vention research centers. In the first wave, lasting five years, there should be a substantial increase in the funds available for peer-reviewed research projects. Preventive intervention research programs should be supported for any mental disorder where there is well-validated evidence of risk factors that appear to be modifiable. After five years, with the impact of new mid-career researchers joining the field and evidence from five years of research programs, a review should be made of the evidence. It is highly likely that several other preventive intervention research centers could be warranted at that time. Research grant support should not decrease at this time.

  • Research on sequential preventive interventions aimed at multiple risks in infancy, early childhood, and elementary school age to prevent onset of multiple behavioral problems and mental disorders should be increased immediately and substantially. This should include a large number of new research grants and at least one new specialized prevention research center. The knowledge base regarding multiple risk factors in infancy and childhood interacting in complex causal chains and resulting in multiple disorders is extensive. Data on the direct linkage to specific disorders that emerge in adolescence and adulthood are becoming available. Many rigorously designed preventive intervention programs document impacts on risk and protective factors that are likely to reduce incidence rates of mental disorders. Addressing clusters of risk and protective factors increases the chances of preventing multiple disorders, especially major depressive disorder and conduct disorder. A number of separate randomized controlled trials have demonstrated the efficacy, and in some studies the effectiveness, of specific preventive interventions across development from the prenatal period through adolescence in reducing risk factors and enhancing protective factors. These should now be combined and delivered in sequence to high-risk populations. The intervention should include high quality prenatal care, childhood immunizations, home visiting and high-quality day care (such as the Prenatal/Early Infancy Project and the Infant Health and Development Program), high quality preschool (such as the Perry Preschool Program), parenting training, and enhancement of social competence and academic performance. High priority should be given to interagency sponsorship of this research, including the specialized prevention research centers. The Department of Health and Human Services (including the Maternal and Child Health Bureau (MCHB), National Institute of Child Health and Human Development (NICHD), Administration on Children, Youth, and Families (ACYF), Substance Abuse and Mental Health Services Administration (SAMHSA), and the National Institute of Mental Health (NIMH)) and the



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