Prevention science research with children, adolescents, and families: Introduction.

Abstract

he concept of prevention has been of longT standing interest to mental health professionals. Over the years, the American Journal of Orthopsychiatry has published many noteworthy essays on prevention that have articulated its promise, its advances, and the challenges that lie ahead (Bower, 1963, 1987; Broskowski & Baker, 1974; Deschin, 1968; Eisenberg, 1962; Garmezy, 1971; Runquist & Behar, 1974). The Journal has also published many empirically based, prevention-oriented articles. In this issue, a special section is devoted to the topic of preventive intervention for children, adolescents, and families. The six articles it contains provide insight, both individually and as a set, into the current status of research in preventive intervention and illustrate many of the dominant themes and activities embodied in work at the cutting edge of the field. Prevention-related activities have a relatively short history, while prevention as a concept has had a long past. As noted by Bower (1978), in Greek mythology, Asklepius, the God of medicine and healing, emphasized the early detection and treatment of illness carried out by skilled practitioners. Asklepius’ daughter, Hygeia, had a somewhat different philosophy; her’s emphasized the promotion of positive practices and competencies as a means of maintaining and improving one’s overall health and mental health. While points of view about the merits of specific disease prevention versus health promotion still differ, many would argue that the two perspectives are complementary, and not competitive. They are surely not mutually exclusive. Nevertheless, a lively debate continues between prevention advocates (Albee, 1982; Bloom, 1981; Eisenberg, 1962) and those who see such activities as premature, given the current state of knowledge, and as a drain on precious resources that could be better spent on treatment and research to help those with serious mental illnesses (Henderson, 1975; Lamb & Zusman, 1979, 1981). The debate about prevention has touched on many professional spheres, including training of mental health professionals, organizational representation, social ethics, and issues of funding and reimbursement. What was once a sizeable gap between the rhetoric and reality of mental health prevention research has been narrowing in recent years. Although prevention researchers have yet to develop interventions that can successfully reduce the incidence of such severe mental illnesses as schizophrenia and affective disorders, the area of “prevention science” has been quietly emerging within the field of mental health over the past decade, spearheaded by collaborative efforts at the National Institute of Mental Health (NIMH) (Coie, et al., 1993; NIMH, 1996, 1998; Reiss & Price, 1996) and the Institute of Medicine (IOM) (IOM 1994; Munoz, Mrazek, & Haggerty, 1996). As outlined by Kellam and Rebok (1992), Coie et al. (1993), and Beardslee in this issue, prevention science represents an amalgamation of knowledge, principles, and methods developed within the fields of epidemiology, human development, psychopathology, and education. Based on a sequence derived from public health