on the juvenile justice system (Institute of Medicine, 2006b). One study estimated that more than one-quarter of the total costs for mental health treatment services among adolescents were incurred in the education and juvenile justice systems (Costello, Copeland, et al., 2007). One estimate puts the total annual economic costs in 2007 at roughly $247 billion (Eisenberg and Neighbors, 2007). In addition, youth with emotional and behavioral problems are at greatly increased risk of psychiatric and substance abuse problems (Gregory, Caspi, et al., 2007). The earlier young people start drinking, the more likely they are to have serious alcohol dependence as adults (Grant and Dawson, 1997; Gruber, DiClemente, et al., 1996). Early aggressive behavior greatly increases the risk of conduct disorder, drug use, and other externalizing behaviors, while environmental and individual-level protective factors (Kellam, Ling, et al., 1998) and preventive interventions can reduce these risks.

The good news, as this report documents, is that research has identified multiple factors that contribute to the development of MEB disorders, and interventions have been developed to successfully intervene with these factors. Through the application of policies, programs, and practices aimed at eliminating risks and increasing strengths, there is great potential to reduce the number of new cases of MEB disorders and significantly improve the lives of young people.

A variety of factors—including individual competencies, family resources, school quality, and community-level characteristics—can increase or decrease the risk that a young person will develop an MEB disorder or related problem behaviors, such as early substance use, risky sexual behavior, or violence. These factors tend to have a cumulative effect: A greater number of risk factors (and for some, a longer exposure, such as from parental mental illness) increases the likelihood of negative outcomes, and a greater number of protective factors (e.g., resources within an individual, family strengths, access to mentors, and good education) decreases the likelihood of negative outcomes. This report makes the case that preventing the development of MEB disorders and related problems among young people, reducing risks, and promoting positive mental health should be high priorities for the nation.

Families, policy makers, practitioners, and scientists share a conceptual commitment to the well-being of young people—that is not a new idea. However, a solid body of accumulated research now shows that it is possible to positively impact young people’s lives and prevent many MEB disorders. In addition, a consensus is emerging around the need to promote positive aspects of emotional development. While additional research is needed, the efficacy of a wide range of preventive interventions has been established, particularly ones that reduce risk factors or enhance protective factors. Less research had been conducted to empirically evaluate strate-



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