Blueprint for a National Prevention Infrastructure for Mental, Emotional, and Behavioral Disorders (2025) / Chapter Skim
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2 The Evidence Base on Programs
2 The Evidence Base on Programs
Pages 45-78
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From page 45... ...
. As noted in these reports and elsewhere, the evidence base regarding the prevention of MEB disorders is robust in some crucial ways and lacking in others: there are a number of interventions with decades of high-quality research to support their effectiveness, particularly focused on children, youth, and families.
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From page 46... ...
It also encompasses research questions related to • psychometric properties such as reliability, generalizability, and validity; • risk assessment and health equity considerations, which includes a wide range of complex risk and protective factors, ranging from individual behaviors or individual biological (including genetic, metabolic, and physiological) risk factors to social drivers of health and lack of fair opportunities to attain one's full potential for MEB health; and • intermediate and long-term outcomes, i.e., potential benefits or harms of interventions.
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From page 47... ...
Primary prevention as used here includes health promotion and consists of approaches to reduce the incidence of MEB disorders and support MEB health (see Figure 2-2 for a visual representation of the spectrum of possible prevention approaches)
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From page 48... ...
Risk factors for MEB disorders across the life course include adverse childhood experiences (ACEs)
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From page 49... ...
PREVENTION APPROACHES This section offers a brief overview of evidence-based and promising approaches that can prevent MEB disorders and promote MEB health across the life course; it is not a comprehensive review of all relevant interventions, nor does it attempt to assess their reach or impact. As discussed in the introduction, examples of different approaches are used to explore the characteristics of programs that may be delivered within the proposed prevention infrastructure, rather than an endorsement of any particular intervention.
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From page 50... ...
While many types of approaches are cited in literature as "evidence based," this report also refers to "practice-based evidence." In this report, evidence-based programs (EBPs) comprise a rigorous evidence base (often including randomized controlled trials [RCTs]
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From page 51... ...
. Overall, the evidence base connects positive MEB outcomes among children and adolescents with interventions that can be tailored to cultural and other community contexts, treat parents as knowledgeable and equal partners in childrearing, integrate services for families with multiple service needs, support peer networks for parents, address trauma among parents, and increase fathers' involvement in parenting (NASEM, 2019a)
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From page 52... ...
Early childhood education programs are associated with increased educational attainment, consistent employment, and improved self-control and self-esteem. All of these are protective factors to support MEB health and reduced the likelihood of receipt of public assistance, involvement in the criminal legal system, and substance misuse (Latimore, 2023; Reynolds et al., 2011)
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From page 53... ...
Approaches for Adults Faith-Based and Community Settings Faith-based settings, such as churches, mosques, synagogues, and other houses of worship, along with other community groups, are well positioned to provide universal preventive interventions and promote social norms that encourage help-seeking (HHS Partnership Center, 2023)
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From page 54... ...
, which has developed and is implementing a 3-year pilot program in 14 of its club organizations to provide behavioral health staff support and trauma-informed training in partnership with the Washington State Of fice of Superintendent of Public Instruction, Paxis Institute, and Norcliffe Foundation. BGCWA deployed three implementation strategies.
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From page 55... ...
. Approaches for Older Adults Because the social and MEB needs of older adults are linked, strategies to improve MEB health will ideally be delivered along with health and social services to meet the MEB needs of low-income and homebound older adults (Forsman et al., 2011; Heisel, 2006)
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From page 56... ...
. Organizational and group-level interventions also have a universal prevention focus -- to support all workers by changing work conditions -- addressing workplace stressors by strengthening protective factors (e.g., flexwork and self-scheduling)
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From page 57... ...
MEB health programs include varying types of professional support, from face-to-face interaction in a teleconference setting to entirely digital interactions through a web-based app. Digital apps have proliferated in recent years, intensified by pandemic-era needs for virtual delivery.
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From page 58... ...
The overall meta-process of setting up a prevention infrastructure for MEB disorders speaks to policy makers, funders, and decision makers, while the hyperlocal community level that will be charged with frontline implementation activities and processes will include providers, faith leaders, educators, activists, and community partners. The interactions between and across these levels of constituents will happen within each community related to implementation of the infrastructure needed for the prevention effort, in a nuanced contextually appropriate way.
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From page 59... ...
GTO is "intended to strengthen agencies' and organizations' use of prevention programs regardless of prior evidence of effectiveness"; it provides tools and supports to help communities identify the best EBP for their needs and context (see Fostering Healthy MEB Development in Youth [2019] for greater detail about blended implementation strategies)
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From page 60... ...
4. Assess Barriers and Facilitators and Understand Context: Bar riers and facilitators, or "determinants," are categories of enablers programs (e.g., from evidence clearinghouses, such as Blueprints for Healthy Youth Development2 and the National Center for Education Statistics)
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From page 61... ...
illustrate potential ways to estimate costs of programs, and (2) to help answer the question "what does an investment in prevention infrastructure buy a community?
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From page 62... ...
Note that counties vary widely in size, need, and local resources of all kinds, that the number of counties does not cover some tribal places and communities, and the 574 federally recognized tribal nations would need comparable levels of investment. RESEARCH NEEDS TO IMPROVE THE EVIDENCE BASE ON INTERVENTIONS AND THEIR IMPLEMENTATION Developing, testing, and establishing numerous evidence-based preventive interventions for MEB health is a notable achievement within the field of prevention science.
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From page 63... ...
. Improving and Maintaining the Evidence Base on Existing Interventions NIH and other research funders have invested significantly in rigorous research to establish dozens of demonstrated effective programs, policies, and practices that improve MEB outcomes (Murray et al., 2021)
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From page 64... ...
. This research should prioritize interventions that target MEB health inequities, are needed for different age groups, and are co-created with the populations they are intended to serve.
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From page 65... ...
-- Joe Neigel, Monroe School District Director of Prevention Services, Washington NIH and other research funders have invested significantly in rigorous research to establish dozens of demonstrated effective programs, policies, and practices that improve MEB health outcomes (Murray et al., 2021)
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From page 66... ...
Clearinghouses can collate and rank prevention programs to support decision makers considering which interventions to implement to promote MEB health. However, the landscape is not able to support these decision makers, because clearinghouses are created, overhauled, and closed without harmonized goals and standards.
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From page 67... ...
Perhaps the most well-known clearinghouse of preventive interventions for MEB disorders was the Substance Abuse and Mental Health Services Administration (SAMHSA) National Registry of Effective Prevention Programs (NREPP)
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From page 68... ...
Many clearinghouses have no dedicated and sustained funding source, making it hard to maintain quality or respond dynamically as the evidence base changes. Sustained, non-grant-dependent resourcing is needed.
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From page 69... ...
An evidence base exists of tested and effective MEB disorder preventive and health promotive interventions particularly targeted for children, youth, and families, which address a variety of BH outcomes, and many are cost effective. The evidence base for other stages of the life course is not as robust.
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From page 70... ...
Clearinghouse usability considerations include having straightforward search functions and being tailorable for different needs, concise, and jargon free. To operationalize a focus on health equity, SAMHSA could include a transparent and consistent section on health equity considerations, e.g., whether there are differential impacts across populations and if an intervention worsens, sustains, or reduces MEB health disparities (Hirsch et al., 2023)
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From page 71... ...
. Blueprints for Healthy Youth Development.
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From page 72... ...
1998. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The adverse childhood experiences (ACE)
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From page 73... ...
Evidence clearinghouses as tools to advance health equity: What we know from a systematic scan. Prevention Science 24:613–624 (2023)
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From page 74... ...
2009. Healthy Indian country initiative promising prevention practices resource guide: Promoting innovative tribal prevention programs.
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From page 75... ...
2017. Using evidence based home visiting for preventing intergenerational adverse childhood experiences.
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From page 76... ...
Implementation Science Communications 5(1)
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From page 77... ...
n.d. Federal understanding of the evidence base.
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