Using effective community coalitions to prevent mental and behavioral disorders on a national scale

This paper describes how knowledge from life-course research and community intervention studies can be integrated within community coalition models to inform a feasible national plan to measurably prevent and reduce mental and behavioral disorders. In many nations, including Australia, mental and behavioral disorders are increasing in child and youth populations, forewarning of increased future disorders. There is limited evidence that treatment interventions can turn the tide. However, we argue here that universal (whole population) and selective (group targeted) preventative interventions are feasible, effective, and cost-effective for reducing child and adolescent mental and behavioral disorders. Modifiable risk factors (causal or associational predictors) and protective factors (risk modifiers) have been identified across diverse settings (e.g., family, school, and community). As no single factor is solely responsible for the development of child and adolescent mental and behavioral disorders, a multi-factor intervention approach is required. Given communities vary in their profile of child and adolescent mental and behavioral disorders, and local risk and protective influences, tailoring prevention strategies to community conditions is essential. We present here the ‘Communities That Care’ model as a feasible community coalition training approach, scalable to cost-effectively prevent and reduce child and adolescent mental and behavioral disorders across large populations. The Communities That Care model comprises five phases that sequentially prepare and formalize a community coalition, assist a needs assessment, strategically planned implementation, and evaluation. Australian evaluations demonstrate that municipal completion of the model achieves youth-reported improvements in substance use, behavior problems and risk and protective factors. Archival data analyses associate municipal completion with annual reductions of above 8 % per annum in child and adolescent injury hospitalization and in reduced police reports of youth crime (5 % pa) and violence (2 % pa). Despite its excellent credentials, the Communities That Care model is presently under-utilized for the prevention of mental and behavioral disorders. To immediately reduce the crisis of increasing child and adolescent mental and behavioral disorders, we advocate for increased funding for the national implementation and evaluation of community coalition models, with a requirement that alternative models should be evaluated against current best-practice as incorporated in the Communities That Care model.