BOX 11-4

The Internet as a Potential Tool for Wide-Scale Dissemination of Preventive Interventions

The enormity of need for mental health services often produces a type of paralysis: since it is not feasible to train enough providers to treat all individuals with mental, emotional, and behavioral disorders, how can preventive interventions be provided to those at risk? This dilemma is caused in part by the exclusive reliance on consumable interventions, such as face-to-face services, and the use of medications. Once a prevention or therapy session is over, no other individual can benefit from that hour of contact. Once a medication is consumed, no one else can benefit from its therapeutic effect. The development and implementation of interventions delivered via the Internet offers the promise of an approach to make interventions available on a continual basis to a wide range of young people at minimal cost while addressing several dissemination and implementation challenges.

Fidelity: The fidelity of Internet interventions is inherent as the material on the computer screen remains the same, no matter how many times it is used. The content of the intervention can be shared widely exactly as tested in randomized control trials.

Scalability: An Internet intervention can be shared with literally thousands of users beyond the locality in which it was created, while remaining accessible to the original locality. The site of a proven Internet intervention can be immediately opened to use by anyone with web access, which also allows effectiveness evaluation on a wide scale.

Sustainability: The cost of maintaining a website hosting an evidence-based preventive intervention is relatively modest, especially if the site is an automated, self-help intervention.

and whether strategic, structural engagement of adolescents increases completion of family therapy more than traditional engagement methods (Szapocznik, Perez-Vidal, and Brickman, 1988). Such designs may have value in exploring ways to increase the reach of prevention programs.

In the years since publication of Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research (Institute of Medicine, 1994), a modest number of experimental tests have aimed at increasing individual- or family-level participation rates for a preventive intervention. For example, motivational interviewing techniques have been used in trials in an attempt to engage parents around problems or issues that they can relate to their own children (Dishion, Kavanagh, et al., 2002).

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