internalizing symptoms in parents (Guyll et al., 2004; Spoth et al., 2006). Several substance abuse prevention programs are specifically targeted to children growing up in homes in which caregivers have substance use disorders. For example, Alateen is a program for children of alcoholics based on the Alcoholics Anonymous 12-Step Program of Recovery, which has been widely adopted. However, at the present time, very few evaluation data on the effectiveness of Alateen are available. In general, a review of the prevention and intervention programs targeted to children of caregivers with alcohol or substance use disorders showed that they have not received enough rigorous evaluation to demonstrate prevention or reduction in alcohol or drug use consumption (Emshoff and Price, 1999), and there are no data on the relative effectiveness for families also coping with depression in the parents.

As described in Chapter 6, residential substance abuse programs for women and their children, such as those that are part of the Boston Public Health Commission and PROTOTYPES, take comprehensive, innovative approaches with potential for addressing the overlapping challenges of substance abuse, depression, and trauma (see Box 6-2). Although rigorous data for child outcomes are not available, the two-generation approach that includes treatment interventions for the parent, parenting training, and preventive interventions for the children is a formula that warrants attention for further evaluation and as an informative model for the design of other intervention programs.

Cultural and Linguistic Competence and Adaptation in Design and Implementation of Prevention Interventions

The availability of culturally and linguistically appropriate interventions is an important element in addressing disparities in attention to depression in vulnerable populations. The discussion of issues of engagement and barriers to care in Chapter 6 applies as well to preventive interventions as it does for treatment.

A crucial component in the effective implementation of programs to prevent the adverse outcomes of depression in vulnerable families is the cultural and linguistic appropriateness of the design and delivery of interventions to serve diverse populations. Van Vorhees and colleagues conducted a systematic review of the literature to identify modifiable mechanisms and effective interventions for the prevention of depression in the health care setting at the system, community, provider, and individual patient level (Van Voorhees et al., 2007; see also Chapter 6). From their review of the limited number of studies that examined potential effects of preventive interventions for adult depression on disparities, Van Vorhees and colleagues concluded that adapting standard preventive interventions to enhance cultural

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