Reducing Risks for Mental Disorders Frontiers for Preventive Intervention Research (1994) / Chapter Skim
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13 CONCLUSIONS AND RECOMMENDATIONS: AN AGENDA FOR THE NEXT DECADE
13 CONCLUSIONS AND RECOMMENDATIONS: AN AGENDA FOR THE NEXT DECADE
Pages 467-484
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From page 467... ...
Opportunities now exist to effectively exploit existing knowledge to launch a promising research agenda on the prevention of mental disorders. Therefore the committee strongly recommends that an enhanced research agenda to prevent mental disorders be initiated and supported across all relevant federal agencies, including, but not limited to, the Departments of Health and Human Services, Education, Justice, Labor, Defense, and 467
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From page 468... ...
The term prevention research refers only to preventive intervention research and is distinct from research that builds a broad scientific base for preventive interventions. BUILDING AN ENHANCED INFRASTRUCTURE FOR PREVENTIVE INTERVENTION RESEARCH Preventive intervention research for mental disorders cannot thrive without providing for its infrastructure.
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From page 469... ...
, educational disabilities, criminal behavior, and physical disorders as though these were separate conditions, whereas, more often than not, coexisting disorders or problems occur; and (4) agencies have different strengths; for example, some are better at applying rigorous research methodologies to intervention programs, whereas others are better at reaching out into communities and forging alliances.
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From page 470... ...
This office could be charged with forming a subcommittee or task group to focus specifically on the coordination of research aimed at preventing mental disorders and substance abuse. These preventive efforts share many features with other disorders already subject to coordination within this office, but the involvement of the criminal justice system, the educational system, child and spousal protective services, civilian and military family support services, and other nonmedical services necessarily encompasses activities in an even broader array of federal agencies.
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From page 471... ...
This council should formulate policies regarding preventive intervention research, evaluation of prevention services, knowledge exchange, coordination of interagency research efforts, and training. Because prevention activities span different departments, the members of the council should be appointed after soliciting nominations from a wide constituency who are willing to use the definitions and rigorous methodological criteria developed in this report to foster policies that will reduce the onset of mental disorders and related problems.
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From page 472... ...
should meet regularly to coordinate collaborative research across public and private agencies and should monitor the standards for rigorous methodological approaches to preventive intervention research. Terms on the council for nonfederal representatives should be limited.
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From page 473... ...
Congress and federal agencies should immediately take steps to develop and support the training of additional researchers who can develop new preventive intervention research trials as well as evaluate the effectiveness of current service projects. This training effort should include consortiums, seminars, fellowships, and research grants to attract existing researchers into prevention research, training programs for new investigators, and expansion of the training component of the specialized prevention research centers.
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From page 474... ...
If efforts to boost doctoral training begin concurrently with mid-career training, we might expect to see the benefits of an increased pool of researchers capable of securing their own research grants by year five of a 10-year plan. · The number of institutional training programs focusing on preventive intervention research should be increased from 5 to 12 over the next five years, including one at every specialized prevention research center, known at NIMH as Preventive Intervention Research Centers ¢PIRCs)
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From page 475... ...
Child epidem~olog~cal study 2.5 2.5 2.5 2.5 2.5 Population studies 5.0 5.0 5.0 5.0 5.0 Mental health promotion study 0.5 0.5 0 0 0 Prevention Research Preventive intervention research projects 20.0 20.0 20.0 25.0 25.0 Preventive intervention research centers 2.0 2.0 5.0 8.0 8.0 Total Budget 50.5 50.5 53.0 61.0 61.0 NOTE: Figures are based on 1993 dollar amounts and are not adjusted for inflation. These recommendations for support are based on the committee's best estimates of current efforts and its judgment of needed resources to create a robust preventive intervention research agenda for mental disorders across the federal government.
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From page 476... ...
These epidemiological investigations should be oriented toward diagnosis but also should record a range of symptomatology, so that future changes in the diagnostic system, or developmental changes in individuals, do not preclude understanding of the development of psychopathology throughout this age range and into adult life. These prospective studies also should be oriented toward identification of modifiable risk factors in this age group with the explicit goal of recommending modifiable targets for preventive interventions in the future.
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From page 477... ...
· Treatment intervention research conducted under rigorous methodological standards that is directly relevant to preventive intervention research should continue to be supported-but not from the prevention research budget. The criteria for "direct relevance" should be reviewed by prevention researchers.
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From page 478... ...
Over a two-year period, $1 million should be allocated to catalog mental health promotion activities and to craft outcome criteria. CONDUCTING WELL-EVALUA1:ED INTERVENTIONS The knowledge base for some mental disorders is now advanced enough that preventive intervention research programs, targeted at risk factors for these disorders, can rest on sound conceptual and empirical foundations.
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From page 479... ...
Many of the programs described in this report are selective preventive intervention research programs, targeting multiple risk factors including poverty, job loss, caregiver burden, bereavement, medical problems, divorce, peer rejection, academic failure, and family conflict. These programs provide an impressive base for more rigorous research trials with larger samples.
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From page 480... ...
Research grant support should not decrease at this time. o Research on sequential preventive interventions aimed at multiple risks in infancy, early childhood, and elementary school age to prevent onset of multiple behavioral problems and mental disorders should be increased immediately and substantially.
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From page 481... ...
· Research on preventive interventions aimed at major depressive disorder should be increased immediately and substantially. This should include a large number of new research grants and at least one new specialized prevention research center.
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From page 482... ...
O Dissemination mechanisms, including publication in peer-reviewed journals, and knowledge exchange opportunities with other researchers and with representatives from the community should be mandated as part of the mission of each specialized prevention research center. · The preventive intervention research cycle as described in this report should be used as a conceptual model for designing, conducting, and analyzing research programs.
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From page 483... ...
The support that is requested in this report is not necessarily new money, but it is new for the field of preventive intervention research for mental disorders. Much of the support should come from a wide array of federal agencies already supporting prevention services that currently lack rigorous evaluation.
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From page 484... ...
It is equally clear that to obtain such programs we need to make a national commitment to rigorous research and increased support for the infrastructure to make that research possible. REFERENCES NAS (National Academy of Sciences)
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