researchers, by nature, are cautious. They appreciate the complexity of etiology and the diverse pathways in the occurrence of mental disorders and usually are skeptical about unidimensional interventions, which may not generalize across populations diverse in age and culture. They have high standards for the quality of the evidence they believe is needed before practice recommendations can be made. This circumspect approach contributes to slowness in publication of evidence. For example, pilot studies and early field trials often are not published because the researchers believe that doing so might be “premature. ”

Although community practitioners, along with representatives from community organizations, may understand the reasons for caution, they are faced on a daily basis with the need for preventive services, and they often are frustrated by what they perceive as the unwillingness of the researchers to provide direction. The bottom line for practitioners, who often must answer to policymakers in state legislatures and local councils, is straightforward: What works? How long does it take? How much will it cost?

When these questions cannot be answered from the results of completed field trials within the research cycle, or when practitioners have creative ideas for new interventions, they proceed to create their own prevention programs. Currently, this is being done at the federal, state, and local levels of government and by private foundations. Such programs are primarily “service” in nature, although some, including demonstration projects, have evaluation components attached to them. The result is that large expenditures are being made without knowing the effectiveness of these services.

THE ROLE OF THE COMMUNITY

The role of the community—defined here as policymakers, community practitioners, and representatives of host organizations—is complicated and time-consuming. Part of this complexity is due to the very nature of “community,” which can rarely be regarded as a unitary whole. Rather, it is a heterogeneous group of individuals, institutions, and special interest groups, among whom it can be difficult to achieve consensus. The role of the community includes the following functions: defining the problem and assessing the needs, ensuring the readiness of the host organization, selecting a model program, balancing fidelity and adaptability while implementing the program, evaluating the program's effectiveness, and providing feedback to the researchers. Attention to this process is necessary for programmatic planning at federal, state, and local levels of government and with private foundations.



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