Rapid Results with Evidence Based Kernels in North Carolina

Rapid

Using Evidence Base Kernels for Prevention, Intervention and Treatment

by Dennis D. Embry, Ph.D. • PAXIS Institute • April 13, 2011

1Thursday, April 14, 2011

How many of you know a regular American family with a child with…

a mental, emotional or behavioral disorder?

Like ADHD or behavior

problems?

Like learning or developmental

disorder?

Like a more serious mental

illness like bipolar or suicidal actions?

Like a serious addictions problem?


How many here think it is acceptable that at least every other American child will be affected by MEB’s before age 18?

This happens for every social class in America…Among your family, your child’s classmates, your neighbors, at church, and at work…every family.


Key messages about mental, emotional & behavioral disorders…

MEB’s are preventable.

Break-even for MEB prevention

is one year.

MEB prevention improves US

business.

Effective MEB prevention

helps national security.

MEB prevention helps US global

success.

MEB prevention balances budgets.

MEB prevention saves Social Security & Medicare.

MEB prevention heals past inequities.


Preapared by PAXIS Institute, Tucson, AZ Copyright© 2009. For educational and policy use only For more info, contact PAXIS at 520-299-6770

Estimates Possible Benefits of Universal GBG Implementation in First Grade by State

Select State:36

9,222,414 Estimated Total Population 2006

138,336 Estimated No. of 1st Graders in 2006

100 100% 138,336 Estimated 1st Graders Reached

20 100% $8,701Average Cost Per Student Per Year

Estimated Current

Population Prevalence of Problem or Behavior

Adjust for Impact of the Good Behavior Game on Problem

Prevalence After

Universal 1st Grade Delivery

Adjust for Average Cost of

Problem Per Child Per Year

Adjusted Average Annual Cost of

Problem Per Child

Average Annual Total Cost of the Problem

Behavior With NOT DOING

GBG

Estimated Per Year Costs

SAVINGS for Percent of 1st

Graders Reached 100%

Child, Adolescent & Adult Problems

Total daily disruptions in state before GBG 4,565,095 70000.00% 1,369,528 $1.0 $0.01 $8,217,171 $5,752,020

ADHD 3rd Grade 2 7.00% 3000.00% 3.00% $750 $7,262,651 $4,150,086

Oppositional Defiance 3rd Grade 3 5.00% 2700.00% 2.30% $900 $6,225,129 $3,361,570

Adolescent Conduct Disorder 4 14.00% 5600.00% 8.40% $1,400 $27,113,897 $10,845,559

Special Education 1st-Grade 12 5 7.00% 2200.00% 4.80% 500.00% $435 $4,212,822 $1,324,030

Adult Criminal Behavior 6 12.00% 1200.00% 10.80% 45000.00% $4,500 $74,701,553 $7,470,155

Serious Adult Drug Addictions 7 20.00% 800.00% 12.00% 4900.00% $490 $13,556,949 $5,422,779

Teen/Adult Suicidal Ideations 8 14.00% 7000% 7.00% $992 $7,684,853 $3,842,427

$148,975,025

$62.00

Esimtated Cost of Implementing the Good Behavior Game Per Classroom $1,550

Cost per 1st Grade Cohort Based on Percentage of Students Reached: $8,576,845

Return on Investment

Net Profit at Start of 2nd Grade Per 1st Grade Cohort: $931,003 11%

Net Profit at 6th Grade Per 1st Grade Cohort: $32,517,918 379%

Net Profit at 12th Grade Per 1st Grade Cohort: $110,701,906 1291%

Net Profit at the 29th Year of Life Per 1st Grade Cohort: $247,316,107 2884%

Note: Over a Decade of 1st Grade Cohorts Getting GBG, these numbers would be x10:

References:1

2

3

4

5

6

7

8

Adust to reflect average cost per student for education compared to national average

Adjust for Percent of 1st Graders Protected by Good Behavior Game in the State

Total Minimum Estimated Child, Adolescent and Adult Morbibity Costs for Each First Grade Cohort if Nothing is Done New Each Year:

This is less than cost of most childhood disease vaccines.

Move slider left if think will less be effective

Move slider right if think

problem costs more

(or per each disruption)

Esimtated Cost of the Good Behavior Game Per First Grader as Behavioral Vaccine (this includes local staff, materials, incentives, training, technical support, and overhead)

Kellam S, Brown CH, Poduska J, Ialongo N, Wang W, Toyinbo P, et al. Effects of a universal classroom behavior management program in first and second grades on young adult behavioral, psychiatric, and social outcomes,. Drug & Alcohol Dependence 2008(Special Issue):24.

Wilcox HC, Kellam S, Brown CH, Poduska J, Ialongo N, Wang W, et al. The impact of two universal randomized first- and second-grade classroom interventions on young adult suicide ideation and attempts. Drug & Alcohol Dependence 2008(Special Issue):14.

Tingstrom DH, Sterling-Turner HE, Wilczynski SM. The Good Behavior Game: 1969-2002. Behavior Modification 2006;30:225-53.

van Lier PAC, Muthen BO, van der Sar RM, Crijnen AAM. Preventing Disruptive Behavior in Elementary Schoolchildren: Impact of a Universal Classroom-Based Intervention. Journal of Consulting & Clinical Psychology 2004;72(3):467-78.

Ibid.

Ialongo N, Poduska J, Werthamer L, Kellam S. The distal impact of two first-grade preventive interventions on conduct problems and disorder in early adolescence. Journal of Emotional & Behavioral Disorders 2001;9(3):146-60.

Bradshaw CP, Zmuda JH, Kellam S, Ialongo N. Longitudinal Impact of Two Universal Preventive Interventions in First Grade on Educational Outcomes in High School. Journal of Educational Psychology 2009;101(4):926-37.

Petras H, Kellam S, Brown CH, Muthen B, Ialongo N, Poduska J. Developmental epidemiological courses leading to antisocial personality disorder and violent and criminal behavior: Effects by young adulthood of a universal preventive intervention in first- and second-grade classrooms. Drug & Alcohol Dependence 2008(Special Issue):15

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North CarolinaIf every cohort of first-graders receives the Good Behavior Game just in first grade, the good people of North Carolina will save$250 million for each group of kids when they are young adults.

Over the next 10 years, that’s $2.5 billion.

The cost? $62 per first grader.


Local NGO: Prevention for

Everyone* (prenatal thru age 21)

Center for Medicaid Services(Medicaid Administrative Match)

Example Enabling Regulations

Preventive services (Act, 42 C.F.R. 440.130 (c), 2004)

Rehabilitative services (Act, 42 C.F.R. 440.130 (d), 2004)

Medical Services under the Individuals with Disabilities Education Act

(IDEA, 2004)

Early and Periodic Screening, Diagnostic, and Treatments

Services

Health Insurers

Local/Regional Media

State Health Authority

Local Health Authority

National Media

Suppliers of Evidence-Based Prevention

Products or Tech. Asst.Tribal Governments

FQHC & Lookalikes

Dept. of Defense

School Personnel

Private Providers

Agency Providers

Local Prevention Scoreboard

Local, State and

National Professional

Groups

Local Gov'ts

County Extension

Universities & Comm. Colleges

Consumer Prevention Products (Retail & Online)

Property/Auto & Life Insurers

Health Care Reform Act

Private Scientific Orgs

*Can be existing entities (e.g., DFC's, non-profits)

Americorps,Teacher Corps

Voluntary & Faith Groups

Social Media

United Way and/or Community Foundations

Family Foundations

Business Donors/ Sponsors

National Foundations

Private Donors

State/local agency grants

Other Federal Funds

And “Good News…”

These types of prevention strategies can be sustained and grow because of laws and regulations…

If we collectively act for the future of all our children’s futures here in this room.


Consumer approach to prevention

Car seatsBike helmetsSafety gatesElectric socket coversBUT WHAT ABOUT…

DepressionADHDSuicideSubstance abuseObesity

Prevention Store


But at the new North Carolina prevention store

Prevention StoreOmega 3 @ $70 a year to prevent multiple mental, emotional and behavioral illnessesDialogic storybooks to prevent behavior problems @ $86 per yearGood Behavior Game for Teachers @ $54 per child per year to prevent mental/health emotional problemsFamilies United @ $4 per child per year to prevent conduct disorders, suicide, ATOD


Conduct Disorders

Depression

Homicide & Suicide

Addictions

Aggression

Obesity

Self harm

Oppositional/ ADHD

ANXIETY


Nearly 75 percent of the nation's 17- to 24-year-olds are ineligible for service

• Medical/physical problems, 35 percent.

• Illegal drug use, 18 percent.

• Mental Category V (the lowest 10 percent of the population), 9 percent.

• Too many dependents under age 18, 6 percent.

• Criminal record, 5 percent.

Army Times, Nov 5, 2009 • www.missionreadiness.org/PAEE0609.pd


http://www.missionreadiness.org/PAEE0609.pd


The US has 75 million children and teens.

40.4 million are on psychotropic medications Wall Street Journal, 12-28-2010


2009:Institute of Medicine Report provides a concise review of the prevention of mental, emotional, and behavioral disorders.


America’s rate of mental, emotional and behavioral

disorders is about twice that of the United Kingdom which is twice that of many other

rich democracies.


Silo busting ideas in prevention science

ADHD ODD Depression Obesity Injury Control


What message do we need to promote?


Reaching the faithful

๏Tell stories of how faith-based groups can use proven prevention strategies

๏ Pastor Smith uses Triple P to counsel his parishioners having common problems with their children. “It’s very easy for me to relate Triple P strategies to Scripture.”

๏ St. John’s uses the Good Behavior Game. “The Game helps us not only with behavior and academics, but also helping students understand how early Christians had to cooperate.”


Reaching businesses๏Give examples of immediate benefits to

productivity. “Having workplace Triple P has reduced our employees having to take time off for dealing with problems of their children.”

๏Link business competition. “Other rich democracies have extensive universal prevention, and those countries have more viable small business sector than the US.”

๏Link to major cost of business, such as depression is now major cause of disability.


Reaching the Tribes

๏Link key cultural wisdom to proven science of prevention, such as:

๏ the use of omega-3 was discovered by the Arctic peoples

๏ the Good Behavior Game mimics common traditional practices of assuring cooperation among children

Like the Inuksuk, traditional practices often

point to the right way


Reach to the political right๏Universal access to prevention enables individual

responsibility; rationing limits it.

๏Use the metaphor of accepted prevention practices like universal inoculations of childhood diseases or car safety seats.

๏Link to balancing budgets, national security and global competition.


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Key message by showing global competion

All of these other rich democracies have nearly

universal access to prevention for MEBs, compared to the rationing

model in the US.

Having “fitter” employees allows these countries to have higher paying manufacturing jobs and

compete globally.


America’s retired 4-start generals find…

Nearly 75 percent of the nation's 17- to 24-year-olds are ineligible for service

• Medical/physical problems, 35 percent.

• Illegal drug use, 18 percent.

• Mental Category V (the lowest 10 percent of the population), 9 percent.

• Too many dependents under age 18, 6 percent.

• Criminal record, 5 percent.

Army Times, Nov 5, 2009 • www.missionreadiness.org/PAEE0609.pd

Explain universal prevention in terms of national security




Reach to the political left๏Explain universal prevention as remedying

historic disparities such as:

๏Good Behavior Game increases high-school graduation and college entry rates and reduces lifetime incarceration rates of inner city kids.

๏Omega-3 improves IQ and reduces effects of poverty on children lives


5-Year Olds

65-Year Olds

Who are lessand less able…

Who are livinglonger though get

progressively sicker…

Requiring more wealth transfer

But elders voting to stop funds to kids

Explain how prevention for our kids protects elders


Reach to the center๏Emphasize that MEB’s affect every family, every

school, every neighborhood, and every business.

๏Example: “How many of you know a reasonably OK middle class or upper class family with a child or teen with a mental illness, learning disability or addictions problem?”


Reach state legislators, county & city leaders

๏Show how prevention for everyone will help balance the local budget and keep it balanced over time—use example estimators.

๏Show data how universal access to prevention will help the jurisdiction specifically

๏Share such data with advocates for local emotional impact


Key message for every group

In every communication say…

๏Mental, emotional and behavioral disorders are preventable like most childhood diseases and childhood injuries.

๏MEB’s harm and kill more children, youth and young adults than any childhood diseases, and the prevention of MEB’s is less expensive than childhood medical vaccines.

“Mental illness is preventable, just like many childhood diseases,tra!c injuries or even addictionsare preventable.”

“Yes, it is preventable. Read all about it, in the ‘09 IOM Report on the Prevention of Mental, Emotional, & Behavioral Disorders. We’ve been conditioned to think these were just manageable…”

O'Connell, M. E., T. Boat, et al., Eds. (2009). Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities. . Committee on the Prevention of Mental Disorders and Substance Abuse Among Children, Youth and Young Adults: Research Advances and Promising Interventions. Washington, DC, Institute of Medicine; National Research Council.

TO READ THE IOM REPORT, GO TO: http://bit.ly/IOMPREV


Hypothesis: Evolutionary “inflammatory” processes

Redness, rubor, a response of body tissues to injury or irritation; characterized by pain and swelling and redness and heat.

Excitation, excitement, fervor, fervour the state of being emotionally aroused and worked up

Inflaming arousal to violent emotion

Firing, ignition, kindling, lighting

the act of setting on fire or catching fire


Human Infectious/Biological Threats Human Predatory Threats

Evolutionary Adaptive Responses(Simplified)

Intra-GroupAffiliation (Anti-Inflammatory) Out-Group

Aggress. (Inflammatory)

Threat Attributional Bias (Inflammatory)

Tit-for-Tat Beh. Bias (Inflammatory)

Intra-GroupCooperation (Anti-Inflammatory)

Evolutionary Adaptive Responses(Simplified)

GeneralizedInflammatoryResponse

LocalizedInflammatory

Response

Anti-Inflammatory Regulators

Mood Modulators

Reward Delay

Modulators

Stress Modulators

Puberty/Sex Modulators

Neuro-Hormones

Modern culture commonly produces multiple evolutionary mismatches triggering multiple inflammatory responses.


Evolutionary Pathof a Child’s Life

KPath

RPath

Probability of long-life and reproductive success

Probability of short-life and doubtful reproductive success

R-Path can be triggered by evolutionary mismatch in social

or physical environment.


Conduct Disorders

Depression

Homicide & Suicide

Addictions

Aggression

Obesity

Self harm

Oppositional/ ADHD

ANXIETY

R PATH = Risky behaviors or health40Thursday, April 14, 2011

MoodStability

AttentionRewardDelay

ExecutiveFunction

BehavioralCompetencies

MotorSkills

Immune-Healing

FunctionsMulti-Inflammatory Threat Reaction

Physiological ReinforcementAntecedents Verbal Relations

Major Ecologic Causes of the Dual Inflammatory Threats to Children & Youth

Mental IllnessSubstance

AbuseViolence

WorkProblems

Obesity, etc

CancerEarlySex

SchoolFailure

STD’s SpecialEd


Cultural Trend:Sleep Deprivation

IOM Report (IOM, page 212)


Parental Monitoring and Parental Networking

(IOM, page 168, 171, 189)


Peer, Family, & Cultural Rewards for NOT breaking rules

IOM Report (page 165, 170,171, 181)


What are the social rewards for these behaviors?

Billy Good Billy Bad


Constant (k) affected by physiology (e.g., diet, perceived stress and threats, exercise, medications, substance abuse) and genes

Rate influenced by:

•Reinforcements•Antecedents•Relational-frames

Rate influenced by:

•Reinforcement•Antecedents•Relational-frames


Diet change in essential “brain food”

IOM Report (page 211-2)


Data on “Brain Food”: Omega-3 deficiency


Successful human neonates born with 60-day supply of

omega-3 in subcutaneous fat from

mother’s diet

NeonatesIn the Rife Valley, the

human brain evolution the result of eating

fish high in omega-3 not savannah animals

EvolutionAmerican infants have been getting steadily

less omega-3 (n3) and more pro-inflammatory omega-6 (n6) in breast

milk

Breast Milk

Almost all adolescent risky behaviors have

now been documented to be related to low n3 and high n6 in US diet change in last 50 years

“Risky” Beh. & Mismatch

Theory

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See HIbbeln et al. (2007).Maternal seafood consumption in pregnancy and

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observational cohort study

Hibbeln et al. (2006). Healthy intakes of n-3 and n-6 fatty acids: estimations

considering worldwide diversity.

See Ailhaud et al. (2006).Temporal changes in dietary fats: Role of n6

polyunsaturated fatty acids in excessive adipose tissue

development and relationship to obesity


Syndemic = reverse of synergies


If we just hit the problem harder…


Reduce Omega 3 Brain Deficiency in baby’s brain


The benefits to the baby and society

Maternal seafood consumption in pregnancy

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Why not reproduce the rapid results in North Carolina to prevent multiple mental, emotional and behavioural

It costs about $70 per person per year.


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The same universal works for high risk youth…

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Other rapid results to consider…

Rapid


Young children


Early stories and reading


Why not distribute specially constructed books for parents with young children…

Reduce dangerous, impulsive, disturbing behavior quickly?

Increase social-competence quickly?

Improve school readiness quickly?

Embry, D. D. and L. Peters (1985). A three-city evaluation of the diffusion of a pedestrian-safety injury control intervention. R. S. Division, New Zealand Ministry of Transport, Wellington, NZ.


Peer-to-Peer Notes

Positive Home Notes

Social Competence Violence

PeaceBuilders School-Community Reinforcement Study


Promote the Triple P (Positive Parenting Program)


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12

13

15

16

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Substantiated Child Maltreatment

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Triple P Counties

Pre Post

Prinz et al., 2009, Prevention Science

Two Years Later


Child Abuse Hospital Injuries

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1.43

1.55

1.68

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Classrooms

Muriel Saunders


Key findings in the first 50 studies of the GBG

๏This was the first widely replicated scientific demonstration that disturbing, disruptive, destructive and inattentive behaviors of children from preschool through secondary education could be reliably reduced by individual teachers using a simple recipe for a 3x daily behavioral vaccine.

ONLY

C linical C hild and Family P sychology R eview, Vol. 5, N o. 4, D ecember 2002 ( C 2002)

T he G ood B ehavior G ame: A B est P ractice C andidateas a U niversal B ehavioral V accine

D ennis D . E mbry1

A “ behavioral vaccine” provides an inoculation against morbidity or mortality, impactingphys-ical, mental, or behavior disorders. A n historical example of a behavioral vaccine is antiseptichand washing to reduce childbed fever. I n current society, issues with high levels of morbidity,such as substance abuse, delinquency, youth violence, and other behavioral disorders (multi-problems) , cry out for a low-cost, widespread strategy as simple as antiseptic hand washing.C ongruent research findings from longitudinal studies, twin studies, and other investigationssuggest that a possibility might exist for a behavioral vaccine for multiproblem behavior. Asimple behavioral strategy called the G ood B ehavior G ame (G B G ) , which reinforces inhibi-tion in a group context of elementary school, has substantial previous research to considerits use as a behavioral vaccine. T he G B G is not a curriculum but rather a simple behavioralprocedure from applied behavior analysis. A pproximately 20 independent replications of theG B G across different grade levels, different types of students, different settings, and somewith long-term follow-up show strong, consistent impact on impulsive, disruptive behaviorsof children and teens as well as reductions in substance use or serious antisocial behaviors.T he G B G , named as a “ best practice” for the prevention of substance abuse or violent be-havior by a number of federal agencies, is unique because it is the only practice implementedby individual teachers that is documented to have long-term effects. Presently, the G B G isonly used in a small number of settings. H owever, near universal use of the G B G , in majorpolitical jurisdictions during the elementary years, could substantially reduce the incidence ofsubstance use, antisocial behavior, and other adverse developmental or social consequencesat a very modest cost, with very positive cost-effectiveness ratios.

K E Y WO R D S: substance abuse prevention; violence prevention; public policy; best practice.

I N T R O D U C T I O N

A behavioral vaccine is a simple, scientificallyproven routine or practice put into widespread dailyuse that reduces morbidity and mortality. A powerfulexample comes from an epidemic that occurred 150years ago.

D uring the nineteenth century, women died inchildbirth at alarming rates in E urope and the U nitedStates. U p to 25% of women who delivered their ba-bies in hospitals died from childbed fever (puerperalsepsis) , discovered later to be caused by Streptococcuspyogenes bacteria.

1PA X I S I nstitute, PO B ox 68494, Tucson, A rizona 85737; e-mail:[email protected].

I n the late 1840s, D r I gnaz Semmelweis worked inthe maternity wards of a V ienna hospital. B y metic-ulous observation, he discovered that the mortalityrate in a delivery room staffed by medical studentswas up to three times higher than in a second deliv-ery room staffed by midwives. Semmelweis postulatedthat the students might be carrying the infection fromtheir dissections to mothers giving birth. H e tested thehypothesis by having doctors and medical studentswash their hands with a chlorinated solution beforeexamining women in labor. T he mortality rate in hismaternity wards eventually dropped to less than 1% .Washing of hands with antiseptic solution—a behav-ioral vaccine—now saves millions of lives every year.Today, the C enters of D isease C ontrol and Prevention(C D C ) web site states, “ [A ntiseptic] hand washing is

273

1096-4037/02/1200-0273/0 C 2002 Plenum Publishing C orporation

pages 273-297

Embry, D. D. (2002). The Good Behavior Game: a best practice candidate as a universal behavioral vaccine. Clinical Child &

Family Psychology Review, 5(4), 273-297.


High Implementationof PAX (Good Behavior) Game

No or Low Implementationof PAX (Good Behavior) Game

Behavior Tracking Results in Baltimore 150+ classrooms

No or Low Implementationof PAX (Good Behavior) Game

17 per/hr X 5.5 class hours X 30

students = 2,805 disruptions

per school day per classroom

6 per/hr X 5.5 class hours X 30

students = 990 disruptions per school day per classroom


PAX IntroducedThe distracLons per hour decreased by 56% with the introducLon of the PAX environment of PAX language and several PAX kernels.

PAX GBG PlayedDisrupLons per hour decreased an addiLonal 30% aQer learning to play PAX GBG .

PAX GBG decreased distracLon in classrooms by an average of 86% aQer only one month

Baseline DisrupIons Six 1st-‐grade classrooms averaged 136 per hour before coaching

2011 Replication in rural Tennessee by coaches trained just like you…


Johns Hopkins Centre for Prevention and Early

Intervention๏ Five longitudinal studies of the effects of the Good

Behavior Game now being studied

๏ All involve random assignment of teachers in schools and schools to use or not use GBG

๏ Here are data from Cohort 1 and 2 studies showing effects 20 years later, after just getting GBG in 1st grade ONLY


3 GBG games a day in just first grade during your normal teaching…

๏Reduces disturbing, disruptive and destructive behaviors by 75%

๏Prevents ADHD and other mental illnesses-without medication or therapy

๏Prevents lifetime crime, violence and drug addiction

๏ Increases high-school graduation & college entry


Timeline of benefits from PAX GBG

Age of Child Benefits

1st Grade 75% reduction in disturbing, disruptive and destructive behavior; 25% increase academic achievement--especially in reading if played well

3rd Grade 43% reduction in ADHD diagnoses; 33% reduction in Oppositional Defiant Disorder; 30%+ reduction special services needs;

6th grade 50%+ reduction in conduct disorders; 25% to 50% reduction tobacco use; major reduction in bullying behaviors

8th Grade 75%r reduction in serious drug use and engagement in delinquent acts

12th Grade Major increase in high-school graduation; lower utilization of special services

Early 20’s Increase in college entry; Major reductions drug use; reductions in prison time

Age 29 Lifetime reduction in violent crime, suicide, psychiatric diagnoses, and lifetime addictions


Adolescents


Why not invite families to promise clear rules about alcohol, tobacco & drugs if…It produces a 23% reduction binge drinking and 27% reduction delinquency rates among 7th graders in 2 years and this has been adopted nationally by Sweden and being adopted by the State of Tennessee?

Koutakis, N., H. Stattin, et al. (2008). "Reducing youth alcohol drinking through a parent-targeted intervention: the Orebro Prevention Program." Addiction 103(10): 1629-1637.

PS. Effect sizes were 0.35 for drunkenness and 0.38 for delinquency.


What is Families Together?

A set of simple, proven, and powerful tools to protect all our children from the leading causes of lifetime suffering, illness, disability and death—securing all our futures.


What do Families Together do?

Increase Family Positive Monitoring. Parental & family clarity and commitment to their child about risky or disturbing behaviors such as not using alcohol, tobacco and drugs (ATOD) and about that child’s friends’ not using of alcohol, tobacco and drugs.

The type of monitoring changes by age of child.



Reward Not Using or Breaking Rules. Family recognition and reinforcement of children and teens doing the right thing (e.g., not using ATOD or not engaging in deviant or risky behaviors.

The rewards and recognition increase intrinsic motivation to do the right thing, and cost little or no money

The rewards and recognition create perceived warmth by children from parents and family.


What do Families Together do?Reduce Sleep Deprivation. Ensuring a child has good sleep patterns, by reducing access to electronic media before bedtime.

Sleep deprivation is the silent but deadly cause of many behavioral, school and health problems—including addictions.



Change Brain Food or Fatty Acid Ratios in Child’s Diet. Increasing children’s “brain food” (omega-3 found in fish oil) protects a child’s basic brain function, brain receptors and brain chemistry from the risk of ATOD as well as other problematic behaviors including depression and aggression.

The main biological factor that has radically changed in the last 20 years, dramatically affecting behavior, mental health and physical health of our children.



Increase Parent Networking to Adolescents’ Friends Families. Sharing and communicating the above with five of the parents of one’s child’s friends.


Families Together getA Promise Card, as do many people from all walks of life in the community.

A Gift card to access a website, gives them the tools to act—videos, downloads and more.

An explanatory flyer.

The above can have local sponsors on the materials for sustainability.

Families United for all our children, for all our youth, for all our futures…

Every community in America gains, when all our children and youth are…

healthy in body, healthy in mind, healthy in spirit, and healthy in behavior.

When children and youth are healthy in body, mind, spirit, and behavior, families are happier, communities are safer, businesses prosper, and America is more secure and prepared for the future.

Families United is available for every family, helping protect every child and youth from common harms of alcohol, tobacco, and other drugs; shield them from depression and other common ills of modern society; and guard against exposure to dangerous acts of others, violence or injuries. Families United helps every child or youth do better in school and achieve heartfelt goals for the future.

I/we promise learn more about Families United at www.SimpleGifts.com/Families United.I/we promise to share the benefits of Families United to others, who in turn can share the benefits to more people.I/we promise to apply—as appropriate to my/our family—the proven Simple Gifts to protect all our children, our youth, and our futures.

Signed____________________________________________Please print_____________________________________________City______________________State____Zipcode__________Date________

Email______________________________ Check if want email updates Check if want

name posted

Families United

Families UnitedFor Your City/County/Statelease join Families United. Families United is a gift to you, your family, and other families in this community.Together, we can use the Simple Gifts in

Families United to make sure all our children and teens have a better, healthier, safer and more productive lives.To redeem your gift, please…Go to www.SimpleGifts.comClick on the Families United boxScratch off the PIN number on the Simple Gifts card, and enter it with the card number.Make your commitment to support Families United in your community.Browse and use the Simple Gifts for

you and your children or teens.

P

Families Together

Families Together

Families Together


Binghamton New York


ONLY

C linical C hild and Family P sychology R eview, Vol. 5, N o. 4, D ecember 2002 ( C 2002)

T he G ood B ehavior G ame: A B est P ractice C andidateas a U niversal B ehavioral V accine

D ennis D . E mbry1

A “ behavioral vaccine” provides an inoculation against morbidity or mortality, impactingphys-ical, mental, or behavior disorders. A n historical example of a behavioral vaccine is antiseptichand washing to reduce childbed fever. I n current society, issues with high levels of morbidity,such as substance abuse, delinquency, youth violence, and other behavioral disorders (multi-problems) , cry out for a low-cost, widespread strategy as simple as antiseptic hand washing.C ongruent research findings from longitudinal studies, twin studies, and other investigationssuggest that a possibility might exist for a behavioral vaccine for multiproblem behavior. Asimple behavioral strategy called the G ood B ehavior G ame (G B G ) , which reinforces inhibi-tion in a group context of elementary school, has substantial previous research to considerits use as a behavioral vaccine. T he G B G is not a curriculum but rather a simple behavioral

Evidence-based Kernels: Fundamental Units of BehavioralInfluence

Dennis D. Embry Æ Anthony Biglan

! The Author(s) 2008. This article is published with open access at Springerlink.com

Abstract This paper describes evidence-based kernels,fundamental units of behavioral influence that appear to

underlie effective prevention and treatment for children,

adults, and families. A kernel is a behavior–influenceprocedure shown through experimental analysis to affect a

This paper presents an analysis of fundamental units ofbehavioral influence that underlie effective prevention and

treatment. We call these units kernels. They have two

defining features. First, in experimental analysis,researchers have found them to have a reliable effect on

Clin Child Fam Psychol Rev

DOI 10.1007/s10567-008-0036-x

COMMUNITY-BASEDPREVENTION USING SIMPLE,LOW-COST, EVIDENCE-BASEDKERNELS AND BEHAVIORVACCINESDennis D. EmbryPAXIS Institute

!A paradox exists in community prevention of violence and drugs. Good

A R T I C L E

Embry, D. D. and A. Biglan (2008). "Evidence-Based Kernels: Fundamental Units of Behavioral Influence." Clinical Child & Family Psychology Review 11(3): 75-113.

Basic understanding of kernels

Embry, D. D. (2004). "Community-Based Prevention Using Simple, Low-Cost, Evidence-Based Kernels and Behavior Vaccines." Journal of Community Psychology 32(5): 575.

Using kernels for population change

Embry, D. D. (2002). "The Good Behavior Game: A Best Practice Candidate as a Universal Behavioral Vaccine." Clinical Child & Family Psychology Review 5(4): 273-297.

Behavioral vaccines for disease control


Is the smallest unit of scientifically proven behavioral influence.

• Is indivisible; that is, removing any part makes it inactive.

Produces quick easily measured change that can grow much bigger change over time.

Can be be used alone OR combined with other kernels to create new programs, strategies or policies.

• Are the active ingredients of evidence-based programs

• Can be spread by word-of-mouth, by modeling, by non professionals.

• Can address historic disparities without stigma, in part because they are also found in cultural wisdom.

What is a kernel?


Four Types of Kernels

AntecedentKernel

ReinforcementKernel

Relational FrameKernel

PhysiologicalKernel

Happens BEFORE the behavior

Happens AFTER the behavior

Creates verbal relations for the

behavior

Changes biochemistry of

behavior

Embry, D. D., & Biglan, A. (2008). Evidence-Based

Kernels: Fundamental Units of Behavioral Influence. Clinical Child & Family

Psychology Review, 39.


What is a behavioural vaccine?It is a simple procedure (a kernel or a recipe of kernels) that, when used repeatedly, reduce morbidity and mortality and/or increase wellbeing or health.

Such behavioural vaccines can become cultural practices.

Embry, D. D. (2004). "Community-Based Prevention Using Simple, Low-Cost, Evidence-Based Kernels and Behavior Vaccines." Journal of Community Psychology 32(5): 575.


Using kernels to build population-level change…

Problem

Kernel

KernelBig

Change

ObservedProximal

EffectObservedProximal

Effect

Effect

Effect

ObservedProximal

Effect

Kernel#1

Kernel#2

Kernel#3


Big changes requires leverage


• Reach X Efficacy X Adoption X Implementation X Maintenance = Population level impact

Big changes requires leverage


Public-health kernel case study


Youth Who Smoked Every Day the Last 30 Days

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Youth Who Smoked During the Last 30 DaysBaseline Reward and Reminder

Population level example of use of kernels

Youth Who Smoked Every Day the Last 30 Days

2.0%

4.0%

6.0%

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16.0%

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14.0%

16.0%

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Source: YRBS, US Centers for Disease Control

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Wisconsin

United States

0.0%

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25.0%

30.0%

35.0%

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1995 1997 1999 2001 2003 2005 2007

Wyoming

Wisconsin

United States

Youth Who Smoked During the Last 30 DaysBaseline Reward and Reminder

Source: YRBS, US Centers for Disease Control

= Trend = Wyoming = Wisconsin =United States

Embry, D. D. and A. Biglan (2009). Reward and Reminder: An Environmental Strategy for Population-Level Prevention. National Registry of Effective Programs and Practices, Substance Abuse and Mental Health Administration.


Kernel Logic Model


If kernels are so good…


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Intervention UniversalTargeted

Kernels lower cost of training, support & change…

Kernels provide robustness, cost-efficiency and community sustainability across syndemics and multi-problem behaviors.


Lifespan example of one kernel for prevention, intervention and

treatment


“Environmental” Policies and Kernels Examples

Any “environmental policy” must be based on an observable, replicable, simple way of influencing human individually, in dyads, triads or small groups.

Kernels or behavioral vaccines (a recipe of kernels) can be wrapped in an environmental policy.

Examples for today


360 Degree Assessment for Policy Prevention Planning Using Kernels


We can spread health, wellbeing and resiliency to every child, youth, family, and community in North Carolina…


By our own hands, we can create the gift of our futuresfor our children, our grandchildren,

ourselves, our communities & nation.


For more info on this presentation read recent scientific paper…

Text

Free access at:

www.slideshare.net/drdennisembry


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Rapid Results with Evidence Based Kernels in North Carolina

Health & Medicine

Transcript of Rapid Results with Evidence Based Kernels in North Carolina