FIGURE 1-1 Growth in randomized controlled trials.

FIGURE 1-1 Growth in randomized controlled trials.

in Medline and Psychinfo.1 Although there may be some published (and clearly unpublished) RCTs that were not identified by this search, the overall trend is unlikely to be affected. While not all of the articles report successful interventions or interventions that have a major impact on outcomes, the evidence base available now is significantly advanced beyond what was available at the time of the 1994 IOM report.2 Similarly, other types of evaluations that provide meaningful insights into mental health promotion and the prevention of MEB disorders have also been conducted. Although RCTs remain the gold standard, they are not always feasible, and other designs can make important contributions.

Some federal programs have directed that resources be used only for programs with evidence of effectiveness, and numerous efforts have emerged to identify and share model programs or best practices. The Substance Abuse and Mental Health Services Administration, the U.S. Department of Justice, and the U.S. Department of Education have each launched a mechanism to identify and disseminate information about interventions, including many preventive interventions. Numerous federal and state organizations have published guides or lists of “model” or “effective” programs (National


The search, modeled on the approach used by the Cochrane Collaboration, identified articles that self-identified as an RCT or included such terms as “random,” “control,” and “double” or “single blind” to describe their design. The abstracts of articles identified by the database search were then reviewed to eliminate those that were not an RCT, did not address the prevention of emotional and behavioral disorders, or were not targeted at young people.


The committee notes that it typically takes years for the results of an RCT to appear in a journal. As a result, the year of publication may not correspond to the year in which the RCT took place.

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