individual- and treatment-centered program to a family- and prevention-centered one. Mass media campaigns, national and local conferences, and seminars were offered, and the clinics’ leadership and the clinicians were eager to learn. Training began with extensive training of master trainers, who then trained many others.

Over time, a decision was made to implement a series of interventions. This included the Family Talk Intervention (see Box 7-3), a 1-2 session intervention using a book for parents, the Let’s Talk About Children discussion, peer groups, and family courses for parents and children. In addition, clinicians or adults (including parents) responsible for children could request a network meeting attended by all professionals involved in the care of a child to devise a coordinated plan. Health help booklets were also provided. This was combined with an extensive campaign to address postpartum depression. Implementation was accompanied by evaluations, with a randomized trial comparing the Family Talk Intervention with the Let’s Talk About Children discussion under way.

Based on research showing that nurses, doctors, psychologists, social workers, and therapists can master the Let’s Talk About Children discussion, the Finnish system now requires that each of these professionals be responsible for initiating child preventive services when working with mentally ill parents.

In this approach, prevention services in the Finnish system are not segregated, but rather routinely included in the work of all clinicians. At the end of 2006, there were 650 fully trained professionals and 80 qualified trainers in a country of 5 million. The work, which began with parental depression, has been extended to drug and alcohol problems, parents with cancer, and other severe physical illnesses. The specific example of children of mentally ill parents takes place against the larger backdrop of Finland’s long tradition of adapting evidence-based preventive interventions in health and mental health nationwide. Their system is set up to accommodate new interventions as they become available.


SOURCES: Beardslee, Hosman, et al. (2005); Solantaus and Toikka (2006); Toikka and Solantaus (2006).

research now available by addressing gaps in the available research and developing a shared vision and strategy for applying the knowledge at hand.

When IOM’s report Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research was published in 1994, the majority of available studies were efficacy studies, with a few addressing the effectiveness of interventions. The report called on the field to continue to develop rigorous efficacy and effectiveness evaluations while at the same time moving further toward the final stage in the proposed prevention research cycle to “facilitate large scale implementation and ongoing evaluation of the pre-



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