of the implications of alternative definitions for prevention research and practice. The report argued that “without a system for classifying specific interventions, there is no way to obtain accurate information on the type or extent of current activities, … and no way to ensure that prevention researchers, practitioners, and policy makers are speaking the same language” (Institute of Medicine, 1994, p. 24).

Early Frameworks

Preventive approaches to MEB disorders have been proposed as a complementary approach to the treatment services that have long been society’s dominant approach to reducing their burden on the population. Treatment services, regardless of their variation in content, share the common features that people are identified (either by themselves or by others) as currently suffering from a recognizable disorder, and they enter treatment with the expectation of receiving some form of relief from the disorder. Prevention is a complementary approach in which services are offered to the general population or to people who are identified as being at risk for a disorder, and they receive services with the expectation that the likelihood of a future disorder will be reduced.

Developing definitions that clearly discriminate different types of prevention from each other and prevention from treatment is fraught with difficulty. Caplan’s (1964) application of the concepts of primary, secondary, and tertiary prevention, which are common in a public health context, had an important influence in developing early prevention models. Cowen (1977, 1980) later found that much of what was labeled as primary prevention did not meet any rigorous standards for such a definition. He suggested two criteria for primary prevention efforts: (1) that they be intentionally designed to reduce dysfunction or promote health before the onset of disorder and (2) that they be population focused, targeted either to the whole population or to subgroups with known vulnerabilities.

From a developmental perspective, however, many MEB disorders are risk factors for later disorders or disability, so all treatment could potentially be labeled as prevention. Gordon (1983) noted that distinctions between prevention and treatment are often based more on historical than on rational or scientific reasons. He reserved the term “prevention” for services for those individuals who were identified as not “suffering from any discomfort or disability from the disease or disorder to be prevented.” Thus the category of tertiary prevention proposed by Caplan (1964), which referred to the prevention of disability for those suffering from disorders, was excluded.

Gordon (1983) proposed an alternative threefold classification of prevention based on the costs and benefits of delivering the intervention to the



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