Evolving the Prevention System That We Need
Shifting from reactive interventions to ones that prevent
Posted January 3, 2015
The ultimate value of the behavioral sciences is that they could improve human wellbeing (Biglan & Embry, 2003). Careful consideration of the gap between our knowledge of the factors influencing human wellbeing and current practices highlights some simple but radical steps that could accelerate societies’ efforts to improve wellbeing.
Societies’ practices for dealing with problems of human behavior are mostly reactive. They have evolved out of understandable efforts to deal with problems once those problems have arisen. We have evolved a mental health treatment system for most of the common and costly psychological disorders and a parallel system for the treatment of drug abuse, once these problems have developed. We have evolved a healthcare system for treating physical illness; it too is mostly reactive, treating disease often long after it has become chronic. Similarly, the criminal justice system apprehends criminals and punishes them, usually only after a pattern of antisocial behavior is well established.
A major advance in reducing the incidence and prevalence of problems of human behavior becomes possible with the development of prevention science. The Institute of Medicine report on prevention (National Research Council & Institute of Medicine, 2009) documents numerous interventions from the prenatal period through adolescence that randomized trials have shown can prevent multiple problems. Most interventions have effects long after the intervention was delivered. And, most have a significant return on investment in terms of reduced criminal justice, healthcare, and educational costs. Although most preventive interventions affect more than one problem, prevention interventions still tend to focus on only a subset of the problems that societies seek to prevent.
We could accelerate progress substantially by organizing to increase the prevalence of nurturing families and schools. The evidence is clear and consistent that, when these environments fail to nurture, they become the crucible in which most of societies’ problems are forged (Biglan, in press; Biglan, Flay, Embry, & Sandler, 2012). And the treatment and preventive interventions validated for these settings demonstrate that, when we reduce coercion in these settings and increase parents’ and teachers’ skills for nurturing prosocial development, we can prevent multiple problems (Dishion & Snyder, in press).
Unfortunately, we have not yet developed systems that would ensure that all families and schools that could benefit from evidence-base interventions receive them. One reason is that the potential of these interventions is not widely understood. Another is that there are no organizations dedicated to affecting the population of families and schools. Our reactive intervention systems have evolved to respond to problems when they happen. We have not evolved a system of prevention. Doing so will require that we target the entire population of families and schools and implement systems that prevent problems from developing in the first place.
The creation of such a prevention system requires that the organizations addressing each of the most common and costly problems band together to create a system that reaches every family that could benefit from evidence-based interventions. As research on Triple P (Sanders, Cann, & Markie-Dadds, 2003) and the Family Check-up (Dishion et al., 2008) shows, intervention need not be extensive and therefore expensive. Similarly it is in the interest of every organization whose mission is to advance human wellbeing to contribute to ensuring that every school—from preschool through Universities—has in place evidence-based practices that minimize toxic social conditions and teach, promote, and richly reinforce prosocial behavior. It is not too soon to create a coalition of such organizations.
Biglan, A. (In press). The nurture effect: How the science of human behavior can improve our lives and our world. Oakland, CA: New Harbinger.
Biglan, A., & Embry, D. D. (2013). A framework for intentional cultural change. Journal of Contextual Behavioral Science, 2, 95-104.
Biglan, A., Flay, B. R., Embry, D. D., & Sandler, I. (2012). Nurturing environments and the next generation of prevention research and practice. American Psychologist, 67, 257-271.
Dishion, T. J., & Snyder, J. (Editors). (In press). Oxford handbook of coercive relationship dynamics: Basic mechanisms, developmental processes, and intervention applications. New York, NY: Oxford University Press.
Dishion, T. J., Shaw, D., Connell, A., Gardner, F., Weaver, C., & Wilson, M. (2008). The Family Check-Up with high-risk indigent families: Preventing problem behavior by increasing parents' positive behavior support in early childhood. Child Development, 79, 1395-1414.
National Research Council and Institute of Medicine. (2009). Preventing mental, emotional, and behavioral disorders among young people: progress and possibilities. Committee on the Prevention of Mental Disorders and Substance Abuse Among Children, Youth, and Young Adults: Research Advances and Promising Interventions, M. E. O'Connell, T. Boat, & K. E. Warner (Eds.). Washington, DC: National Academies Press. Available from http://www.ncbi.nlm.nih.gov/books/NBK32765/.
Sanders, M. R., Cann, W., & Markie-Dadds, C. (2003). The Triple P-positive parenting programme: A universal population-level approach to the prevention of child abuse. Child Abuse Review, 12, 155-171.
Wilson, D. S., Hayes, S. D., Biglan, A., & Embry, D. D. (2014). Evolving the future: toward a science of intentional change. Behavioral and Brain Sciences, 37, 395-416.