440 Community Psychology
PREVENTIVE INTERVENTIONS
Paralleling the development of frameworks and methods that
represent an ecological orientation, efforts toward translating
community research into action have been an integral part of
the field’s history through the design and implementation of
preventive interventions. The history of prevention research
in the United States is a history of cultural changes, such as
the emergence of public health as an approach to disease pre-
vention and health promotion in the 1920s (Rosen, 1993).
The role of citizen advocates for prevention research also has
been critical in defining the practice of prevention (B. B.
Long, 1989). In addition, private foundations and the found-
ing of the NIMH gave prevention prominent attention
(Levine, 1981). The creation of the Joint Commission on
Mental Illness and Health to review the nation’s mental
health contributed to the gradual emergence of prevention as
a national priority in the 1960s (Goldston, 1995). Brief com-
ments will be made about each of these factors and events
prior to the Swampscott Conference, after which, the concept
of prevention will be reviewed as a defining focus for com-
munity psychology. For further discussions of the history of
prevention, the reader is referred to sources such as Caplan
(1969), Levine (1981), Levine and Perkins (1997), and
Spaulding and Balch (1983).
The emergence of prevention in the United States has
benefited from a long history of the social consciousness of
citizens and citizen groups. Notable preventionists include
Dorothea Dix, Clifford Beers, Jane Addams, the General
Federation of Women’s Clubs, the National Association of
Colored Women, and, more recently, Beverly Long, among
others (Beers, 1908; Brinkley, 1993; Dain, 1980; B. B. Long,
1989; Ridenour, 1961). These citizens, most often women,
campaigned to improve the quality of community-based ser-
vices by shifting the aim to prevention programming for the
poor and less formally educated. In 1909, the founding of the
National Mental Health Association meant that, at both na-
tional and local levels, advocates for prevention could draw
on voluntary organizations to create forums and make it eas-
ier for citizens to lobby legislatures for improved community-
based prevention services (Ridenour, 1961).
National policy began to emphasize prevention of chronic
diseases such as cancer, heart disease, and mental illness just
before World War II (Levine, 1981). The aim of public health
practice, to reduce the number of new casualties of a disease
in a community, began to be applied to mental diseases at the
time of the war. From this public health perspective, scientists
developed the concepts of primary, secondary, and tertiary
prevention (Leavell & Clark, 1965). These terms referred
to taking measures to reduce systemic factors to prevent a
problem from occurring (primary prevention); reducing a
problem from occurring for persons who have already estab-
lished risk factors for that problem (secondary prevention);
and reducing the opportunities for reappearance of a problem
for these persons (tertiary prevention). Recently these three
prevention concepts have been elaborated and discussed in
terms of risk, protection, resilience, strengths, and thriving
(Dalton et al., 2000).
World War II created an opportunity for mental health pro-
fessionals to observe the salience of public health approaches
to mental health (G. Caplan, 1964). Mental health profes-
sionals discovered that short-term therapeutic services could
reduce the number of soldiers succumbing to the stress of
battle (Grob, 1991). Given this finding, multidisciplinary
mental health teams began to organize services at or near
battlefields to reduce future mental breakdowns and hospital-
izations among soldiers (Glass, 1958). The rehabilitation of
soldiers in the armed services impacted the practice of men-
tal health services on the home front.
The experiences of mental health professionals in World
War II emphasized the significance of contextual factors
(e.g., war conditions) rather than only individual and consti-
tutional factors for the expression of mental health problems
(Grob, 1991). After the war and with a more active public
health orientation, early detection and prevention of mental
problems became operational in the mental health system. In
adopting more active and community-oriented preventive in-
terventions, mental health professionals became more aware
of the qualities of communities where interventions would
take place. Adding a focus on the qualities of communities in-
creased the sensitivities of clinicians about the relationship
between the mental health of individuals and the characteris-
tics of communities (Grob, 1991).
After World War II, the prevention perspective was bol-
stered by a combination of federal, local, and professional
interests, as well as strong support from private foundations
and national lobbying organizations (Levine & Perkins,
1997). In 1955, the congressionally mandated review of the
nation’s mental health services gave further prominence to
prevention via the work of the Joint Commission on Mental
Illness and Health. As a result of the availability of increased
funds, prevention-oriented psychologists had the resources to
develop programs and research. Research groups began em-
phasizing prevention research and services. For example,
Ralph Ojemann (1957) at the State University of Iowa
organized conferences beginning in 1957 that brought to-
gether prevention researchers interested in prevention in the
schools. The St. Louis County Mental Health Department pi-
oneered a systematic effort to assess the benefits of a preven-
tive school mental health program (Gildea, 1959; Glidewell,