Embry Nov 2010 colloquium for uni manitoba faculty of medicine

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The Community Medicine Department of the University of Manitoba sponsored a colloquium by Dr. Embry. This talk emphasizes scientific approaches to non-pharacuettical methods to prevent mental, emotional and behavioral disorders

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  • Please see http://en.wikipedia.org/wiki/1854_Broad_Street_cholera_outbreak

    This story is about how Dr. John Snow did a major public health change by removing the pump handle on the pump on Broadwick Street, thereby dramatically reducing cholera.

    We need to remove the pump handles of current epidemics affecting America’s children, youth and young adults.









































  • Embry Nov 2010 colloquium for uni manitoba faculty of medicine

    1. 1. CHS Colloquium for University of Manitoba Faculty of Medicine • November 18, 2010 Behavioral Vaccines and Evidence Based Kernels: Non-Pharmaceutical Approaches for the Prevention of Mental, Emotional and Behavioral Disorders Dennis D. Embry, Ph.D., Senior Scientist, PAXIS Institute; Co-Investigator, Johns Hopkins Center for Prevention and Intervention; Co-Investigator, Promise Neighborhood Research Consortium, Eugene, OR www.slideshare.net/drdennisembry
    2. 2. Purpose today Define scientific alternative strategies for behavioral influence that can be used for the prevention of mental, emotional and behavioral disorders: Behavioral vaccines Evidence-based kernels Review a bold scientific opportunity and agenda that is possible in Manitoba My dislaimers
    3. 3. FREE DOWNLOAD Embry, D. D., & Biglan, A. (2008). Evidence-Based Kernels: Fundamental Units of Behavioral Influence. Clinical Child & Family Psychology Review, 39. Download at: www.pubmed.gov Described in the 2009 IOM Report, p. 210
    4. 4. A R T I C L E C linical C hild and Family P sychology R eview, Vol. 5, N o. 4, D ecember 2002 ( C 2002) COMMUNITY-BASED PREVENTION USING SIMPLE, LOW-COST, EVIDENCE-BASED KERNELS AND BEHAVIOR T he G ood B ehavior G ame: A B est P ractice C andidate VACCINES as a U niversal B ehavioral V accine Dennis D. Embry PAXIS Institute D ennis D . E mbry1 A paradox exists in community prevention of violence and drugs. Good research now exists on evidence-based programs, yet extensive expenditures on prevention have not produced community-level results. Various multiproblems are quite prevalent in the United States, such as violence, Attention Deficit Hyperactivity Disorder (ADHD), conduct problems, A “ behavioral vaccine” provides an inoculation against morbidity or mortality, impactingphys- learning disabilities, depression, and other mood problems. Various studies ical, mental, or behavior disorders. A n historical example of a behavioral vaccine is antiseptic have observed that intuitively appealing community-based coalitions and hand washing to reduce childbed fever. I n current society, issues with high levels of morbidity, LY best practice requirements have not produced prevention gains as hoped such as substance abuse, delinquency, youth violence, and other behavioral disorders ( multi- for by many. Calls for more money, fidelity, or dose seem unlikely to problems) , cry out for a low-cost, widespread strategy as simple as antiseptic hand washing. succeed. Other alternatives may be possible. Most of the best practices C ongruent research findings from longitudinal studies, twin studies, and other investigations N aimed at preventing these community problems are composed of suggest that a possibility might exist for a behavioral vaccine for multiproblem behavior. A evidence-based kernels, which act on core principles of prevention (risk O simple behavioral strategy called the G ood B ehavior G ame ( G B G ) , which reinforces inhibi- and protective factors). What is not widely known is that the evidence-based kernels are powerful in their own right. Evidence-based tion in a group context of elementary school, has substantial previous research to consider kernels are irreducible units of behavior-change technology, and they can its use as a behavioral vaccine. T he G B G is not a curriculum but rather a simple behavioral be put together into behavioral vaccines (daily practices) with powerful procedure from applied behavior analysis. A pproximately 20 independent replications of the longitudinal prevention results. Kernels and behavioral vaccines are G B G across different grade levels, different types of students, different settings, and some simple, and they are not programs or curriculum in the conventional with long-term follow-up show strong, consistent impact on impulsive, disruptive behaviors sense. This article presents examples of evidence-based kernels and of children and teens as well as reductions in substance use or serious antisocial behaviors. behavioral vaccines that can be promoted easily across whole communities T he G B G , named as a “ best practice” for the prevention of substance abuse or violent be- or states using social marketing principles. Widespread propagation of havior by a number of federal agencies, is unique because it is the only practice implemented evidence-based kernels and behavioral vaccines could have a significant by individual teachers that is documented to have long-term effects. Presently, the G B G is impact on communities and their prevention norms, providing low-cost alternatives and practical models for community psychology, public health, only used in a small number of settings. H owever, near universal use of the G B G , in major and policy makers. Behavioral kernels and vaccines can add needed political jurisdictions during the elementary years, could substantially reduce the incidence of precision to prevention science and community psychology. © 2004 Wiley substance use, antisocial behavior, and other adverse developmental or social consequences Periodicals, Inc. at a very modest cost, with very positive cost-effectiveness ratios. K E Y W O R D S: substance abuse prevention; violence prevention; public policy; best practice. Correspondence to: Dennis D. Embry, Ph.D., PAXIS Institute, P.O. Box 68494, Tucson, AZ 85737. E-mail: dde@paxis.org INT R OD U CT ION I n the late 1840s, D r I gnaz Semmelweis worked in JOURNAL OF COMMUNITY PSYCHOLOGY, Vol. 32, No. 5, 575–591 (2004) © 2004 Wiley Periodicals, Inc. the maternity wards of a V ienna hospital. B y metic- Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/jcop.20020 A behavioral vaccine is a simple, scientifically ulous observation, he discovered that the mortality proven routine or practice put into widespread daily rate in a delivery room staffed by medical students use that reduces morbidity and mortality. A powerful was up to three times higher than in a second deliv- example comes from an epidemic that occurred 150 ery room staffed by midwives. Semmelweis postulated years ago. that the students might be carrying the infection from D uring the nineteenth century, women died in their dissections to mothers giving birth. H e tested the childbirth at alarming rates in E urope and the U nited hypothesis by having doctors and medical students States. U p to 25% of women who delivered their ba- wash their hands with a chlorinated solution before bies in hospitals died from childbed fever ( puerperal examining women in labor. T he mortality rate in his sepsis) , discovered later to be caused by Streptococcus maternity wards eventually dropped to less than 1% . pyogenes bacteria. Washing of hands with antiseptic solution—a behav- ioral vaccine—now saves millions of lives every year. 1 PA X I S I nstitute, PO B ox 68494, Tucson, A rizona 85737; e-mail: Today, the C enters of D isease C ontrol and Prevention dde@paxis.org. ( C D C ) web site states, “ [A ntiseptic] hand washing is 273 1096-4037/02/1200-0273/0 C 2002 Plenum Publishing C orporation
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
    6. 6. Relational Antecedent Reinforcement Physiological Frame Kernel Kernel Kernel Kernel Changes Creates verbal Happens BEFORE Happens AFTER the biochemistry of relations for the the behavior behavior behavior behavior Embry, D. D., & Biglan, A. (2008). Evidence-Based Four Types of Kernels Kernels: Fundamental Units of Behavioral Influence. Clinical Child & Family Psychology Review, 39.
    7. 7. What is a kernel? 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 often 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.
    8. 8. Rapid
    9. 9. 52 Examples of Kernels Antecedents Reinforcements Physiological Relational frames
    10. 10. = Public Posting Kernel Antecedent Kernel Happens BEFORE the behavior = radar
    11. 11. Kernel Description Behaviors Affected References Combinations of visual, kinesthetic and/or auditory Non-verbal cues that single shifting attention or task in Reduces dawdling, increases time on task or Rosenkoetter, & Fowler, 1986; Krantz, & Risley, 1977; Abbott et al., 1998; transition cues patterned way, coupled with praise or occasional engaged learning; gives more time for instruction Embry et al., 1996 rewards. Antecedent Stop lights in Traffic light signals when behavior is appropriate/ (Cox, Cox, & Cox, 2000; Jason & Liotta, 1982; Jason, Neal, & Marinakis, desirable or inappropriate/undesirable in real time, Decreases noise, off task behavior, or increases Kernel school settings or traffic settings and connected to some kind of occasional stopping in dangerous intersections 1985; Lawshe, 1940; Medland & Stachnik, 1972; Van Houten & Malenfant, 1992; Van Houten & Retting, 2001; Wasserman, 1977) reinforcement. These may be lines or other cues such as ropes or Decreases dangerous behavior; decreases Boundary cues and (Carlsson & Lundkvist, 1992; Erkal & Safak, 2006; Marshall, et al., 2005; rails that signal where behavior is safe, acceptable pushing and shoving; increases waiting behavior railings or desired in a queue; reduces falls Nedas, Balcar, & Macy, 1982; Sorock, 1988) Happens Cooperative, Planned activities happen during children play time Decreases aggression and increases social competence; also affects body mass index, and (Bay-Hinitz, Peterson, & Quilitch, 1994; Leff, Costigan, & Power, 2004; BEFORE the Structured peer play that involve rules, turn taking, social competencies, and cooperation with or without “soft competition.” appears to reduce ADHD symptoms, and increase academics afterwards; reduces social rejection in Mikami, Boucher, & Humphreys, 2005; Murphy, et al., 1983; Ridgway, Northup, Pellegrin, LaRue, & Hightsoe, 2003) behavior middle school (Barker & Jones, 2006; Ben Shalom, 2000; Bray & Kehle, 2001; Buggey, 2005; Clare, Drawn, photographic or video model viewer/listener Increases academic engagement; increases attention; Jenson, Kehle, & Bray, 2000; Clark, Beck, Sloane, Goldsmith, & et al., 1993; Clark, Kehle, increases recall and long term memory; improves behavior; Jenson, & Beck, 1992; Clement, 1986; R. A. Davis, 1979; Dowrick, 1999; Dowrick, Kim- Self-modeling engaging targeted behavior, receiving rewards or reduces dangerous behavior; increases social competence; Rupnow, & Power, 2006; Elegbeleye, 1994; Hartley, Bray, & Kehle, 1998; Hartley, Kehle, & recognition. improved sports performance; reduced health problems Bray, 2002; Hitchcock, Prater, & Dowrick, 2004; Houlihan, Miltenberger, Trench, Larson, & et al., 1995; Kahn, Kehle, Jenson, & Clark, 1990; Kehle, Bray, Margiano, Theodore, & Zhou, 2002; Law & Ste-Marie, 2005; Lonnecker, Brady, McPherson, & Hawkins, 1994; Meharg & (Agran, et al., 2005; Blick & & Woltersdorf, 1990; Owusu-Bempah& Frank, 1990; Buggey, 1995; Lipsker, 1991; Meharg Test, 1987; Boyle & Hughes, 1994; Brown & Howitt, 1985; Owusu- Reductions in alcohol, tobacco use; reductions in illness Buggey, Toombs, Gardener, & Cervetti, 1999; Burch, Clegg, & Bailey, 1987; Carr & Punzo, 1993; Cavalier, Coding target behavior with a relational frame, which symptoms from diabetes; increased school achievement; changes Bempah & Hodges, 1983;Clare, et al., 2000;McLoughlin,Kehle, & Truscott, 2001; Dalton, Martella, & Ferretti, & Howitt, 1997; Possell, Kehle, Clarke, Bray, & Bray, 1999; Ram & McCullagh, 2003; Reamer, Brady, & Hawkins, 1998; Rickards-Schlichting, Kehle, & Bray, 2004; Rickel & Fields, Self-monitoring is often charted or graphed for public or semi-public in other social competencies or health behaviors; reductions in Marchand-Martella, 1999; de Haas-Warner, 1991; R. M. Foxx & Axelroth, 1983; Glasgow, Klesges, Godding, & Gegelman, 1983; Glasgow, Klesges, & Vasey, 1983; Gray & & Simon, 1997; Walker & 1983; Schunk & Hanson, 1989; Schwartz, Houlihan, Krueger, Shelton, 1992; Hall & Zentall, display, occasioning verbal praise from others ADHD, Tourettes and other DSM-IV disorder; improvement in 2000; K. R. Harris, Friedlander, 1992; Wedel & Fowler, 1984; Woltersdorf, 1992) 1990; Hitchcock, Clement, Saddler, Frizzelle, & Graham, 2005; Hertz & McLaughlin, brain injured persons et al., 2004; Hughes, et al., 2002; Kern, Dunlap, Childs, & Clarke, 1994; Martella, Leonard, Marchand- Martella, & Agran, 1993; M. Y. Mathes & Bender, 1997; McCarl, Svobodny, & Beare, 1991; McDougall & Brady, 1995; McLaughlin, Krappman, & Welsh, 1985; Nakano, 1990; O'Reilly, et al., 2002; Petscher & Bailey, 2006; Possell, et al., 1999; Rock, 2005; Selznick & Savage, 2000; Shabani, Wilder, & Flood, 2001; After hearing or seeing some content, person is told Shimabukuro, Prater, Jenkins, & Edelen-Smith, 1999; Stecker, Whinnery, & Fuchs, 1996; Thomas, Paragraph Abrams, & Johnson, 1971; Todd, Horner, &G. Mathes, Fuchs, Fuchs, Henley,Winn, Skinner, (Bean & Steenwyk, 1984; P. Sugai, 1999; Trammel, Schloss, & Alper, 1994; & et al., to “shrink” meaning to 8-10 words, full sentence; Improved reading responses and retention Allin, & Hawkins, 2004; Wood, Murdock, & Cronin, 2002; Wood, Murdock, Cronin, Dawson, & Kirby, 1998) Shrinking praise typically happens for good summaries. 1994; Spencer, Scruggs, & Mastropieri, 2003)
    12. 12. Prize Bowl/Mystery Motivator Kernel Reinforcement Kernel Happens AFTER the behavior
    13. 13. Kernel Description Behaviors Affected References Person or group receives spoken (or Examples: Cooperation, social competence, academic (Leblanc, Ricciardi, & Luiselli, 2005; Lowe & McLaughlin, 1974; Marchant engagement, academic achievement, positive-parent child signed) recognition for engagement in & Young, 2001; Marchant, Young, & West, 2004; Martens, Hiralall, & Verbal Praise target acts, which may be descriptive or interactions, positive marital relations, better sales Bradley, 1997; Matheson & Shriver, 2005; C. M. Robinson & Robinson, performance; reduced disruptive or aggressive behavior; 1979; S. Scott, Spender, Doolan, Jacobs, & Aspland, 2001) simple acknowledgements reduced DSM-IV symptoms Reinforcement Peer-to-peer written A pad or display of decorative notes are Examples: social competence, academic (Cabello & Terrell, 1994; Embry, Flannery, Vazsonyi, Powell, & Atha, 1996; praise--“Tootle” Notes, posted on a wall, read aloud, or placed in a Kernel compliments books/ photo type album in which behaviors achievement, work performance, violence, Farber & Mayer, 1972; Heap & Emerson, 1989; Mayer, Butterworth, Nafpaktitis, & Sulzer-Azaroff, 1983; Mayer, Mitchell, Clementi, Clement- aggression, physical health, vandalism Robertson, & et al., 1993; Skinner, Cashwell, & Skinner, 2000) praise notes receive written praise from peers Tokens or symbolic rewards for positive behavior result in random rewards from Academic achievement, disruptive behavior, (Thorpe, Darch, & Drecktrah, 1978; Thorpe, Principal Lottery status person (e.g., principal, authority aggression Drecktrah, & Darch, 1979) figures) such as positive phone calls home Happens AFTER Safety or Tokens or reward tickets given out for Safety behaviors, accident reduction, (Geller, Johnson, & Pelton, 1982; Putnam, Handler, Ramirez- Performance observed safety or performance behavior, Platt, & Luiselli, 2003; Roberts & Fanurik, 1986; Saari & the behavior Lottery which are entered into lottery improved sales or work performance Latham, 1982) Music is played or stopped in real time, Increased weight gain of babies, improved baby (Allen & Bryant, 1985; Barmann & Croyle-Barmann, 1980; Barmann, Croyle-Barmann, & McLain, 1980; Bellamy & Sontag, 1973; Blumenfeld & Eisenfeld, 2006; Cevasco & Grant, 2005; Cook & Freethy, 1973; development possibly, work performance, academic Contingent music Cotter, 1971; W. B. Davis, Wieseler, & Hanzel, 1980; Dellatan, 2003; Deutsch, Parks, & Aylesworth, 1976; based on observed behavior of the achievement, attention and focus (ADHD symptoms Eisenstein, 1974; Harding & Ballard, 1982; Hill, Brantner, & Spreat, 1989; Holloway, 1980; Hume & Crossman, 1992; Jorgenson, 1974; Larson & Ayllon, 1990; Madsen, 1982; McCarty, McElfresh, Rice, & individual or group. down); reduced aggression Wilson, 1978; McLaughlin & Helm, 1993; Standley, 1996, 1999; Wilson, 1976; D. E. Wolfe, 1982) Improved academic engagement and achievement, (Beersma, et al., 2003; Hoigaard, S?fvenbom, & Soft Team Groups compete on some task, reduced disruptive behavior, increased sales, increased funding raising, increased safety; reduced Tonnessen, 2006; Kivlighan & Granger, 2006; Koffman, competition performance, or game. smoking; changed brain chemistry favoring attention Lee, Hopp, & Emont, 1998; Neave & Wolfson, 2003; and endurance Tingstrom, Sterling-Turner, & Wilczynski, 2006) Peer-to-peer Increased academic achievement; reduced (Allsopp, 1997; Delquadri, Greenwood, Stretton, & Hall, 1983; Dyad or triad take turns asking questions, ADHD and conduct problems; long-term DuPaul, Ervin, Hook, & McGoey, 1998; Fantuzzo & Ginsburg-Block, tutoring give praise or points and corrective effects on school engagement; decreased 1998; Greenwood, 1991a, 1991b; Maheady, Harper, & Sacca, feedback 1988; Maheady, Sacca, & Harper, 1988; Sideridis, et al., 1997) special education needs.
    14. 14. Omega 3 kernel 30% Physiological Percentage with Psychosis at 12 months Kernel 27.5% 24% 18% Changes 12% biochemistry of behavior 6% 4.9% 0% Omega-3 Placeo Psychosis Amminger, G. P., M. R. Schafer, et al. (2010). "Long-Chain {omega}-3 Fatty Acids for Indicated Prevention of Psychotic Disorders: A Randomized, Placebo-Controlled Trial." Arch Gen Psychiatry 67(2): 146-154.
    15. 15. Reduced
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    16. 16. Consilience Issues (pardon a digression) Parsimony or Occams’ Razor: "Pluralitas non est ponenda sine neccesitate" or "plurality should not be posited without necessity." The words are those of the medieval English philosopher and Franciscan monk William of Ockham (ca. 1285-1349). Links to meta theories versus depending on mezzo-theories—e.g., “selection by consequences that embraces evolution, neural plasticity, and principles of reinforcement.”
    17. 17. Apparent consumption o inoleic acid (% of dietary energy) among Australia, Canada, UK and USA for the years 1961–2000 #" +651.-:8- A-0-;- BC BD+2 +,,-./012340567,1840 492:804:/83 -38; $ & ' <=2/0/.>?@ ( % * ) ! # " #$(" #$(% #$'" #$'% #$&" #$&% #$$" #$$% !""" “Risky” Beh. Evolution Neonates Breast Milk & Mismatch In the Rife Valley, the Successful human American infants have human brain evolution neonates born with been getting steadily less Theory the result of eating fish 60-day supply of omega-3 (n3) and more Almost all adolescent pro-inflammatory risky behaviors have now high in omega-3 not omega-3 in omega-6 (n6) in breast been documented to be savannah animals subcutaneous fat from milk related to low n3 and mother’s diet high n6 in US diet See Broadhurst, Cunnane, & See HIbbeln et al. (2007).Maternal seafood change in last 50 years Crawford (1998). Rift Valley lake fish See Ailhaud et al. (2006).Temporal changes consumption in pregnancy and in dietary fats: Role of n6 and shellfish provided brain-specific neurodevelopmental outcomes in childhood Hibbeln et al. (2006). Healthy intakes of n-3 polyunsaturated fatty acids in excessive nutrition for (ALSPAC study): an observational cohort adipose tissue and n-6 fatty acids: estimations considering early Homo study worldwide diversity. development and relationship to obesity
    18. 18. Text Text Text Text Text Text Text Text
    19. 19. Kernel Description Behaviors Affected References Pleasant greeting with Affects donations; social status an Friendly physical and verbal perceptions of safety or harm; affects (Edwards & Johnston, 1977; Ferguson, 1976; T. Field, 1999; Fry, or without positive 1987; Howard, 1990; la Greca & Santogrossi, 1980; Schloss, gestures, on a frequent basis. behavior streams of aggression, hostility or Schloss, & Harris, 1984) physical touch politeness Physiological (Diego, et al., 2002; T. Field, N. Grizzle, et al., 1996; T. Field, Kilmer, Massage, Any method of rubbing, stroking Reduces aggression, arousal, cortisol, Kernel brushing or and therapeutic touch applied to depressive symptoms, PTSD Hernandez-Reif, & Burman, 1996; T. Field, Seligman, Scafidi, & Schanberg, 1996; T. M. Field, 1998; T. M. Field, Grizzle, Scafidi, & Schanberg, 1996; Jones, Field, & Davalos, 1998; Scafidi & Field, stroking the body symptoms, and pain 1996) Using a turtle metaphor, child holds self, Turtle verbal frame, breaths through nose, and Reduces arousal and aggression (Heffner, Greco, & Eifert, 2003; Robin, engage in sub-verbal or verbal self- against peers or adults Schneider, & Dolnick, 1976) Technique coaching, with peer or adult reinforcement Changes “Rough and Tumble” Several times per week child or adolescent Reduces aggression, teaches self-control, may improve status among same-sex peers; changes c-fos gene expression in (Boulton & Smith, 1989; Gordon, Kollack-Walker, Akil, & engages in rough and tumble play, causing Panksepp, 2002; Hines & Kaufman, 1994; Jacklin, DiPietro, & biochemistry of Free Play with higher status conspecific increased arousal and self-control mediated laboratory animals; the behavior may be especially important to the development of positive behavior among boys and unique Maccoby, 1984; Paquette, 2004; Pellegrini & Smith, 1998; by status adult or peer contribution of fathering Reed & Brown, 2001; E. Scott & Panksepp, 2003) behavior (Antunes, Stella, Santos, Bueno, & de Mello, 2005; Atlantis, Chow, Kirby, & Singh, 2004; Aerobic play Daily or many times per week child or adult Reduces ADHD symptoms, reduces depression; engage running or similar aerobic solitary reduces stress hormones; may increase cognitive Berlin, Kop, & Deuster, 2006; Blue, 1979; Blumenthal, et al., 2005; Crews, Lochbaum, & Landers, 2004; Doyne, Chambless, & Beutler, 1983; Dunn, Trivedi, Kampert, Clark, & Chambliss, 2005; Dunn, Trivedi, & O'Neal, 2001; Dustman & et al., 1984; Khatri, et al., 2001; or behavior activities, game, or food gathering behavior function; decreases PTSD Kubesch, et al., 2003; Manger & Motta, 2005; Marin & Menza, 2005; Phillips, Kiernan, & King, 2003; M. B. Stein, 2005; Stella, et al., 2005) Progressive Person tenses and relaxes sequence of Reduces panic, fear, anxiety; decreases negative (Larsson, Carlsson, Fichtel, & Melin, 2005; Norlander, Mo?s, muscles in combination with anxiety attributions; decreases phobic responses with & Archer, 2005; Pawlow & Jones, 2005; Wencai, Xinhu, Kele, muscle relaxation evoking stimulus paired with evoking stimuli & Yiyuan, 2005) Zinc Evolving evidence shows that the addition of zinc (Akhondzadeh, Mohammadi, & Khademi, 2004; Arnold, et al., 15 mg per day eaten or to the diet or by supplementation increases the 2005; Arnold & DiSilvestro, 2005; Bilici, et al., 2004; McGee, supplementation or effectiveness of drug treatment and/or may Williams, Anderson, McKenzie-Parnell, & Silva, 1990; dietary consumption supplemented prevent ADHD symptoms. Sandyk, 1990)
    20. 20. Motivational (values expression) kernel A Simple Gift Example: My Values1 Relational Please provide responses to questions about your ideas, your beliefs, and your life. Please bear in mind that, Frame there are no right or wrong answers. There are just answers important to you. Please circle the 1st, 2nd and 3rd most important value from this list Kernel Athletic ability 1 2 3 Being good at art 1 2 3 Being smart or getting good grades 1 2 3 Creativity 1 2 3 Independence 1 2 3 Living in the moment 1 2 3 Membership in a social group (such as your community, racial group or club) 1 2 3 Music 1 2 3 Creates verbal Politics Relationships with friends or family 1 1 2 2 3 3 relations for the Religious values Sense of humor 1 1 2 2 3 3 behavior Please look at the values you picked as most important to you, and to think about times when these values were important to you. Please describe in a few sentences why the selected values are important to you. Focus on your thoughts and feelings, and don’t worry about spelling, grammar, or how well written it is. Please list the top two reasons why the values you selected are important to you: Reason #1: Cohen, G. L., J. Garcia, et al. (2009). "Recursive Processes in Self-Affirmation: Intervening to Close the Minority Achievement Gap." Science 324(5925): 400-403.
    21. 21. Motivational (values expression) kernel A Simple Gift Example: My Values1 Relational Please provide responses to questions about your ideas, your beliefs, and your life. Please bear in mind that, Frame there are no right or wrong answers. There are just answers important to you. Please circle the 1st, 2nd and 3rd most important value from this list Kernel Athletic ability 1 2 3 Being good at art 1 2 3 Being smart or getting good grades 1 2 3 Creativity 1 2 3 Independence 1 2 3 Living in the moment 1 2 3 Membership in a social group (such as your community, racial group or club) 1 2 3 Music 1 2 3 Creates verbal Politics Relationships with friends or family 1 1 2 2 3 3 relations for the Religious values Sense of humor 1 1 2 2 3 3 behavior Please look at the values you picked as most important to you, and to think about times when these values were important to you. Please describe in a few sentences why the selected values are important to you. Focus on your thoughts and feelings, and don’t worry about spelling, grammar, or how well written it is. Please list the top two reasons why the values you selected are important to you: Reason #1: Cohen, G. L., J. Garcia, et al. (2009). "Recursive Processes in Self-Affirmation: Intervening to Close the Minority Achievement Gap." Science 324(5925): 400-403.
    22. 22. Motivational (values expression) kernel A Simple Gift Example: My Values1 Relational Please provide responses to questions about your ideas, your beliefs, and your life. Please bear in mind that, Frame there are no right or wrong answers. There are just answers important to you. Please circle the 1st, 2nd and 3rd most important value from this list Kernel Athletic ability 1 2 3 Being good at art 1 2 3 Being smart or getting good grades 1 2 3 Creativity 1 2 3 Independence 1 2 3 Living in the moment 1 2 3 Membership in a social group (such as your community, racial group or club) 1 2 3 Music 1 2 3 Creates verbal Politics Relationships with friends or family 1 1 2 2 3 3 relations for the Religious values Sense of humor 1 1 2 2 3 3 behavior Please look at the values you picked as most important to you, and to think about times when these values were important to you. Please describe in a few sentences why the selected values are important to you. Focus on your thoughts and feelings, and don’t worry about spelling, grammar, or how well written it is. Please list the top two reasons why the values you selected are important to you: Reason #1: Cohen, G. L., J. Garcia, et al. (2009). "Recursive Processes in Self-Affirmation: Intervening to Close the Minority Achievement Gap." Science 324(5925): 400-403.
    23. 23. Motivational (values expression) kernel A Simple Gift Example: My Values1 Relational Please provide responses to questions about your ideas, your beliefs, and your life. Please bear in mind that, Frame there are no right or wrong answers. There are just answers important to you. Please circle the 1st, 2nd and 3rd most important value from this list Kernel Athletic ability 1 2 3 Being good at art 1 2 3 Being smart or getting good grades 1 2 3 Creativity 1 2 3 Independence 1 2 3 Living in the moment 1 2 3 Membership in a social group (such as your community, racial group or club) 1 2 3 Music 1 2 3 Creates verbal Politics Relationships with friends or family 1 1 2 2 3 3 relations for the Religious values Sense of humor 1 1 2 2 3 3 behavior Please look at the values you picked as most important to you, and to think about times when these values were important to you. Please describe in a few sentences why the selected values are important to you. Focus on your thoughts and feelings, and don’t worry about spelling, grammar, or how well written it is. Please list the top two reasons why the values you selected are important to you: Reason #1: Cohen, G. L., J. Garcia, et al. (2009). "Recursive Processes in Self-Affirmation: Intervening to Close the Minority Achievement Gap." Science 324(5925): 400-403.
    24. 24. Kernel Description Behaviors Affected References Increased rule governed behavior; (Choenarom, Williams, & Hagerty, 2005; Adjectival Noun for Verbal phrase “I am/we _____” is paired increases behavior associated with the Relational Belonging to Status with status, belonging, protection or named group; decreases aggression Embry, et al., 1996; Gaskell & Smith, Group safety Frame within group; may affect physical health 1986; Ju?rez, 2002; Mishima, 2003) Kernel Public Individuals sign or pledge self to Voting, contributing money, collective behavior (Burns & Oskamp, 1986) Commitment recycling, Individuals or groups are divided into Increase aggression and (Roos, 2005; Sherif, 1958, 1968, 1970; “US” and “THEM” two groups, with differences highlighted Creates verbal framed around clothing, adornment, violence by each group toward Sherif, Hogg, & Abrams, 2001; Sherif, Role Framing language, social position, etc. each other White, & Harvey, 1955) relations for the (Collier, Czuchry, Dansereau, & Pitre, 2001; Czuchry & Dansereau, 1996, 1999, 2003; behavior Graphic/ node A graphic organizer for goal-based Increased sobriety and goal Czuchry, Dansereau, Dees, & Simpson, 1995; Dansereau, Dees, Greener, & Simpson, 1995; Dansereau, Joe, & Simpson, 1993; Dees, Dansereau, & Simpson, 1994; Joe, Dansereau, maps behavior, guided by other status completion; increased treatment Pitre, & Simpson, 1997; Joe, Dansereau, & Simpson, 1994; Melville, Davis, Matzenbacher, & Clayborne, 2004; Newbern, Dansereau, Czuchry, & Simpson, 2005; Newbern, Dansereau, & individuals compliance Pitre, 1999; Pitre, Dansereau, & Joe, 1996; Pitre, Dansereau, Newbern, & Simpson, 1998; Pitre, Dansereau, & Simpson, 1997) Verbal questioning by status individual Reduction in substance abuse, increase in social (Bernstein, et al., 2005; Burke, Arkowitz, & Motivational around major goals of target person, competences and related goals; reduction in Menchola, 2003; Resnicow, et al., 2001; Rusch & Interviewing with clarifying questions about injuries or antisocial behaviors; increase in Corrigan, 2002; D. K. Smith, 2004; Sobell, et al., interferring behaviors. healthy behaviors (Monti, et al., 1999) 2003; L. A. R. Stein, et al., 2006) Media associating Reduces sexually transmitted (Beyth-Marom, Austin, Fischhoff, Palmgren, & et Media (TV, video, radio) showing behavior with al., 1993; Downs, et al., 2004; Pechmann, 2001; “immediate” negative behavior results in social rejection or diseases; reduces alcohol, Pechmann & Ratneshwar, 1994; Pechmann, escape from social rejection social outcomes tobacco and other drug use Zhao, Goldberg, & Reibling, 2003)
    25. 25. !"##$#%&'()*+&,-./012!/3&0/4415-6&72!&/33& & !"#$%&'(&)*"+,$%&!"#$%&-.&/%01%$&234$435&.-0&6%$%73%89&:1847"3%8&"18&214;%0<"$& =0%;%134-1& );48%17%>?"<%8& 6%$%73%8& :1847"3%8& 214;%0<"$& /%01%$& Treatment =0%;%134-1& Intervention =0%;%134-1& Prevention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
    26. 26. What is a behavioral 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. Behavioral vaccines can be used by individuals, families, schools, businesses, organizations to produce rapid population level change. Embry, D. D. (2004). "Community-Based Prevention Using Simple, Low-Cost, Evidence-Based Kernels and Behavior Vaccines." Journal of Community Psychology 32(5): 575.
    27. 27. “Behavioral health could learn from public health in endorsing a population health perspective”—(IOM, page 19). “Families and children have ready access to the best available evidence-based prevention interventions, delivered in their own communities…in a respectful non-stigmatizing The story of the Broad Street water pump during way”—(IOM, page 387). the cholera epidemic in London.
    28. 28. What is a public-health approach? Potential harm is universal, Personal or Group Risk is Common, Stigmatizing Persons or Groups At Risk Reduces Prevention Results, and/or More Cost Efficient to Reach All Above “Case Finding.”
    29. 29. Community reinforcement case study
    30. 30. PeaceBuilders School-Community Reinforcement Study Positive Peer-to-Peer Social Home Notes Notes Competence Violence
    31. 31. Injury Prevention Study Using Positive Reinforcement Change in Nurses’ Office Visits from Year to Year Control/Wait List Intervention Krug, E. G., N. D. Brener, et al. (1997). "The impact of an elementary school-based violence prevention program on visits to the school nurse." American Journal of Preventive Medicine 13(6): 459-463.
    32. 32. Injury Prevention Study Using Positive Reinforcement 60% 50% Change in Nurses’ 40% Office Visits from 30% Year to Year 20% 10% 0% -10% -20% All Visits Injury Viists Non-Injuries Fighting Injuries Non-Fighting Injuries Control/Wait List Intervention Krug, E. G., N. D. Brener, et al. (1997). "The impact of an elementary school-based violence prevention program on visits to the school nurse." American Journal of Preventive Medicine 13(6): 459-463.
    33. 33. Injury Prevention Study Using Positive Reinforcement 60% 50% Change in Nurses’ 40% Office Visits from 30% Year to Year 20% 10% 0% -10% -20% All Visits Injury Viists Non-Injuries Fighting Injuries Non-Fighting Injuries Control/Wait List Intervention Krug, E. G., N. D. Brener, et al. (1997). "The impact of an elementary school-based violence prevention program on visits to the school nurse." American Journal of Preventive Medicine 13(6): 459-463.
    34. 34. Injury Prevention Study Using Positive Reinforcement 60% 50% Change in Nurses’ 40% Office Visits from 30% Year to Year 20% 10% 0% -10% -20% All Visits Injury Viists Non-Injuries Fighting Injuries Non-Fighting Injuries Control/Wait List Intervention Krug, E. G., N. D. Brener, et al. (1997). "The impact of an elementary school-based violence prevention program on visits to the school nurse." American Journal of Preventive Medicine 13(6): 459-463.
    35. 35. Reward & Reminder case study on tobacco
    36. 36. Reward & Reminder: Logic model
    37. 37. Baseline After Reward and Reminder 60% Wyoming Percentage of Illegal or Non-Compliant Tobacco Sales to Minors 50% 40% Reward & 30% 20% Reminder Impact 10% on Access 0% 60% 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Wisconsin 50% 40% 30% 20% 10% 0% 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Data Source: Synar Report, SAMSA
    38. 38. Reward & Reminder: Impact on prevalence Source: Youth Risk Behavior Survey (YRBS), Centers for Disease Control
    39. 39. Reward & Reminder: Impact on prevalence Source: Youth Risk Behavior Survey (YRBS), Centers for Disease Control
    40. 40. Good Behavior Game Case Study
    41. 41. Why not turn about the lives of high risk primary grade children using a teacher invented procedure? Muriel Saunders, the teacher
    42. 42. Her invention immediately increases time to learn
    43. 43. Why not turn about the lives of high risk primary grade children using a teacher invented procedure?
    44. 44. Safe Playing Case Study
    45. 45. A environmental policy case study in reducing early rebelliousness, risk taking and sensation seeking This risk factor can be easily measured in early-childhood, and it predicts lifetime injuries, delinquency, alcohol/drug abuse abuse, and school difficulties.
    46. 46. Contextual example of such risk
    47. 47. Oh,prior prevention efforts in Sweden had resulted in more fatalities…
    48. 48. Safe Playing Self-Modeling Books
    49. 49. Safe Playing Boundary Lines
    50. 50. Safe Playing Beat the Timer
    51. 51. Safe Playing Verbal Praise/Stickers
    52. 52. Safe Playing Sit and Watch Sit and Watch
    53. 53. Conduct small single subject studies first to test tools Use the first studies to identify sources of variation
    54. 54. Prevention Store Prevention Science Meets Retail Consumers
    55. 55. From Kernels to Public Health Ecological assessments in high, medium and Randomized or interrupted time-series studies low settings at population level Early interrupted time series designs to identify Opportunity for many studies here in Manitoba. potential active ingredients. Middle combined interrupted time series that look for adverse effects Testing mechanisms that increase participation Small randomized or cross over studies, run as “mini-effectiveness” trials
    56. 56. Calculating RE-AIM for population-level change (PC) RE-AIM MATH REACH = Total population being targeted (see IMPLEMENTATION = The percent of persons/ Reach, Efficacy, census data) entities who actually adopted kernel who Adoption, actually use it (needs to be at least 40% to Implementation, & EFFICACY = The effect size difference produced 60%). Maintenance by the kernel or collection of kernels. MAINTENANCE = This is the percent of people ADOPTION = The percent of reach actually or settings who keep doing the kernel over choose to use the kernel or collection of time. kernels (must be above 20%-25% to achieve population-level change. Change = R * E * A * I * M for more info, visit www.re-aim.org
    57. 57. Reach Reach is the absolute number, proportion Representativeness refers to whether participants (percent), and representativeness of individuals have characteristics that reflect the target who participate in a given strategy. population's characteristics. If the intent is to increase physical activity in sedentary people between the ages of 35 and 70, you wouldn't test your program on triathletes or toddlers.
    58. 58. Reach Reach is the absolute number, proportion Representativeness refers to whether participants (percent), and representativeness of individuals have characteristics that reflect the target who participate in a given strategy. population's characteristics. 0% to 100%—higher number, leverages more result If the intent is to increase physical activity in sedentary people between the ages of 35 and 70, you wouldn't test your program on triathletes or toddlers.
    59. 59. Efficacy Efficacy/Effectiveness is the impact of a strategy on produce the change if used—from none to hig important outcomes. This includes potential negative potent. effects, quality of life, and costs or increase in positive outcomes. Think of this of this measured ability to Be mindful that all strategies have negative effects that subtract from the good effects.
    60. 60. Efficacy Efficacy/Effectiveness is the impact of a strategy on produce the change if used—from none to hig important outcomes. This includes potential negative potent. effects, quality of life, and costs or increase in positive outcomes. Think of this of this measured ability to Higher efficacy X more reach = more leverage Be mindful that all strategies have negative effects that subtract from the good effects.
    61. 61. Adoption Adoption is the absolute number, proportion, and settings who must adopt the strategy to achie representativeness of people, settings and/or staff results. who are willing to offer a strategy. Notice there can be multiple levels of people or
    62. 62. Adoption Adoption is the absolute number, proportion, and settings who must adopt the strategy to achie representativeness of people, settings and/or staff results. who are willing to offer a strategy. Notice there can be multiple levels of people or Hi efficacy X large reach X many adoptions = more leverage
    63. 63. Implementation Implementation, at a setting level (home, clinic, consistency of delivery as intended and the time office, business, etc), refers to how closely the user and cost of the program. or agents (e.g., staff members) follow the strategy that is recommended or proven. This includes
    64. 64. Implementation Implementation, at a setting level (home, clinic, consistency of delivery as intended and the time office, business, etc), refers to how closely the user and cost of the program. or agents (e.g., staff members) follow the strategy that is recommended or proven. This includes (efficacy X reach X adoptions) X robust implementation = Hi leverage
    65. 65. Maintenance Maintenance is the extent to which a strategy, At the individual level, maintenance is the long- program or policy becomes routine or stable term effects on outcomes after 6 or more months organizationally. after adoption and implementation.
    66. 66. Dennis Embry dde@paxis.org www.slideshare.net/drdennisembry

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