Using Research and Theory to Develop Prevention Programs for High Risk Families

Abstract

The goal of prevention programs is to reduce the incidence, duration, or intensity of undesirable developmental outcomes (Coie et al., 1993; Lorion, Price, & Eaton, 1989). Interest in prevention has grown rapidly over the past two decades. Many programs have been developed to address juvenile delinquency, smoking, alcohol and drug abuse, school dropout, adolescent pregnancy, and mental health problems, and most communities have one or more of these prevention programs in operation. Many family professionals have been involved in the development and implementation of these interventions. However, few of these programs have been systematically developed on theoretical or empirical foundations or rigorously evaluated, and few professionals in the family field have received formal training in the development of prevention programs. These deficiencies have the potential to undermine the credibility of prevention efforts and the political will to sustain these efforts. Fortunately, recent efforts to develop the science of prevention now provide a basis for such training (Coie et al., 1993; Mrazek & Haggerty, 1994; National Institute of Mental Health, 1993; Shaffer, Philips, & Enzer, 1989; Steinberg & Silverman, 1987). The purpose of this article is to illustrate the use of this nascent science to guide the development and implementation of prevention programs, in this case a program designed to prevent mental health problems in children living in low income, urban communities. In so doing, we hope to engage family professionals' interest in approaching prevention as a scientific enterprise as well as a service mission. The development of prevention programs has been characterized as a recursive process composed of interrelated stages (Mrazek & Haggerty, 1994; Price, 1983). Figure 1 depicts the stages as conceptualized in our project.[Figure 1 omitted] Each of these stages includes components that program developers may have to cycle through repeated times before moving on. In terms of prevention science, the aim of the initial stages of the development process (Stages 1 and 2) is the formulation of a theory of intervention (Lipsey, 1990; Mrazek & Haggerty, 1994; Price, 1987; Sandler, Wolchik, Pillow, & Gersten, 1991). The design of a prototype prevention program represents a hypothesis derived from the intervention theory. The implementation of the prototype program (Stages 3 and 4) becomes a test of the hypothesis and, thus, of the validity of the intervention theory. The aims of the later stages of the development process are to refine the prevention program based on rigorous evaluation of its efficacy (Stage 4) and to manage its dissemination (Stage 5). Evaluation of the adoption of the prevention program, in turn, stimulates a re-analysis of the problem. In this article, we describe our progress through the first three stages of the prevention intervention development process--problem analysis, program design, and pilot testing. Our goal is to show the productive interplay between applied and basic research in making decisions about how, where, and with whom to intervene. STAGE 1: PROBLEM ANALYSIS Defining the Problem/Goal The goal of problem analysis is the identification of modifiable mediators of an undesirable developmental outcome. Mediators are variables (e.g., supportive parenting, stress) through which the effects of one variable (e.g., poverty) influence another variable (e.g., children's mental health). Mediators can be positive or negative qualities. Identifying modifiable mediators requires clear problem definition informed by research on the prevalence and etiology of the undesirable outcome, knowledge of risk and protective factors, and data on the accessibility of the target population. Identifying Risk and Protective Factors Risk factors are variables that increase the chances of children experiencing poor developmental outcomes. …