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Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities
protective factors to aid in selecting an intervention or interventions for implementation.
This chapter outlines criteria for assessing the applicability of screening for selective and indicated preventive interventions, building on criteria published by the World Health Organization (WHO). It also addresses issues related to each of the three levels of screening—community, group, and individual. The chapter closes with conclusions and recommendations on where the field should move to further consider screening in the context of prevention. Although screening approaches have been used in a research context to identify potential participants in indicated preventive interventions, the focus here is on prevention in real-world environments.
CRITERIA FOR SELECTIVE AND INDICATEDPREVENTION SCREENING
Fifty years ago, WHO established guidelines to use in determining the public health applicability of screening (Wilson and Jungner, 1968). The 10 basic principles, in various forms, are used today to assess applicability of biomarkers or other diagnostic information for presymptomatic detection of serious disorders. However, the WHO criteria were developed from the perspective of early detection of disease, with the goal of providing treatment before the disorder becomes symptomatic.
For prevention, one of the goals of screening should be to identify communities, groups, or individuals exposed to risks or experiencing early symptoms that increase the potential that they will have negative emotional or behavioral outcomes and take action prior to there being a diagnosable disorder. Successful screening and preventive interventions can reduce diagnosable disorders that require treatment. Thus, considering screening in the context of prevention requires a shift in thinking and adaptation of some of the WHO criteria. For example, mental health screening targets both risk factors and early behaviors or biomarkers that predict MEB disorders. Table 8-1 presents a revised set of criteria that are likely to lead to successful prevention through screening at the individual level. We discuss below the extent to which the amended criteria are met.
The MEB disorders to be prevented through identification of thisrisk factor should be a serious threat to mental health or increase the likelihood of substance abuse or delinquent or violent behavior. MEB disorders among young people result in significant personal and family suffering and substantial societal costs associated with service use and lost productivity (see Chapter 9). Available data on the prevalence of MEB disorders suggest that one in five or six young people is currently experiencing a significant disorder (see Chapter 2), and there are strong links between childhood and