Levels of Risk, Levels of Intervention

Universal, Selective, & Indicated Prevention

Not all people or populations are at the same risk of developing behavioral health problems. Preventive interventions are most effective when they are appropriately matched to their target population’s level of risk. The Institute of Medicine defines three broad types of prevention interventions:

1. Universal preventive interventions take the broadest approach, targeting “the general public or a whole population that has not been identified on the basis of individual risk” (O'Connell, 2009). Universal prevention interventions might target schools, whole communities, or workplaces.

Examples: community policies that promote access to early childhood education, implementation or enforcement of anti-bullying policies in schools, education for physicians on prescription drug misuse and preventive prescribing practices, social and decision-making skills training for all sixth graders in a particular school system

2. Selective preventive interventions target “individuals or a population sub-group whose risk of developing mental disorders [or substance abuse disorders] is significantly higher than average”, prior to the diagnosis of a disorder (O'Connell, 2009). Selective interventions target biological, psychological, or social risk factors that are more prominent among high-risk groups than among the wider population.

Examples: prevention education for new immigrant families living in poverty with young children, peer support groups for adults with a history of family mental illness and/or substance abuse

3. Indicated preventive interventions target “high-risk individuals who are identified as having minimal but detectable signs or symptoms foreshadowing mental, emotional, or behavioral disorder” prior to the diagnosis of a disorder (IOM, 2009). Interventions focus on the immediate risk and protective factors present in the environments surrounding individuals.

Examples: information and referral for young adults who violate campus or community policies on alcohol and drugs; screening, consultation, and referral for families of older adults admitted to emergency rooms with potential alcohol-related injuries

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