targeted population. Universal prevention includes strategies that can be offered to the full population, based on the evidence that it is likely to provide some benefit to all (reduce the probability of disorder), which clearly outweighs the costs and risks of negative consequences. Selective prevention refers to strategies that are targeted to subpopulations identified as being at elevated risk for a disorder. Indicated prevention includes strategies that are targeted to individuals who are identified (or individually screened) as having an increased vulnerability for a disorder based on some individual assessment but who are currently asymptomatic. Selective and indicated prevention strategies might involve more intensive interventions and thus involve greater cost to the participants, since their risk and thus potential benefit from participation would be greater.

The 1994 IOM Framework

The 1994 IOM report Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research emphasized the importance of putting prevention into a broader context, which includes not only treatment but also maintenance interventions when continued care is indicated (Institute of Medicine, 1994). Treatment was distinguished by two features: “(1) case identification and (2) standard treatment for the known disorder, which includes interventions to reduce the likelihood of future co-occurring disorders” (Institute of Medicine, 1994, p. 23). The features of maintenance were “(1) the patient’s compliance with long-term treatment to reduce relapse and recurrence and (2) the provision of after-care services to the patient, including rehabilitation” (Institute of Medicine, 1994, p. 24).

The term “prevention” was reserved for interventions designed to reduce the occurrence of new cases. While noting that neither the Gordon framework (universal, selective, and indicated prevention) nor the public health framework (primary, secondary, and tertiary prevention) was specifically developed for mental health, a modified version of the Gordon approach was adopted. The defining feature for classifying preventive interventions was the population that was targeted. Similar to that of Gordon, the 1994 IOM report’s rationale for targeting a type of intervention either universally or to a high-risk subgroup was that the potential benefit was substantially higher than the cost and the risk of negative effects. The concepts of universal and selective prevention were essentially the same as in Gordon’s system. The concept of indicated prevention was modified to include interventions targeted to high-risk individuals who do not meet diagnostic criteria for a disorder but who have detectable markers that warn of its onset.

The 1994 IOM report acknowledged that some people in the groups targeted for universal, selective, or indicated preventive interventions may



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