What Works in Prevention

1 what Works in PreventionPrinciples of Effective Prevention ProgramsMaury NationVanderbilt UniversityCindy CrustoYale University School of MedicineAbraham WandersmanUniversity of South CarolinaKarol L. KumpferUniversity of UtahDiana SeyboltUniversity of Maryland, BaltimoreErin Morrissey-Kane and Katrina DavinoUniversity of South CarolinaThe high prevalence of drug abuse, delinquency, youthviolence, and other youth problems creates a need toidentify and disseminate effective Prevention principles gleaned from effective interventionsmay help Prevention practitioners select, modify, or createmore effective programs. Using a review-of-reviews ap-proach across 4 areas (substance abuse, risky sexual be-havior, school failure, and juvenile delinquency and vio-lence), the authors identified 9 characteristics that wereconsistently associated with effective Prevention programs:Programs were comprehensive, included varied teachingmethods, provided sufficient dosage, were theory driven,provided opportunities for positive relationships, were ap-propriately timed, were socioculturally relevant, includedoutcome evaluation, and involved well-trained staff.

2 Thissynthesis can inform the planning and implementation ofproblem-specific Prevention interventions, provide a ratio-nale for multiproblem Prevention programs, and serve as abasis for further analyses concerning the status of Americanyouth and families have concluded that the UnitedStates is a nation at risk in regard to many socialindicators such as substance abuse, adolescent pregnancy,youth violence, and school dropouts (Bronfenbrenner, Mc-Clelland, Wethington, Moen, & Ceci, 1996; Weissberg,Walberg, O Brien, & Kuster, 2003). In addition to theobvious public health concerns, the cost of the social,therapeutic, and rehabilitative services needed to addressthese problems has made the search for effective preven-tion programs work with community coalitions indicates thatcommunity-based preventionists and mental health practi-tioners are seeking to provide effective Prevention pro-grams.

3 The science-based research and evaluation literaturehas consistently shown that a number of Prevention pro-grams are beneficial in helping youth to avoid numerousproblems (Albee & Gullotta, 1997; Durlak & Wells, 1997;Price, Cowen, Lorion, & Ramos-McKay, 1989; Weissberg& Greenberg, 1998). However, the difficulty in replicatingexpensive, science-based Prevention models or proprietarycommercial products has resulted in many local agenciescreating or adapting their own Prevention programs withmarginal effects. Consequently, there is a gap between thescience-based Prevention programs and what is providedby practitioners to families and children in the UnitedStates (Morrissey et al.)

4 , 1997). As private and publicfunders require greater accountability, practitioners areasking the question: what practical information does pre-vention research have to offer to improve the effectivenessof Prevention practice? Furthermore, granting agencies andpractitioners ask questions such as, what are the evidence-based programs that work ? what is the essence of goodprevention programs? and Whom should these programstarget?Reviews of Prevention programs have provided someanswers to these questions. Some reviews provide casestudies of effective programs (Albee & Gullotta, 1997) orsummarize the research within a particular content areasuch as substance abuse (Center for Substance Abuse Pre-vention [CSAP], 2001; Tobler & Stratton, 1997), teenpregnancy (Kirby, 1997), and HIV/AIDS (Choi & Coates,1994).

5 An advantage of these reviews is that they can bringprevention theory within a content area to bear in drawingconclusions about the effectiveness of programs. Thesereviews suggest that there are some principles that tran-Editor s special issue was developed by Roger P. Weissbergand Karol L. Kumpfer as a result of the work of the APA Task Force onPrevention: Promoting Strength, Resilience, and Health in Young s Nation, Department of Human and OrganizationalDevelopment, Vanderbilt University; Cindy Crusto, Department of Psy-chiatry, Yale University School of Medicine; Abraham Wandersman, ErinMorrissey-Kane, and Katrina Davino, Department of Psychology, Uni-versity of South Carolina; Karol L.

6 Kumpfer, Department of HealthPromotion and Education, University of Utah; Diana Seybolt, School ofMedicine, University of Maryland, of the supporting documentation and references were omittedbecause of space thank the following people for recommending reviews andproviding feedback on earlier drafts of this article: Joy Dryfoos, JosephDurlak, Anthony Biglan, and Maurice concerning this article should be addressed toMaury Nation, Department of Human and Organizational Development,Vanderbilt University, Peabody College, #90, Nashville, TN : 2003 American PsychologistCopyright 2003 by the American Psychological Association, Inc. 0003-066X/03/$ 58, No.

7 6/7, 449 456 DOI: the individual programs or content areas. Preventionnow has a sufficient knowledge base to begin a meta-assessment of the characteristics of effective preventionprogramming and thereby assist practitioners in selectingprograms that are likely to produce positive step of this process has been accomplished byreviews of Prevention programs specific to one outcomearea. By comparingfindings across problem outcome areas,the usefulness of these studies can be strengthened. Dry-foos (1990) made a vital contribution toward this goal byreviewing over 100 Prevention programs related to sub-stance abuse, teen pregnancy, school dropout, and juveniledelinquency.

8 Her review yielded several key characteristicsassociated with successful programs, such as the provisionof intense individualized attention, intervention in severaldomains of the child s life, early identification of andintervention in the development of problem behaviors,training in social skills, and engagement of peers andparents in the intervention. Similar reviews conducted onschool-based curricula (Elias, Gager, & Leon, 1997) andprograms focused on children and adolescents (Weissberg& Greenberg, 1998) continue to identify the types of in-terventions that work and to suggest general principles ofeffective complement earlier reviews, we used areview-of-reviews approachto identify general principles of effectiveprevention programs that might transcend specific contentareas.

9 At the start of this process, we placed some limits onthe scope of the reviews. First, we limited our review tofour content areas: (a)substance abuse Prevention ofuse/abuse of alcohol, tobacco, or other drugs; (b)riskysexual behavior Prevention of unwanted pregnancies andHIV/AIDS; (c)school failure Prevention of general aca-demic problems and high school dropout; and (d)juveniledelinquency and violence Prevention of aggressive or an-tisocial behavior. Although this is not a comprehensive listof issues affecting young people, they are critical publichealth issues, and our work with community-based practi-tioners indicates these are priority second important limit involved the types of pre-vention programs that would be included in our review ofreviews.

10 The Institute of Medicine (Mrazek & Haggerty,1994) identified three categories of Prevention that areappropriate for participants with different levels of riskfactors:universal,selective, andindicated. A completesurvey of all three types of preventive interventions was notattempted because the theory, goals, and structure of indi-cated interventions are significantly different from those ofuniversal and selective interventions and therefore maylimit the applicability of the results to any of the , we limited the review for this special issueon primary Prevention to reviews of universal and selectiveprevention MethodWe conducted a literature search through PsycLIT andCriminal Justice Abstracts from 1990 to 1999 and con-sulted key informants (see acknowledgments)