...strategies. This article builds on three Aaron Rosen lectures: Aaron Rosen's call for the use of evidence-based practice in the first lecture in this series, Mark Fraser's call for more intervention research in social work, and Claudia Coulton's explorations of "The Place of Community in SocialWork Practice Research." It documents key developments in prevention science over the past 25 years and explores what these developments could mean for social work education and research over the next few years.

KEY WORDS: evidence-based practice; prevention science; research; social work

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In my early working days, I lived in a rural fishing community off the coast of Washington. I , was the county's juvenile probation officer. I had a position subsidized by the state through the intensive probation subsidy program. That program provided money for probation officers in Washington counties to do intensive counseling with reduced caseloads in hopes of sending fewer young people to state institutions.

I mention this here because it was as a probation officer that I first became convinced of the importance of preventing adolescent behavior problems before young people encounter the juvenile justice system. I worked with young people ages 12 to 17 referred for delinquent behavior and drug possession. Over time, I came to see my job as akin to operating an ambulance service at the bottom of a cliff. We were the emergency workers patching up those who fell over the edge. That experience convinced me that we must broaden crime reduction efforts beyond the justice system to include prevention. I will return to the intensive probation program later in this article.

Before 1980 there was little evidence that delinquency or adolescent drug abuse could be prevented. School-based drug prevention programs that were evaluated were found to be largely ineffective (Elmquist, 1995; Hansen, 1992; Moskowitz, 1989). Some studies found that school-based drug information programs were associated with increased drug use among teenagers (Tobler, 1986).

In 1980 a review of the delinquency experiments conducted in the United States to that year identified nine well-controlled trials (Berleman, 1980). None of them was effective in preventing delinquency. Perhaps the most notable was the Cambridge Somerville Study, a program of wrap-around services for "high-risk" boys. Dr. Richard Cabot of Harvard believed that the intervention of a friendly, socialized adult with a vulnerable boy when the child was still young might lead the child to a normal nondelinquent life. In 1935 he funded a nonprofit foundation that sustained the delinquency prevention study for 10 years. Cabot employed community-based counselors who worked predominantly in the field in this economically disadvantaged community. Services were individualized for each boy and his parents. The model was "casework with the individual boy" (Berleman, p. 130). Counselors used their practice wisdom to address needs they encountered.

The randomized controlled trial of this intervention showed that the program had no effects on police contacts for delinquency or commitments to state institutions. A long-term follow-up of the program conducted by McCord (1992) found that youths exposed to the program were more likely than the control group to develop serious behavior problems, alcoholism, and mental health problems over their lives. The Hippocratic oath requires that physicians "never do harm to anyone." This is our responsibility as social workers as well. Our best conceived interventions could do harm. We must evaluate our ideas to know what outcomes they produce. Twenty-five years ago we did not know how to prevent delinquency, drug abuse, or other mental health or behavior problems. Today this has changed. Studies have shown that these problems can be prevented. Prevention science has emerged as a field with its own journal, Prevention Science, and professional society, the Society for Prevention Research (SPR).

PREVENTION SCIENCE

Phases of Research

Prevention science is an interdisciplinary endeavor involving five distinct and interrelated phases of research related to prevention practice (Mrazek & Haggerty, 1994):

1. Epidemiology--understanding the prevalence in time and space of well-being and its predictors and of problems and their predictors (Eaton, 1998).

2. Etiology--understanding what causes positive or negative health and behavior outcomes through qualitative studies, longitudinal descriptive studies, and theory development.

3. Efficacy trials--Designing and conducting trials of the effects of preventive interventions under optimal conditions (SPR, 2004).

4. Effectiveness trials--Designing and conducting trials of effects of preventive interventions under real-world conditions (SPR, 2004).

5. Diffusion research--Research on diffusion of tested, effective prevention technologies (Elliott & Mihalic, 2004).

Epidemiology. Understanding the prevalence in time and space of well-being and its predictors and of problems and their predictors is the first step in prevention science.

The classic example is John Snow's work in the London cholera epidemic of the 19th century. At the time it was widely believed that cholera was spread through the air; however, Snow showed that areas of London serviced by a water company taking water from upstream in the Thames had lower rates of cholera than areas serviced by a company taking water from downstream. He thought, therefore, that cholera must be spread by water. Then in a cholera epidemic, Snow found that cases of cholera clustered around a single water pump at Broad Street. This was epidemiology: understanding the prevalence of cholera in space. He removed the pump handle and the cholera epidemic ended. Understanding epidemiology, the incidence and prevalence of disorder, is fundamental to prevention. Polluted water from that well was the shared risk factor for that epidemic. Removing the handle eliminated the risk (Eaton, 1998).

Etiology. Understanding predictors of the problem to be prevented is key to prevention. Prevention science is built on the assumption that predictors of problems and factors that inhibit problems can be identified. The premise of prevention science is that to be effective preventive interventions must be targeted at empirically identified predictors that can be changed. Health and behavior problems can be prevented by identifying and reducing identified predictors of those problems and by identifying and strengthening factors associated with less likelihood of problems (Coie et al., 1993).

Longitudinal and epidemiologic studies have identified malleable predictors--risk factors, protective factors, and promotive factors--for a wide range of youth health and behavior problems. These studies have found that factors in neighborhoods and communities, families, schools, and peer groups, as well as characteristics of individuals themselves, increase the probability of delinquency, violence, substance abuse, teenage pregnancy, dropping out of school, and other behavior problems in adolescence and young adulthood (Howell, 2003). These are problems that get in the way of success in life. Helen Reinherz, a social work pioneer in this research, has contributed much to our knowledge of the etiology of mental health and behavior problems (Reinherz, Giaconia, Carmola Hauf, Wasserman, & Paradis, 2000; Reinherz, Giaconia, Carmola Haul, Wasserman, & Silverman, 1999; Reinherz et al., 1993; Reinherz, Paradis, Giaconia, Stashwick, & Fitzmaurice, 2003).

Our efforts to summarize the empirically supported risk factors that influence the development of several health and behavior problems during adolescence are shown in Table 1. The factors listed there have been found in two or more high-quality longitudinal or epidemiological studies to predict later health and behavior problems. Identifying these factors is important for prevention because these are potential targets for preventive interventions. These factors are sometimes labeled differently by different researchers, but there is widespread agreement among social scientists about the factors that predict multiple problem behaviors of adolescents (Biglan, Brennan, Foster, & Holder, 2004).

Understanding causation is more than understanding correlation. Risk factors may increase the probability of negative outcomes, but how? To understand causation requires theory. Theory provides a model of how risk and protective factors work to produce the outcome of interest. Its assumptions should be clearly stated, its hypotheses explicit, internally consistent, and testable. In seeking to design interventions that could prevent delinquent behavior, Richard Catalano, Joseph Weis, and I found that we needed a theory of positive social development. We recognized that we needed to describe how young people develop positive, prosocial behaviors in the normal course of growing up, to understand the effects of factors that might either interrupt or overwhelm that process of prosocial development (Catalano & Hawkins, 1996; Hawkins & Weis, 1985).

We were seeking to identify what Sameroff and Gutman (2004) have called promotive factors. Promotive factors have positive effects on development regardless of the level of an individual's risk exposure. In developing our theoretical foundation for preventive intervention, the Social Development Model (SDM), we first described the factors that we think need to be in place to promote positive social development. Our theory of how these promotive factors interact to produce healthy behaviors, called the social development strategy, is shown in Figure 1....

NOTE: All illustrations and photos have been removed from this article.



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