Interventions

Promotion, Prevention, and Treatment

Interventions that adhere to a promotion framework seek to improve well-being in one or more developmental domains, often with the goal of helping individuals move toward achieving their full potential. This is in contrast with a prevention framework wherein the absence of a disease or a poor outcome such as adolescent delinquency is viewed as an indicator of intervention success. Many prevention programs focus on protective factors that are expected to attenuate the effects of a likely problematic trajectory such as age-associated declines in cognitive ability. In some domains of well-being, there are unsettled questions about the cost-effectiveness of promotion and prevention efforts aimed at general populations and thus many publicly supported interventions such as early childhood programs often are targeted to at-risk populations rather than universally available.

Distinctions between promotion and prevention are important to consider in interpreting the effects of an intervention because the absence of a poor outcome does not ensure the presence of optimal functioning. Furthermore, statistically significant positive outcomes of some interventions are a function of declines among persons assigned to a control group in comparison to no change (thus, no improvement) among persons assigned to the intervention group. Many prevention programs are directed to populations known to be at risk for poor outcomes. School readiness interventions for young children living in poverty, for example, are of keen interest to policy makers at national, state, and local levels.

A treatment framework is employed in interventions aimed at populations with an identified problem. Goals may include amelioration of a problem (e.g., substance use abstinence), adoption of strategies for adaptive management of a problem (e.g., cognitive and behavioral skills for managing a chronic disease), or limiting the growth or magnitude of a problem (sometimes referenced as harm reduction). Most intervention practices and programs represent a package of specific elements or features configured in a distinctive manner. There is considerable variation across interventions in whether an intervention directly engages the target individual and/or aspects of the individual’s immediate environment such as the practices of a child’s parents or the norms of an adolescent’s peers regarding alcohol use. There also is great variation across interventions in the type, intensity, and duration of direct work with a target individual. Some interventions employ a single method (e.g., small group discussions), whereas other interventions offer multiple supports such as a combination of cognitive and physical exercises for preventing or slowing cognitive declines among older persons.

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