PERSPECTIVE
Next Generation of Preventive Interventions

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ABSTRACT

Objective

With increasing numbers of efficacious prevention programs, the field needs strategies to disseminate the interventions broadly.

Method

The authors examined the life course of prevention programs, identified barriers to dissemination, and outlined an alternative dissemination model.

Results

Private enterprise models of product development can be viable strategies for increasing the dissemination of the intervention to the general public. Market principles suggest that the next generation of interventions would be facilitated if interventions are initiated by teams committed to a specific problem and investigators receive training in management; if the acceptability of the program's design features to consumers, providers, and funding agencies is established prior to the development and evaluation of the program; if data from national marketing surveys are used to tailor intervention designs and delivery formats for different subgroups; if essential ingredients of the intervention are identified to facilitate adaptation of the program; if the program is implemented with a goal to maintain change over extended periods of time; if the implementation plan includes program evolution over time, rather than replication with fidelity; and if interventions are branded and certified by a credible agency.

Conclusions

Private enterprise models may be useful; however, investigators are likely to be resistant given a priori biases, potential ethical conflicts of interest, and the challenges presented by new technologies (e.g., the Internet and Human Genome Project). J. Am. Acad. Child Adolesc. Psychiatry, 2003, 42(5):518‐526.

Section snippets

Development of Efficacious Interventions

The development and dissemination of efficacious interventions has been investigator‐driven, theory‐based, focused on changing a target behavior, and replicated with fidelity over time. Each of these characteristics creates challenges to broad dissemination of efficacious programs.

Investigator‐Driven. Creative, intuitive clinicians typically design multifaceted programs to change clients' behaviors. After efficacy is demonstrated, program dissemination usually depends on the persistence and

Alternative Successful Models of Intervention Dissemination

While prevention programs from academic researchers have not been broadly recognized and disseminated to the U.S. public, programs created with identified delivery vehicles and private enterprise prevention models have been highly successful in achieving broad dissemination.

First, there is a set of programs that have identified a “vehicle” for reaching communities and families. The Drug Abuse Reduction Education (DARE) program is an example of this model (Bureau of Justice Assistance, 1995).

Market Orientation for Prevention Programs

If academic researchers adopted a market orientation to disseminate and to refine their interventions through a private enterprise model, a paradigm shift would occur. This shift may accelerate the dissemination of efficacious interventions nationally and worldwide. Similar to businesses, prevention researchers want the public to buy their products (adopt healthier behaviors and lifestyles) and to make this happen in the most cost‐effective manner possible. We hope for a large market share (for

The Future: Embracing the Enemy?

Academic researchers have long divorced themselves from the market and private enterprise. A set of presumptions about the intentions, motives, and impact of market‐driven forces has led many researchers to be wary of collaborations and partnerships with the private sector. In particular, there are many potential conflicts of interest (Bowie, 1994). As a group most social science researchers endorse liberal positions on a variety of social science issues; for example, 74% are Democrats and only

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    This paper was given as an invited address to the Biannual Meeting of the International Society for Research in Child and Adolescent Psychopathology, Vancouver, 2001.

    This paper was written with support of NIMH Center Grant P30 MH 58107 . The authors thank Coleen Cantwell, Susan Cantwell, Amy Elkavich, Mark Etzel, and Danielle Seiden.

    Letters to the Editor in response to this Perspective are encouraged. They will be forwarded to the authors, and selected letters will be published in the Journal.

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