conclusive that this screening improves clinical outcomes (see Chapter 7). Abused and neglected children are more likely to be abusive and neglectful when they become parents (an intergenerational risk factor) (Noll, Trickett, et al., 2009). It is potentially important to recognize, but there are limited studies that document effectiveness of a specific intervention for children or adolescents known to be abused that reduces their abusive behaviors as they mature. The rationale for screening is strong; however, a robust evidence base must be assembled to demonstrate where investment in broad screening efforts is effective and cost-efficient. In particular, studies should address identification of types of risks that can lead to mobilization of community resources to address risk.
For some disorders, effective prevention strategies are available. Before implementing an individual screening strategy, it would be important to compare its impact with that of a universal strategy. For the prevention of conduct disorder, youth can be identified through screening of teachers and parents for those exhibiting aggressive behavior (Perrin and Stancin, 2002). A number of individual-level interventions are available, ranging from behavioral reinforcement with a mental health professional to long-term intervention, as used in the Fast Track project (see Box 6-9). Alternatively, universal preventive interventions have been shown to have lasting impact on those with the highest levels of aggressive behavior early on (Kellam, Brown, et al., 2008), and they do not encounter the kinds of stigma or labeling that occur from individual-level interventions. Where multiple levels of preventive intervention are available, universal interventions may serve as an informal screening mechanism, with those who do not respond to the intervention being identified for more targeted approaches based on elevated risk.
We note that screening should target not only young people, but also their extended family members and caretakers as well as peers and community environments, including norms and policies, for example, around substance use. Home visitation has been one useful strategy for screening of relevant figures and experiences in a child’s life. For example, postpartum depression was detected in more than 40 percent of socioeconomically disadvantaged mothers by home visitation (Stevens, Ammerman, et al., 2002). Situational stresses, such as death of a parent, affect all family members (Melhem, Walker, et al., 2008). Screening for parental mental disorders, such as depression, PTSD, domestic violence, and substance use, is key to designing interventions to reduce children’s risk and has been recommended for primary care (Whitaker, Orgol, and Kahn, 2006) as well as emergency room (Grupp-Phelan, Wade, et al., 2007) settings. Preventing behavior problems in young children requires family-oriented strategies that address the needs of both parents and their children.