Implementing the Prevention Guidelines and
Transforming the Profession of Psychology
Sally M. Hage
Teachers College, Columbia University
John L. Romano
University of Minnesota, Twin Cities
Robert K. Conyne
University of Cincinnati
Maureen Kenny
Boston College
Jonathan P. Schwartz
University of Houston
Michael Waldo
New Mexico State University
The Major Contribution aimed at strengthening a prevention focus in psychology, so as to
more effectively and equitably promote the well-being of all members of psychology communities.
The 3 reactions (L. A. Bond & A. Carmola Hauf, 2007 [this issue]; L. Reese,
2007 [this issue]; E. Rivera-Mosquera, E. T. Dowd, & M. Mitchell-Blanks 2007 [this
issue]) give strong support for the best practice prevention guidelines, while providing
new insights for their implementation in the field of psychology. In this rejoinder, the
authors make an effort to build upon their colleagues’ ideas, by addressing the topics of
community-based collaboration, prevention across the life span, and implementation of
the best practice guidelines. The authors urge further interdisciplinary collaboration by
members of the American Psychological Association, and others interested in prevention,
and invite genuine action to expand prevention efforts.
Undoubtedly, the expression—“You can talk the talk, but can you walk
the walk?”—is familiar to many people. A shortened variation of the original
phrase, “Walk the talk,” may be less well known but can be found in
the Encarta World English Online Dictionary (2006), and is defined as “to
act on what you profess to believe in or value.” The words suggest that real
After the first two authors listed above, the remaining authors of this article are listed in alphabetical
order. Correspondence concerning this article should addressed to Sally M. Hage,
Teachers College, Columbia University, Counseling and Clinical Psychology Department,
Box 102, 426A Horace Mann, New York, NY 10027; e-mail: [email protected].
THE COUNSELING PSYCHOLOGIST, Vol. 35, No. 4, July 2007 594-604
DOI: 10.1177/0011000006297158
© 2007 by the Division of Counseling Psychology
594
change happens when leaders not only say they want change and advancement
but also match their words with actions. We are grateful to the authors
who provided reactions to our article (Bond & Carmola Hauf, 2007 [this
issue]; Reese, 2007 [this issue]; Rivera-Mosquera, Dowd, & Mitchell-Blanks,
2007 [this issue]). Their thoughtful commentary and suggestions highlight
the importance of moving these Prevention Guidelines (Hage et al., 2007
[this issue]) from a publication in a scholarly journal to genuine actions for
change in the field of psychology. We are also grateful to The Counseling
Psychologist (TCP) Editor Robert T. Carter who gave us the opportunity to
develop the article into a Major Contribution manuscript, and to receive
reactions to these guidelines by eminent scholars in the field.
The reaction articles in this Major Contribution include authors from
specialties in social work, clinical psychology, and counseling psychology.
In addition, they represent work settings as diverse as university psychology
departments, a government mental health department, a community
advocacy agency, and a medical school. The work of prevention is multidisciplinary,
and it is critically important that researchers, practitioners, and
policy makers from across the professional landscape collaborate and form
partnerships to advance a prevention agenda. We are extremely pleased and
honored that these scholars, from different specialties and professional
work environments, have given their reactions to the guidelines. In the limited
space in this rejoinder, we will address several of the issues presented
by the reaction articles.
COMMUNITY-BASED COLLABORATION
Bond and Carmola Hauf (2007), Reese (2007), and Rivera-Mosquera
et al. (2007) all identified the importance of collaboration as a central component
of best practices in prevention. Although our guidelines did not
explicitly address collaboration, our third practice guideline emphasizes
the importance of including “clients and other relevant stakeholders in all
aspects of prevention planning and programming” and thus recognizes the
necessity of forming community partnerships in prevention work (p. 508).
That being said, the reactants did a service by further emphasizing the
importance of collaboration as an integral component of best practices at
several levels. All three reaction articles note that the perspectives and
knowledge base of any single profession are limited in informing and
guiding the practice of prevention. Indeed, these authors collectively
describe why collaboration should occur at the local community level,
with other helping professionals, and with scholars and researchers from
other disciplines.
Hage et al. / WALKING THE TALK 595
Bond and Carmola Hauf (2007) maintain that interdisciplinary scholarship
should provide the theory and research base for effective prevention.
They effectively explain how community collaboration is critical to the
development of comprehensive and multisystemic interventions. In addition,
Rivera-Mosquera et al. (2007) advocate for collaboration across the
health and mental health professions, including counseling and clinical psychologists,
social workers, nurses, and public health workers. Reese (2007)
similarly notes that the knowledge base of multiple disciplines, such as epidemiology,
health, economics, and sociology, are integral to public health
practice and prevention. By insulating ourselves from other disciplines and
professions, we are likely to miss important research knowledge. Similarly,
by cutting ourselves off from the communities we serve, we may miss an
understanding of local needs and knowledge. Furthermore, from a training
perspective, learning the art of collaboration represents an example of an
area where even more “how to” guidance is needed. Some authors (e.g.,
Kenny, Sparks, & Jackson, in press) are documenting their work in collaboration
in efforts to identify lessons to further guide training and practice in
interprofessional collaboration. Developing and sustaining effective collaborations
with multiple stakeholders and then negotiating and reconciling
the competing needs represented by varied perspectives are challenging
tasks.
Similarly, as Bond and Carmola Hauf (2007) suggest, community-based
collaboration enables more accurate and relevant prevention research. One
potential function of Waldo and Schwartz’s (2003) prevention research
matrix presented in this issue is to point out how diverse sources of expertise
available through community and interdisciplinary collaboration can be
integrated to conduct comprehensive prevention research. For example,
community members can provide unique information on the epidemiology
of problems within their community; they can inform the design of preventive
interventions, ensuring they are targeted on the most salient variables
and are sensitive to community norms; and they can identify the systems
and resources within a community that will allow wide and sustained delivery
of prevention services.
The expertise of different disciplines may also make unique contributions
in each of these service areas. For example, the field of public health
is especially suited to clarifying epidemiology, clinical psychology is
strong in the design and evaluation of interventions, and the social work
profession is adept at creation and assessment of service delivery systems.
Rivera-Moquera et al. (2007) eloquently state that “each of us brings a
unique experience and set of skills that are needed to begin to address the
serious societal problems facing our country and our world” (p. 590).
Hence, the diverse communities and professional disciplines must work
596 THE COUNSELING PSYCHOLOGIST / July 2007
together in “sharing our skill sets, lessons learned, and methodology to
bring about real social change” (Rivera-Mosquera et al., 2007, p. 590).
Nevertheless, in spite of our strong agreement with all three of the reactants
that collaborative community partnerships are critically important to
the work of prevention specialists, we are reluctant to identify the forming
of such partnerships as the “overarching best practice” of prevention. The
major reason for our hesitation to adopt this perspective, as argued by Bond
and Carmola Hauf (2007), is that “community” is too often interpreted narrowly.
A framework of “community” may not give sufficient visibility to
educational training of psychologists or political advocacy for prevention.
As Rivera-Mosquera et al. (2007) comment, the four conceptual areas of
the guidelines, which include practice, research, training, and social advocacy,
provide a necessary conceptual framework. In addition, a community
is not a single voice and may, for example, include parents, teachers, businesses,
workers, social services agency leaders, clergy, and youths. In addition
to a divergence in voices emanating from the field, these voices may
not be congruent with those from multiple professions and scholarly disciplines.
Thus, although better practice may eventually emerge, the processes
through which this happens are not always clear. Indeed, Bond and
Carmola Hauf (2007) recognize the tensions that often exist when preventionists
attempt to apply prevention interventions across diverse groups of
people.
One method to address specific needs across divergent groups or to assess
in-group differences is through a process called “elicitation research”
(Flores, Tschann, & Marin, 2002). This research process collects information
during the development phase of a prevention intervention to better
understand relevant personal cognitions and social norms important to a
group or population receiving the intervention, thus strengthening the relevancy
of the intervention for those receiving it. Conducting elicitation
research prior to finalizing a prevention intervention increases the chances
of a successful outcome for behavior change by addressing variables important
to the group being served. Romano and Netland (in press) demonstrated
how elicitation research and the theory of reasoned action (Ajzen &
Fishbein, 1980; Albarracin, Fishbein, Johnson, & Muellerleile, 2001) can
address within-group differences in the development and implementation of
prevention interventions.
PREVENTION ACROSS THE LIFE SPAN
Reese (2007) notes that many of the examples of prevention interventions
provided in our set of Prevention Guidelines were drawn from practice with
Hage et al. / WALKING THE TALK 597
young people, despite the fact that prevention theory and practice cut across
the life span. We concur with Reese on his point and hope that our examples
of effective interventions with youths do not lead readers to think of prevention
as an activity only for the early years. Prevention is not only for children
and adolescents but also must be applied throughout the life cycle,
including the development of preventative interventions for diverse groups
of women and men at midlife and communities of older adults. Indeed,
developmental challenges, risks, and opportunities for positive development
occur across the life span, and these many stages of life represent significant
opportunities for prevention-minded psychologists to engage in active collaborative
efforts across the disciplines. It is possible that many of our
examples emerge from youth work because schools and colleges have been
available settings for prevention interventions, and they also offer opportunities
for funding of prevention research. As we move to increase the reality
of prevention across the life span, we will need to find mechanisms to fund
and house prevention activities for all phases of life.
There are indications that the field of psychology is increasing its attention
to the unique needs of older adults. For example, interventions have
addressed the prevention of suicide and depression in older adults (Heisel
& Duberstein, 2005; Whyte & Rovner, 2006). In addition, the American
Psychological Association (APA) Public Interest Directorate has established
an Office on Aging, which coordinates APA activities pertaining to
aging and geropsychology. The Office on Aging also supports the work of
the APA Committee on Aging, which has published a handbook on psychology
and aging (American Psychological Association Committee on
Aging, 2006). This work recognizes that not only are people 65 years of age
and older the fastest growing segment of the U.S. population, with an
increasing number of these older adults of immigrant status or members of
ethnic or racial minority groups, but that more than 5 million older adults
have incomes below the poverty level or are classified as poor. Adulthood
is also a period of life where adults confront a variety of changes related to
families, interpersonal relationships, careers, health, and end-of-life issues.
Prevention has a role to play in helping adults manage and prevent the
adverse effects of these changes.
Hence, we welcome Reese’s (2007) reminder to “cast a broad net” in the
goal of expanding our prevention efforts. He insightfully challenges psychologists
to more effectively address the interface of physical and mental health,
and reminds us of the imperative to decrease health disparities and improve the
quality of life of communities in the United States and abroad. His remarks
reflect the social justice orientation out of which the Prevention Guidelines
emerge. This perspective demands that we become aware of how the numerous
systems that are part of U.S. society, including economic, governmental,
598 THE COUNSELING PSYCHOLOGIST / July 2007
and educational structures, define truth for the entire community (Dounce,
2004; Dworkin & Yi, 2003). Prevention work can and should begin within the
local context (e.g., to apply the social justice model in our own communities)
but also needs to be thoughtfully concerned with systemic practices and the
state of power and oppression around the globe. Our efforts must aim to
enhance personal and collective well-being and to create social and political
change aimed at improving environments where people live, learn, and work
(Hage, 2005).
Similarly, we endorse Bond and Carmola Hauf’s (2007) recognition of the
importance of moving beyond a focus on strengths and protective factors at
the individual level, to also address such strengths at multiple systemic levels
(e.g., microsystem, organizations and institutions, community, sociopolitical,
cultural–environmental). While strength-based models related to individuals
have received attention in the literature, there is much less focus on strengths
and protective factors of communities, organizations, and institutions. Hence,
it is important to consider the strengths, as well as the limitations, of institutions,
such as schools, cultural centers, faith communities, and community
organizations, when planning and implementing prevention interventions.
IMPLEMENTATION OF THE PREVENTION GUIDELINES
In their reaction articles, Rivera-Mosquera et al. (2007) and Reese (2007)
recognize the significance of moving beyond the “ivory tower” and the level
of “rhetoric” to make the Best Practices Prevention Guidelines a reality.
Similarly, Bond and Carmola Hauf (2007) remind us that prevention review
articles of this nature have been presented in other professional journals, with
remarkably similar conclusions. We would like to recognize the validity
of these concerns, while also providing further explanation of the process of
development of these guidelines. Members of the Prevention Section of
Division 17 developed these Prevention Guidelines with the goal of eventually
bringing them forth for adoption by APA and other professional organizations
and government entities, as suggested by Reese (2007). Therefore,
the Prevention Guidelines were formulated in accordance with Criteria for
Practice Guideline Development and Evaluation, developed by APA in 1995
and later revised and approved by the APA Council of Representatives
(American Psychological Association, 2002). The APA criteria specify that
proposed guidelines, such as those presented in our article, need to focus on
educating and informing the practice of psychologists, as well as stimulating
debate and research. As such, the APA document specifies that guidelines
“must be reasonable, well researched, aspirational in language, and appropriate
in goals” (Section 1.1). Hence, the specificity of these requirements meant
Hage et al. / WALKING THE TALK 599
that content related to the implementation of the Prevention Guidelines was
mostly left out of our article. However, despite this limitation, the Prevention
Guidelines are the first set of comprehensive prevention guidelines that
encompass the major areas of prevention work (i.e., practice, research, training,
and social advocacy) that have been prepared for eventual adoption by
APA. Finally, as noted in our article, these guidelines are an “initial step” in
what we hope will be a broader collaboration of psychologists working
together to enhance and implement these recommendations for prevention
within the Society of Counseling Psychology, other appropriate APA divisions,
as well as APA and other professional organizations.
We share the concern voiced by Rivera-Mosquera et al. (2007): If further
efforts beyond the publishing of these guidelines are not made, this work
may likely “fail to provide forceful guidance for significant change”
(p. 587). Hence, while the guidelines may be recognized, as Reese (2007)
notes, as a “next step” in stimulating counseling psychologists to engage in
prevention, they represent just one step, and further discourse on implementation
and process is essential to move prevention more visibly from the
fringes of the field to center stage in the profession. Similar comments were
made by two past presidents of Division 17, Rosie Bingham and Derald
Wing Sue, at the 2006 APA Symposium addressing the implications of these
guidelines (Hage & Romano, 2006). In their presentations, Bingham and
Sue drew comparisons between the Prevention Guidelines and the
Guidelines on Multicultural Education, Training, Research, Practice, and
Organizational Change for Psychologists (American Psychological
Association, 2003) in terms of their movement from an academic article to
implementation and action. In summary, the challenge for prevention specialists
as well as the larger community of scholars and practitioners is to
develop creative ways to advance a prevention agenda, and we hope that
these Guidelines provide guidance.
We appreciate the specific recommendations put forth by the reactants for
how best to advance the dissemination of the Prevention Guidelines, and
would like to highlight some of their suggestions. Education and training,
both at the pre- and the postdoctoral levels, was cited as one essential area for
implementation. We strongly concur with Rivera-Mosquera et al. (2007) and
with Reese (2007) in their recommendation that prevention theory, research,
and practice need to be included within counseling psychology curricula
at all levels. The challenge that demands further attention is how we move
forward to infuse prevention practice and research not only in counseling
psychology training but also throughout psychology education.
Reese’s (2007) suggestion that the Prevention Guidelines become part of
“any reading packet for courses on prevention” is well taken, as is the recommendation
to include implementation of the Prevention Guidelines on the
600 THE COUNSELING PSYCHOLOGIST / July 2007
Hage et al. / WALKING THE TALK 601
agenda for discussion at the annual meeting of the Council of Counseling
Psychology Training Programs. We would also suggest that the guidelines
be included in the training of doctoral students and be discussed by other
psychology training groups (e.g., Council of School Psychology Training
Programs). Reese also suggests partnerships with professional organizations
outside of psychology (e.g., public health), government entities (e.g., U.S.
Department of Health and Human Services), and stakeholders in the community.
We would add other academic disciplines (e.g., social work, counseling)
as well as accreditation bodies such as the APA’s Committee on
Accreditation, the Council for Accreditation of Counseling and Related
Educational Programs, and psychology as well as other mental health licensing
boards to the list of disciplines and partnering organizations. Moreover,
Rivera-Mosquera et al. (2007) note the importance of addressing the ethics
of prevention. This need has begun to be addressed, although not as broadly
as we would like (e.g., Hage & Schwartz, 2006; Schwartz & Hage, in press).
Prevention practica are also urgently needed, as Reese (2007) suggests.
Finally, developing the equivalents of “preventive medical residency programs”
for counseling psychologists, as well as pre- and postdoctoral internships
in prevention research and practice, are excellent suggestions that
deserve careful consideration.
In addition, one of the most innovative ideas for dissemination of these
guidelines comes from Rivera-Mosquera et al. (2007), who point out that the
economics of prevention has been a major obstacle in furthering prevention
efforts. Their unique contribution is the suggestion that preventive services be
viewed as a type of therapeutic program. They argue that by conceptualizing
prevention as a “therapeutic intervention,” new avenues to support the work of
prevention (e.g., third-party reimbursement) may emerge. By extension, if
third-party reimbursement were to become possible for prevention, then the
place of prevention in psychology education and training programs will be
more fully secured. This perspective is an interesting one to consider and merits
close attention and further discussion among scholars, practitioners, and policy
makers. However, it may be more effective to develop financial models that
can prove the cost-effectiveness of prevention, rather than compromising the
conceptualization of prevention. For example, several recent studies have found
that teaching clients interventions based on cognitive–behavioral therapy is
cost-effective in preventing the onset of a full-blown depressive disorder
(Churchill et al., 2001; McCrone et al., 2004; Schulberg, Raue, & Rollman,
2002; Smit et al., 2006). The dissemination of more findings like these studies
on depression is critical in convincing policy makers and funding organizations
that prevention is cost-effective.
Reese (2007) issues a similar call for prevention research that is relevant,
disseminated, and utilized. We agree that too much good prevention research
602 THE COUNSELING PSYCHOLOGIST / July 2007
remains academic, and thus fails to realize its potential to improve lives,
particularly in communities disadvantaged by disparities in resources. We
believe that including a focus on service delivery systems as an integral component
of programmatic prevention research has significant potential for correcting
this deficit. For example, we recommend that investigators examine
the practical utility and economic feasibility of their research by utilizing the
prevention research matrix presented in this issue, and by examining how a
research project relates to the third category—Prevention Service Delivery
Systems. The prevention research matrix provides a tool to understand the
need for research and how the outcome of this research can inform the field.
Understanding this process will often lead to more open and informed communication
with participating communities about the meaning and scope of
the prevention program at each step of the intervention.
CONCLUDING OBSERVATION
A final observation we would like to make is to underline the significance
of the reaction articles being intentionally authored by a clinical psychologist,
a counseling psychologist, and a social worker. This effort by TCP represents
an excellent attempt at reflecting an important reality about prevention: It is
an interdisciplinary science and practice that requires interdependent collaboration
in order to be effective. We need more efforts like this one, including
applications to education and training in prevention. In addition, Reese
(2007) provides a valuable perspective as a counseling psychologist who previously
was employed by the Centers for Disease Control and Prevention,
and currently is in the Department of Community Health and Preventive
Medicine, Morehouse School of Medicine. He observes that psychology
must move prevention more forcefully from the margins of the field to the
heart of the profession, and that the Society of Counseling Psychology ought
to take the lead for all of psychology in making this transformation happen.
We whole-heartedly agree with this perspective, and we invite psychologists
and others interested in prevention to join this effort by becoming involved in
the Prevention Section (http://www.div17.org/preventionsection).
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