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Committee on the Prevention of Mental Disorders and Substance Abuse Among Children, Youth, and Young Adults: Research Advances and Promising Interventions Mary Ellen OâConnell, Thomas Boat, and Kenneth E. Warner, Editors Board on Children, Youth, and Families Division of Behavioral and Social Sciences and Education
THE NATIONAL ACADEMIES PRESSâ500 Fifth Street, N.W.âWashington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This study was supported by Grant No. NO1-OD-4-2139, Task Order #181 Â between the National Academy of Sciences and the Department of Health and Â Human Â Services. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project. Library of Congress Cataloging-in-Publication Data Preventing mental, emotional, and behavioral disorders among young people : progress and possibilities / Committee on Prevention of Mental Disorders and Substance Abuse Among Children, Youth, and Young Adults: Research Advances and Promising Interventions ; Mary Ellen OâConnell, Thomas Boat, and Kenneth E. Warner, editors ; Board on Children, Youth, and Families, Division of Behavioral and Social Sciences and Education. p. cm. Rev. ed. of: Reducing risks for mental disorders. 1994. Includes bibliographical references and index. ISBN 978-0-309-12674-8 (hardcover) â ISBN 978-0-309-12675-5 (pdf) 1. Mental illnessâPreventionâResearchâGovernment policyâUnited States. 2. Mental health promotionâResearchâGovernment policyâUnited States. 3. Mental illnessâUnited StatesâPrevention. 4. Mental health promotionâUnited States. I. OâConnell, Mary Ellen. II. Boat, Thomas F. III. Warner, Kenneth E., 1947- IV. Institute of Medicine (U.S.). Committee on Prevention of Mental Disorders and Substance Abuse Among Children, Youth, and Young Adults: Research Advances and Promising Interventions. V. National Research Council (U.S.). Board on Children, Youth, and Families. VI. Reducing risks for mental disorders. RA790.6.R44 2009 362.196â²890072âdc22 2009003378 Additional copies of this report are available from National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334- 3313 (in the Washington metropolitan area); Internet, http://www.nap.edu. Copyright 2009 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: National Research Council and Institute of Medicine. (2009). Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibili- ties. Committee on the Prevention of Mental Disorders and Substance Abuse Among Chil- dren, Youth, and Young Adults: Research Advances and Promising Interventions. Mary Ellen OâConnell, Thomas Boat, and Kenneth E. Â Warner, Editors. Board on Children, Youth, and Families, Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press.
The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general wel- fare. Upon the authority of the charter granted to it by the Congress in 1863, the Â Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding e Â ngineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineer- ing programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is presi- dent of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Insti- tute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of ÂSciences in 1916 to associate the broad community of science and technology with the Academyâs purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The C Â ouncil is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council. www.national-academies.org
COMMITTEE ON THE PREVENTION OF MENTAL DISORDERS AND SUBSTANCE ABUSE AMONG CHILDREN, YOUTH, AND YOUNG ADULTS: Research Advances and Promising Interventions KENNETH E. WARNER (Chair), School of Public Health, University of Michigan THOMAS F. BOAT (Vice Chair), Cincinnati Childrenâs Hospital Medical Center WILLIAM R. BEARDSLEE, Department of Psychiatry, Childrenâs Hospital, Boston CARL C. BELL, University of Illinois at Chicago and Community Mental Health Council ANTHONY BIGLAN, Center on Early Adolescence, Oregon Research Institute C. HENDRICKS BROWN, College of Public Health, University of South Florida E. JANE COSTELLO, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center TERESA D. LaFROMBOISE, School of Education, Stanford University RICARDO F. MUÃOZ, Department of Psychiatry, University of California, San Francisco PETER J. PECORA, Casey Family Programs and School of Social Work, University of Washington BRADLEY S. PETERSON, Pediatric Neuropsychiatry, Columbia University LINDA A. RANDOLPH, Developing Families Center, Washington, DC IRWIN SANDLER, Prevention Research Center, Arizona State University MARY ELLEN OâCONNELL, Study Director BRIDGET B. KELLY, Christine Mirzayan Science and Technology Policy Graduate ellow (September-November 2007) and Senior Program F Associate (December 2007-August 2008) WENDY E. KEENAN, Program Associate MARY ANN KASPER, Senior Program Assistant
BOARD ON CHILDREN, YOUTH, AND FAMILIES Bernard Guyer (Chair), Bloomberg School of Public Health, Johns Hopkins University Barbara L. Wolfe (Vice Chair), Department of Economics and Population Health Sciences, University of Wisconsin William R. Beardslee, Department of Psychiatry, Childrenâs Hospital, Boston Jane D. Brown, School of Journalism and Mass Communication, University of North Carolina, Chapel Hill Linda Marie Burton, Sociology Department, Duke University P. Lindsay Chase-Lansdale, Institute for Policy Research, Northwestern University Christine C. Ferguson, School of Public Health and Health Services, George Washington University William T. Greenough, Department of Psychology, University of Illinois Ruby Hearn, Robert Wood Johnson Foundation (emeritus), Princeton, New Jersey Michele D. Kipke, Saban Research Institute, Childrenâs Hospital of Los Angeles Betsy Lozoff, Center for Human Growth and Development, University of Michigan Susan G. Millstein, Division of Adolescent Medicine, University of California, San Francisco Charles A. Nelson, Laboratory of Cognitive Neuroscience, Childrenâs Hospital, Boston Patricia OâCampo, University of Toronto and Centre for Research on Inner City Health, St. Michaelâs Hospital, Toronto Frederick P. Rivara, Schools of Medicine and Public Health, University of Washington, and Childrenâs Hospital and Regional Medical Center, Seattle Laurence D. Steinberg, Department of Psychology, Temple University John R. Weisz, Judge Baker Childrenâs Center and Harvard Medical School Michael Zubkoff, Department of Community and Family Medicine, Dartmouth Medical School Rosemary Chalk, Board Director Wendy Keenan, Program Associate vi
Acknowledgments T his report is the work of the Committee on the Prevention of ÂMental Disorders and Substance Abuse Among Children, Youth, and Young Adults: Research Advances and Promising Interventions, a project of the National Research Council (NRC) and the Institute of Medicine (IOM). The expertise and hard work of the committee were advanced by the sup- port of our sponsors, the contributions of able consultants and staff, and the input of outside experts. The majority of funding for this project was provided by the Center for Mental Health Services of the Substance Abuse and Mental Health Services Administration (SAMHSA), with supplemen- tary funding from the National Institute of Mental Health (NIMH), the National Institute on Drug Abuse (NIDA), and the National Institute on Alcohol Abuse and Alcoholism (NIAAA). The guidance and support of Anne Mathews-Younes and Paul Brounstein, SAMHSA; Robert Heinssen, NIMH; Elizabeth Robertson, NIDA; and Vivian Faden, NIAAA, were much appreciated. Throughout this process, the committee benefited from presentations or written input by individuals with a range of perspectives (see Appen- dix B). The committee is thankful for the useful contributions of these many individuals. We would like to thank those who wrote papers that were invaluable to the committeeâs discussions: Tom Dishion, University of Oregon; Daniel Eisenberg, University of Michigan; Pauline E. Ginsberg, Utica College; Mark Greenberg, Pennsylvania State University; J. David Hawkins, University of Washington; Kamilah Neighbors, University of Michigan; Ron Prinz, University of South Carolina; Anne W. Riley, Johns Hopkins University; Herbert Severson, Oregon Research Institute; Brian vii
viii ACKNOWLEDGMENTS Smith, University of Washington; Hill Walker, Oregon Research Institute; and Hirokazu Yoshikawa, Harvard University. We are also thankful to those who assisted committee members with literature searches, back- ground research, or analyses, including Mark Alter, Columbia University; Christine Cody, Oregon Research Institute; Alaatin Erkanli, Duke Univer- sity Medical Center; Erika Hinds, University of Oregon; Armando Pina, Arizona State University; and Joan Twohey-Jacobs, University of La Verne. We also thank Casey Family Programs for their travel support. This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the Report Review Committee of the NRC. The purpose of this independent review is to provide candid and critical com- ments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We thank the following individuals for their review of this report: Sherry Glied, Mailman School of Public Health, Columbia University; Larry A. Green, University of Colorado Health Science Center, Denver, CO; Mark T. Greenberg, Prevention Research Center, Pennsylvania State University; Deborah Gross, Department of Psychiatry and Behavioral ÂSciences, Johns Hopkins University, School of Nursing and School of Medicine; Peter S. Jensen, Presidentâs Office, The REACH Institute (REsource for Advancing Childrenâs Health), New York; Sheppard G. Â Kellam, Center for Integrat- ing Education and Prevention Research in Schools, American Institutes for Research; Bruce G. Link, Mailman School of Public Health, Columbia University; Patricia J. Mrazek, independent consultant; Estelle B. Richman, Secretaryâs Office, PÂennsylvania Department of Public Welfare; and Huda Y. Zoghbi, Departments of Pediatrics, Molecular and Human Genetics, Neurology, and Neuroscience, Baylor College of Medicine. Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Floyd E. Bloom, Pro- fessor Emeritus, Department of Molecular and Integrative NeuroÂscience, Scripps Research Institute, and Richard G. Frank, Department of Health Care Policy, Harvard University Medical School. Appointed by the NRC, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.
ACKNOWLEDGMENTS ix The committee appreciates the support provided by members of the Board on Children, Youth, and Families, under the leadership of Bernard Guyer, and we are grateful for the leadership and support of Rosemary Chalk, director of the Board on Children, Youth, and Families. Finally, numerous National Academiesâ staff played meaningful roles that contributed to the production of this report. Ann Page, with the IOM Board on Health Care Services, provided useful guidance and suggestions during the launch of the study. Bridget Kelly, who initially joined the team as a policy fellow, was convinced to stay on to assist with innumerable analytic and writing tasks that were consistently handled with the utmost competence. Along with Bridget, Margaret Hilton served as a reviewer of project abstracts, and Hope Hare helped set up an abstract database. Wendy Keenan was an asset to the team from the very first day by helping with a range of research, analysis, contracting, and logistical challenges. In addition, Matthew Von Hendy and Bill McLeod, research librarians, provided invaluable assistance with literature searches and references. Jay Labov provided a very insightful review of an earlier draft of the neuro- science chapter. A final thanks is due to Mary Ann Kasper, who managed numerous administrative details during our multiple meetings, workshops, and conference calls. Kenneth E. Warner, Chair Thomas F. Boat, Vice Chair Mary Ellen OâConnell, Study Director Committee on the Prevention of Mental Disorders and Substance Abuse Among Children, Youth, and Young Adults: Research Advances and Promising Interventions
Contents Preface xiii Acronyms xvii Glossary xxiii Summary 1 1 Introduction 15 PART I: OVERVIEW AND BACKGROUND 2 The Nature and Extent of the Problem 35 3 Defining the Scope of Prevention 59 4 Using a Developmental Framework to Guide Prevention and Promotion 71 5 Perspectives from Developmental Neuroscience 113 PART II: PREVENTIVE INTERVENTION RESEARCH 6 Family, School, and Community Interventions 157 7 Prevention of Specific Disorders and Promotion of Mental Health 191 8 Screening for Prevention 221 xi
xii CONTENTS 9 Benefits and Costs of Prevention 241 10 Advances in Prevention Methodology 263 PART III: NEW FRONTIERS 11 Implementation and Dissemination of Prevention Programs 297 12 Prevention Infrastructure 337 13 Toward an Improved Approach to Prevention 377 References 397 APPENDIXES* A Biographical Sketches of Committee Members and Staff 495 B Open Session and Workshop Agenda 503 C Sources of Data on Prevalence of MEB Disorders of Young People 511 D Preventive Intervention Meta-Analyses 515 E Tables of Risk Factors 521 F Intervention Research Portfolio One-Year Snapshot: Summary Analysis 533 Index 539 *Only Appendix A is printed in this volume. The other appendixes are avail- able online. Go to http://www.nap.edu and search for Preventing Â Mental, Emotional, and Behavioral Disorders Among Young People.
Preface T his report calls on the nationâits leaders, its mental health research and service provision agencies, its schools, its primary care medical systems, its community-based organizations, its child welfare and criminal justice systemsâto make prevention of mental, emotional, and behavioral disorders and the promotion of mental health of young people a very high priority. By all realistic measures, no such priority exists today. The report therefore urges action at the highest levels to ensure that public health decision makers and the public understand the nature and magnitude of this problem; that research to prevent it is carefully coordinated and well funded; and that institutions and communities have the resources and the responsibility to promote the implementation of prevention interventions that can address shortfalls in the public response. Mental, emotional, and behavioral disorders incur high psychosocial and economic costs for the young people who experience them, for their families, and for the society in which they live, study, and will work. Yet there is a significant imbalance in the nationâs efforts to address such disÂ orders. People await their emergence and then attempt to treat them, to cure them if possible, or to limit the damage they cause if not. This happens with any number of expensive interventions, ranging from psychiatric care to incarceration. Myopically, we devote minimal attention to preventing future disorders or the environmental exposures that increase risk. This report builds on a highly valued predecessor, the 1994 Institute of Medicine (IOM) report entitled Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research. That report provided the basis for understanding prevention science, elucidating its then-existing xiii
xiv PREFACE research base, and contemplating where it should go in the future. This report documents that an increasing number of mental, emotional, and behavioral problems in young people are in fact preventable. The proverbial ounce of prevention will indeed be worth a pound of cure: effectively apply- ing the evidence-based prevention interventions at hand could potentially save billions of dollars in associated costs by avoiding or tempering these disorders in many individuals. Furthermore, devoting significantly greater resources to research on even more effective prevention and promotion efforts, and then reliably implementing the findings of such research, could substantially diminish the human and economic toll. This could be done, but as Hadorn has observed, the basic tendency is to focus on âthe rule of rescue . . . the powerful human proclivity to rescue endangered life.â As a society, we suffer from a collective health care myopia: we have not yet figured out how to balance rescueâwhich is after-the-fact treatmentâwith the less dramatic but often far more cost-effective and socially desirable prevention of the onset of a problem. The very definition of prevention is itself a problem. The authors of the 1994 IOM report emphasized the need for clear definitions to guide the field. The authors proposed a new typology of prevention: universal interventions, which address the population at large, selective interventions, which target groups or individuals with an elevated risk, and indicated interventions, which target individuals with early symptoms or behaviors that are precursors for disorder but are not yet diagnosable. In essence, this typology of prevention was proposed as a set of interventions to target individuals and populations that do not currently have a disorder, with variations in exactly who is targeted. Yet ardent proponents of prevention, including members of the 1994 IOM committee, do not wish to exclude the prevention of disease relapse or disability from their conception of prevention. While acknowledging the legitimacy of this perspective, our committee thinks that the disproportionate emphasis on treatment of existing condi- tions needs to be corrected. We propose a new emphasis on true prevention, which for the purposes of this report we define as occurring prior to the onset of disorder, as well as mental health promotion, discussed imme- diately below. We do not disparage societyâs emphasis on treatment and indeed think that in the domain of mental health, far more resources should be devoted to the effort. Rather, we want to highlight the critical need for a more proactive, preventive focus on mental health. The primary charge for this committee is prevention, but we add to our focus the emerging field of mental health promotion, an important â Hadorn, D.C. (1991, May 1). Setting health care priorities in Oregon: Cost-effectiveness meets the rule of rescue. Journal of the American Medical Association, 265(17), 2218-2225.
PREFACE xv and largely ignored approach toward building healthy development in all young people. Prevention emphasizes the avoidance of risk factors; promo- tion strives to promote supportive family, school, and community environ- ments and to identify and imbue in young people protective factors, which are traits that enhance well-being and provide the tools to avoid adverse emotions and behaviors. While research on promotion is limited, emerging interest and involvement in it and the potential it holds for enhancing health warrant its inclusion in the consideration of how the nation can improve its collective well-being. The committeeâs focus on young people and the stigma associated with the term âmental disorderâ led us to adopt the term âmental, emo- tional, and behavioral disordersâ to encompass both disorders diagnosable using Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) criteria and the problem behaviors associated with them, such as violence, aggression, and antisocial behavior. Many mental, emotional, and behavioral disorders of youth exist on a continuum and exert significant costs on the young people themselves, the people affected by them, and society at large. The term âmental, emotional, and behavioral disordersâ encompasses mental illness and substance abuse, while including a some- what broader range of concerns associated with problem behaviors and conditions in youth. One factor lurks in the background of every discussion of the risks for mental, emotional, and behavioral disorders and antisocial behavior: poverty. Poverty in the United States often entails a range of material hard- ships, such as overcrowding, frequent moves (which often mean changes of school), poor schools, limited health care, unsafe and stressful environ- ments, and sometimes lack of adequate food. All of these imperil cognitive, emotional, and behavioral development. Although not the focus of this report, there is evidence that changes in social policy that reduce exposure to these risks are at least as important for preventing mental, emotional, and behavioral disorders in young people as other preventive interventions. We are persuaded that the future mental health of the nation depends cru- cially on how, collectively, the costly legacy of poverty is dealt with. As chairs of the committee that has produced this report, we have ben- efited immensely from the commitment, energy, and effort of two groups of people. We are grateful to the committee members, who demonstrated devotion to the subject of this report and to the arduous task of develop- ing it. All committee members contributed to the writing of the report, and the âthink tankâ nature of our innumerable meetings, conference calls, and e-mail exchanges played enormously important roles in shaping both the structure and content of the report. We are deeply indebted, as well, to the National Academiesâ staff, who performed at a consistently high level all of the myriad tasks that are essential to compiling a large and complex
xvi PREFACE report such as this one. One staff member is particularly deserving of men- tion: Mary Ellen OâConnell, the study director, is the consummate Jill of all trades. From the inception of the study to the crossing of the final t, she directed all aspects of the committeeâs work with insight and across-the- board competence. We admire her incredible work ethic and express our jealousy at her apparent ability to work without sleep. Kenneth E. Warner, Chair Thomas F. Boat, Vice Chair Committee on the Prevention of Mental Disorders and Substance Abuse Among Children, Youth, and Young Adults: Research Advances and Promising Interventions
Acronyms ABCD Assuring Better Child Health and Development ABFM American Board of Family Medicine ACF Administration for Children and Families of the U.S. Department of Health and Human Services ACGME Accreditation Council for Graduate Medical Education ADAMHA Alcohol, Drug Abuse, and Mental Health Administration, the predecessor to the Substance Abuse and Mental Health Services Administration ADHD attention deficit hyperactivity disorder AHRQ Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services AILS American Indian Life Skills Program AIM awareness, intervention, and methodology AMERSA Association for Medical Education and Research in Substance Abuse ASPE Office of the Assistant Secretary for Planning and Evaluation of the U.S. Department of Health and Human Services ATP Adolescent Transitions Program AUD alcohol use disorder CAPT Regional Centers for the Application of Prevention Technologies of the Substance Abuse and Mental Health Services Administration CBA cost-benefit analysis CBPR community-based participatory research xvii
xviii ACRONYMS CBT cognitive-behavioral therapy CD conduct disorder CDC Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services CDISC Computerized Diagnostic Interview Schedule for Children CEA cost-effectiveness analysis CHAMP Chicago HIV Adolescent Mental Health Program, renamed the Collaborative HIV Adolescent Mental Health Program when expanded beyond Chicago CHAMP-SA Collaborative HIV Adolescent Mental Health Program, South Africa CMHS Center for Mental Health Services of the Substance Abuse and Mental Health Services Administration CMS Centers for Medicare and Medicaid Services of the U.S. Department of Health and Human Services CPC Child-Parent Centers CRISP Computer Retrieval of Information on Scientific Projects of the National Institutes of Health CSAP Center for Substance Abuse Prevention of the Substance Abuse and Mental Health Services Administration CTC Communities That Care DALY disability-adjusted life year DBD disruptive behavior disorders DHA docosahexaenoic acid DSM-IV Diagnostic and Statistical Manual of Mental Disorders, 4th Edition ED U.S. Department of Education EIFC Early Intervention Foster Care EPA eicosapentaenoic acid EPSDT Early and Periodic Screening, Diagnostic, and Treatment ESOL English for Speakers of Other Languages FY fiscal year GBG Good Behavior Game GSMS Great Smoky Mountains Study HFA Healthy Families America HFNY Healthy Families New York HHS U.S. Department of Health and Human Services
ACRONYMS xix HRSA Health Resources and Services Administration of the U.S. Department of Health and Human Services ICD-9 International Statistical Classification of Diseases and Related Health Problems, 9th Edition IDEA Individuals with Disabilities Education Act IES Institute of Education Sciences of the U.S. Department of Education IOM Institute of Medicine LIFT Linking Interests of Families and Teachers project LST Life Skills Training Program MCHB Maternal and Child Health Bureau of the U.S. Department of Health and Human Services MDE major depressive episode MEB mental, emotional, and behavioral MI motivational interviewing MPP Midwestern Prevention Program MTF Monitoring the Future MTFC multidimensional treatment foster care NAMHC National Advisory Mental Health Council NASHP National Academy of State Health Policy NBP New Beginnings Program NCAST Nursing Child Assessment Satellite Training NCLB No Child Left Behind Act of 2001 NCS National Comorbidity Survey NCS-R National Comorbidity Survey-Replication NECON New England Coalition for Health Promotion and Disease Prevention NFP Nurse-Family Partnership NHANES National Health and Nutrition Examination Survey NHIS National Health Interview Survey NIAAA National Institute on Alcohol Abuse and Alcoholism NICHD National Institute of Child Health and Human Development NIDA National Institute on Drug Abuse NIH National Institutes of Health of the U.S. Department of Health and Human Services NIJ National Institute of Justice of the U.S. Department of Justice NIMH National Institute of Mental Health NRC National Research Council
xx ACRONYMS NREPP National Registry of Evidence-Based Programs and Practices of the Substance Abuse and Mental Health Services Administration NSDUH National Survey on Drug Use and Health ODD oppositional defiant disorder OJJDP Office of Juvenile Justice and Delinquency Prevention of the U.S. Department of Justice PALS Positive Attitudes Toward Learning in Schools PATHS Promoting Alternative Thinking Strategies POP Penn Optimism Program PPN Promising Practices Network PPP Penn Prevention Program PROSPER Promoting School-community-university Partnerships to Enhance Resilience PRP Penn Resiliency Program PSMG Prevention Science and Methodology Group PTC Parenting Through Change PTSD posttraumatic stress disorder PUP Prohibition of Youth Possession, Use, or Purchase of Tobacco QALY quality-adjusted life year SAMHSA Substance Abuse and Mental Health Services Administration of the U.S. Department of Health and Human Services SBD sleep-related breathing disorder SCHIP State Childrenâs Health Insurance Program SDB sleep-disordered breathing SDFS Safe and Drug-Free Schools Program of the U.S. Department of Education SEL social and emotional learning SFP Strengthening Families Program SPR Society for Prevention Research SSDP Seattle Social Development Program SS/HS Safe Schools Healthy Students Program of the U.S. Departments of Health and Human Services, Education, and Justice TANF Temporary Assistance for Needy Families TLFB Timeline Follow Back Interview TPRCs Transdisciplinary Prevention Research Centers of the National Institute on Drug Abuse
ACRONYMS xxi Triple P Positive Parenting Program USPHS U.S. Public Health Service WHO World Health Organization WIC Special Supplemental Nutrition Program for Women, Infants, and Children WISC-R Wechsler Intelligence Scale for Children, Revised YRBSS Youth Risk Behavior Surveillance System
Glossary Adaptation: The modification of evidence-based interventions that have been developed for a single ethnic, linguistic, and/or cultural group for use with other groups. Adoption: The selection and incorporation of a prevention program into a service system. Alcohol abuse: The consumption of alcohol despite negative consequences. Alcohol dependence: The persistent consumption of alcohol despite nega- tive consequences, often with a physiological dependence characterized by tolerance and/or symptoms of withdrawal. Alcohol use disorder: An inclusive term referring to either alcohol abuse or alcohol dependence. Comorbidity: The presence of one or more disorders in addition to a pri- mary disorder. Confound: A variable in an experiment or trial that may be related to observed effects and therefore may limit the ability to make inferences about causal effects of the experimental variables. Cost-benefit analysis: A method of economic analysis in which costs and outcomes of an intervention are both valued in monetary units, permit- ting a direct comparison of the benefits produced by the intervention with its costs. Cost-effectiveness analysis: A method of economic analysis in which out- comes of an intervention are measured in nonmonetary terms. The outcomes and costs are compared with both the costs and the same out- come measure for competing interventions or an established standard xxiii
xxiv GLOSSARY to determine if the outcomes are achieved at a reasonable Â monetary cost. Cross-sectional study: A study to estimate the relationship between an outcome of interest and specified variables by comparing groups that differ on those variables at a single point in time. Developmental competence: The ability to accomplish a broad range of appropriate social, emotional, cognitive, and behavioral tasks at vari- ous developmental stages, including adaptations to the demands of different social and cultural contexts and attaining a positive sense of identity, efficacy, and well-being. Developmental competencies: Social, emotional, cognitive, and behavioral tasks that are appropriate at various developmental stages and in vari- ous social and cultural contexts. Developmental neuroscience: The study of the anatomical and functional development of the nervous system in humans and animal models. This encompasses the fields of molecular and behavioral genetics, molecular and cellular neurobiology, biochemistry, physiology, pharmacology, pathology, and systems-level neuroscience and applies methods ranging from molecular biology to imaging to functional studies of cognition and behavior. Dissemination: The distribution of program information with the aim of encouraging program adoption in real-world service systems or communities. Dissemination trial: A trial designed to experimentally test approaches and strategies to influence providers, communities, or organizations to adopt evidence-based prevention programs in real-world service settings. DSM-IV: The current edition of the Diagnostic and Statistical Manual of Mental Disorders, a handbook published by the American Psychiatric Association describing different categories of mental disorders and the criteria for diagnosing them. Effect size: A statistical measure of the strength of the relationship between two variables. Effectiveness: The impact of a program under conditions that are likely to occur in a real-world implementation. Effectiveness trial: A trial designed to test whether an intervention can achieve effects when delivered by a natural service delivery system (i.e., similar to the institutions or communities that are ultimately intended to implement the intervention). The emphasis is on demonstrating posi- tive outcomes in a real-world setting using nonresearch staff to deliver the intervention.
GLOSSARY xxv Efficacy: The impact of a program under ideal research conditions. Efficacy trial: A trial designed to test whether a new or significantly modi- fied intervention has effects when it is delivered in a research environ- ment by research staff under optimal conditions. Efficacy trials can take place in research or real-world settings but are typically delivered by trained research staff under the direction and control of the research team, using resources beyond what might be available in the natural course of service delivery. A trial is also considered an efficacy trial if an intervention is being tested by research staff with a new population or in an amended form. Encouragement designs: Trial designs that randomize individuals to dif- ferent modalities of recruitment, incentives, or persuasion messages to influence their choice to participate in one or another intervention condition. Epidemiology: The study of factors that influence the health and illness of populations. Epigenetics: Alterations in gene expression through mechanisms other than modifications in the genetic sequence. Etiology: The cause of a disease or condition. Externalizing: Problems or disorders that are primarily behavioral (e.g., conduct disorder, oppositional defiant disorder). Fidelity: The degree to which an intervention is delivered as designed. Genotype: An individualâs genetic makeup. Iatrogenic effect: An adverse effect caused by an intervention. ICD-9: The current International Statistical Classification of Diseases and Related Health Problems, a classification system published by the World Health Organization and used to code disease as well as signs, symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or disease. Implementation: The process of introducing and using interventions in real-world service settings, including how interventions or programs are adopted, sustained, and taken to scale. Implementation trial: A trial designed to experimentally test approaches and strategies for successful utilization of evidence-based prevention programs in real-world service settings. Incidence: The number, proportion, or rate of occurrence of new cases of a disorder in a population within a specified period of time. Indicated prevention: Preventive interventions that are targeted to high-risk individuals who are identified as having minimal but detectable signs or symptoms that foreshadow mental, emotional, or behavioral disorder,
xxvi GLOSSARY as well as biological markers that indicate a predisposition in a person for such a disorder but who does not meet diagnostic criteria at the time of the intervention. Internalizing: Problems or disorders that are primarily emotional (e.g., anxiety, depression). Longitudinal study: A study that involves repeated observations of targeted outcomes over a long period of time. Main effect: The effect of an independent variable averaged over all levels of other variables in an experiment. Mediator: A variable factor that explains how an effect occurs (i.e., the causal pathway between an intervention and an outcome). Mental, emotional, and behavioral disorders: A diagnosable mental or substance use disorder. Mental, emotional, and behavioral problems: Difficulties that may be early signs or symptoms of mental disorders but are not frequent or severe enough to meet the criteria for a diagnosis. Mental health promotion: Interventions that aim to enhance the ability to achieve developmentally appropriate tasks (developmental competen- cies) and a positive sense of self-esteem, mastery, well-being, and social inclusion and to strengthen the ability to cope with adversity. Mental illness: A condition that meets DSM-IV diagnostic criteria. Meta-analysis: A statistical analysis that combines the results of several studies that address the same research question. Moderator: A variable factor that influences how an intervention or Âmediator exerts its effect. Natural experimental design: A naturally occurring opportunity to observe the effects of defined variables that approximates the properties of a controlled experiment. Neural systems: Functionally integrated circuits in the nervous system that operate in the context of genetic and environmental influences to pro- duce complex behaviors. Nonexperimental studies: Observational research designs that do not include an experimental manipulation of variables by the researchers. Odds ratio: The ratio of the odds of an outcome occurring in an experi- mental group to the odds of it occurring in a control group, a measure of the size of the effect of an intervention. Pathogenesis: The mechanisms by which etiological factors cause a disease or disorder.
GLOSSARY xxvii Pathophysiology: The disturbance of normal functions that are the result of a disease or disorder. Phenotype: An individualâs observed physical or behavioral characteristics. Polymorphism: A variation in genetic sequence. Premorbid: A sign or symptom that occurs before the development of disease. Pre-post studies: Nonrandomized studies that evaluate an intervention on the basis of the changes that occur in the same subject from a baseline (the âpreâ measurement) to after the intervention period (the âpostâ measurement). Prevalence: The total number of cases of a disorder in a population. Prevention: Interventions that occur prior to the onset of a disorder that are intended to prevent or reduce risk for the disorder. Prevention research: The study of theory and practice related to the preven- tion of social, physical, and mental health problems, including etiology, methodology, epidemiology, and intervention. Prevention science: A multidisciplinary field devoted to the scientific study of the theory, research, and practice related to the prevention of social, physical, and mental health problems, including etiology, epidemiology, and intervention. Preventionist: A practitioner who delivers prevention interventions. Problem behaviors: Behaviors with negative effects that are often signs or symptoms of mental, emotional, or behavioral disorders that may not be frequent or severe enough to meet the criteria for a diagnosis (e.g., aggressiveness, early alcohol use) but have substantial personal, family, and societal costs. Prodrome: An early, nonspecific set of symptoms that indicate the onset of disease before specific, diagnosable symptoms occur. Protective factor: A characteristic at the biological, psychological, family, or community (including peers and culture) level that is associated with a lower likelihood of problem outcomes or that reduces the negative impact of a risk factor on problem outcomes. Psychiatric disorder: A condition that meets DSM-IV diagnostic criteria. Psychopathology: Behaviors and experiences that are indicative of mental, emotional, or behavioral disorder or impairment. Qualitative data: Research information that is descriptive but not measured or quantified for statistical analysis. Qualitative review: A review of research evidence relevant to a research question that does not include new statistical analysis. Quantitative data: Research information that is measured for statistical analysis.
xxviii GLOSSARY Quasi-experimental studies: Experimental designs in which subjects are not randomly assigned to experimental and control groups. Randomized studies: Experimental designs that randomly assign subjects (individuals, families, classrooms, schools, communities) into equiva- lent groups that are exposed to different interventions in order to com- pare outcomes with the goal of inferring causal effects. Replication: The reproduction of a trial or experiment by an independent researcher. Research funders: For purposes of this report, federal agencies and founda- tions that fund research on mental health promotion or prevention of mental, emotional, or behavioral disorders. Resilience: The ability to recover from or adapt to adverse events, life changes, and life stressors. Retrospective study: A study that looks back at the histories of a group that currently has a disorder or characteristic in comparison to a similar group without that disorder or characteristic to determine what factors may be associated with the disorder or characteristic. Risk factor: A characteristic at the biological, psychological, family, com- munity, or cultural level that precedes and is associated with a higher likelihood of problem outcomes. Selective prevention: Preventive interventions that are targeted to individu- als or to a subgroup of the population whose risk of developing mental, emotional, or behavioral disorders is significantly higher than average. The risk may be imminent or it may be a lifetime risk. Risk groups may be identified on the basis of biological, psychological, or social risk fac- tors that are known to be associated with the onset of a disorder. Those risk factors may be at the individual level for nonbehavioral character- istics (e.g., biological characteristics such as low birth weight), at the family level (e.g., children with a family history of substance abuse but who do not have any history of use), or at the community/population level (e.g., schools or neighborhoods in high-poverty areas). Substance abuse: The use of alcohol or drugs despite negative consequences. Substance dependence: The persistent use of alcohol or drugs despite nega- tive consequences, often with a physiological dependence characterized by tolerance and/or symptoms of withdrawal. Substance use disorder: An inclusive term referring to either substance abuse or substance dependence. Systematic review: A literature review that tries to identify, appraise, select, and synthesize all high-quality research evidence relevant to a research question.
GLOSSARY xxix Taxonomy: A system of names and classifications. Translational research (type 1): The transfer of basic science discoveries into clinical research as well as the influence of clinical research findings on basic science research questions. Translational research (type 2): The study of the real-world effectiveness and implementation of programs for which efficacy has been previously demonstrated. Treatment: Interventions targeted to individuals who are identified as cur- rently suffering from a diagnosable disorder that are intended to cure the disorder or reduce the symptoms or effects of the disorder, including the prevention of disability, relapse, and/or comorbidity. Universal prevention: Preventive interventions that are targeted to the gen- eral public or a whole population group that has not been identified on the basis of individual risk. The intervention is desirable for everyone in that group. Wait-list designs: Research designs that provide the new intervention first to the experimental group and later to those who were initially assigned to the control group. Young people: For purposes of this report, children, youth, and young adults (to age 25).