History of Community Psychology
The history of the field of community psychology is a history of psychologists promoting the use of social and behavioral sciences for the well-being of people and their communities. Community psychologists promote theory development and research to increase the understanding of human behavior in its social context. The field encourages the exchange of knowledge and skills in community research and action among community psychologists, other social scientists and citizens. Community psychologists emphasize the use of multicultural and pluralistic approaches to ensure that preventive and social programs are tailored to the particular needs and aspirations of persons from different cultural, social, and ethnic backgrounds.
The knowledge and research base of the field interconnects with other disciplines, such as anthropology, sociology, and public health, and has close connections with cognitive, social, and developmental psychology. Community psychology approaches to conducting research include action research, case studies, sample surveys, various types of observational methods, epidemiologic methods, and natural experiments. Methods of analysis include a range of quantitative and qualitative methods, as well as participatory research methods, that focus on the role of research participants as partners in the entire research process. Community psychologists have pioneered research on various topics, such as social support and social competencies, that have later been elaborated upon by clinical, developmental, and social psychologists.
World War II and the 1950s
Powerful social forces contributed to the founding of the field. World War II stimulated public awareness of the country’s domestic difficulties and was a catalyst to innovate mental health services. During this time, harassment of African Americans and women working in war plants on the home front was widely communicated in the media. It was increasingly difficult for any informed citizen to deny the widespread conditions of American life such as poverty, racism, and sexism. This new consciousness contributed to awareness among some social scientists that symptoms of personal stress were pervasive. In addition, there was an emerging consensus among investigators that social and environmental stress factors reduce autonomy, a sense of justice, and personal dignity. It also became clear in evaluating the mental health status of soldiers serving in the war that social and environmental conditions, such as being in battle and experiencing prolonged stress, contributed to a person expressing symptoms of inadequate coping and/or mental illness. Accompanying this greater realization that social factors contribute to mental health and illness was a mood of optimism in the United States as a result of the allied victory in World War II.
The postwar period of optimism, with collective attention to social issues, created an opportunity for new types of research to be carried out in the large metropolitan areas of the United States. Such large scale investigations focused in more detail than ever before on the relationships among community social conditions, cultural factors, and an individual’s mental health status. It was being confirmed that a person’s social environment was related to his/her expression of mental distress and subsequent treatment. Private foundations, such as the Milbank Memorial Fund, sanctioned and funded these activities and advocated community approaches to mental health and illness for the rank and file of the mental health professions. Formal and informal conversations among professionals focused on the review of these findings, and the National Institute of Mental Health (NIMH) gave priority to the creation of community approaches to the treatment of mental illness and the promotion of mental health. The climate among the mental health professions encouraged the implementation of community approaches to mental illness and health.
Accompanying the growing awareness of community and preventive approaches to mental health by foundations and professionals was widespread public anger about the status of mental health treatment. With the appearance of public investigations and journalists’ reports of maltreatment and abuse of mental patients, such as the powerful newspaper accounts by Albert Deutsch, more and more citizens were informed about the plight of the mentally ill who. at the time, were being “warehoused” in large facilities. Many local citizen groups advocated change in mental health treatments and living conditions in large hospitals, where individuals were isolated from their families and communities. In this same period, the U.S. Congress, with NIMH and private foundation support, established the Joint Commission on Mental Illness and Health to review the state of the nation’s mental health. Its final report, Action for Mental Health (1961), called for a new community perspective for treating the mentally ill.
The founding of the field is often identified as occurring at the Boston Conference on the Education of Psychologists for Community Mental Health at Swampscott, Massachusetts (4-8 May 1963), more commonly referred to as the Swampscott Conference. At this conference, the term community psychology was coined, emphasizing prevention, policy research, and the active understanding of and intervention with social problems. The role of the community psychologist was proposed as an alternative to the treatment and disease orientation of the clinical psychologist, who at that time provided services to individuals after severe and traumatic personal stress had already occurred. The Swampscott Conference was an explicit and affirmative response by the 39 psychologists in attendance to the new national mood of community-based mental health work.
The widely circulated report of the Swampscott Conference facilitated, with NIMH training support. the development of the first doctoral community training programs. Most of this training was nested in clinical psychology training programs at six universities: University of Colorado (Bernard L. Bloom); Duke University (John Altrocchi and Carl Eisdorfer); University of Michigan (James G. Kelly and Harold Raush); University of Rochester (Emory Cowen); University of Texas (Ira Iscoe); Yale University (Murray Levine and Seymour Sarason). Three programs were established independent of clinical psychology: Boston University (Donald C. Klein and Herbert Lipton); George Peabody College 0. R. Newbrough. William Rhodes, and Julius Seeman); and New York University (Isidor Chein, Walter Neff, and Stanley Lehmann).
After Swampscott, Robert Reiff of Albert Einstein Medical College was nominated by community psychologists as their spokesperson. Reiff and this new group’s board of directors proposed to the members of the American Psychological Association (APA) that a new division be created. The APA Representatives accepted the proposal and the Division of Community Psychology (27) became official in September 1966.
With the acceptance of the field of community psychology by the larger psychological association, community psychologists began to explore how the knowledge of community psychology could be communicated. To facilitate publication two journals were founded: the American Journal of Community Psychology (Charles Spielberger, founding editor, 1973) and the Journal of Community Psychology (Frederick C. Thorne, founding editor, 1973).
Since the inception of the field there has been a continuing debate regarding whether community psychology is a part of clinical psychology or a distinct and separate field. This difference in perspective reflects a number of issues, including whether the emphasis of the field should be to improve the mental health of individuals or to reduce the incidence of a social condition at the community level. This difference represents continuing debates within the field about the proper focus of research and action and whether the priority emphasis should be on the individual or the larger neighborhood or the community. This difference in emphasis is likely to remain.
In the mid and later 1970s, the maturity of the field was evident. Growth was reflected in the publication of several community psychology text books. The first chapter on community psychology topics appeared in the prestigious Annual Review of Psychology. Faculty directing doctoral training programs concerned with common curricular and training issues formed the Council of Community Psychology Training Directors. Today there are 45 members of this group who meet annually to coordinate doctoral training in the field.
While white males contributed predominately to the earlier development of the field, younger community psychologists, women, and persons of color in the mid-1970s had been strongly requesting that the Division examine the impact of race and gender on the nature of the field itself. The Austin Conference, held at the University of Texas in April of 1975, included doctoral students and recent Ph.D.s who were not only younger but who were also nonwhite. This was a major step in developing broader representation and encouraging different voices in the Division. This change in participation also increased serious attention to the role of cultural and subcultural factors in health and illness.
Following the Austin Conference, the participants began to create systematic ways to facilitate more informal communication among the members. One approach was to create a regional coordination network to develop forums for public discussion of theory, research, and practice. This mechanism is still in place today. In 1978, at Michigan State University, Deborah Bybee, William Davidson, and Donald Davis began informal faculty-student sessions away from campus to review training and professional issues. These sessions, which have evolved into student-driven regional meetings known as eco-community conferences, have served as an important resource for informal exchanges among doctoral students interested in the field.
Two major issues emerged in the second decade. One issue was community psychologists’ attitudes toward accreditation and licensing for the field. Some believed that participating in accreditation would give the field more status and provide more career options for recently trained community psychologists. In contrast, J. R. Newbrough of George Peabody College, in his 1979 Division 27 presidential address, argued that accreditation would give priority to the profession rather than the communities served by community psychologists and would inhibit interdisciplinary training. The preferred approach, as expressed by Newbrough, was that community psychologists should be a resource to various self-help and community development activities.
Another issue of rising interest for community psychologists was the desire to increase their connections to the communities in which they were situated. Irma Serrano-Garcia of the University of Puerto Rico, emphasized this issue during her later presidency (1992-1993). The earlier proposition against specialization for this field strengthened the resolve of the members ten years later to increase community-based activities advocated by Serrano-Garcia.
While members of the field were assessing and debating these issues, the field was building a strong foundation in university training programs with the establishment of new master’s and doctoral degree programs. During this period, in addition to publications in the two primary journals, four more Annual Review of Psychology chapters were published.
During the SCRA presidencies of Jean Ann Linney (University of South Carolina), Dick Reppucci (University of Virginia). and Edward Seidman (New York University), 1984-1989, the field took steps toward solidifying its identity. There was wide recognition that the annual meetings of the APA were too large for informal exchanges. Biennial conferences specific to community psychology were planned to facilitate participation with undergraduate and graduate students, citizens, and members of different disciplines. The first such conference was held at the University of South Carolina in 1987.
Community psychologists also moved to rename the Division to reflect a more open, action-oriented, and interdisciplinary association. As a result of carrying out surveys of the membership, the Division was renamed the Society for Community Research and Action (SCRA) in 1987. During this period two more chapters were published in the Annual Review of Psychology, which has continued to cover the field’s evolution and diversity.
The liveliness of the field stimulated society leadership to hold a conference in Chicago in 1988. Funded by the APA, 80 individuals attended to evaluate current research methods. Increased attention was given to creating methods that reflect the historical commitment of the field to take into account how social contexts affect human behavior. Equally emphasized were attending to the processes of designing community programs that reflect a direct and personal relationship between the investigator and informants and in addition increasing the policy connections of community research and action. Since the Chicago conference, community psychologists have been active in extending and innovating new forms of inquiry. The diversity of SCRA’s activities is reflected in its varied committees and interest groups. The standing committees include APA Program Committee, Cultural and Racial Affairs, Dissertation Award, Elections, Fellowship, International, Liaison to Canadian Community Psychological Association, Membership, Nominations, Publications, Social Policy, and Women. The interest groups include aging, children and youth, community action, community health, disabilities, mutual support, prevention and promotion, rural school intervention, stress and coping, and undergraduate awareness.
Particularly since the 1980s, SCRA has facilitated active participation among community psychologists representing different interests and points of view. Additionally, community psychologists in the United States increased their communication with community psychologists around the world. For example, universities that have been particularly active in establishing community psychology training programs are located in Argentina, Austria, Australia, Canada, England, Germany, Italy, Mexico, Netherlands, New Zealand, Norway, Portugal, Scotland, and South Africa. There also has been more active participation among the practitioner and action-oriented community psychologists during the past several years. This increased participation of researchers, practitioners, and representatives from other countries has created a more dynamic organization than a solely academic, domestic U.S. organization might be. Increasingly, young people are finding that SCRA is a validating organization for their personal and career interests as they pursue the science and profession of psychology with an explicit research and action orientation to a broad range of community issues.
The SCRA has emerged as an active group of researchers and community action professionals. Community psychologists are proponents of a variety of community and preventive interventions, many of whom have been nationally honored and widely emulated. These programs of community research include interpersonal social problem-solving programs for young children, preventive programs for newly separated persons, heart disease prevention, and diversion from the juvenile justice system.
Information about SCRA activities, programs, and membership can be accessed from the Internet. There is a website: http://www.scra27.org/.
Community Psychology Theories
Because community psychology is social problem oriented, it draws its knowledge base from both its own scholarship and from the work of researchers and scholars in other fields, in and outside of psychology. The nature of theories that have shaped the field is a joint function of the kind of problems addressed, the sort of people attracted to the field, and the historical and social realities of the day. Theory tends to be dominated by views that include more than one level of analysis, suggest open systems, reciprocal causality, respect for diversity, and social change-oriented values. Social regularities and institutions are critically analyzed, especially as they affect the most vulnerable members of society. Theory tends not to be of the classical variety with logical statements and corollaries out of which a precise program of research flows, so much as orienting frameworks for action research. An overarching theoretical inclination of community psychology, regardless of the particular theory, is to avoid a victim blaming, culturally unaware, interpretive frame. This exerts a strong influence on the design of research and on interpretation of the available empirical knowledge base.
As Murray and Adeline Levine have pointed out in their historical analysis, Helping Children: A Social History (2nd edition, 1992), there is a correlation in human services work between the general social ethos of the times and the form of help offered. Individual, biological, and internal psychological explanations tend to dominate during periods of political conservatism, while environmental and social contextual explanations are more influential in times of progressive social change. More generally, the politics of the times tend to influence the nature of social science explanations for human behavior. The same may be said for what difficulties are considered a social problem, and for what are seen as acceptable social programs and policies. Notwithstanding historical fluctuations in the social ethos, community psychology has tended to attract adherents who favor theories that emphasize environmental context and critical social analysis, including critique of the methods, and practices of psychologists. Community psychology theories are called upon to provide more than a framework for studying particular phenomena of interest. They are also expected to provide an analysis of the roles and activities of the psychologist. as well an intervention approach to social problems.
Scope of Theory
An APA-sponsored conference and publication on theory and method in community psychology (Tolan, Keys, Chertok, & Jason, 1990) identified five influential theoretical orientations, including those borrowed from other areas of the discipline (developmental, organizational, and behavioral) and those developed within community psychology (ecological and empowerment). The ecological analysis offered by James G. Kelly and Edison J. Trickett has had an enduring theoretical impact on the field. They introduced the analytic principles of social ecology, including interdependence, cycling of resources, adaptation, and succession that have served as a bridge to other systems theories. Kelly’s (1990) work has also been seminal in providing a vision and a set of goals for the field, including the role of the community psychologist as boundary spanner who works with ordinary citizens and other professionals using multiple methods and epistemologies. Rappaport’s 1981 and 1987 American Journal of Community Psychology papers introduced the idea of empowerment to the community psychology literature (see also a 1995 special issue of the American Journal of Community Psychology, edited by Perkins & Zimmerman).
The Handbook of Community Psychology section on theoretical frameworks includes chapters on prevention, empowerment, individualism and collectivism, wellness, behaviorism, social cognition, and ecological analysis. But in a field where research, intervention, and analysis are not viewed as distinct activities, it would be misleading to exclude from theoretical influence scholarship on topics such as intervention strategies and tactics, stress theory, social support, citizen participation, life span and community development, social systems, research dissemination and policy analysis, the psychological sense of community, and the creation of alternative settings, all of which make important theoretical statements.
Contextualism and Action Research
Community psychology emerged in the United States as an identifiable substantive area during the last third of the twentieth century, a time of considerable social and cultural change, with a strong interest in environmental, sociopolitical and cultural critique, including a critique of psychology practices and methods. The field has always been receptive to action research, in which theory, data collection, and intervention are reciprocal and iterative rather than linear, and in which social criticism, intervention, evaluation, and empirical research go hand in hand. This approach is embraced because the theoretical underpinnings of the field have long emphasized the principle of contextualism, i.e., that the ideal empirical research should take place in contexts about which conclusions are to be drawn. Thus, while laboratory experimental work with convenience samples is sometimes necessary, it is considered (in a reversal of traditional preferences in psychology) to be a compromise from more desirable, if difficult, work in the field. Multiple methods for empirical data collection and analysis, both quantitative and qualitative, are used.
Collaboration with research participants during all phases of the research process is a strongly held aspiration. Influenced early by the same historical forces that resulted in legislative change and judicial decisions accompanying the U.S. African American civil rights movement, the field has followed an outspoken concern for the rights and full participation of cultural, ethnic, and social minorities as legitimate voices in the policies and decisions (as well as the research) that affect their lives. This concern has also played itself out in the context of changes in role relationships and gender-based stereotypes. Although some scholars have argued that the field had initially neglected many issues of concern to women, others suggest that community psychology and feminism share basic insights and an agenda that is similar (A. Mulvey, Journal of Community Psychology, 1988).
A community psychology division of the American Psychological Association was formed in 1966, and the division (later formed into a freestanding Society for Community Research and Action) has sponsored a scholarly journal (American Journal of Community Psychology) since 1973. Other journals where theoretical papers may be found include the Journal of Community Psychology and more recently the (British) Journal of Community and Applied Social Psychology. In addition to participation in APA, the Society holds its own biennial meeting and invites membership from professionals, students, and citizens who are not psychologists.
The field was created and influenced early by people, most of whom had been trained as clinical or social psychologists, who shared a critical analysis of the conceptual frameworks, intervention strategies, and professional roles in their own fields, especially with respect to mental illness. Initially they focused on the difficulties of reaching many people thought to be in need of human services, particularly the socially marginalized. Early on the community mental health movement, including deinstitutionalization and the prevention of mental illness, as well as a concern for how to create a human services system to better reach the socially marginalized and economically disadvantaged, was central to the field. The search for alternatives to in-the-office, one-to-one treatments of individuals by therapists led to exploration of new ways to locate and mobilize various community resources, including indigenous people, volunteers, and local citizens to promote mental health and well-being, and to prevent problems before they occur. Later, as prevention came to include the promotion of positive life circumstances, including social, educational, and economic justice, a broader perspective than mental health per se became possible.
As community psychology became much broader than an exclusive focus on mental health, research extended into areas such as education, law and juvenile justice, child welfare and domestic violence, health care and social support, citizen participation, self- and mutual help, as well as community and neighborhood organization, social advocacy, and policy. It has been widely accepted that different theoretical approaches are necessary, depending on the level of analysis at which one is working (individual. small group, organizational. institutional. community) with a search for strengths rather than deficits at every level. This way of thinking was greatly enhanced by William Ryan’s now classic volume, Blaming the Victim, published by Random House in 1971. Ryan made clear the social process by which well-meaning helping professionals learn to blame individuals for their own problems in living, rather than to analyze the social systems and contexts that create difficulties for people. His thinking led the way to a community psychology emphasizing cultural relativity, diversity, ecological analysis, and person environment fit (Rappaport, 1977).
Sources of Help
Originally the field was closely linked to the community mental health movement, and to critiques of long-term psychotherapy. Many psychologists participated in an analysis of the failure of mental hospitals to meet the needs of the long-term mental patient (thus requiring development of alternative, community-based settings) and the lack of reach or effectiveness of human services for the economically disadvantaged (thus requiring development of alternative sources of person power and new helping, advocacy, and community organization roles for both citizens and psychologists). Both of these observations led to a variety of conceptual and theoretical approaches designed to account for why people untrained in professional practice, often working with people in their own community, usually are no worse at being helpful than professionals. The field has also been receptive to behavioral, environmental, and social systems theories, as well as to models of self and mutual help. (See. for example, Cowen, Gardner, & Zax, Emergent Approaches to Mental Health Problems, Appleton-Century-Crofts, 1967: Cowen, 1973, Annual Review of Psychology chapter; Rappaport, 1977; Christensen & Jacobson, 1994; Psychological Science, for a related review in the context of therapeutic services; and Humphreys & Rappaport, 1994, Applied and Professional Psychology, for a review in the context of self and mutual help theories and practices).
Public Health and Prevention
George Albee’s Mental Health Manpower Trends (New York, 1959) made it clear that we would never be able to train enough mental health professionals to meet the need for treatment within a clinical services paradigm and that it is desirable to take a public health approach that seeks to prevent problems before they occur. This observation remains a basic assumption for the field. Theories forged in the fires of community mental health concerns tend to be primarily about the nature of systems for service delivery. Early influences from public health models of prevention and community psychiatry, especially the thinking of people such as Gerald Caplan, a psychiatrist who made popular the distinctions between primary prevention (intervention targeted for an entire population intended to reduce the incidence of new cases), secondary prevention (detecting and treating a problem early in its course or in the person’s life), and tertiary prevention (rehabilitation), was an important theoretical influence. Current thinking continues to use a now more sophisticated version of the public health model and this portion of the field has tended to shift toward a disciplinary practice called “prevention science.” Generally, the notion of “risk” is adopted, such that depending on the nature of the analysis one speaks of people at risk, or of risky circumstances. The notion of prevention science itself tends to call for the prevention of specific diagnosable disorders through identification of hypothesized causal mechanisms, as opposed to more general efforts to improve life circumstances, living conditions, and social inequities. This is a controversial distinction and some feel that prevention science is actually less likely to create effective change than, for example, a more global approach to providing wellness enhancement for all children (Cowen, 1999)—an approach that does not posit specific mechanisms tied to specific disorders, but emphasizes reciprocal effects, such that neither the exact nature of the expression of a disorder is predictable, nor is it necessary to know the mechanism in order to correct certain obvious social inequities. (See also Albee, American Psychologist. 1996; Felner, Felner & Silverman, 2000, in Rappaport & Seidman’s Handbook of Community Psychology.)
A focus on specific disorders is likely to move theory toward the biomedical disciplines, albeit with an epidemiological, public health perspective. Attention to social inequity, whether it leads to development of theories related to promotion of health, educational opportunity, neighborhood and community development, empowerment, or wellness, is more likely to be influenced by the social sciences and humanities, including critical social theory and qualitative research methods. A single unifying theory for community psychology, if possible or desirable, remains a project for the future.
Community Psychology Methods of Study
From the time of the Swampscott Conference, usually seen as the origin of community psychology, it has been clear that this new discipline would require new methods of research. Traditional laboratory methods favored by psychologists would prove inadequate to the study of people’s behavior in social and cultural contexts and to understanding processes and effects of social interventions and social change.
This article discusses six principles that guide research in community psychology. Although not every project undertaken by a community psychologist demonstrates all of them, most members of the field would agree that all six are ideals. The principles are (1) research embodies social values, (2) research should be linked to action, (3) research should involve collaboration between researchers and participants, (4) research in the real world is complex, (5) research must attend to context and to multiple levels of analysis, and (6) research should be culturally anchored.
Research Embodies Social Values
Most community psychologists believe that research in the social sciences reflects social values both in the choice of topic and the approach taken. Values enter into the initial framing of a research question. For example, the question, “Why do some youths drop out of high school?” focuses attention on differences in the backgrounds, skills, and motivations of youths who complete and fail to complete high school. The question, “Why do some high schools have high drop-out rates?” focuses attention instead on the organization and financing of schools, the quality of education that they provide, and their ability to engage the youths in their charge. The first question implicitly fixes responsibility for dropping out of school on youths or their families; the second suggests that responsibility may rest with schools. The questions also imply different approaches to intervention to increase rates of high school completion, for example, tutoring to remedy youths’ deficient skills, in the first case, and modifying curricula or restructuring high schools to clarify expectations and promote better relationships among students and teachers, in the second. (Other questions, with different implied solutions, are also possible.)
Community psychologists emphasize peoples’ strengths rather than weaknesses. Many psychologists try to understand the particular ways that adolescents can get into trouble, by investigating the causes of high school dropout, teen pregnancy, substance abuse, delinquency, and the like. A community psychologist might ask instead how most youths, even those from poor backgrounds, manage to negotiate the shoals of adolescence and emerge as competent and contributing adults. Competence in adolescence does not involve only avoiding dropout, pregnancy, substance use, or delinquency, but also doing well in school, participating in extracurricular activities including sports, and contributing to one’s family and community. Children may succeed in these realms even if they also engage in some problem behaviors. At the least, it is an empirical question whether a focus on promoting positive behaviors in adolescents is more or less effective than a focus on preventing negative behaviors in producing successful adults.
The point of these examples is not that one approach is right and another wrong. A complete understanding of adolescent development is likely to involve both individual factors and contextual ones, both strengths and problems. Rather, the point is that the choice of question in any particular study involves social values about what outcomes are most important and often unexamined premises about what predictors are most likely to explain them. Community psychologists are more likely than other psychologists to focus on people’s strengths and to look for dysfunction in social environments rather than in individuals.
Research Should Be Linked to Action
Another central value of community psychology is that research should serve, ultimately, to promote human welfare. Community psychologists may work directly to develop and evaluate interventions to prevent mental health or behavioral problems or to promote well-being. For example, community psychologists have developed and evaluated programs to prevent adults who lose jobs from becoming depressed, to prevent teen smoking both by enhancing teens’ skills in refusing involvement with substances and by delivering sanctions to merchants who violate the law by selling cigarettes to minors, and to enhance early development of children from poor backgrounds. In order to conduct interventions, community psychologists must first do generative research to understand the processes by which mental health problems arise or by which good outcomes ensue. For example, the program to prevent depression among workers who lose their jobs rests on research showing links between job loss and depression. Community psychologists also study processes of social change that they do not themselves instigate, including the self-help movement or community mobilization to fight environmental toxins.
Other community psychologists do research relevant to social policy. For example, studies that show that children in child care centers do better when teachers have good education and training, group sizes are not too large, and there are not too many children for each adult, can inform state regulations governing day care centers. Research that shows that homeless families who are given subsidized housing are every bit as stable as other poor families, regardless of individual problems, suggests that policies to increase the supply of affordable housing would reduce homelessness in the United States.
Community psychologists have been influenced by Kurt Lewin’s model of action research (Field Theory in Social Research, New York, 1951), which involves a cycle of activities beginning with problem definition and research or fact finding, followed by a setting of goals and undertaking actions to reach them, followed by an evaluation of the efforts and a redefinition of the problem. In this model, research leads directly to action, which in turn leads to additional research. The model is particularly useful in working with small community organizations that can engage in multiple cycles of activity and evaluation.
Community psychologists believe not only that research should inform action, but also that action can inform theory. From this perspective, the community psychologist’s social intervention is analogous to the laboratory psychologist’s experimental manipulation of a variable to understand its effect. Generative research is most often correlational, and allows researchers to examine associations among variables, but not to determine causal pathways. Experimental interventions do permit us to understand causal relationships and test underlying theories.
Research Should Involve Collaboration between Researchers and Participants
The report of the Swampscott conference described the community psychologist as a participant conceptualizer who would bring the conceptual and methodological tools of psychology to community problems but also who would be an active participant in social action in collaboration with members of the community (Bennett et al., Community psychology: A Report of the Boston Conference on the Education of Psychologists for Community Mental Health, Boston. 1966). Collaboration has at least two goals. First, research is likely to be better and more useful if it takes advantage of the knowledge and perspectives of research participants, including their sense of the questions that are worth asking. Second, interventions are more likely to have a lasting impact if participants make them their own. Over the years, community psychologists increasingly have taken a constructivist approach to knowledge. That is, they believe that knowledge is socially constructed, and that different participants or stakeholders may have different understandings of the same situation. For example, an intervention in a school would include as stakeholders, students, teachers, administrators, school-board members, and parents, at a minimum. Any particular intervention might include other groups. For a program to distribute free condoms in the schools, additional stakeholders might include clergy, public health officials, service providers at Planned Parenthood, and owners of pharmacies where youths might otherwise buy condoms. Different stakeholders will focus on different issues, including protection of youths from disease and unwanted pregnancy, the proper role of families and schools, sexual morality, efficiency of intervention, disruption of the school day, and economic loss. A psychologist who studies this intervention may also have a unique perspective, informed by the research literature on similar interventions and by knowledge of methodology, but this perspective is simply different, not more valid, than the others.
Even when community interventions are less controversial than condom distribution in schools, research is likely to be most useful and informative if the researcher can collaborate with local stakeholders and research participants to understand their perspectives when framing questions, and to incorporate their local knowledge in designing studies. Research that does not address participants’ concerns is likely to sit on the shelf.
Further, interventions designed solely by psychologists or imported from elsewhere may meet with local resistance—even interventions that it reasonably well with the local culture. They are unlikely to draw the same level of commitment as interventions that participants aid in designing. Designing and carrying out an intervention may be empowering and thus have greater benefits than simply participating in an intervention designed by others.
Of course, creating an intervention to obtain some desired outcome is hard work, and few interventions are successful the first time out. Rather, interventions are frequently modified and improved several times before attaining success. Thus it makes sense for people designing interventions to draw on the research literature regarding similar interventions that have worked in the past. Tension may arise between fidelity to an intervention that has been proven to work, at least under the circumstances where it was originally developed and adaptation of the intervention to local circumstances with local ownership. Blakely and colleagues, in a large-scale study of 70 adaptations of seven different well-documented interventions, showed that modifications that changed key features of the original intervention reduced success, but that additions to the intervention to fit local circumstances enhanced it (Blakely et al.., American Journal of Community Psychology, 1987, 15. 253-268).
Research in the Real World Is Complex
As is probably obvious by now, research in real-world contexts is often more complex than research in psychological laboratories. Laboratory experiments are designed to manipulate only a small number of variables at a time, holding all other influences on outcomes constant. Researchers who study naturally occurring processes or interventions in natural contexts do not have the luxury of isolating only a few variables to examine their effects. Community psychologists and others have made numerous creative responses to the resulting challenges.
Some researchers adopt qualitative techniques to substitute rich description of social phenomenon in a necessarily small number of people or settings for a quantitative look at a larger number of people or settings. These researchers often borrow techniques from anthropologists or sociologists, including ethnography, extensive observation, and in-depth interviewing, often with multiple stakeholders. Observational designs, including most qualitative methods and more quantitative ones such as survey research, are particularly useful when the researcher has little or no control over the phenomenon under study. Sometimes longitudinal designs, in which researchers study the same group of people at multiple points in time, are used to tease apart relationships among variables over time.
Community researchers can also conduct true experiments in field situations, randomly assigning individuals or settings, such as classrooms, schools, or even communities, to intervention and control groups. Often the control group gets an alternative intervention, either for ethical reasons, or to motivate their continued participation in the study. In principle, if the experimental group does better than the control group on some outcome, the intervention was a success. But inferences are actually more complicated. First, researchers must be sure that the intervention was in fact delivered to the experimental group as planned. If not, the comparison is meaningless. Second, in real situations, people who are assigned to (or invited to participate in) interventions may not show up or may drop out. And those who drop out may have been doing worse than those who stayed. (For example, people may drop out of a treatment program for substance abuse because they have returned to using substances.) Comparing only people who complete the intervention with those who do not will lead to biased (misleading) results. Often researchers compare all those who were invited to participate with all those who were invited to the comparison group to avoid this bias, but other more sophisticated solutions are sometimes possible. Third, people may complete the intervention, but not the posttest. Wherever there are missing data, researchers must work to understand why, and whether they can estimate what would have happened if data were complete.
More elaborate analyses provide additional information. Follow-up data are useful in determining whether the effects of an intervention are temporary or more permanent, or even whether interventions, by altering trajectories of development, may have increasing effects over time. Researchers can bolster their conclusions by examining patterns of relationships among variables. If the theory says that an intervention to prevent college dropout works because students develop closer relationships with faculty, then it is important to test the theory to see whether closer relationships do in fact develop, and whether students with closer relationships are less likely to drop out. Finally, programs are often subjected to cost-effectiveness analysis, to see whether they are more or less effective than other programs with similar costs.
In between experimental designs where the researcher has a large degree of control and observational designs where there is little or no control, lie designs in which the investigator has some control, at least over who gets measured. A variety of clever quasi-experimental designs exploit naturally occurring variation to understand social phenomenon. If researchers cannot assign some participants at random to a control group, perhaps they can find similar people who have not been exposed to the intervention, and study them as a comparison group. Perhaps they can find measures of the outcome that extend back in time over a long period before the intervention. If the outcomes (for example, in a school setting, achievement, attendance, or drop-out rates) are quite stable for years before the intervention, and then exhibit important changes at the time of the intervention, it may be possible to infer that the intervention had an effect. Making inferences requires careful attention to other possible explanations for the phenomenon, sometimes called rival hypotheses or threats to validity. Researchers must also consider whether the phenomenon is likely to occur in the same way in other social contexts.
Research Must Attend to Context and to Multiple Levels of Analysis
A central concern of community psychologists is understanding relationships between persons and settings. Settings such as peer groups, schools, work organizations, neighborhoods, or society as a whole may influence individual behavior; people in turn can create new social settings or influence the settings they are involved in. And settings can condition or influence the nature of relationships between other variables. For example, the level of parental control that is optimal for adolescent development may depend on the level of risk in the neighborhood or the level of delinquency among the adolescent’s friends. Settings may also operate in different ways for people with different characteristics. For example, police may be more likely to arrest minority adolescents than white adolescents who commit the same offense, creating different environments for the two groups. Systematic patterns of this sort are called social regularities.
Psychologists in general are far more expert in assessing individuals than in assessing social environments. Community and environmental psychologists have made considerable progress in understanding characteristics of social settings, particularly the most immediate face-to-face settings for human behavior, which Bronfenbrenner calls microsystems. Research on characteristics of larger and more diffuse settings, such as neighborhoods, and their influence on individual behavior has burgeoned recently with new techniques for locating respondents in particular neighborhoods (known as geocoding) and then examining characteristics of those neighborhoods with census data, surveys, or observational techniques. Such research remains in its infancy, but holds considerable promise.
Failures to consider contextual effects can lead to misattributions of causality to characteristics of individuals. For example, William Julius Wilson (The Truly Disadvantaged, Chicago, 1987) points out that African Americans of any socioeconomic status are more likely to live in areas of concentrated poverty than are European Americans of the same socioeconomic status. If living in a poor neighborhood has adverse effects on employment (because there are fewer jobs or fewer role models) or school success (because schools are more poorly funded, have less inspired teachers, or spend more time on remedial work), researchers who ignore neighborhoods will mistakenly attribute these effects to individual race. Understanding contextual influences is thus critical to understanding the level of analysis at which a particular effect occurs. Statistical techniques can help to sort out these effects.
Research Should Be Culturally Anchored
An important context that is receiving increasing attention from community psychologists and others is culture, including values, norms, behaviors, and “blueprints for living” that may vary among groups with different national origins or, sometimes in more subtle ways, between groups defined by race/ethnicity, gender, socioeconomic status, sexual orientation, or other variables (see Hughes, Seidman, & Williams, American Journal of Community Psychology, 1993, 21, 687-703). Early research by psychologists on cultural differences tended to compare some other group, most often African Americans or women, to a white male standard, with any differences seen as implying the inferiority of the other group.
Community psychologists have rejected this approach for many reasons. The values of the field preclude taking any group’s characteristics as the standard of worth. Many supposedly objective categories, such as race, are in fact fluid and more dependent on perceptions than on any objective criterion. There are as many differences within particular groups (e.g., among Latin Americans from various countries of origin) as between groups. The most interesting questions may not involve comparisons between groups, but variation within groups. Even the questions may vary from group to group. For example, questions about successful adaptation to a new culture make sense only for immigrants; questions about consequences of antigay hate crime make sense only for homosexuals and bisexuals.
Other questions make sense for multiple groups, but answers may vary. For example, researchers have hypothesized that extended family, church, and informal sources of help may be more important to mental health for African Americans than for European Americans. One important class of questions concerns the extent to which prevention and intervention programs that have been shown to be effective for a particular group are also useful for other groups, or how they should be modified to be more culturally sensitive and effective. Researchers must be careful that prevention programs, such as parent training, do not simply impose the researcher’s values on participants with different values.
Where similar questions make sense across different groups, it is important to understand the extent to which the underlying concepts and ways of measuring them are also comparable. If one group scores worse than another on an inventory of psychological symptoms, does the first group really have worse mental health, or are members of the first group simply more willing to acknowledge symptoms? Are mental health problems organized in similar ways for different groups?
Research is culturally anchored when it asks questions that are meaningful to the group or groups being studied, in language that makes sense to them, and with measures that are suitable for the group. Collaboration between researchers and participants may help to increase the cultural appropriateness of research efforts. Nonetheless, cultural anchoring of research remains a challenge to community psychologists, and to other psychologists as well.
In sum, although community psychology shares many methodological approaches with other types of psychology, there are important differences in emphasis. Values are central to research in community psychology and core values include linking research to action and involving research participants as collaborators. The complexities of research in the real world require clever designs and attention to the social and cultural contexts in which participants live.
Community Psychology Prevention and Intervention
In the nineteenth century John Snow halted the cholera epidemic in London by removing the handle of the Broad Street water pump. By cutting off access to contaminated water, Snow managed, in a single stroke, to mount a major successful prevention effort against cholera. Neither Snow nor anyone else had a very clear understanding of the mechanisms of cause and effect that were involved. Nearly a century later, in 1962 in Ypsilanti, Michigan, a high-quality preschool program for impoverished African American children was begun. The program taught basic cognitive skills and was accompanied by weekly home visits by trained teachers. This program was different in one important way. Half of the children were randomly assigned to the program and half had the usual preschool experience in their community. The children were followed for more than 20 years to learn what effects early exposure to the program might have had. As time went on, remarkable differences between the children who participated in the program and those who had not began to emerge. By primary school, children who had been in the program were much less disruptive in school, and by the time they were adolescents, the group was involved in fewer violent acts and less police contact. By the time they were 19 years old, the preschool program children had much higher rates of high school completion, lower arrest records, less placement in special education classes, and higher levels of economic achievement.
While quite different, each of these is an example of a successful prevention effort. In the case of the cholera epidemic, an infectious disease was involved. John Snow’s dramatic intervention had a preventive impact, even though the reason for the success of the prevention effort was poorly understood. In the case of the preschool program, an enriching experience for vulnerable children at a critical time in their lives dramatically altered their life course, both enhancing their own life prospects and providing clear benefits for society.
More than a century after John Snow’s prevention effort, our knowledge of infectious disease and our capacity to protect populations through hygienic efforts and immunization has made prevention of infectious diseases almost routine in some parts of the world. However, new challenges for prevention are emerging. Today, with the notable exception of Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) and certain infectious childhood diseases such as measles, many of the targets of prevention programs are not infectious diseases. Instead they are chronic long-term recurring disorders with developmental roots and long-term trajectories such as drug abuse, failures of academic achievement, depression, conduct problems, and school failure. All of these problems have complex biological, psychological, and social roots that intertwine in the development of disorder. The field of prevention draws some of its most dramatic examples from public health, but prevention of personal, social, and developmental problems represents a common goal of many fields including education, criminal justice, psychology, psychiatry, and human development.
Risk and Protection across the Life Course
It is helpful to think about prevention from the point of view of human development over the life course. Each developing individual is continuously changing and the risk and protective factors to which they are exposed will emerge and disappear over time. Furthermore, at every stage of the life course, certain critical developmental tasks must be accomplished, and if they are not, they will compromise development later in the life course. Early in life for example, many developmental tasks involve biological regulation, perception of the physical environment, and developing cognitive abilities. In infancy and in early childhood, critical developmental tasks involve the acquisition of language skills and the development of impulse control. Later, as the child enters school, the capacity to read and write becomes important. and social skills to get along with peers are also critical. With entry into puberty and increased freedom from parental support and supervision, new risks associated with sexuality, substance use, and health are encountered. Skills to resist peer pressure, solve complex interpersonal problems, and pursue goals in the face of setbacks become important.
Human development and risks do not end with adolescence. Indeed, as the individual moves from adolescence to adulthood, additional critical transitions emerge. The choice of an occupation and the emergence of committed relationships come to center stage. As the focus turns to the key developmental tasks of parenting, working life, and sustaining a relationship, risks associated with divorce, job loss, or disruptive parent-child relationships become salient. An important feature of risks in adulthood is that they often carry liabilities not only for the adult, but also for those with whom the adult has intimate relationships, including spouse, partner, or child. Even middle adulthood and old age expose the individual to new risks, both planned and unplanned. At the end of life, life transitions and crises associated with illness and the death of a spouse occur, still new risks emerge, and with them new opportunities for prevention.
The settings in which we live our lives, family, community, and work, can involve both risk and protection throughout the life course. Early in life, the biological and social environments of parental caregivers are critical for the development of infants and small children. Later, the school emerges as a key community setting for risk and protection. Still later, intimate relationships in family, home, neighborhood, and the community and workplace influence life trajectories. Because the social settings that are vital to human development and well-being change during the life course from clinic and nursery to school and neighborhood and finally to workplace and family, the settings most appropriate for prevention efforts change as well.
Definitions of Prevention and Classification of Prevention Efforts
Perhaps the most dramatic and successful examples we have of large-scale prevention efforts involve efforts to prevent the spread of infectious diseases. A century ago, infectious diseases such as smallpox and influenza were the leading causes of death and disability, but through the introduction of hygienic measures and immunization, these diseases had dramatically declined by 1970. Indeed, smallpox has been eradicated on a worldwide basis primarily through effective prevention efforts. Some advocates of prevention argue that no major disease has ever been eradicated through treatment.
Attempts to classify prevention efforts provide one set of organizing principles for the field. One widely recognized classification system emphasizes prevention efforts aimed at the risk characteristics of entire populations, rather than individuals. This approach, originally proposed by the Commission on Chronic Illness in 1957, defines primary prevention as efforts to reduce the rate of development of new cases (incidence) of disorder or illness. Primary prevention requires that we know enough about the early roots of disease or disorder to alter the risk factors for populations to prevent illness from occurring in the first place. This is a worthy and challenging goal made attractive by its success in earlier public health efforts with infectious diseases. Secondary prevention includes all efforts designed to reduce the number of already existing cases (prevalence) in the population. Secondary prevention can be accomplished by early and effective intervention once early signs of the problem have been identified. Finally, tertiary prevention is not actually aimed at preventing disorders at all, but instead at reducing the amount of disability and dysfunction associated with a disorder once it occurs. For example, the effort to reduce the disability associated with a serious injury, once it has occurred, is an example of tertiary prevention. This classification system focuses primarily on outcomes, but says little about how they might be achieved.
A more recent approach classifies prevention efforts in terms of how broadly they can be applied to the population with widespread benefit. For example, a universal preventive effort is one that can offer confidence to everyone in the general public where the overall benefits outweigh the risk for those who receive the program. An example of a universal preventive effort is water purification and another is smoking cessation. In each case, the benefits clearly outweigh the risks and costs, and therefore, could be provided on a universal basis. A selective preventive strategy is one that is appropriate only for people whose risk of harm is above average, and where more expensive interventions might therefore be justified. An example of a selective preventive strategy might be annual mammograms for women or special safety devices that are required for dangerous occupations. Finally, indicated preventive strategies are only appropriate for an even narrower group of people who already show a strong indication that they will develop a problem, disease, or disorder. In this case, a targeted and even aggressive intervention might be appropriate because the benefits outweigh the costs and risks, even when the cost or risk involved in the intervention is appreciable. An example might be license suspension in the case of a driver with a long record of driving while intoxicated. Here intervention with the individual could outweigh the costs and risks for society.
Recently, some researchers and community practitioners have argued that the focus of prevention may be too narrow, and that a greater emphasis should be placed on the promotion of health, mental health, and positive human development. They contend that the negative outcomes identified in prevention ignore the fact that effective promotion efforts can enhance coping ability or resistance to later disorder. There is little doubt that efforts that promote social skills, academic achievement, and personal resilience in the face of stress and adversity have substantial value in themselves. In some cases, promotion efforts may also have preventive effects, particularly for persons who are vulnerable to disorder. The distinction between prevention and promotion can be best thought of as a distinction between means and ends. Promotion efforts have a value in and of themselves, and can also be thought of as a means of preventing disorder. For example, a preschool program designed to increase social problem-solving skills may also prevent the development of disorder in children who are particularly at risk for later problems.
Strategies for Prevention Through the Life Course
Over the life course, individuals and families develop, and risks to health and well-being ebb and flow. At the beginning of life many of the risk factors are biological, and critically determine how the organism develops. Later, risks and vulnerabilities are more social in nature, both in their origins and impacts. The acquisition of language, the ability to delay gratification, to get along with peers, and to provide and care for others have both biological and social aspects.
In addition, each individual life trajectory encounters critical transitions. or milestones in development such as beginning school, entry into the world of work, the development of a committed relationship, birth of a first child, and retirement. Many of these transitions are normal and expected in society, and a number of social institutions have been developed to help negotiate these transitions. They are, nevertheless, moments of risk in the life course. Beyond these life transitions, there are numerous unplanned or unscheduled turning points in the lives of individuals and families that also present major sources of risk. These turning points can involve, for example, illness or injury in childhood, school expulsion or dropout, unplanned pregnancy, job loss or loss of a close personal relationship, bereavement or widowhood, or the death of a parent or child, In what follows, we will review a sampling of prevention efforts through the life course.
Prevention in Infancy and Early Childhood
In the development of a new life many of the risks are biological, and preventive efforts are directed at protecting the fetus and the health of the mother. High quality prenatal and perinatal care are among the most important preventive measures that can be provided at the beginning of life. Unfortunately, the availability of good prenatal care is not universal, and continued efforts are needed to make good prenatal care more widely available. The research evidence clearly suggests that a number of health and developmental complications can be avoided and healthy development can be enhanced through the simple provision of prenatal and perinatal care.
Immunization against infectious disease shortly after birth is a second universal strategy with substantial preventive benefit. Immunization protects infants against a variety of childhood diseases, such as measles, that a century ago took a substantial toll on the health and well-being of the population. Immunization is a classic example of the traditional public health prevention model. A vaccine can confer long-term protection against a particular physical disease. For example, children not immunized against Type B influenza and meningitis can suffer long-term negative effects on the brain, resulting in learning disabilities and psychological and behavioral disorders.
An example of a successful prevention program for prenatal and perinatal care of infants focuses on working with single teenage mothers. The program uses home health visits by public health nurses to assure high quality prenatal and perinatal care. Visiting nurses also teach young mothers about risks to the infant from smoking, poor diet, and alcohol use. Visiting nurses also provide parent training and vocational guidance for the young mother as she prepares to enter the world of work. Research has shown that this program provides improved maternal diet and reduces smoking during pregnancy for teenage mothers. The program also reduces premature deliveries, and results in higher birth weight and less child abuse. In short, this prevention program uses the skills of a public health nurse to reduce a wide variety of risks for the mother and infant, and supports the transition to healthy development for both mother and child.
Prevention in Childhood
In early childhood, new developmental tasks become prominent in successful development, particularly, the acquisition of language skills and social and impulse control. When children have not yet entered school, but are learning to interact with their social world, language and social competence is critical to social development. Research has shown that programs that focus on enhancing mother-child interaction, either through home visits or through participation in a local parent-child developmental center also result in fewer behavioral problems for children, better family management practices, and higher levels of cognitive competence.
Once children enter primary school, they encounter different developmental tasks and risks. The acquisition of reading skills and the capacity to get along with peers become increasingly important in elementary school. As a community setting, the school is a major source of rewards and punishments, social models, and opportunities for skill acquisition, and a place where children spend a substantial portion of their waking life. Preventive interventions that enhance the social competence of children of elementary school age can reduce behavior problems and enhance later development. If early developmental, health, or mental health problems begin to appear in elementary school children, detection and early intervention is possible in the school setting. For example, research has shown that school based programs that teach children social and interpersonal skills can reduce early behavior problems or poor impulse control, and produce better cognitive problem solving skills.
At this age, major social transitions in home life, such as divorce, death of a parent, or severe illness in the family can present substantial risks to the child. Divorce and the conflict between parents that often accompanies it can be a significant risk factor for children. Research on a number of school-based programs have shown that weekly sessions for children that help them understand their own feelings about divorce and deal with related anxiety, anger, and interpersonal conflicts can have significant positive preventive effects on child adjustment. Although less common, children are also at risk when a parent dies. Researchers have shown that a family grief workshop followed by sessions with a family advisor can reduce school and behavior problems among children who have experienced the death of a parent.
The school is a social setting in which a wide range of childhood vulnerabilities can be ameliorated. School programs that help children master academic challenges and learn social skills to control their own behavior can have positive effects on aggressive and shy children. They can improve cognitive competence, especially among those children who have early symptoms of depression. While such school programs are not yet widely available, they have substantial promise in preventing problems for children at risk.
Prevention for Adolescents
As children move from childhood to adolescence the patterns of risk change yet again. With the onset of puberty, competent coping with sexuality becomes a major developmental task. It is not only the risk of pregnancy, but also contracting sexually transmitted diseases, including AIDS, that become critical risks for young adolescents. In addition, substance and alcohol abuse become risks with very substantial potential for negative effects on development and health. Adolescence is also a time when increased risks of other problems emerge, including school failure, dropout, or behavior problems and delinquency.
A large number of drug abuse prevention programs have been developed to reduce the likelihood of alcohol or substance abuse among early teenagers. A survey of these programs suggests that successful programs have two elements. First, they encourage students to adopt attitudes against drug abuse during adolescence. Second, they involve classroom-based training to teach teenagers to identify peer and media influences to use drugs and to resist those influences. Typically prevention programs that are effective involve classroom practice at role playing to resist peer influences to use drugs, providing examples from peers and other forms of classroom instruction. Research has shown that it is possible to reduce the prevalence of cigarette smoking, alcohol, and marijuana use in adolescents through such programs.
Prevention in Adulthood
With entry into adulthood, the focus shifts yet again to new developmental tasks. In adulthood, the tasks include the establishment of committed relationships, the challenges of child-bearing and child rearing, finding paid employment, and successfully sustaining a work life. There are also new risks in adulthood, including the risks associated with poverty, or the stressful burden of caring for ill or elderly family members.
Prevention programs have been designed and tested that can help adults cope with many of these key transitions and crises. For example, programs to teach couples to handle disagreements in constructive ways and to communicate more effectively have been shown to increase couples relationship satisfaction, reduce negative communication. and reduce the risk of divorce. If divorce occurs. However, the resulting conflict can negatively influence not only children in the family, but also the health and mental health of the divorcing individuals. Programs that are aimed at helping individuals cope with the multiple challenges of divorce can provide real preventive benefits. One program that provides highly specialized workshops on starting new relationships, child rearing, single parenting, and legal and financial issues has been shown to prevent depression and anxiety and enhance self-confidence and well-being.
Job loss is another unplanned life transition that can also produce significant risks for individuals and families, including increased family conflict, economic hardship, depression, and anxiety. Prevention programs have been developed to teach job search skills and skills for coping with setbacks in the job search process. The program has been shown to increase reemployment rates among participants, reduce the risk of depression, and at the same time, produce higher paying jobs for program participants.
Prevention in Later Life
Later in the life course, as chronic illness becomes more likely, family members may become responsible for the care of a parent or spouse who has become seriously ill. The caregiving task can produce a continuing stream of stressors with which the caregiver must cope. Peer and professionally led groups to support family caregivers can help people share their stressful experiences, express their support to one another, and learn tactics for coping more effectively. Caregivers who participated in these programs experience mental health benefits and better levels of knowledge about community resources that can help to relieve the caregiving burden.
At the end of life, loss of a spouse or loved one can produce prolonged bereavement with complicating health problems. Prevention efforts can be effective even for the elderly toward the end of the life course. Mutual help programs in which widows were able to share experiences and mutual support have been shown to prevent distress and depression. National networks of self-help groups for widows have been formed, and research has shown that participants greatly benefit from participation.
Evidence of Effectiveness of Prevention
The effectiveness of prevention efforts should be a concern not only to researchers, but parents and citizens as well. As the parent of a child concerned about the effectiveness of a school program to prevent drug abuse, or as a community member curious about claims of a program to prevent juvenile crime, it is natural to ask whether prevention programs are actually effective. Parents and community members should become thoughtful and demanding consumers of prevention programs, and ask for evidence of effectiveness. In the enthusiasm of public advocacy or the heat of debate, concerns for evidence of effectiveness may be lost. Yet in the long run, critical and demanding citizen consumers are essential to genuine and sustained prevention efforts in the community.
Researchers have observed that successful prevention programs have a number of characteristics in common. First, they are targeted and are informed by an understanding of the risks and problems encountered by the target group. In addition, they are designed to influence the life trajectory of people who participate in them. They are aimed at long-term change, setting individuals on a new developmental course, opening opportunities, changing life circumstances, or providing support.
What evidence should be considered in choosing a prevention program? Without doubt one of the highest standards for the evaluation of prevention programs is a study in which the program has been tested in randomized trials where both those who received the program and those who did not are followed over time to assess long-term program impact. Such studies are expensive and have been conducted only on a few of the programs that claim to prevent problems in health and human development. Nevertheless, evidence from randomized studies is very important in evaluating the worth of a prevention program.
Another kind of evidence for effectiveness is increasingly becoming available. It is called metaanalysis and involves the careful accumulation of results across multiple studies. For example, a recent metaanalysis of prevention programs reviewed 177 prevention programs designed to prevent behavioral and social problems in children and adolescents. The study found that most of the programs reviewed produced favorable outcomes, similar or greater in magnitude than those obtained in other intervention sciences. This evidence compares very favorably with that generally accepted for medical and social interventions and should be a source of considerable optimism about the effectiveness of prevention efforts. Many prevention programs actually influence a spectrum of health, mental health, and developmental outcomes, and some of the beneficial results may not appear for some time. For example, the preschool program described earlier had effects on school achievement, occupational achievement, and criminal justice outcomes. Many of these beneficial effects did not become apparent for a number of years after the end of the preschool program. This makes it clear that long-term follow-up is a critical ingredient in evaluating prevention programs.
Although developing and sustaining effective prevention programs presents challenges to the skills of psychologists and citizens alike, their costs may be small compared to the social costs of school dropout, drug abuse, depression, or delinquency. As health-care costs continue to be a national concern, we are becoming more and more aware that for every problem in development, health, and disability, someone is paying the bill in tax dollars, insurance premiums, or human suffering. Community-based programs to prevent disorders and disability promise to reduce costs to society as well as to antidote disability and human suffering.
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