For the goals of prevention of MEB disorders to be achieved, the three elements of prevention program infrastructure in this chapter must be the focus of ongoing improvement efforts: innovation driven by funded research, a coordinated and effective delivery system, and enhancement of workforce quality and quantity.

Developing a Coordinated and Effective Delivery System

Numerous federal programs and resources fund and guide states and communities in their promotion and prevention efforts. Coordination across these efforts is limited and presents a barrier to large-scale implementation of best practices. Funding for programs and their evaluation is fragmented and inadequate to reach many youth in need. As communities increasingly are able to select programs from available lists of evidence-based approaches, the infrastructure to sort out how best to match program features with community needs and resources and to learn what constitutes the most effective match is often not in place.

Conclusion: Federal programs whose goals include the prevention of MEB disorders are not well coordinated, and there is little strategic synergy between research and service delivery.

Compounding the deficiencies of infrastructure are substantial barriers to implementation of prevention programs in potentially advantageous settings, such as day care, schools, and primary medical care. Too often programs are created de novo and require costly new infrastructure. Barriers such as funding or reimbursement of services can be addressed most effectively at a national or state level. Program funding often does not include expectations that demonstrably effective programs be implemented with fidelity or that outcomes of these programs be rigorously evaluated, and it does not typically support outcomes assessments.

Conclusion: There is a need for the development of systems (service sites and networks) that can implement evidence-based programs, test their effectiveness in real-world environments, and provide a funding stream for evidence-based prevention services.

Funding and infrastructure for substance abuse prevention interventions is more advanced than for prevention or promotion of mental health. There are no targeted funding streams for prevention in the mental health area.

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