Guidelines for Prevention in Psychology

The effectiveness of prevention to enhance human functioning and reduce psychological distress has been demonstrated (Catalano, Berglund, Ryan, Lonczak, & Hawkins, 2002; Greenberg, Domitrovich, & Bumbarger, 2001; National Research Council & Institute of Medicine, 2009). Successful preventive interventions are typically theory driven, culturally relevant, developmentally appropriate, and delivered across multiple contexts (Nation et al., 2003). Preventive services and interventions help to further the health and well-being of individuals, communities, and nations (Satcher, 2000; World Health Organization, 2008). Expanding preventive services reduces the costs of mental health care (Tolan & Dodge, 2005), while emerging technological innovations (e.g., telehealth) offer promise for preventive interventions (Bull, 2011; Chinman, Tremain, Imm, & Wandersman, 2009). From infancy through adulthood, access to preventive services and interventions is important to improve the quality of life and human functioning and reduce illness and premature death (Grunberg & Klein, 2009; Konnert, Gatz, & Hertzsprung, 1999). Prevention has typically taken a developmental approach, focusing on children and adolescents, in order to facilitate trajectories leading to positive outcomes (National Research Council & Institute of Medicine, 2009). Children and adolescents are at significant risk for substance abuse, violence, and sexually transmitted infections, and their access to quality health services is limited (Centers for Disease Control and Prevention, 2007; Weissberg, Walberg, O’Brien, & Kuster, 2003). Thus, normal development may be impeded at large costs to society, and additional strains imposed on families. In any given year, 14%–20% of children and adolescents experience a mental, emotional, or behavioral disorder (National Research Council & Institute of Medicine, 2009). In addition, national surveys show that the majority of youth who could potentially benefit from mental health services do not receive services (Ringel & Sturm, 2001). Early and focused interventions can limit the length and severity of symptoms and enhance functioning (Cicchetti & Toth, 1992; Durlak, Weissberg, & Pachan, 2010). Prevention also includes the collaborative design and delivery of strengths-based health promotion and environmental improvement strategies (e.g., Cowen, 1985). Health promotion approaches equip people with life skills and coping competencies, such as problemsolving skills, contributing to their capacity to live more fully while being better able to withstand future stressful life events. Preventive services and interventions also address issues of health, educational, and social inequities that reflect disparities across demographic groups such as those based on race, gender, and socioeconomic class. Environmental improvement prevention strategies, such as consultation to improve community–family–school coordination or interventions to help communities create well-paying jobs, aim to inform social policy, which can minimize or eliminate factors contributing to unhealthy functioning. The importance of prevention is consistent with the Patient Protection and Affordable Care Act (2010), which calls for expansion of preventive services to maximize positive health outcomes, as well as with the U.S. National Prevention Strategy (National Prevention Council, 2011), which “provides an unprecedented opportunity to shift the nation from a focus on sickness and disease to one based on wellness and prevention” (National Prevention, Health Promotion, and Public Health Council, 2011, p. 1) throughout the life span. Several disciplines other than psychology have been historically and currently active in prevention (e.g., public health, social work). However, beginning in the mid-20th century with the field of community psychology, psychology began to play an increasingly important role (e.g., Eby, Chin, Rollock, Schwartz, & Worell, 2011). Even with the increased focus on prevention, psychology training programs rarely require specific courses on prevention (O’Neil & Britner, 2009). In particular, conceptualizations about best practices in prevention, particularly at the environmental level, are lacking (Snyder & Elliott, 2005). In addition, the Ethical Principles of Psychologists and Code of Conduct (American Psychological Association [APA], 2010) do not fully address unique ethical issues that may arise in prevention (e.g., Schwartz & Hage, 2009). Therefore, psychologists engaged in prevention can benefit from a set of guidelines that address and inform prevention practices.