Science, Social Work, Prevention: Finding the Intersections

Abstract

Over the past 25 years the science of prevention of adolescent health and behavior problems has matured as a result of longitudinal studies of predictors of these problems and controlled studies of preventive interventions focused on those predictors that have revealed efficacious prevention strategies. This article builds on three Aaron Rosen lectures: Aaron Rosen's call for the use of evidence-based practice in the first lecture in this series, Mark Fraser's call for more intervention research in social work, and Claudia Coulton's explorations of Place of Community in SocialWork Practice Research. It documents key developments in prevention science over the past 25 years and explores what these developments could mean for social work education and research over the next few years. KEY WORDS: evidence-based practice; prevention science; research; social work ********** In my early working days, I lived in a rural fishing community off the coast of Washington. I , was the county's juvenile probation officer. I had a position subsidized by the state through the intensive probation subsidy program. That program provided money for probation officers in Washington counties to do intensive counseling with reduced caseloads in hopes of sending fewer young people to state institutions. I mention this here because it was as a probation officer that I first became convinced of the importance of preventing adolescent behavior problems before young people encounter the juvenile justice system. I worked with young people ages 12 to 17 referred for delinquent behavior and drug possession. Over time, I came to see my job as akin to operating an ambulance service at the bottom of a cliff. We were the emergency workers patching up those who fell over the edge. That experience convinced me that we must broaden crime reduction efforts beyond the justice system to include prevention. I will return to the intensive probation program later in this article. Before 1980 there was little evidence that delinquency or adolescent drug abuse could be prevented. School-based drug prevention programs that were evaluated were found to be largely ineffective (Elmquist, 1995; Hansen, 1992; Moskowitz, 1989). Some studies found that school-based drug information programs were associated with increased drug use among teenagers (Tobler, 1986). In 1980 a review of the delinquency experiments conducted in the United States to that year identified nine well-controlled trials (Berleman, 1980). None of them was effective in preventing delinquency. Perhaps the most notable was the Cambridge Somerville Study, a program of wrap-around services for high-risk boys. Dr. Richard Cabot of Harvard believed that the intervention of a friendly, socialized adult with a vulnerable when the child was still young might lead the child to a normal nondelinquent life. In 1935 he funded a nonprofit foundation that sustained the delinquency prevention study for 10 years. Cabot employed community-based counselors who worked predominantly in the field in this economically disadvantaged community. Services were individualized for each and his parents. The model was casework with the individual boy (Berleman, p. 130). Counselors used their practice wisdom to address needs they encountered. The randomized controlled trial of this intervention showed that the program had no effects on police contacts for delinquency or commitments to state institutions. A long-term follow-up of the program conducted by McCord (1992) found that youths exposed to the program were more likely than the control group to develop serious behavior problems, alcoholism, and mental health problems over their lives. The Hippocratic oath requires that physicians never do harm to anyone. This is our responsibility as social workers as well. Our best conceived interventions could do harm. We must evaluate our ideas to know what outcomes they produce. …