Episode 57: Today's Social Work Podcast is on community-based prevention services for children and adolescents. I spoke with Dr. Richard Catalano, who along with David Hawkins, developed Communities That Care, a prevention-planning system that promotes the positive development of children and youth and prevents problem behaviors, including substance use, delinquency, teen pregnancy, school drop-out and violence. It is a system for identifying community needs, matching those needs to evidence-based prevention programs, and evaluating the outcomes. The system has been used in dozens of communities around the United States, and has demonstrated effectiveness in reducing problem behaviors and promoting positive youth development.

But before we get to the interview, I want you to imagine for a moment how you would work with a pregnant 16-year old sexual abuse survivor who was addicted to crack, semi-illiterate, suicidal, diagnosed with bipolar disorder, and whose baby daddy was prostituting her in exchange for drugs. Ok, got your treatment plan figured out? If you’re thinking, "I know I need to address her suicidality first, but after that, I’m not really sure," then you’d be right, and you’re probably not alone. Most social workers, most service providers, treat individual or family problems once they’ve occurred. And this young woman has a lot of problems. So, what if I suggested that the best place to start with this client was 17 years ago, before she was born, before she was raped, before she turned to drugs to dull her pain or perhaps used drugs to make herself look cooler to her father-figure boyfriend pimp? What if I suggested that the best use of time and money was in preventing these problems from occurring in the first place? If you’re with me on this one, you’re not alone.

In 2006, the New Yorker published an article by Katherine Boo (2006, Feb 6) called "Swamp Nurse." The story takes place about an hour southwest of New Orleans, Louisiana, a place where infant mortality, illiteracy rates, and child poverty are among the highest in the country. The title, Swamp Nurse, refers to a group of nurses who do home visits with low-income women during pregnancy and work with them until their child turns two. These nurses are expected to, and I’m not making this up, reduce infant mortality, illiteracy rates and child poverty, and in turn improve the overall health, education, and economic self-sufficiency of these families and consequently the community as a whole. Uh huh. All through home visits. I know. And the most remarkable part? They did it, more or less. How? They were part of a decades-old prevention program called the Nurse-Family Partnership (www.nursefamilypartnership.org/About/What-we-do). These nurses promoted the use of prenatal care, healthy eating, not using cigarettes, alcohol or illegal drugs. They worked with parents to provide responsible and competent care – and to a 16 year old that might include getting them to understand that it is their job to make their baby feel loved, not the other way around. And they helped the parents plan for their future, including future pregnancies, education, and jobs. This program works because it prevents certain behaviors by promoting others. That is the essence of prevention programs. And, according to Dr. Catalano, there are tons of effective prevention programs out there. The trick is to figure which ones are right for your community.

Benjamin Franklin famously said, "an ounce of prevention is worth a pound of cure." This idea, that prevention is a better value for the money that cure, is at the core of public health policy and one of the most compelling arguments for investing in prevention services. Steve Aos, associate director of the Washington State Institute for Public Policy has done cost-benefit analyses on dozens of prevention programs, and found that while most programs do not have a 16:1 return ratio, there are many programs out there that return $3 and $4