The Journal of Primary Prevention, Vol. 14, No. 2, 1993
Video Review: Prevention Captured on Film Anne Hamel
AN O U N C E OF PREVENTION. Program 13 in the video series/telecourse, "The World of Abnormal Psychology." 58:53. Produced by Alvin H. Perlmutter, Inc., in association with Toby Levine Communications, Inc. and the Annenberg/Corporation for Public Broadcasting Project. Available from Annenberg/CPB, 901 E Street, Northwest, Washington, DC. 20004. $29.95. "We must recognize the fact," wrote George Albee in 1982, "that no mass disorder affecting large numbers of human beings has ever been controlled or eliminated by attempts at treating each affected individual or by training enough professionals as interventionists" (p. 1045). Despite this truism, the mental health care system still prefers to pay for treatment after a mental health disorder has developed, rather than for prevention of the problem. There are several factors contributing to this standstill of the mental health care system. One is what Richard Price calls in the documentary An Ounce of Prevention "the elusive nature of prevention." It is difficult to measure problems that do not appear. Nevertheless, funding for prevention is unlikely without measurement or other evidence that each effort is cost-effective. A second factor is the intense pressure on anyone working in mental health care to think at the level of the individual rather than at the level of the system (Thomas and Elias, 1990). This article is the result of the viewing and discussion of An Ounce of Prevention by a class in community psyeholo~%j at the Graduate School of Applied and Professional Psychology at Rutgers University. Class members are students in GSAPP's clinical, school, and organizational/behavioral Psy.D. programs. The class considered the appropriateness of the video for classroom use and addressed ways thc video might be enhanced through directed discussion. A secondary consideration was thc effectiveness of the video ior public education about prevention. The primary writer was Anne Hamel, a second year clinical Psy.D student. The other students in the class were: Lisa Blum, Patrick Connelly, Deirdre Gordon, Amy Hartford, Joel Kushner, Kathy Lewis, Elaine Lukenda, Bridget Taylor, Elizabeth Torres-McCarthy, and Deborah Wright. Correspondence concerning this article can be sent to Anne Hamel, c/o GSAPP, Busch Campus, Rutgers University, New Brunswick, NJ 08903 141 © 1993 HumanSciencesPress,Inc.
142
Hamel
"Professional training which focuses on conceptualizingproblemswithin the medical model, a health care system geared toward this framework (including the Community Mental Health System), and a society which places great value on individualism characterize the proverbial tide against which psychologistsand social workers must swim.... Currently within the third-party reimbursement system for the payment of psychologicalservices no provision is made for even individual-level prevention services." (p. 30) In order to work on prevention, we need special tools which are not always given to us in the course of traditional undergraduate or graduate training, but perhaps should be. Primary among these is the ability to think at a systems level. The documentary An Ounce of Prevention will be of value in teaching about prevention because it addresses both of these areas. It shows us that there are many prevention projects that attempt to measure their own effectiveness. It can also help us begin to look at problems with a wider lens on the system or systems, rather than with a tight focus on the individual. This fifty-eight minute video describes four model prevention projects each of which targets an important milestone in human development: childhood, adolescence, adulthood, and old age. Interviews with the project developers give the viewer an understanding of the problems that the project tackles. As though we were invited to take a look around, we see scenes of the project in action; interviews with participants fill out this picture. The narration and interviews with experts provide both a conceptual overview of the programs and the research evidence supporting each program's preventive claim. Each project works in a different way, but all of them create systems-level change. A brief summary of these projects follows.
SCOPE OF THE VIDEO A v a n c e , the p r o g r a m addressing issues of early childhood, was founded in 1973 by Gloria Rodriguez, Ph.D. in San Antonio, Texas. This program influences the experiences of young children by providing a variety of community based services for parents and children. These include parent training for both mothers and fathers, education and job skills training, and job placement assistance. In addition, child care services offer a particularly enriched, child-centered environment for the children of this community. T h e second program attempts to prevent many of the problems that can develop during adolescence such as alcohol and drug abuse, sexual assault, teen pregnancy, conduct disorder, and depression. The Social Develo p m e n t Project developed by James Comer, M. D., Roger Weissberg,
Review of An Ounce of Prevention
143
Ph.D., and Timothy Shriver in New Haven, Connecticut, provides students in the New Haven public schools with systematic instruction in critical thinking skills and problem solving strategies, helping students apply these strategies to real problems. A mental health team also addresses some of the emotional and psychological needs of the students. A third important aspect of this project is its focus on forging cooperative relationships with parents. The third program is The Michigan Jobs Project, an intensive, five-day ,program for the recently unemployed begun by Richard Price, Ph.D. This project works to prevent depression and other psychological disorders that can result from the loss of a job. This project prepares the unemployed to anticipate and handle the stresses of unemployment and of searching for work. A combination of role-playing and problem-solving help participants to develop both confidence-building skills and a feeling of support. The program not only prevents the loss of self esteem that can result from a period of unemployment, but also enables its participants to find betterpaying work more quickly than non-participants. The fourth program is Austin Groups for the Elderly (AGE), which coordinates the efforts of many social service agencies serving the elderly in Austin Texas. By centralizing, coordinating, and sharing resources and person-power, the many agencies which are part of AGE have prevented the turf wars and overwhelming bureaucracy that often impede the best delivery of services to the elderly. The elderly thus benefit from a greater sense of community and support, as well as more accessible, coordinated services. Some of the struggle of service-seeking is reduced. These programs seem to have been selected for this video not only because they target several important developmental milestones, but also because they illustrate a range of possibilities for prevention programming. They represent a diversity of settings (school, community), levels of intervention (individual, microsystem, exosystem), and ethnic populations (white, African American, Latino). They also have established their effectiveness through long term program evaluation. Not only do these projects represent the value of "sticking around, '~ they also show they have reason to be proud.
THE VIDEO AS A TEACHING TOOL: SOME KEY QUESTIONS Those of you who might consider using this film to teach about prevention, either in the context of a general psychology course, a community psychology course, or a social work course will probably want to know the answers to the following questions before ordering your own copy.
144
Hamei
1) Does the video inform the viewer about the general idea of prevention? Does it help us understand how someone concerned with prevention would think about each problem ? The video itself is rich with material for a discussion of prevention. It illustrates many of the most salient concepts in the field by bringing the theory to life and linking theory with action. In addition, the faculty and student guides offered with the video provide some interesting questions and structure for a lesson on prevention. These materials include a thorough overview of the unit written by Edward Katkin, review questions, and a case study by .Judith Rosenberger and Edith Gould. All of these will probably be helpful in the classroom. However, while the classic concepts of primary, secondary, and tertiary prevention (Caplan, 1964) may be the core of the standard lesson on prevention in most classes in general psychology (as they are in these materials), there are other current concepts which can better help us appreciate the richness of these four projects. Some of these include the social ecology of Kelly (Kelly, 1966; Trickett & Birman, 1989); Bronfenbrenner's "nested environments" (1977); Albee's prevention equation (1982) and its derivative (Elias, 1987); the concept of wellness (Cowen, 1991); and the competent community (Cottrell, 1976). Using one or more of these concepts in an analysis of the video is likely to help the viewer think about the systems involved in the problems. It might also be more interesting to the student. Any discussion of each project could incorporate many of these concepts; three examples are offered here, with questions one might ask of students who have read the relevant articles and viewed the film. James Kelly's thinking about social ecology takes principles "drawn from the study of biological communities and [applies them] to human communities" (Trickett and Birman, 1989, p. 363). The four key principles of the ecological metaphor are: 1) adaptation or assessing the structures, norms, and rules of the setting; 2) the cycling of resources, which means paying attention to people, settings and events; 3) interdependence which refers to how change ripples through the system; and 4) succession or looking at both the history of change and hopes for the future of the setting. Through the use of these concepts one understands how "the long term use of a prevention strategy depends on the relationship between the intervention and its ... context" (p. 362). One could ask students to consider what the developers of Avance have needed to know about the ecology of this community before starting this program. What was its primary resource in creating a lasting program? In a powerful article, Albee (1982) makes a good case for prevention, and suggests a "new model of causation" as an alternative to the medical model. He provides a "prevention equation" (p. 1046) which describes how
Review of An Ounce of Prevention
145
the incidence (number of new cases) of a disorder is mediated both by stressors and protective factors. His equation is as follows:
Incidence =
organicfactors coping skills + self esteem
+ +
stress supportgroups
Through Albee's equation we can better understand the risk and protective factors contributing to the occurrence of a disorder in an individual. However, in a 1987 article, Elias describes the distinction between the individual level intervention and the systems level intervention and develops a systems-level prevention equation, which addresses structural change in a system. Elias' (1987, p. 544) equation is as follows:
Likelihood of disorder = in a population
stressors
+
socialization practices
+
risk factors in the environment socialsupport resources
+
opportunities for connectedness
Both the Social Development Project and the Jobs Project have created change, but perhaps at different levels. In thinking about the Jobs Project and the Social Development Project, in what parts of each equation is each effecting change? Do these projects address risk factors or protective factors? Do they do more at the individual or systems level? If they accomplish structural change, how does this type of change affect the individuals working this system? Finally, consider Cottrell's idea of a competent community (1977). Parts of such a community carry out four functions: they (1) collaborate in identifying problems and needs, (2) achieve working consensus on goals and priorities, (3) agree on ways of achieving goals, and (4) collaborate on required actions. AGE represents the work of the community of elderly citizens, service providers, and support organizations to become more competent through the improved communication among all groups. Ho~ does AGE achieve systems-level change? Not only are the elderly served more quickly through AGE than through previous structures, but also fewer people "fall through the cracks," and a feeling of community develops in places where competition may have flourished before. How does this happen? Where does a feeling of community come from? 2) Does the video offer alternative models for what psychologists can do? Would it inspire the student to work in prevention?
146
Hamel
The video illustrates many ways that psychologists can work apart from the more traditional choices of researcher or clinician. Indeed, community psychologists need to have the willingness and ability both to research and evaluate the effectiveness of their work, and to immerse themselves in the community for purpose, learning, energy, and support. For those future psychologists who worry about being bored by the role of laboratory researcher or the role of clinician, this video is an eye opener. 3) Does it convince the viewer that these particular programs are worthwhile? Does it go beyond this and convince us that investment in prevention in general is smart public policy? This film is a remarkable step in educating students of psychology, and the public in general, about prevention. Its effect can only be enlightening. For those of us looking for the broader implications of prevention, the film unquestionably supports the effectiveness and economy of prevention, especially through the data given on the projects, and would therefore seem to have the potential to influence public opinion in the direction of greater support for prevention. "But," as Albee wrote in 1982, "logic and good sense rarely guide the formulation and development of social policy" (p. 1043). If logic and good sense won't, then what will? More connections need to be made between these local efforts and the changes that must also occur in the macrosystem for prevention to become a priority of our health care system. The links between how well these projects work, how much money they save by forestalling the more serious problems which our educational, penal, and health care systems must later manage, and the obvious need to invest in major prevention efforts nationwide are not completely soldered in this short film. Indeed, this was not its goal. Educators whose focus is on prevention and public policy might want to consider one of two other documentaries recently aired on public television. The first, Our Children at Risk (Wiesberg, 1990), narrated by Walter Cronkite, profiles several individuals who are unable to obtain adequate health care. It addresses the need for adequate preand post-natal care for all women, and for long term preventive health care for millions of children in the United States who show the physical and psychological effects of poverty. Despite its beginning with the effects on individuals, it makes its point about the need for systems-level change. A second on-hour documentary, Childhood In America (Haines-Stiles, 1991), was created by the makers of the recent popular Childhood series shown on public television. Childhood In America is a round-table discussion, hosted by Phil Donahue, with policy-makers and educators about the needs of children in the 1990%. Like An Ounce of Prevention, it shows us that there are many different and equally valuable approaches to working toward change, and that no one model will succeed everywhere. These vid-
Review of An Ounce of Prevention
147
cos provide a broader context within which the projects in An Ounce of Prevention, or indeed, the entire prevention agenda, can be presented to students.
4) How successfully does this video represent a diversity of racial and ethnic groups? All of the communities in the video are traditionally underserved by our current health care system. Beyond this, one project is based in a Mexican American community, and a second is based in a primarily African American community. The other two projects serve racially diverse groups. While this awareness of ethnic diversity is admirable, it risks giving the wrong impression. Some could conclude that these are, somehow, the only communities with these problems. Some could apply the "just-world hypothesis" (Rosenberg, Solarz, & Bailey, 1991) and conclude that these communities "deserve" their problems. However, the prevention advocates in this film are careful to point out that the problems being addressed are a problem (to some degree) for all people. All adolescents face the same peer pressures and difficulties in growing up. All parents with young children need social support and help in parenting. We are all a risk. Nevertheless, this point may be missed by the casual viewer. Someone using the video for instructional purposes will surely want to address these points explicitly and repeatedly. Despite this problem, there is strength in acknowledging our diversity, and in demonstrating how some communities have successfully identified and met their needs.
CONCLUSION This film could be a useful tool in teaching about prevention to undergraduates or graduate students in psychology, social work, and education. The video is accompanied by print materials, both for faculty and students, which include textbook reading suggestions, an overview of the video, review questions, and an individual case study, Its academic use is enriched by these materials, especially for those who know very little about prevention. Reading about concepts, even reading about the application of concepts to real settings, can rarely be as compelling as actually watching the setting unfold before you. While some might lament that educators who use videos are yielding to the pressure to compete for the attention of those nourished only by sound bites, I disagree. This video is not a slick production. It can be used to challenge the student. Educators could do no better to get across the point that prevention is more than just an idea, that it is about real lives.
148
Hamel
REFERENCES Albee, G. W. (1982). Preventing psychopathology and promoting human potential. American Psychologist, 37(9), 1043-1050. Bronfenbrenner, U. (1977). Toward an experimental ecology of human development. American Psychologist, 32(7), 513-531. Caplan, G. (1964). Principles of preventive psychiaoy. New York: Basic Books. Cottrell, L. S., Jr. (1976). The competent community. In B. H. Kaplan, R. N. Wilson, & A. H. Leighton (Eds.), Further explorations in socialpsychiatry (pp. 195-209). New York: Basic Books. Cowen, E. (1991). In pursuit of wellness. American Psychologist, 46(4), 404-408. Elias, M. (1987). Establishing enduring prevention programs: Advancing the legacy of Swampscott. American Journal of Community Psychology, 15(5), 539-553. Haines-Stiles, G. (Exec. Producer). (1991). Childhood h2 America [Film]. New York: Ambrose Video. Kelly, J. G. (1966). Ecological constraints on mental health services. American Psychologist, 21, 535-539. Rosenberg, A. A., Solarz, A. L., & Bailey, W. A. (1991). Psychology & Homelessness: A public policy and advocacy agenda. American Psychologist, 46(11), 1239-1244. Thomas, E. & Elias, M. (1990). Graduate training in community psychology: Integrating primary prevention into the training and repertoire of all professional psychologists and social workers. The Community Psychologist, 23(2), 30-31. Trickett, E. & Birman, D. (1989). Taking ecology seriously: A community approach to individually based preventative interventions in schools. In. L. Bond & B. E. Compas (Eds.), Primaly Prevention and Promotion h~ Schools (pp. 361-389). Newbury Park, CA: Sage Publications. Weisberg, R. (Writer, Director, Producer). (1990). Our Children At Risk [Film]. New York: Public Policy Productions.
Video Review: Prevention Captured on Film Anne Hamel
AN O U N C E OF PREVENTION. Program 13 in the video series/telecourse, "The World of Abnormal Psychology." 58:53. Produced by Alvin H. Perlmutter, Inc., in association with Toby Levine Communications, Inc. and the Annenberg/Corporation for Public Broadcasting Project. Available from Annenberg/CPB, 901 E Street, Northwest, Washington, DC. 20004. $29.95. "We must recognize the fact," wrote George Albee in 1982, "that no mass disorder affecting large numbers of human beings has ever been controlled or eliminated by attempts at treating each affected individual or by training enough professionals as interventionists" (p. 1045). Despite this truism, the mental health care system still prefers to pay for treatment after a mental health disorder has developed, rather than for prevention of the problem. There are several factors contributing to this standstill of the mental health care system. One is what Richard Price calls in the documentary An Ounce of Prevention "the elusive nature of prevention." It is difficult to measure problems that do not appear. Nevertheless, funding for prevention is unlikely without measurement or other evidence that each effort is cost-effective. A second factor is the intense pressure on anyone working in mental health care to think at the level of the individual rather than at the level of the system (Thomas and Elias, 1990). This article is the result of the viewing and discussion of An Ounce of Prevention by a class in community psyeholo~%j at the Graduate School of Applied and Professional Psychology at Rutgers University. Class members are students in GSAPP's clinical, school, and organizational/behavioral Psy.D. programs. The class considered the appropriateness of the video for classroom use and addressed ways thc video might be enhanced through directed discussion. A secondary consideration was thc effectiveness of the video ior public education about prevention. The primary writer was Anne Hamel, a second year clinical Psy.D student. The other students in the class were: Lisa Blum, Patrick Connelly, Deirdre Gordon, Amy Hartford, Joel Kushner, Kathy Lewis, Elaine Lukenda, Bridget Taylor, Elizabeth Torres-McCarthy, and Deborah Wright. Correspondence concerning this article can be sent to Anne Hamel, c/o GSAPP, Busch Campus, Rutgers University, New Brunswick, NJ 08903 141 © 1993 HumanSciencesPress,Inc.
142
Hamel
"Professional training which focuses on conceptualizingproblemswithin the medical model, a health care system geared toward this framework (including the Community Mental Health System), and a society which places great value on individualism characterize the proverbial tide against which psychologistsand social workers must swim.... Currently within the third-party reimbursement system for the payment of psychologicalservices no provision is made for even individual-level prevention services." (p. 30) In order to work on prevention, we need special tools which are not always given to us in the course of traditional undergraduate or graduate training, but perhaps should be. Primary among these is the ability to think at a systems level. The documentary An Ounce of Prevention will be of value in teaching about prevention because it addresses both of these areas. It shows us that there are many prevention projects that attempt to measure their own effectiveness. It can also help us begin to look at problems with a wider lens on the system or systems, rather than with a tight focus on the individual. This fifty-eight minute video describes four model prevention projects each of which targets an important milestone in human development: childhood, adolescence, adulthood, and old age. Interviews with the project developers give the viewer an understanding of the problems that the project tackles. As though we were invited to take a look around, we see scenes of the project in action; interviews with participants fill out this picture. The narration and interviews with experts provide both a conceptual overview of the programs and the research evidence supporting each program's preventive claim. Each project works in a different way, but all of them create systems-level change. A brief summary of these projects follows.
SCOPE OF THE VIDEO A v a n c e , the p r o g r a m addressing issues of early childhood, was founded in 1973 by Gloria Rodriguez, Ph.D. in San Antonio, Texas. This program influences the experiences of young children by providing a variety of community based services for parents and children. These include parent training for both mothers and fathers, education and job skills training, and job placement assistance. In addition, child care services offer a particularly enriched, child-centered environment for the children of this community. T h e second program attempts to prevent many of the problems that can develop during adolescence such as alcohol and drug abuse, sexual assault, teen pregnancy, conduct disorder, and depression. The Social Develo p m e n t Project developed by James Comer, M. D., Roger Weissberg,
Review of An Ounce of Prevention
143
Ph.D., and Timothy Shriver in New Haven, Connecticut, provides students in the New Haven public schools with systematic instruction in critical thinking skills and problem solving strategies, helping students apply these strategies to real problems. A mental health team also addresses some of the emotional and psychological needs of the students. A third important aspect of this project is its focus on forging cooperative relationships with parents. The third program is The Michigan Jobs Project, an intensive, five-day ,program for the recently unemployed begun by Richard Price, Ph.D. This project works to prevent depression and other psychological disorders that can result from the loss of a job. This project prepares the unemployed to anticipate and handle the stresses of unemployment and of searching for work. A combination of role-playing and problem-solving help participants to develop both confidence-building skills and a feeling of support. The program not only prevents the loss of self esteem that can result from a period of unemployment, but also enables its participants to find betterpaying work more quickly than non-participants. The fourth program is Austin Groups for the Elderly (AGE), which coordinates the efforts of many social service agencies serving the elderly in Austin Texas. By centralizing, coordinating, and sharing resources and person-power, the many agencies which are part of AGE have prevented the turf wars and overwhelming bureaucracy that often impede the best delivery of services to the elderly. The elderly thus benefit from a greater sense of community and support, as well as more accessible, coordinated services. Some of the struggle of service-seeking is reduced. These programs seem to have been selected for this video not only because they target several important developmental milestones, but also because they illustrate a range of possibilities for prevention programming. They represent a diversity of settings (school, community), levels of intervention (individual, microsystem, exosystem), and ethnic populations (white, African American, Latino). They also have established their effectiveness through long term program evaluation. Not only do these projects represent the value of "sticking around, '~ they also show they have reason to be proud.
THE VIDEO AS A TEACHING TOOL: SOME KEY QUESTIONS Those of you who might consider using this film to teach about prevention, either in the context of a general psychology course, a community psychology course, or a social work course will probably want to know the answers to the following questions before ordering your own copy.
144
Hamei
1) Does the video inform the viewer about the general idea of prevention? Does it help us understand how someone concerned with prevention would think about each problem ? The video itself is rich with material for a discussion of prevention. It illustrates many of the most salient concepts in the field by bringing the theory to life and linking theory with action. In addition, the faculty and student guides offered with the video provide some interesting questions and structure for a lesson on prevention. These materials include a thorough overview of the unit written by Edward Katkin, review questions, and a case study by .Judith Rosenberger and Edith Gould. All of these will probably be helpful in the classroom. However, while the classic concepts of primary, secondary, and tertiary prevention (Caplan, 1964) may be the core of the standard lesson on prevention in most classes in general psychology (as they are in these materials), there are other current concepts which can better help us appreciate the richness of these four projects. Some of these include the social ecology of Kelly (Kelly, 1966; Trickett & Birman, 1989); Bronfenbrenner's "nested environments" (1977); Albee's prevention equation (1982) and its derivative (Elias, 1987); the concept of wellness (Cowen, 1991); and the competent community (Cottrell, 1976). Using one or more of these concepts in an analysis of the video is likely to help the viewer think about the systems involved in the problems. It might also be more interesting to the student. Any discussion of each project could incorporate many of these concepts; three examples are offered here, with questions one might ask of students who have read the relevant articles and viewed the film. James Kelly's thinking about social ecology takes principles "drawn from the study of biological communities and [applies them] to human communities" (Trickett and Birman, 1989, p. 363). The four key principles of the ecological metaphor are: 1) adaptation or assessing the structures, norms, and rules of the setting; 2) the cycling of resources, which means paying attention to people, settings and events; 3) interdependence which refers to how change ripples through the system; and 4) succession or looking at both the history of change and hopes for the future of the setting. Through the use of these concepts one understands how "the long term use of a prevention strategy depends on the relationship between the intervention and its ... context" (p. 362). One could ask students to consider what the developers of Avance have needed to know about the ecology of this community before starting this program. What was its primary resource in creating a lasting program? In a powerful article, Albee (1982) makes a good case for prevention, and suggests a "new model of causation" as an alternative to the medical model. He provides a "prevention equation" (p. 1046) which describes how
Review of An Ounce of Prevention
145
the incidence (number of new cases) of a disorder is mediated both by stressors and protective factors. His equation is as follows:
Incidence =
organicfactors coping skills + self esteem
+ +
stress supportgroups
Through Albee's equation we can better understand the risk and protective factors contributing to the occurrence of a disorder in an individual. However, in a 1987 article, Elias describes the distinction between the individual level intervention and the systems level intervention and develops a systems-level prevention equation, which addresses structural change in a system. Elias' (1987, p. 544) equation is as follows:
Likelihood of disorder = in a population
stressors
+
socialization practices
+
risk factors in the environment socialsupport resources
+
opportunities for connectedness
Both the Social Development Project and the Jobs Project have created change, but perhaps at different levels. In thinking about the Jobs Project and the Social Development Project, in what parts of each equation is each effecting change? Do these projects address risk factors or protective factors? Do they do more at the individual or systems level? If they accomplish structural change, how does this type of change affect the individuals working this system? Finally, consider Cottrell's idea of a competent community (1977). Parts of such a community carry out four functions: they (1) collaborate in identifying problems and needs, (2) achieve working consensus on goals and priorities, (3) agree on ways of achieving goals, and (4) collaborate on required actions. AGE represents the work of the community of elderly citizens, service providers, and support organizations to become more competent through the improved communication among all groups. Ho~ does AGE achieve systems-level change? Not only are the elderly served more quickly through AGE than through previous structures, but also fewer people "fall through the cracks," and a feeling of community develops in places where competition may have flourished before. How does this happen? Where does a feeling of community come from? 2) Does the video offer alternative models for what psychologists can do? Would it inspire the student to work in prevention?
146
Hamel
The video illustrates many ways that psychologists can work apart from the more traditional choices of researcher or clinician. Indeed, community psychologists need to have the willingness and ability both to research and evaluate the effectiveness of their work, and to immerse themselves in the community for purpose, learning, energy, and support. For those future psychologists who worry about being bored by the role of laboratory researcher or the role of clinician, this video is an eye opener. 3) Does it convince the viewer that these particular programs are worthwhile? Does it go beyond this and convince us that investment in prevention in general is smart public policy? This film is a remarkable step in educating students of psychology, and the public in general, about prevention. Its effect can only be enlightening. For those of us looking for the broader implications of prevention, the film unquestionably supports the effectiveness and economy of prevention, especially through the data given on the projects, and would therefore seem to have the potential to influence public opinion in the direction of greater support for prevention. "But," as Albee wrote in 1982, "logic and good sense rarely guide the formulation and development of social policy" (p. 1043). If logic and good sense won't, then what will? More connections need to be made between these local efforts and the changes that must also occur in the macrosystem for prevention to become a priority of our health care system. The links between how well these projects work, how much money they save by forestalling the more serious problems which our educational, penal, and health care systems must later manage, and the obvious need to invest in major prevention efforts nationwide are not completely soldered in this short film. Indeed, this was not its goal. Educators whose focus is on prevention and public policy might want to consider one of two other documentaries recently aired on public television. The first, Our Children at Risk (Wiesberg, 1990), narrated by Walter Cronkite, profiles several individuals who are unable to obtain adequate health care. It addresses the need for adequate preand post-natal care for all women, and for long term preventive health care for millions of children in the United States who show the physical and psychological effects of poverty. Despite its beginning with the effects on individuals, it makes its point about the need for systems-level change. A second on-hour documentary, Childhood In America (Haines-Stiles, 1991), was created by the makers of the recent popular Childhood series shown on public television. Childhood In America is a round-table discussion, hosted by Phil Donahue, with policy-makers and educators about the needs of children in the 1990%. Like An Ounce of Prevention, it shows us that there are many different and equally valuable approaches to working toward change, and that no one model will succeed everywhere. These vid-
Review of An Ounce of Prevention
147
cos provide a broader context within which the projects in An Ounce of Prevention, or indeed, the entire prevention agenda, can be presented to students.
4) How successfully does this video represent a diversity of racial and ethnic groups? All of the communities in the video are traditionally underserved by our current health care system. Beyond this, one project is based in a Mexican American community, and a second is based in a primarily African American community. The other two projects serve racially diverse groups. While this awareness of ethnic diversity is admirable, it risks giving the wrong impression. Some could conclude that these are, somehow, the only communities with these problems. Some could apply the "just-world hypothesis" (Rosenberg, Solarz, & Bailey, 1991) and conclude that these communities "deserve" their problems. However, the prevention advocates in this film are careful to point out that the problems being addressed are a problem (to some degree) for all people. All adolescents face the same peer pressures and difficulties in growing up. All parents with young children need social support and help in parenting. We are all a risk. Nevertheless, this point may be missed by the casual viewer. Someone using the video for instructional purposes will surely want to address these points explicitly and repeatedly. Despite this problem, there is strength in acknowledging our diversity, and in demonstrating how some communities have successfully identified and met their needs.
CONCLUSION This film could be a useful tool in teaching about prevention to undergraduates or graduate students in psychology, social work, and education. The video is accompanied by print materials, both for faculty and students, which include textbook reading suggestions, an overview of the video, review questions, and an individual case study, Its academic use is enriched by these materials, especially for those who know very little about prevention. Reading about concepts, even reading about the application of concepts to real settings, can rarely be as compelling as actually watching the setting unfold before you. While some might lament that educators who use videos are yielding to the pressure to compete for the attention of those nourished only by sound bites, I disagree. This video is not a slick production. It can be used to challenge the student. Educators could do no better to get across the point that prevention is more than just an idea, that it is about real lives.
148
Hamel
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