these groups to identify potential preventive services or treatment needs are warranted.

Identifying and addressing groups or communities with elevated risk can serve a preventive function complementary to identification of individuals at risk. This screening level uses public health principles and may be particularly cost effective.

Conclusion: Screening for community- and group-level risk factors as well as individual-level screening for symptoms is an important public health function.

Community-level screening in the United States has largely been limited to communities assessing their own strengths and needs (e.g. Communities That Care; see Box 11-1) rather than using known risk factors to identify specific communities with elevated needs. For example, although there is substantial documentation that factors such as poverty place young people in communities with these characteristics at greater risk for negative emotional and behavioral outcomes, few programs have targeted resources to these communities to address community-level risks.

Recommendation 8-2: The U.S. Departments of Health and Human Services, Education, and Justice should develop strategies to identify communities with significant community-level risk factors and target resources to these communities.

Although this would be a novel approach in the United States, there are models available from the United Kingdom that could guide these efforts. Since 2000, the United Kingdom has a system for identifying areas with high need for intervention using the Indices of Multiple Deprivation. The index is based on the idea that certain areas can be characterized as deprived on the basis of the proportion of people in the area experiencing various manifestations of deprivation. The indices include seven domains: income deprivation; employment deprivation; health deprivation and disability; education, skills, and training deprivation; barriers to housing and services; living environment deprivation; and crime. These are measured using 38 indicators based on census and other publicly available data (Noble, McLennan, and Whitworth, 2009). Areas identified with high levels of deprivation are targeted for additional local and national-level resources. In addition to permitting precise focus on areas with high multiple deprivations, this approach provides the ability to track change using the same criteria. The committee was not aware of any outcomes data on this approach, however.



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