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Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities
first called to pay attention to mental illness and its prevention by President John F. Kennedy in the early 1960s. The report provided a new definition of mental illness prevention and a conceptual framework that emphasized the reduction of risks for mental disorders. And it proposed a focused research agenda, with recommendations on how to develop effective intervention programs, create a cadre of prevention researchers, and improve coordination among federal agencies.
Numerous other reports and activities have emerged since the 1994 IOM report, drawing more attention to the need for research, prevention, and treatment of mental disorders (see Box 1-1 for a timeline of key events), including the New Freedom Commission on Mental Health report (2003), reports of the National Advisory Mental Health Council’s Workgroup on Child and Adolescent Mental Health Intervention Development and Deployment (2001) of the National Institute of Mental Health, and reports from the surgeon general on children’s mental health (U.S. Public Health Service, 2000), violence (U.S. Public Health Service, 2001c), and suicide prevention (U.S. Public Health Service, 1999b, 2001b). The SurgeonGeneral’s Call to Action to Prevent and Reduce Underage Drinking (U.S. Public Health Service, 2007) similarly called for concerted national action to address this significant concern affecting young people. Mental health and substance abuse professional and consumer organizations have taken steps to embrace prevention without abandoning the need for treatment.
At the same time, the growth in research-based evidence and new government mandates related to program accountability have prompted focused attention on specific preventive interventions. The Government Performance and Results Act of 1993 launched a trend toward requiring federal programs to provide evidence of effectiveness (U.S. Office of Management and Budget, 2003). The Safe and Drug Free Schools Act of 1990 specified “principles of effectiveness,” and the No Child Left Behind Act of 2001 called for school districts to implement evidence-based programming (Hallfors and Godette, 2002). More recently, the Consolidated Appropriations Act of 2008 created a new grant program to support “evidence based home visitation programs” that meet “high evidentiary standards” as well as a new wellness program in the mental health programs of regional and national significance that would require grantees to “evaluate the success of the program based on their ability to provide evidence-based services.”
The number of preventive interventions tested using randomized controlled trials (RCTs), an approach generally considered to be the “gold standard” and strongly recommended by the 1994 IOM report, has increased substantially since that time. Figure 1-1 illustrates the number of published RCTs (between 1980 and 2007) based on a search of articles related to preventive interventions for MEB disorders with young people included