In Texas we are told that everything is bigger. True to form, at the opening session of the 2010 Blueprints for Violence Prevention conference in San Antonio, moderator Clay Yeager paraded a “company of giants”.

His panel line-up included seven of the world’s leading prevention scientists alongside Shay Bilchik, who was a policy maker at the Office of Juvenile Justice and Delinquency Prevention (OJJDP) during the 1990s and instrumental in the foundation of Blueprints.

The purpose of the “intimate conversation in front of 700 delegates” was to reflect on a decade of violence and substance abuse prevention efforts and to set out the challenges and tasks that lie ahead.

To this end we were taken back to 1996 - a time of school shootings, media frenzy, the ephemeral ‘super predators’, rising arrest rates and associated political tension in the US. It was in this context that Delbert Elliot set up Blueprints, an effort to counter these trends and misconceptions (see: Proving that answers don't come out of the blue)

Since that time a sea-change has occurred; evidence-based prevention programs such as those listed on the Blueprints database are now accepted by prevention scientists and many (but not enough) policy makers as the only logical and cost-efficient means by which to reduce violence and substance abuse.

But here is the rub: evidence-based programs still represent only a tiny fraction of those services provided and they are notoriously difficult to sustain at scale. How, asks Clay, does the field of prevention science progress?

Delbert Elliot, always at the vanguard, takes the stand to say that it is essential that evidence-based programs are an intrinsic element of public systems rather than a bolt-on; “it is the direction we have to go; only when programs are embedded within systems will we have a genuine and significant impact upon the outcomes of the nation’s children”.

So how do we understand the context in which systems operate? It boils down to juvenile justice systems wanting programs to reduce crime and violence; education systems wanting to improve educational performance; healthcare systems wanting to prevent disease and illness, and so on.

Reflecting on this David Olds, developer of the home-visitation program, Nurse Family Partnership, recalls his surprise when he received a call back in the mid-1990s not from the healthcare system but from Shay Bilchik at OJJDP.

This, according to Mark Greenberg, represents a trick that many evidence-based programs have missed. He argues that, instead of focusing on improving on outcomes limited just to one system context, programs would benefit from enhancing those developmental skills and assets leading to outcomes sought by multiple systems.

Greenberg provides the illustration appearing in the upcoming publication by Joseph Durlack and colleagues in Child Development demonstrating that social-emotional learning (SEL) programs not only improve emotional regulation and reduce substance abuse also lead to marked improvement in children’s academic performance: in effect moving the child at the 50th percentile up to the 61st.

Whilst a widening of outcome-focus may not in itself solve the problem of seriously embedding programs within systems nor correcting the rigid funding streams limiting uptake, approaches such as these may help draw attention to the connections between prevention science and multiple system interests.

To conclude, the “pioneers of prevention” throw down the gauntlet: First, systems must support the rigorous evaluation of more promising approaches to widen the store of truly evidence-based programs. Second, program developers must engage seriously with policy makers to alter the funding streams and ways in which systems may embed programs into usual practice. Third, researchers need to get smarter at communicating the potential of what may be achieved. Then, and only then, will prevention science achieve Texan size impacts on children’s outcomes.

* Alongside Delbert Elliot, Shay Bilchik, David Olds and Mark Greenberg on the panel were Jim Alexander (developer of Functional Family Therapy), Gil Botvin (developer of Life Skills Training) and Scott Henggeler (developer of Multisystemic Therapy).

See: Durlack J and colleagues (in press). The Impact of Enhancing Students’ Social and Emotional Learning: A Meta-analysis of School-based Universal Interventions. Child Development.