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Kernels for-life-manitoba-2010

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Healthy Child Manitoba (HCM) is unique in the Western Hemisphere, as the only provincial or state level strategy for the comprehensive support and prevention of children's issues from prenatal through …

Healthy Child Manitoba (HCM) is unique in the Western Hemisphere, as the only provincial or state level strategy for the comprehensive support and prevention of children's issues from prenatal through young adulthood. All data are linked, with care for confidentiality, so that the impact of provincial initiatives can be evaluated. Dr. Embry was a keynote speaker outlining what might happen in the next decade of Healthy Child Manitoba.

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  • 1. Kernels for Life: from what we know about prevention science and human development to what we do for children and youth for our futures… Twitter hashtag: #HCMMB Slides and publications http://www.slideshare.net/drdennisembry Copyright © 2010, PAXIS Institute, All rights reserved. May be reproduced in whole without charge, provided copyright notice included. Thursday, November 18, 2010 1
  • 2. Thursday, November 18, 2010 2
  • 3. We must move in the right direction, with all due speed for the next decade—not just for the children of Manitoba, but also as the Inukshuk for the Western Hemisphere. Thursday, November 18, 2010 3
  • 4. Thursday, November 18, 2010 4
  • 5. Thursday, November 18, 2010 5
  • 6. Thursday, November 18, 2010 6
  • 7. 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 Thursday, November 18, 2010 7
  • 8. 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. Thursday, November 18, 2010 8
  • 9. 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 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. Thursday, November 18, 2010 9
  • 10. Rapid Thursday, November 18, 2010 10
  • 11. Community Prenatal Ages 0-2 Ages 3-5 Text Text Text Text Primary Intermediate Early Teens Later Teens Thursday, November 18, 2010 11
  • 12. Your take away task for communities and families… List five ideas you can take back to your community or even your own family Explain the benefits of how these five things Ask others to try one or more of these thing Ask them use their social and electronic networks to spread these ideas For the benefit of all children and families in Manitoba Thursday, November 18, 2010 12
  • 13. Epigensis revisited Fraser Mustard’s talk Thursday, November 18, 2010 13
  • 14. Obesity Conduct Disorders Homicide & Suicide Early Sex Early Pregnancy Addictions Aggression Disease School failure Epigensis results in a risky path or a healthy path Thursday, November 18, 2010 14
  • 15. Thursday, November 18, 2010 15
  • 16. 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 Hypothesis: Evolutionary “inflammatory” processes Thursday, November 18, 2010 16
  • 17. Threat from parasites, Threat from humans bacteria, and viruses who might kill or steal Thursday, November 18, 2010 17
  • 18. Thursday, November 18, 2010 18
  • 19. Human Infectious/Biological Threats Human Predatory Threats Evolutionary Adaptive Responses Evolutionary Adaptive Responses (Simplified) (Simplified) Neuro-Hormones Mood Modulators Reward Delay Intra-Group Threat Attributional Generalized Localized Modulators Affiliation Bias (Inflammatory) Inflammatory Inflammatory (Anti-Inflammatory) Out-Group Response Response Stress Modulators Aggress. (Inflammatory) Intra-Group Cooperation Tit-for-Tat Beh. Bias Anti-Inflammatory Regulators Puberty/Sex (Anti-Inflammatory) Modulators (Inflammatory) Thursday, November 18, 2010 19
  • 20. Substance Work Obesity, Early Mental Illness Violence Cancer School Abuse Problems etc Sex Failure Mood Reward Executive Behavioral Attention Stability Delay Function Competencies Immune- STD’s Motor Healing Special Skills Multi-Inflammatory Threat Reaction Functions Ed Major Ecologic Causes of the Dual Inflammatory Threats to Children & Youth Physiological Antecedents Reinforcement Verbal Relations Thursday, November 18, 2010 20
  • 21. K R Path Path Evolutionary Path of a Child’s Life Probability of short-life and doubtful Probability of long-life and reproductive success reproductive success Thursday, November 18, 2010 21
  • 22. Obesity Conduct Disorders Homicide & Suicide Early Sex Early Pregnancy Addictions Aggression Disease School Disabilities failure R PATH = Risky behaviors or health Thursday, November 18, 2010 22
  • 23. Physically and Successful in emotionally life-long healthy learning Safe and Socially engaged secure Healthy Child and responsible Manitoba Thursday, November 18, 2010 23
  • 24. Community Prenatal Ages 0-2 Ages 3-5 Text Text Text Text Primary Intermediate Early Teens Later Teens Thursday, November 18, 2010 24
  • 25. Coaster and Poster case study for women Thursday, November 18, 2010 25
  • 26. Do these effect epigensis? Thursday, November 18, 2010 26
  • 27. Antecedent Kernel Happens BEFORE the behavior Thursday, November 18, 2010 27
  • 28. Antecedent Kernel Happens BEFORE the behavior Thursday, November 18, 2010 28
  • 29. Addictions intervention or treatment kernels Thursday, November 18, 2010 29
  • 30. Antecedent Kernel “Wait for the Timer” for addictions and other issues Thursday, November 18, 2010 30
  • 31. Reinforcement Kernel “Prize Bowl” for change, recovery & addictions Thursday, November 18, 2010 31
  • 32. Reward & Reminder case study on tobacco Thursday, November 18, 2010 32
  • 33. Thursday, November 18, 2010 33
  • 34. Thursday, November 18, 2010 34
  • 35. Reward & Reminder: Logic model Thursday, November 18, 2010 35
  • 36. Baseline After Reward and Reminder 60% Wyoming Percentage of Illegal or Non-Compliant Tobacco Sales to Minors 50% 40% Reward & 30% Reminder Impact 20% 10% on Access 0% 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 60% Wisconsin 50% 40% 30% 20% 10% 0% 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Data Source: Synar Report, SAMSA Thursday, November 18, 2010 36
  • 37. Reward & Reminder: Impact on prevalence Source: Youth Risk Behavior Survey (YRBS), Centers for Disease Control Thursday, November 18, 2010 37
  • 38. The Lancet case study on fish consumption Thursday, November 18, 2010 38
  • 39. Thursday, November 18, 2010 39
  • 40. 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 Theory the result of eating 60-day supply of less omega-3 (n3) and Almost all adolescent fish high in omega-3 omega-3 in more pro-inflammatory risky behaviors have omega-6 (n6) in breast now been documented not savannah animals subcutaneous fat from milk to be related to low n3 mother’s diet and high n6 in US diet See Broadhurst, Cunnane, & Crawford (1998). Rift Valley lake fish See HIbbeln et al. (2007).Maternal seafood consumption in pregnancy and See Ailhaud et al. (2006).Temporal change in last 50 years changes in dietary fats: Role of n6 and shellfish provided brain-specific neurodevelopmental outcomes in Hibbeln et al. (2006). Healthy intakes of polyunsaturated fatty acids in excessive nutrition for childhood (ALSPAC study): an adipose tissue n-3 and n-6 fatty acids: estimations early Homo observational cohort study considering worldwide diversity. development and relationship to obesity Thursday, November 18, 2010 40
  • 41. Low maternal omega-3 consumption from seafood and 34 Physiological 32 Kernel 30 Percentage of children with low verbal IQ, WISC-III , 8y 28 Hibbeln et al, Lancet 2007: 369: 578-585 UK 26 r = 0.97 24 r2 = 0.95 F=27.2 22 p<0.02. 20 Changes 18 biochemistry of 16 behavior 14 0 0.05 0.10 0.15 0.20 0.25 0.30 0.35 0.40 0.45 0.50 0.55 0.60 - Estimated omega 3 fatty acids from seafood (en %) Mother at 32 wk gestation Thursday, November 18, 2010 41
  • 42. Physiological Mother Mother concordant Kernel concordant exceeds Changes biochemistry of behavior Mother concordant Mother concordant exceeds exceeds Thursday, November 18, 2010 42
  • 43. Omega-3 for all pregnant mothers, nursing mothers and weaned infants and toddlers Thursday, November 18, 2010 43
  • 44. The cost? About $40 per year Thursday, November 18, 2010 44
  • 45. Why not help our serious at- risk children with omega-3? 30% Percentage with Psychosis at 12 months 27.5% 24% 18% 12% 6% 4.9% 0% Omega-3 Placeo Psychosis Amminger, G. P., M. R. Schafer, et al. (2010). "Long-Chain {omega}-3 Fatty Acids for Indicated Prevention of Psychotic Disorders: A Randomized, Placebo-Controlled Trial." Arch Gen Psychiatry 67(2): 146-154. Thursday, November 18, 2010 45
  • 46. Before Omega 3 Omega-3 can improve school grades and success Omega 3 Placebo 7 These were gains in 6 After Omega 3 academics after 3 5 months of 4 exposure to fish oil. 3 2 1 0 -1 -2 Reading Spelling See www.durhamtrial.org/ Thursday, November 18, 2010 46
  • 47. The British and Netherlands Prison Studies Thursday, November 18, 2010 47
  • 48. Thursday, November 18, 2010 48
  • 49. Reduce Omega 3 and Micronutrient Brain Deficiency Thursday, November 18, 2010 49
  • 50. !"#$%"#&'"()*+&,-)("*.&/0"*%"1&23)*4&56-1)*"61& 7-.8&6"%)33"*#"#&#9-(+&93)$*.1&):&;-.93-*1<&3-*"69(1&9*#&"11"*=9(&:9>+&9%-#1 Ratio of Disciplinary Incidents Supplementation/Baseline 1.00 2%=;"&CDGKOQ 5(9%"J)&CFOKFQ 0.75 &B&R&OKOOS &B&T&*1 0.50 Active 0.25 Placebo 0 Before supplementation During supplementation ?@&39A-3$3&1"%$6-.+&B6-1)*&C&DDE&)0"*%"1&93)*4&FGH&B6-1)*"61&);"6&I&3)*.81&.6"9.3"*.&-*&9& %)3B96"#&.)&I&3)*.81&J91"(-*"K& L"1%8&".&9(K&&M6&N&51+%8-9.6+&HOOH<&FEFPHHCHE Thursday, November 18, 2010 50
  • 51. Why not reproduce the rapid results in Manitoba to get a 37% reduction in jail violence? It cost the Brits 19¢ per day or $69.35 per year. Thursday, November 18, 2010 51
  • 52. Safe Playing Case Study Thursday, November 18, 2010 52
  • 53. 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. Thursday, November 18, 2010 53
  • 54. Contextual example of such risk Thursday, November 18, 2010 54
  • 55. Oh,prior prevention efforts in Sweden had resulted in more fatalities… Thursday, November 18, 2010 55
  • 56. A book about “me” being a Safe Player Thursday, November 18, 2010 56
  • 57. Adults defining boundaries of safe play Thursday, November 18, 2010 57
  • 58. Adults setting timer to watch safe play in child Thursday, November 18, 2010 58
  • 59. Parent praising safe play with stickers Thursday, November 18, 2010 59
  • 60. Study 1 showed preschool intervention alone had short- term benefits Study 2 showed preschool plus parenting intervention had long-term benefits Study 3 showed strategy could be implemented in 35 Head Starts nationally Study 4 showed parents could change child’s behavior from special story workbook Study 5 showed behavior change for over 100 preschoolers, with no adverse effect. Study 6 showed effort could be successful in a 3-city multiple baseline in New Zealand Study 7 is national campaign, adopted by 50% of New Zealand families Study 8 replicates city results in US Thursday, November 18, 2010 60
  • 61. Kernels and 4-P’s used in multi-city/national Safe Playing campaign Proclamations in cities and nationally Endorsements/Sponsorships by prestige organizations AND businesses Media models of adoption by high-status people Media models showing rapid results/benefits Public posting of rates of adoption/use Competitions between cities on adoptions Placement in supermarket or other easy venues Price free after filling out Safe Playing Promise (with address, etc.) Promotion for every family who wants their child to be safe Product promises child will be safer in two weeks when steps followed Thursday, November 18, 2010 61
  • 62. 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. Thursday, November 18, 2010 62
  • 63. Good Behavior Game Case Study Thursday, November 18, 2010 63
  • 64. Why not turn about the lives of high risk primary grade children using a teacher invented procedure? Muriel Saunders, the teacher Thursday, November 18, 2010 64
  • 65. Her invention immediately increases time to learn Thursday, November 18, 2010 65
  • 66. Why not turn about the lives of high risk primary grade children using a teacher invented procedure? Thursday, November 18, 2010 66
  • 67. Thursday, November 18, 2010 67
  • 68. Community reinforcement case study Thursday, November 18, 2010 68
  • 69. PeaceBuilders School-Community Reinforcement Study Positive Peer-to-Peer Social Home Notes Notes Competence Violence Thursday, November 18, 2010 69
  • 70. Injury Prevention Study Using Positive Reinforcement 60% 50% Change in 40% Nurses’ Office Visits from Year to 30% 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. Thursday, November 18, 2010 70
  • 71. Prevention Store Prevention Science Meets Retail Consumers Dennis D. Embry, Ph.D., Society for Prevention Research, Denver, June, 2010 Thursday, November 18, 2010 71
  • 72. If kernels are so good… Thursday, November 18, 2010 72
  • 73. How have kernels evolved? The first (almost certainly antecedents) were selected by consequence for immediate reinforcement of food, protection, etc. Early tools come to mind as examples. The second (physiological) probably also arouse by selection by consequences by providing relief from physical or emotional distress. The third (relational frames) arouse with invention of oral and written language, selected by consequences to protect against danger from other humans or natural harm. The forth (contingent reinforcement) arouse with invention of oral and written language, selected by consequences for social advantage within groups and survival advantage of kin. Thursday, November 18, 2010 73
  • 74. Using kernels to build population-level change… Problem Kernel #1 Observed Proximal Observed Effect Kernel Proximal Kernel #2 Effect Kernel Big Kernel #3 Change Effect Observed Proximal Effect t Thursday, November 18, 2010 74
  • 75. Rule #1 of big change A big population-level change requires myriads of reliable, measurable small behavioral changes in at least 20% to 25% of the the total population. Blame is not a kernel. A diagnoses is not a kernel. “Shoulds” are not a kernel. Blame, diagnoses, and “shoulds” are personal or group ways of experiential avoidance for dealing with failure of the methods to create desired change. Thursday, November 18, 2010 75
  • 76. Rule #2 of big change Always maximize the dignity and self-sufficiency of the persons whose behavior you wish to influence. If you fail this step, you will be meet resistance, counter-control and sabotage of the group of persons to maintain their dignity and self-sufficiency. This is a basic feature of human social interactions from which our species has evolved. Dead, disposed or failed chiefs and leaders liter human history who failed to observe the key universal feature of human societies. Thursday, November 18, 2010 76
  • 77. Rule #3 of big change Pay attention to variations in behavior for improvement. Small differences—when done by many people— can make the difference between night and day. These small differences are the the variation in quality control that great car companies like Toyota or Honda to make incremental improvements. Look for innovations as well as problems. Thursday, November 18, 2010 77
  • 78. Rule # 4 Big Change with a kernel requires other kernels A kernel that you want to promote to affect a specific behavior will require other kernels to make the specific action happen. This because other behaviors or people will be required before and after or in other settings for cooperation to happen. Thursday, November 18, 2010 78
  • 79. Why not use a new word to convey our support every child being healthy in Manitoba Thursday, November 18, 2010 79
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  • 93. Spreading healthy children in Manitoba like dandelions Thursday, November 18, 2010 93
  • 94. is the gift of our futures Thursday, November 18, 2010 94
  • 95. Contact: Dr. Dennis D. Embry, PAXIS Institute, PO Box 31205, Tucson, AZ USA dde@paxis.org • www.paxis.org • www.slideshare.net/drdennisembry Thursday, November 18, 2010 95