Evaluations should begin to address the fact that multiple interventions over the span of childhood may have important dynamic complementarities (Heckman, 2007). For example, participation in an early childhood intervention such as Head Start may enhance a child’s ability to benefit from a later intervention to prevent substance use. Although it would be difficult to randomize children to different sequences of interventions over a long time span, empirical research to address these complementarities to the extent possible would be very informative.

Similarly, understanding the causal links between aspects of poverty (e.g., food insecurity, disadvantaged neighborhoods, low-quality schools) and mental health should be improved. These links may reveal some of the most important mechanisms by which to prevent MEB disorders in costeffective ways, but it is very difficult to establish incontrovertible causal relationships due to the many likely confounders in observational data.19

While there have been calls for increased economic analyses, the number of projects that include calculation of costs and cost-effectiveness will increase only if guidelines on how to conduct these types of analyses are widely available and the additional costs recognized.

Recommendation 9-2: Funders of intervention research should incorporate guidelines and measures related to economic analysis in their program announcements and provide supplemental funding for projects that include economic analyses. Once available, supplemental funding should also be provided for projects with protocols that incorporate recommended outcome measures.

Although one might argue that grant awards should be increased rather than providing supplemental funding to those that conduct economic analyses, there is a precedent for providing supplemental funding in other areas. For example, the National Institutes of Health (NIH) provides research supplements for projects involving underrepresented minorities and individuals to improve the diversity of the research workforce. Although these supplements are modest, NIH has reported that they are an effective means of encouraging institutions to recruit from currently underrepresented groups.

Evaluations of the costs and cost-effectiveness of prevention interventions will increase only if researchers include them in their protocols. Studies designed to determine the effectiveness of interventions in a realworld setting should be clear not only on what the intervention costs, so that a community can judge the feasibility of funding the project, but also

19

For discussions of links between poverty and mental health among children, see, for example, Ripple and Zigler (2003) and the Center on the Developing Child (2007).



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