where formerly chronic, hospitalized patients can
learn independent-living skills. The Mendota Pro-
gram (Marx, Test, & Stein, 1973) was a pioneering
attempt to help formerly undischargeable patients
find jobs, learn cooking and shopping skills, and
so on. Finally, there is the growing popularity of
day hospitals that are often more effective and less
expensive than traditional 24-hour hospitalization.
Intervention in Early ChildhoodPublic health workers and mental health workers
have long been aware of the educational disadvan-
tages experienced by the poor. Of great concern is
the fear that early deprivation in crucial develop-
mental periods will mark the child for life. Impov-
erished preschool environments and experiences
may almost guarantee that the child will do poorly
in school and thus become vulnerable to a wide
variety of mental health, legal, and social problems.
But if successful preschool interventions can be
developed, then a truly preventive course of action
will have been taken.
Head Start Programs. We have already dis-
cussed the High/Scope Perry Preschool Program
in Box 16-2. However, probably the best-known
early childhood program isHead Start. In the mid-
1960s, President Johnson created the Office of Eco-
nomic Opportunity (OEO). Head Start was one of
the programs targeted specifically for disadvantaged
children. It was designed to prepare preschool chil-
dren from disadvantaged backgrounds for elemen-
tary school. Head Start programs are locally
controlled but required to conform to general fed-
eral guidelines. Local programs vary in number of
hours of attendance, number of months (summer
vs. the entire year), background of teachers, and
so on. The specific techniques used also vary, but
basic learning skills are usually stressed. Physical and
medical needs are also addressed, as are general
school preparation and adjustment.
Evaluation. How effective are these early child-
hood programs? Gomby, Larner, Stevenson, Lewit,
and Behrman (1995) find it useful to distinguish
between child-focused programs and family-
focused programs. In the former case, interventions
are administered directly to the child; in the latter
case, family members (e.g., parents) receive the
intervention or training. A recent Institute of Med-
icine report (NRC-IOM, 2009) provides multiple
examples of effective family, school, and commu-
nity prevention programs. Here we mention a few
examples.
Participation in a child-focused program results
in an average IQ gain of about 8 points immedi-
ately after program completion (although these rel-
ative gains dissipate over time), makes it less likely
that the child will be placed in special education or
retained in grade, and makes it more likely that the
child will graduate from high school (Barnett, 1995;
Gomby et al., 1995). Positive social outcomes
resulting from program participation have also
been reported, including fewer contacts with the
criminal justice system, fewer out-of-wedlock
births, and higher average earnings than nonpartici-
pants (Gomby et al., 1995; Yoshikawa, 1995).
Although family-focused programs appear to
have more impact on parents’behaviors than do
child-focused programs, it is not clear how much
positive impact they have on children (Gomby et
al., 1995; Yoshikawa, 1995). Not only is the focus
of the intervention different, but so is its intensity
and frequency. In the case of family-focused inter-
ventions, services may be rendered only once a
week.Self-Help
Not all help comes from professionals. Informal
groups of helpers can provide valuable support
that may stave off the need for professional inter-
vention. Furthermore, such nonprofessionalself-help
groupsas Alcoholics Anonymous, Parents Without
Partners, La Leche League, Al-Anon, Narcotics
Anonymous, and many others can be incorporated
as an effective part of treatment by a referring
professional.
What needs do self-help groups meet? Orford
(1992) discussed eight primary functions of self-help
groups: (a) They provide emotional support to478 CHAPTER 16