff;
 Task force to develop policies, conduct school-wide fairs,
seek funds for the school, & conduct field trips
 Parent training workshops.
 Significant effects on violence, drug use, & boys
recent sexual intercourse
* Funded in part by NIDA
Community Psychiatry Protective
Factor Field Principles





Rebuilding the Village/Constructing Social Fabric
Access to Modern Medical Technology
Connectedness
Social Skills
Self Esteem - Activities that create a sense of power; a
sense of connectedness; a sense of models; a sense of
uniqueness


Reestablish the Adult Protective Shield
Minimize the Effects of Trauma
RE-ESTABLISHING THE ADULT
PROTECTIVE SHIELD OUTCOMES
CPS SUMMARY
# Random
sweeps
Firearms
Knives, box
cutters,
razors
Narcotics
Other
weapons
1997-1998 1998-1999 1999-2000
59
65
89
0
107
1
96
1
54
75
158
63
200
51
29
Evidence of School-related Effects
 School-based
violence prevention
can reduce aggressive problems by
one-quarter to one-third
 Social and emotional learning programs
may improve academic outcomes
 Promising but limited benefit-cost
information
Needed to Build on Existing
Knowledge


Effectiveness trials
Dissemination Research
Experimental evaluations of dissemination
strategies
Implement evidence-based programs,
policies, and “kernels”
 Comprehensive neighborhood and
community interventions

Prevention is possible
 Teacher training in classroom instruction &


management, child social & emotional skill
development, & parent workshops were the
intervention.
A significant multi-varied effect across all 16
primary outcome indices were found.
Specific effects included significantly better
educational and economic attainment, mental
health and sexual health by age 27 years (all
P<.05).

Hawkins JD, Kosterman R, Catalano RF, Hill KG, and Abbott RD. Effects of
Social Development Intervention in Childhood 15 Years Later. Arch Pediatr
Adolesc Med. 162(12), pp 1133-1141, 2008.
Implementation
Need to move from efficacy toward
effectiveness trials
Implementation research has
highlighted:
Complexity
Consideration of the important role of
community
Implementation Approaches
 Implement
specific evidence-based
programs
 Adapt (and evaluate) evidence-based
program to community needs
 Develop and test community-driven
models
Opportunities for Linkages with
Neuroscience
 Interactions
between modifiable
environmental factors and expression of
genes linked to behavior
 Greater understanding of biological
processes of brain development
 Opportunities for integration of genetics
and neuroscience research with
prevention research
Recommendation Themes
 Putting
Knowledge into Practice
 Continuing Course of Rigorous
Research
Putting Knowledge Into Practice:
Overarching Recommendations
White House should establish ongoing multiagency strategic planning mechanism& Align
federal resources with the strategy
Patient Protection and Affordable Care Act.
States and communities should develop
networked systems
Putting Knowledge Into Practice:
Overarching Recommendations
Make healthy mental, emotional, & behavioral
development a national priority by establishing
public prevention goals.

The first, the National Prevention, Health
Promotion, & Public Health Council, will sit at the
Department of Health and Human Services, and will
be chaired by the Surgeon General.
 The
Council will provide federal coordination & leadership
in regard to prevention, wellness, health promotion, the
public health system, & integrative health care, & will
develop a National Prevention Strategy.
Putting Knowledge Into Practice:
Overarching Recommendations
State grants for evidence-based early
childhood home visitation programming are
also included in health reform. $1.5 billion
over five years will be awarded to improve
maternal and children health, childhood
injury prevention, school readiness, juvenile
delinquency, family economic factors, and
coordination of community resources.
Putting Knowledge Into Practice:
Funding
 Prevention
set-aside in mental health
block grant.


The Prevention and Public Health Fund
administered by the Office of the Secretary at
HHS will support wellness and disease
prevention activities authorized by the Public
Health Services Act at an unprecedented level.
Nationally, this new fund will provide $15 billion
for public health programs over 10 years.
Putting Knowledge Into Practice:
Funding
 Braided
funding
 Fund state, county, and local prevention
and promotion networks


State and local governments & community-based
agencies will be eligible to compete for a number of
grants.
Community Transformation Grants will be available for
activities that reduce chronic disease rates, prevent the
development of secondary conditions, address health
disparities, and improve the evidence base for prevention
Putting Knowledge Into Practice:
Funding
 Target
resources to communities with
elevated risk factors
 Facilitate researcher-community
partnerships
 Prioritize use of evidence-based
programs and promote rigorous
evaluation across range of settings
Putting Knowledge Into Practice:
Data Collection and Monitoring
 HHS
should provide annual
prevalence data and data on key
risk and protective factors
 SAMHSA should expand service use
data collection
Putting Knowledge Into Practice:
Workforce Development




HHS, ED, and Justice should develop
training guidelines
Set aside funds for competitive prevention
training grants
Professional training programs should include
prevention
Certification and accrediting bodies should set
relevant standards
Continuing a Course of Rigorous
Research:Overarching Recommendations
 NIH
should develop comprehensive
10-year prevention and promotion
research plan
 Research funders should establish
parity between research on
preventive interventions and
treatment interventions
Continuing a Course of Rigorous
Research: 10-Year Priorities
Prevention (specific disorders and common
risk factors) and promotion
 Replication, long-term outcomes, and
multiple groups
 Collaborations across institutes and
agencies for developmentally related
outcomes
 Further improve current interventions

Continuing a Course of Rigorous
Research: 10-Year Priorities
Guidelines and funding for economic
analyses
 Etiology and measurement of developmental
competencies
 Effectiveness of mass media and internet
interventions
 Address research gaps in populations and
settings

Additional Information
 Report
available at:
http://www.nap.edu
 Summary available as free download
 Search the full report on line
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