Clinical Psychology

trials yield encouraging results, the program is
implemented in the community, and its effective-
ness is again assessed. As can be seen from
Figure 16-4, this last step does not mark the end
of the process. Rather, information regarding the
effectiveness of the intervention in the community
(does it lead to decreases in the incidence of the
problem or disorder?) leads to modification of the
intervention, and the steps are repeated. In this way,

prevention programs are refined with the ultimate

goal of improving their effectiveness.

Empowerment

In their discussion of poverty, Gurin and Gurin

(1970) emphasize the importance of a low expec-

tancy of attaining valued goals and an expectancy of

powerlessness. These notions are closely related to the

M

ai

nt

en

an

ce

Pr

ev

en

tio

n

Treatment

Universal

Selective

Indicated

Case identification

Standard treatment forknown disorders

Compliance with long-term

treatment (Goal: Reduction

in relapse and recurrence)

Aftercare (including

rehabilitation)

F I G U R E 16-3 Prevention on a continuum of services addressing mental health needs

SOURCE: Institute of Medicine (1994).Summary: Reducing risks for mental disorders. Washington, DC: National Academy Press, p. 8. Reprinted with permission.

BOX16-4 Focus on Clinical Applications: Primary Prevention Mental Health Programs for

Children and Adolescents

Durlak and Wells (1997) published a meta-analytic

review of 177 primary prevention programs designed

to prevent behavioral, emotional, and social problems

in children and adolescents. Durlak and Wells found

that these programs, on average, produced meaning-

ful positive effects such that the average participant in

a primary prevention program showed better (more

adaptive) outcome than 59% to 82% of those in a

control group. Most intervention programs not only

reduced problems but they also significantly increased

competencies across a number of affective/emotional,

cognitive, academic, and behavioral domains. Finally,

Durlak and Wells found that, in general, in those

studies that collected follow-up data, these effects

were durable over time. This study demonstrates that a

wide range of primary prevention programs do work—

that is, the mental health of children and adolescents

improves significantly as a result of these programs.

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