Selection of levels of prevention

This article outlines the advantages and disadvantages of universal and tar geted intervention programs. Two advantages of universal programs are the a bsence of labeling and stigmatization,and the inclusion of the middle class which makes it more likely that the program will be well run. Two disadvan tages are that they are unappealing to the public and politicians, and they may have their greatest effect on those at lowest risk. Targeted programs have the potential of addressing problems early on, and are potentially eff icient if targeting can be done accurately. Disadvantages include difficult ies around screening and the possibility of labeling and stigmatization. Th e argument is put forth that what is needed to reduce the immense burden of suffering from child and adolescent psychiatric disorders is the optimal m ix of universal, targeted, and clinical programs carried out in the context of a civic community. There will always be trade-offs among these strategi es, and the elements of the combination will change as knowledge accumulate s. (C) 2000 Elsevier Science Ltd.