grams targeting children younger than age 5, cost data were available for only a small percentage of the studies (Brown, Berndt, et al., 2000).

There have been limited commitment and funding for prevention training and materials at government and community levels (Hallfors, Pankratz, and Hartman, 2007), with few targeted funding sources and available sources providing limited amounts. For example, SDFS, which represents 70 percent of school funding for drug prevention programs, provides an average of only $6.30 per child (Hallfors, Pankratz, and Hartman, 2007), well below the copying costs let alone the costs of training and sustaining an effective prevention program. Furthermore, two-thirds of the states do not provide any additional funding beyond that provided by SDFS. A report on Nevada’s implementation of school-based substance abuse and violence prevention programs concluded that funding was inadequate in most school districts to implement the type of prevention program needed (Nevada State Department of Education, 1998). Half of the states have two or fewer full-time staff available to support schools’ selection and implementation of drug prevention programs statewide (Hallfors, Pankratz, and Hartman, 2007). The Safe Schools/Healthy Students Grant Program, funded jointly by three federal agencies, aims to help local communities develop integrated programming that involves prevention, treatment, and school reform efforts in K-12 based on evidence-based interventions. However, although over 150 communities have been funded through this program, there is as yet little published research on this model.

Service System Priorities

Prevention is often tangential or only weakly related to the mission of the institutions and communities in which its programs could be housed, leading to limited infrastructure to support and sustain prevention programs in their natural settings (Greenberg, 2004; Spoth, Greenberg, et al., 2004). For example, integrating mental health and drug prevention into the existing primary health care system would require more accessible reimbursement mechanisms. The mental health system, which is primarily focused on treatment of disorder, would need to be reoriented.

Similarly, the primary mission of schools is to educate students, with an emphasis on core subjects, like science, math, history, and reading; it is unlikely that they will support a program that does not directly relate to this primary mission (Kellam, 2000). American schools face many competing demands, and education leaders must make difficult choices about priorities (Adelman and Taylor, 2000; Berends, Bodilly, and Kirby, 2002; Hall and Hord, 2001). Currently most education leaders focus on the student academic performance requirements of the NCLB. While a potential



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