lunch programs. Box 16-4 presents the results of a
recent meta-analysis evaluating the efficacy of pri-
mary prevention mental health programs for children
and adolescents (Durlak & Wells, 1997).
Secondary Prevention. This involves programs
that promote the early identification of mental health
problems and prompt treatment of problems at an
early stage so that mental disorders do not develop.
The basic idea ofsecondary preventionis to attack
problems while they are still manageable, before
they become resistant to intervention (Caplan,
1961; Sanford, 1965). Often, this approach suggests
the screening of large numbers of people. These peo-
ple are not seeking help, and they may not even
appear to be at risk. Such screening may be carried
out by a variety of community service personnel,
including physicians, teachers, clergy, police, court
officials, social workers, and others. Early assessment
is followed, of course, by appropriate referrals.
An example of secondary prevention is the
early detection and treatment of individuals with
potentially damaging drinking problems (Alden,
1988). A further example is the Rochester Primary
Mental Health Project pioneered by Emory
Cowen, which began in 1957. The project system-
atically screens primary-grade children for risk of
school maladjustment. The development of early
detection and prevention programs in several
states has been described by Cowen, Hightower,
Johnson, Sarno, and Weissberg (1989).
Tertiary Prevention. The goal oftertiary preven-
tionis to reduce the duration and the negative effects
of mental disorders after their occurrence. Thus, ter-
tiary prevention differs from primary and secondary
prevention in that its aim is not to reduce the rate of
new cases of mental disorder but to reduce the
effects of mental disorder once diagnosed.
A major focus of many tertiary programs is reha-
bilitation. This can range from increasing vocational
competence to enhancing the client’s self-concept.
The methods used may be counseling, job training,
and the like. Whether the purpose of a program is to
teach better independent-living skills to those with
mental retardation or to restore the social skills of a
recently discharged patient with a diagnosis of
schizophrenia, the goal is the prevention of addi-
tional problems. Although their language is a bit dif-
ferent, tertiary preventive programs are not very
different from person-oriented programs based on a
deficit philosophy. However, it is important to
remember that all forms of prevention are distin-
guished by their attempts to reduce the rates of, or
problems associated with, mental disorder on a
community-wide (or population-wide) basis.Alternative Models of Prevention. Although
the traditional primary-secondary-tertiary preven-
tion model (Caplan, 1964) is the one most com-
monly cited, alternative classification frameworks
have been proposed (Orford, 1992). As one exam-
ple, we will briefly discuss a framework for prevent-
ing mental disorder proposed in the 1994 Institute
of Medicine (IOM) report,Reducing Risks for Mental
Disorders. This model, adopting terms proposed by
R. Gordon (1983, 1987), classifies prevention inter-
vention into one of three types.Universal preventive
interventions target the entire population; these
interventions may be costly because they are given
to everyone. Selective preventive interventions target
individuals or subgroups of the population that
have a higher-than-average likelihood of develop-
ing the disorder in question (either in the near or
distant future). These targeted individuals are iden-
tified on the basis of biological, psychological, or
social risk factors that have been shown to be asso-
ciated with disorder development. Finally,indicated
preventive interventionstarget“high-risk”individuals,
identified by their manifestation of subthreshold
symptoms of the disorder or by biological markers
indicating a predisposition to develop the disorder.
The value of this model is that it places preven-
tion, treatment of mental disorder, and maintenance
on a continuum representing the full range of inter-
ventions for mental disorders. Prevention occurs
before a disorder develops; treatment is administered
to those who meet (or are close to meeting) diagnostic
criteria for a disorder; and maintenance involves inter-
ventions for individuals with a diagnosis of mental
disorder whose illness continues to warrant attention
(Institute of Medicine, 1994). Figure 16-3 depicts theCOMMUNITY PSYCHOLOGY 467