WITHDRAWN: Moving Toward the Next Generation of Family-Based Prevention: Current Knowledge and Next Steps

The next generation of family-based prevention will move programs from university lab or community mental health settings to medical settings, such as primary care. In this scenario, family-based programs would cleanly integrate with existing medical provider workflows and information technology. Families with children presenting certain behavioral problems or meeting certain risk criteria would be referred to family-based services as an integrated component of their overall health care. The family’s progress could be monitored and service provision could be escalated in a timely manner as needed for those families most at risk or who failed to respond to less intensive services. This integration of behavioral health into medical settings will provide the opportunity for more efficient care, reductions in cost, greater accessibility, and improve customer service and client satisfaction.

Before this integration can be achieved, however, family-based programs must be re-engineered to become smaller, more compact, and less time-intensive, containing only the key components required to effect the needed change in families (and nothing more). In pursuit of the goal of reducing program size and emphasizing only the most relevant program mechanisms, we review the literature on family-based programs in search of insight into program processes, the relative effectiveness of various program components, and key aspects of program delivery that can impact effectiveness. The literature we review includes:

• Exploration of program processes, generally by means of mediation of program effects, from randomized trials of specific family-based programs;
• Meta-analyses of family-based programs that delve into program components and/or modes of program delivery; and,
• Preliminary research on cutting-edge program development that could support more complete integration into medical settings.

Along with a summary of our findings, we propose a framework for program delivery that could enhance the strengths and abide by the limitations of primary care settings, and we outline the steps necessary to move toward this framework. The framework includes:

• Regular screening for various kinds of child behavioral problems or family maladaptation, which would provide the data needed for referral to the optimal family-based prevention resources;
• A multi-tiered suite of prevention resources, including more short-term technology-supported resources for lower-risk families and more intensive in-person resources for families at higher risk; and,
• Integrated tracking and follow-up to ensure families are utilizing resources appropriately and being referred for additional resources according to demonstrated level of need.