Preventing Mental, Emotional, and Behavioral Disorders Among Young People Progress and Possibilities (2009) / Chapter Skim
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12 Prevention Infrastructure
12 Prevention Infrastructure
Pages 337-376
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From page 337... ...
content of training programs directed to enhancing the prevention workforce. The chapter begins with a discussion of federal funding, highlighting the challenges in determining the level of funding for either prevention research or services, indications that the federal commitment to prevention research may have waned since the publication of Reducing Risks for ental Disorders: Frontiers for Preventive Intervention Research (Institute M of Medicine, 1994)
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, and the Administration for Children and Families (ACF) fund prevention research involving young people.
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Furthermore, there are no plans for the RCDC system to provide linkage to financial data, limiting opportunities to quantify the federal investment in prevention research. NIMH, NIDA, and NIAAA Funding The National Institute of Mental Health (NIMH)
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Consistent with the 1994 Institute of Medicine (IOM) report Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research funding for prevention research on drug abuse was proportionately greater than the funding for prevention research on mental disorders.
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The position, however, has no funding authority. NIMH does have a Child and Adolescent Treatment and Preventive Intervention Research Branch, which funds many of its prevention research projects; HIV prevention programs are funded out of its Primary Prevention Branch.
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Focused on basic and with children at risk for applied research leading to developing mental health Drug Abuse Prevention During the development of problems because of Developmental Transitions, effective prevention exposure to high-stress Rutgers University: Focused on programs to reduce situations, such as parental how individuals transitioning alcohol abuse and related divorce or death. developmental phases acquire problems, with an and integrate information emphasis on environmental Center for Prevention and about substance use into their approaches.
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designed to bring together the expertise of basic and applied disciplines to accelerate the development and implementation of preventive interventions. Neuroscientists, behavioral and cognitive scientists, and drug abuse prevention researchers collaborate on discovery and translational research areas that have the potential for producing new approaches to drug abuse prevention.
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In its 2006 publication Advancing the Nation's Health: Guide to Public Health Research, 2006-2015, health promotion is
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In addition, CDC provides funding for Community-Based Participatory Prevention Research, although prevention of MEB disorders among young people has been a relatively small component of funded projects.
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. Within SAMHSA, this falls to the Center for Substance Abuse Prevention (CSAP)
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Grants for the integration of Schools and Mental Health Systems aim to increase linkages between schools, mental health, and juvenile justice authorities to improve access to quality mental health services, including preventive services. ED also provides grants to assist local education authorities develop "innovative and effective" alcohol abuse prevention programs.
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ACF administers the Head Start and Child Abuse Prevention Programs and recently included prevention-related activities in a component of the Compassion Capital Fund. In addition to its involvement in the SSHS Progam, the Department of Justice, primarily through its Office of Juvenile Justice and Delinquency Prevention, operates multiple grant programs aimed at delinquency prevention, violence prevention, and truancy reduction.
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. Another example is the Pennsylvania Commission on Crime and Delinquency's Research-Based Programs Initiative, which began funding replications of efficacious prevention programs a decade ago.
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For example, the National Association of State Alcohol and Drug Abuse Directors convenes the National Prevention Network, an organization of state-level agencies involved with alcohol and drug abuse prevention. A similar organization, Community Anti-Drug Coalitions of America, advances a c ommunity-level focus on drug and alcohol prevention.
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. In Clinical Preventive Services in Substance Abuse and Mental Health Update: From Science to Services (Nitzkin and Smith, 2004)
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. SYSTEMS THAT SUPPORT DELIVERY OF PREVENTIVE SERVICES In addition to the provision of funding, federal, state, and local governments can support service delivery systems that provide preventive services by identifying effective interventions as well as by offering technical assistance to community coalitions or organizations.
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The Model Programs Guide of the Department of Justice lists 38 exemplary and 67 effective prevention programs, and NREPP lists 32 reviewed mental health promotion14 and 30 reviewed substance abuse prevention programs.15 In addition to these federally sponsored systems, a number of private and state-level organizations have established online systems to identify effective programs. Blueprints for Violence Prevention (see Chapter 11)
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regarding effectiveness based on a combination of theory, research, and practice experience. The Society for Prevention Research (SPR)
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First, in response to a general lack of knowledge about how to disseminate and implement effective prevention programs, they are convening trans-NIH forums to prepare applicants for new grant programs on dissemination and implementation research that explore characteristics of communities, interventions, and system change that impact prevention outcomes in community settings. Ideally, researchers and community organizations will develop partnerships to move this next generation of research forward in a productive manner.
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Specific to substance abuse prevention, SAMHSA funds five Regional Centers for the Application of Prevention Technologies,18 which provide training and technical assistance and offer a range of online resources through Prevention Pathways.19 Technical assistance resources on the Communities That Care initiative (see Box 11-1) designed to help communities match evaluated programs with local risk and protective factors, are available on SAMHSA's Strategic Prevention Framework website.20 SAMHSA's Suicide Prevention Resource Center provides training to strengthen suicide prevention networks, and most of the technical assistance centers provide some level of informal implementation training.
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http://www.safeyouth.org Suicide Prevention Resource Center (HHS/SAMHSA) http://www.sprc.org NOTES: ACF = Administration for Children and Families, CDC = Centers for Disease Control and Prevention, CMHS = Center for Mental Health Services, CSAP = Center for Substance Abuse Prevention, ED = U.S.
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The 1994 IOM report contained limited information on training activities in the areas of prevention science and prevention implementation, but it concluded that training needs and output were approximately in balance with workforce needs. It reported a total of 22 NIH-funded research trainee slots per year and estimated that there were no more than 500 pro fessionals conducting prevention research related to MEB disorders.
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Overview of Training/Education Since 1994 Since the 1994 IOM report, membership in the Society for Prevention Research increased 450 percent from 125 in 1992 to 690 in 2005 (see http://www.preventionresearch.org/about.php, accessed February 8, 2008)
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However, these numbers have dwindled in the last several years, with five current programs.23 Needs for prevention research and implementation capacity building have not been formally assessed. Blueprint for Change: Research on Child and Adolescent Mental Health (National Advisory Mental Health Council Workgroup on Child and Adolescent Mental Health Intervention Development and Deployment, 2001)
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Current Training Efforts Since 1994, when the focus of training was on prevention researchers, training and education needs have broadened. These now include other basic researchers who serve as discovery engines as well as a broad array 24 See http://www.projectmainstream.net.
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, particularly the history of prevention research, funding for prevention research, and the conduct of economic analyses. Early career participants were considerably behind established researchers in the areas of design of preventive intervention t rials and community collaboration.
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Although data are not available to allow quantification of the contribution of schools of public health to the workforce related to prevention of MEB disorders, these schools should prepare future leaders in mental health promotion and disorder prevention, whether in research, community services, or administration/policy.
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98) recommended "that the National Board of Medical Examiners increase behavioral and social science content on the US Medical Licensing Examination." Response to this recommendation would be a step in the right direction, but more specific attention to prevention and mental health promotion education is needed to prepare medical students for prevention activities related to MEB disorders.
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For example: • Psychiatry training requirements state that the didactic curriculum must include the fundamental principles of epidemiology, etiology, diagnosis, treatment, and prevention of all psychiatric disorders, including biological, psychosocial, sociocultural, and iatrogenic factors that affect the prevention, incidence, prevalence, long-term course, and treatment of psychiatric disorders. They state that the resident should "know how to advocate for the promotion of mental health and the prevention of disease." These are the only 2 sentences in 34 pages of requirements that directly address pre vention of mental disorders and substance abuse; only eight hours on average are devoted to substance use health care in psychiatry residency (Isaacson, Fleming, et al., 2000)
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found that only 12 schools offered a course in prevention (not specifically prevention of MEB disorders) , most schools of social work have elective courses in drug and alcohol abuse prevention, and many offer courses in mental health interventions, as well as child maltreatment prevention and treatment.
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, but prevention research is a relatively small part of these initiatives. Clinical Psychology.
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Substance Abuse and Mental Health Counseling. Substance abuse counselors and mental health counselors together comprise the largest group of mental health professionals.
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. The National Association of School Psychologists has 25,000 members and strongly encourages mental health promotion and prevention of disorders through a variety of programs.
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Such situations arise frequently when such issues as child custody and visitation are decided in cases of divorce, domestic violence, or child abuse and neglect. Recognition that these situations place children's mental health at risk should lead to decisions that consider, above all, the children's well-being.
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Funding and infrastructure for substance abuse prevention interventions is more advanced than for prevention or promotion of mental health. There are no targeted funding streams for prevention in the mental health area.
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Departments of Health and Human Services, Education, and Justice should braid funding of research and practice so that the impact of programs and practices that are being funded by service agencies (e.g., the Substance Abuse and Mental Health Services Administration, the Office of Safe and Drug-Free Schools, the Office of Juvenile Justice and Delinquency Prevention) are experimentally evaluated through research funded by other agencies (e.g., the National Institutes of Health, the Institute of Education Sci ences, the National Institute of Justice)
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Departments of Health and Human Services, Education, and Justice should fund states, counties, and local communities to implement and continuously improve evidence based approaches to mental health promotion and prevention of MEB disorders in systems of care that work with young people and their families. A dizzying array of technical assistance centers, online resources, and publications and guides is available.
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An informed and supportive public is needed to adopt and advocate for effective prevention of MEB disorders and promotion of better mental health outcomes. Research Although the volume of prevention research and evidence for successful intervention efforts has grown substantially since 1994, there are rapidly expanding needs for more and better research.
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. To date there is relatively little cofunding of prevention research across NIH institutes.
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set guidelines for model prevention research and practice training programs and (2) contribute to the development of training standards for certifying and accredit ing training programs in specific disciplines, such as health (including mental health)
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