How Universal Approaches Can Maximize Prevention Efforts

Photograph of children playing in a fountain
Figure 1 Photographer Andrew Seaman on

Submitted by: Cara Karter


Universal services prevent stigma, normalize help seeking, and often have higher rates of service acceptance.
Broader services can facilitate linkages to targeted programs based upon an individual’s unique needs and concerns.
Including family assistance can maximize the impacts of more focused efforts.

A preference for prevention programs in policy and practice is often driven by the belief that targeting services to a population with known risk factors is the most appropriate and efficient way to allocate resources. In a context with limited resources, it may appear that a universal approach equates to less to spentd on those with the greatest need.

However, targeted prevention requires accurate criteria for directing services. The reality is that many needs remain hidden. Limiting prevention efforts only to those with visible risk factors is an incomplete solution for efficient and effective prevention services.

“When a social service system begins from the premise that the efficient choice is to direct public investments solely to those with demonstrated risk, the system loses its potential to…fully engage all citizens in resolving their problems and using the most appropriate…preventive services.”

In many cases, universal strategies offer key benefits for prevention efforts. These are summarized below:

  • Universal services often do not carry the same stigma as targeted interventions. Many universal programs are offered in convenient locations where individuals may be more comfortable receiving support (e.g., homes, schools, other community settings). Normalizing help-seeking results in higher rates of service acceptance.
  • Universal services often provide immediate solutions to needs and can facilitate linkages to other services based on an individual’s unique concerns. Service systems that include universal assistance can maximize the impacts of more focused efforts.
  • Using assessment data from universal services, public leaders can make more informed and cost-effective investments in social services.

One example of a highly effective universal approach are home visiting programs offered to all new parents. These programs support positive parenting practices before challenges emerge. Home visitors often connect parents with additional supports and resources based on more targeted criteria (i.e., income, child behavioral/developmental needs) as they get to know a family. The public campaign to decrease tobacco use is another example of a highly impactful prevention effort that focused on changing public perceptions of tobacco use through both education and legislation. As Dr. Leonard Jason described on NPR’s The Academic Minute, “no condition has ever been eliminated by focusing just on those with the problem. An impressive example of prevention occurred with community efforts to change the landscape of tobacco use over the past 60 years. Today attitudes have changed toward tobacco use and there are substantially fewer smokers.”

Universal services are also important components of the coordinated, multi-pronged prevention strategies necessary to find and serve those most impacted by hidden issues like human trafficking and housing instability. Regardless of their current situation, everyone can benefit from understanding available resources and the knowledge of how to use them when needed.

What Does This Mean For?

Policy and Practice: When communities invest in universal prevention, they improve access and service uptake and decrease stigma associated with more targeted services. By weaving together a universal foundation with the range of available targeted services into a coordinated system of care, communities can maximize their prevention efforts. This will almost always require investments in shared data infrastructure and collaboratively developed referral mechanisms.

Original Citation: Daro, D. & Karter, C. (2019). Universal services: The foundation for effective prevention. In B. Lonne, D. Higgins, & T. Herrenkohl (Eds.), Re-visioning public health approaches for protecting children. New York, NY: Springer Nature.

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