Box 1
Example of Intervening Early to Prevent Mental Health Problems

• Program: Nurse-Family Partnership
  
• Goal: To improve pregnancy outcomes by helping mothers to adopt healthy behavior, to improve child health and development, to reduce child abuse and neglect, and to improve families' economic self-sufficiency.
  
• Features: A nurse visits the homes of high-risk women beginning in pregnancy and continuing for the first year of children's lives. The nurse adheres to visit-by-visit protocols to help women adopt healthy behaviors and to responsibly care for their child. In many States, Nurse-Family Partnership programs are funded as special projects or via state appropriations.
  
• Outcomes: For mothers: 80% reduction in abuse of their children, 25% reduction in maternal substance abuse, and 83% increase in employment. For children (15 years later): 54-69% reduction in arrests and convictions, less risky behavior, and fewer school suspensions and destructive behaviors. This is the only prevention trial in the field with a randomized, controlled design and 15 years of follow-up. The program began in rural New York 20 years ago, and its benefits have been replicated in Denver and in minority populations in Memphis (Olds et al., 1997; Olds et al., 1998; Kitzman, 2000).
  
• Biggest Challenge: To preserve the program's core features as it grows nationwide. The key feature is a trained nurse, rather than a para-professional, who visits homes. A randomized, controlled trial found para-professionals to be ineffective (Olds et al., 2002).
  
• How Other Organizations Can Adopt: Modify requirements of federal programs, where indicated, to facilitate adoption of this effective, cost-effective model.
  
• Contact Point: Dr. David Olds, University of Colorado
  
• Sites: 270 communities in 23 states

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