Child Psychology and Psychiatry

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Promoting well-being
Table 13.1
Universal, selective and indicated prevention.
Prevention
Provision
Advantages
Disadvantages
Universal prevention,
e.g. anxiety prevention
programmes for
9/10-year-old children
Universal — provided
to all regardless of
risk status
Far-reaching coverage
Opportunity for
primary prevention,
i.e. reduce prevalence
of new disorders
Screening not required
Avoids need for
labelling, which could
be stigmatizing
Low cost/high volume
Limited resources used to
provide interventions to
many who are, and will
remain, ‘healthy’
Intervention effects are
typically small
Face validity, relevance
and engagement can be
difficulties
Selective prevention,
e.g. anxiety prevention
programmes for
children where parents
are separating
Targeted — upon
those at increased
risk of developing
problems through
exposure to known
risk factors
Resources focused upon
‘at-risk’ groups
Opportunity for
primary prevention
Potentially stigmatizing
Difficulties in accurately
identifying ‘at-risk’ groups
within the community
Indicated prevention,
e.g. children with
significant anxiety
symptoms but not
meeting full diagnostic
criteria
Targeted — upon
those displaying
mild/moderate
problems
Efficient use of limited
resources
Provide early
interventions for those
with emergent
problems
Demonstrate larger
treatment effects
May require screening,
which can be costly and
practically complicated
Potentially stigmatizing
and unacceptable to some
of the identified group
members of the target population irrespective
of risk status, such as children of a certain age.
Selective programmes target children at increased
risk of developing problems through exposure to
known risk factors – for instance, children of par-
ents with a mental illness. Universal and selective
programmes are primarily concerned with promot-
ing well-being and in reducing the occurrence of
new problems. Indicated programmes are early
interventions provided on a targeted basis to those
already displaying mild or moderate problems to
prevent them from worsening – for example, chil-
dren with symptoms of anxiety or depression.
Each approach has strengths and limitations.
Universal programmes offer the greatest potential
to optimize the well-being of the wider population.
They provide opportunities for prevention (e.g.
maximizing potential), protection (e.g. developing
competencies) and intervention (e.g. minimizing
impairment). Far-reaching and accessible, they
minimize any potential negative stigma arising
from more targeted approaches. However, their
general focus may not be of sufficient depth or
dosage to benefit those with more established dis-
orders. Similarly, from an economic perspective,
many of those who receive universal interven-
tions are already healthy and do not, and will not,
require any intervention to maintain this status or
maximize their potential.
Selective and indicated approaches are more
targeted, focusing limited resources upon those
with potentially greater needs. The effects are
often large since initial levels of symptoms and
the subsequent change are greater. However,