What prevention science can offer all Ireland's children

Prevention strategies hold the key to improving and safeguarding the health and development of children in the island of Ireland, a leading advocate of prevention science told an influential group of Northern Ireland policy makers and practitioners in Belfast last night.

US Professor Mark Greenberg, Director of the Prevention Research Center [1] at Penn State University, said the benefits were beyond doubt. Gains in terms of the well-being of the whole population were reinforced by proven cost effectiveness. Good prevention relieved the strain on children and youth services, reduced the number of arrests and lowered demand for expensive treatments.

His presentation at Belfast Castle was one of several he is to give as he reviews a program of investment by The Atlantic Philanthropies [2] to boost prevention and early intervention in the island of Ireland. The Together 4 All strategy, reviewed here yesterday, is one of a score of innovations made possible by the US foundation’s investment.

He was talking, he said, to the long-distance runners – "people working over a lifetime to improve outcomes for children. Long distance runners train for the long race".

Mark Greenberg's studies of the troubling developmental trends in Western societies and his connection with the growth of prevention science span three decades. Impulsive behavior, emotional dysregulation and insecure relationships partly explained the decline in mental health of children in some States, he said. Helping children to solve problems, develop self control and relate better to their friends and adults were promising avenues toward a remedy.

He went on to gave a dizzying survey of proven models, across many domains of children's lives. His virtual tour began in 1963 when John F Kennedy called upon science to seek out the cause of mental ill-health, and made famous use of Benjamin Franklin’s dictum that “an ounce of prevention“ was worth “a pound of cure”.

Much had been achieved since Kennedy's call to action and Lyndon Johnson's subsequent pragmatic response, he said. Tests, trials and monitoring had established a number of empirically validated programs. Experimental evaluation was becoming accepted as the best way to find out if programs worked. And there were many authoritative reviews of the evidence.

Some, such as his own PATHs program, soon to be implemented by Together 4 All in four communities around Lurgan, were universal – of benefit to all children. Others, such as Multisystemic Therapy, were designed for children with significant impairments. (Another ‘targeted’ program, The Queensland Early Intervention and Prevention of Anxiety project, will be reviewed by Prevention Action soon.)

To explain how a well-designed intervention insinuated itself beneficially into the fiber of family life, he gave the example of an evaluation by an Iowa State University team led by Richard Spoth of a brief program designed to reduce teenage drunkenness. (Like other parts of UK and Ireland, Northern Ireland is coming to terms with a huge rise in alcohol use by teenagers.)

Eighteen months after the intervention, when the young people concerned were 12 years old, the effects were negligible. But at 30 months the impact was significant, and the benefits had been shown to increase into adolescence.

Paradoxically, although the evidence supporting the “ounce of prevention” argument had accumulated since Kennedy's 1963 appeal, the proportion of expenditure on evidence based prevention programs remained small compared to investments in the many unevaluated programs – some of which might actually be harmful. This was true, he said, even across the US and in Pennsylvania where he had introduced proven models to over 100 communities.

The antidote to the shortcomings of past policy and practice should begin with the development of community level leadership across schools and agencies. For it to work those responsible for children's services needed to understand the impact of prevention and the benefits of integration across sectors. Training for practitioners and the development and showcasing of prevention models by the communities who introduced them were crucial ingredients.

As importantly, programs based in schools needed heart. “Is the teacher an emotional leader for this project; do they talk about it voluntarily and with enthusiasm? Do the coaches who help the teachers like the people they are supporting. If the teachers are emotional and the coaches like the teachers, the projects tend to work."

Mark Greenberg’s strategy is mirrored in the The Atlantic Philanthropies’ program on the island of Ireland; the Together 4 All initiative, described at the same Belfast Castle seminar passes all his tests.

Like all other prevention efforts in Ireland, he said, its success would depend to a large extent on its ability to achieve program fidelity. Ireland, North and South, had in the past been a place where strategies were written, services were designed but implementation bore little resemblance to the plan.

The commitment on the part of the The Atlantic Philanthropies to standard service design methods and rigorous evaluation should mean that the lessons Mark Greenberg has learned over three decades can be rapidly and faithfully applied.

[See also Penn State on the PATHS to resilience [3] and Lurgan comes together for Together 4 All [4]

References

Spoth, R., Redmond, C., Shin, C., & Azevedo, K. (in press)."Brief family intervention effects on adolescent substance initiation: School-level curvilinear growth curve analyses six years following baseline. Journal of Consulting and Clinical Psychology