New Hampshire Keynote on Prevention for Whole County 11 10-11
 

New Hampshire Keynote on Prevention for Whole County 11 10-11

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Cheshire County, NH, seeks to be the healthiest county in America by 2020. The County is off to a roaring start: it has statistical snapshots and research briefs. Now the summit is about moving into ...

Cheshire County, NH, seeks to be the healthiest county in America by 2020. The County is off to a roaring start: it has statistical snapshots and research briefs. Now the summit is about moving into high-gear to influence the behavior of 77,000 people from birth to 100 to meet the challenge.

How will the organizers and advocates do this with due hast and cost-efficiency in terms of people power, money and time?

How will the organizers and advocates make increased wellness and reduced morbidity and mortality happen across all the categories —from healthy weights, to mental illness, to cancer, to unintentional or intentional injuries, to addictions, to self harm, and heart disease?

This talk lays out real answers from somebody who has done large scale prevention trials with success, with diverse problems.

First, people will learn to tackle the problems not so much by topic (i.e., each separate issue), but by tackling the underlying common threads that hold and cause multiple problems. When you cut the common thread, you have impact across many domains. This is called a multi-problem or syndemic approach, and participates will learn from examples how to apply this to real-world issues from the Research Briefs.

Second, people need to use powerful yet low cost tools to influence those 77,000 to make changes in their behavior—with enough people to tip the balance of change. We cannot do therapy with every citizen to achieve the change; we need a public health model that empowers each citizen—young or old—to act not just for themselves but also in ways that help the health and wellbeing futures of many others. Again, the talk and related activities will illustrate how such behavior change and mobilization can be done using the same basic toolkit over and over, with examples.

Third, the whole community needs a way to be invested in ALL OUR FUTURES, not just self. Why? Because, the aggregate success actually reduces the “behavioral contagion” causing many of these problems. And, health equals wealth, both an individual and community level. This part of the presentation gives examples and illustrations that can help create the healthiest county not just for 2020—but also for decades to come

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  • There are now studies showing that grades and behavior improve in school when children and teens increase their daily intake of omega-3 brain food. \n\nIn a randomized study on Durham school district in the England, children got omega-3 or placebo. During the first 3 months the average gain for children taking fatty acids was 9.5 months for reading and 6.5 months for spelling. Yes, this was very statistically significant. Notice the improvement in writing skills, as an example of change.\n\nLater the children who got the placebo received omega-3, and their results then improved.\n\n\n
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  • Here are relevant studies, most of which are available from PAXIS Institute or at www.pubmed.gov\n\nBradshaw, C. P., J. H. Zmuda, et al. (2009). "Longitudinal Impact of Two Universal Preventive Interventions in First Grade on Educational Outcomes in High School." Journal of Educational Psychology 101(4): 926-937.\n\nWilcox, H. C., S. Kellam, et al. (2008). "The impact of two universal randomized first- and second-grade classroom interventions on young adult suicide ideation and attempts." Drug & Alcohol Dependence 95(Suppl 1): 60-73\n\nPoduska, J. M., S. G. Kellam, et al. (2008). "Impact of the Good Behavior Game, a universal classroom-based behavior intervention, on young adult service use for problems with emotions, behavior, or drugs or alcohol." Drug and Alcohol Dependence 95(Suppl1): S29-S44.\n\nPetras, H., S. Kellam, et al. (2008). "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 95(Suppl 1): 45-59.\n\nMiller, T. R. and D. Hendrie (2008). Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis. C. f. S. A. Prevention.\n\nKellam, S., C. H. Brown, et al. (2008). "Effects of a universal classroom behavior management program in first and second grades on young adult behavioral, psychiatric, and social outcomes,." Drug & Alcohol Dependence(Special Issue): 24.\n\nvan Lier, P. A. C., B. O. Muthen, et al. (2004). "Preventing Disruptive Behavior in Elementary Schoolchildren: Impact of a Universal Classroom-Based Intervention." Journal of Consulting & Clinical Psychology 72(3): 467-478.\n\nFurr-Holden, C. D., N. S. Ialongo, et al. (2004). "Developmentally inspired drug prevention: middle school outcomes in a school-based randomized prevention trial." Drug & Alcohol Dependence 73(2): 149-158.\n\nIalongo, N., J. Poduska, et al. (2001). "The distal impact of two first-grade preventive interventions on conduct problems and disorder in early adolescence." Journal of Emotional & Behavioral Disorders 9(3): 146-160.\n\nIalongo, N. S., L. Werthamer, et al. (1999). "Proximal impact of two first-grade preventive interventions on the early risk behaviors for later substance abuse, depression, and antisocial behavior." American Journal of Community Psychology 27(5): 599-641.\n
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  • MISSION: READINESS\nIn a study being released Thursday Nov 5, 2009 in Washington, Education Secretary Arne Duncan and a group of retired military officers led by former Army Gen. Wesley Clark will sound the alarm bells and call young Americans’ relative lack of overall fitness for military duty a national security threat. The group, Mission: Readiness, will release a report that draws on Pentagon data showing that 75 percent of the nation’s 17- to 24-year-olds are ineligible for service for a variety of reasons.\n\nPut another way, only 4.7 million of the 31.2 million 17- to 24-year-olds in a 2007 survey are eligible to enlist, according to a periodic survey commissioned by the Pentagon. This group includes those who have scored in the top four categories on the Armed Forces Qualification Test, or AQFT; eligible college graduates; and qualified college students.\n\nAccording to the Pentagon, the ineligible population breaks down this way:\n\n•Medical/physical problems, 35 percent.\n•Illegal drug use, 18 percent.\n•Mental Category V (the lowest 10 percent of the population), 9 percent.\n•Too many dependents under age 18, 6 percent.\n•Criminal record, 5 percent.\n
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New Hampshire Keynote on Prevention for Whole County 11 10-11 New Hampshire Keynote on Prevention for Whole County 11 10-11 Presentation Transcript

  • Creating Our Futures:How we can better thehealth of our communityand ourselvesby Dennis D. Embry, Ph.D.Vision 2020 Community SummitKeene, NH • November 10, 2011
  • How fast do we need to go?
  • Public-health kernel case studies of change
  • 30.0% 12.0% 25.0% 10.0% 20.0% 8.0% 15.0% Youth Who Smoked During the Last 30 Days 6.0% Youth Who Smoked Every Day the Last 30 Days Youth Who Smoked During the Last 30 Days Baseline Youth Who Smoked Every Day the Last 30 Days Baseline Reward and Reminder Reward and Reminder 45.0% Baseline Reward and Reminder 18.0% Baseline Reward and Reminder 10.0% 45.0% Wyoming 4.0% 18.0% Wyoming 40.0% Wyoming 16.0% Wyoming 40.0% 16.0% 5.0% 35.0% 2.0% 14.0% 35.0% 14.0% 30.0% 12.0% 0.0% 30.0% 12.0% 25.0% 10.0% 25.0% 18.0% 10.0% 20.0% 8.0% 20.0% United States 8.0% United States 40.0% 15.0% 15.0% 16.0% 6.0% 6.0% 10.0% 4.0% 10.0% 4.0% 35.0% 5.0% 14.0% 2.0% 5.0% 2.0% 0.0% 30.0%0.0% 12.0% 18.0% 18.0% Wisconsin Wisconsin Wisconsin 40.0% Wisconsin 16.0% 25.0% 40.0% 10.0% 16.0% 35.0% 35.0% 14.0% 14.0% 20.0% 30.0% 30.0% 8.0% 12.0% 12.0% 25.0% 25.0% 10.0% 10.0% 15.0% 6.0% 20.0% 20.0% 8.0% 8.0% 10.0% 15.0% 15.0% 4.0% 6.0% 6.0% 10.0% 10.0% 4.0% 4.0% 5.0%5.0% 5.0% 2.0% 2.0% 2.0% Source: YRBS, US Centers for Disease Control Source: YRBS, US Centers for Disease Control 0.0% 0.0% 0.0% 0.0% 18.0% 1995 1997 1999 2001 2003 2005 2007 1995 1997 1999 2001 2003 2005 2007 = Trend = Wyoming = Wisconsin =United States Population level example of use of kernels for big changeEmbry, 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.
  • 30.0% 12.0% 25.0% 10.0% 20.0% 8.0% 15.0% Youth Who Smoked During the Last 30 Days 6.0% Youth Who Smoked Every Day the Last 30 Days Youth Who Smoked During the Last 30 Days Baseline Youth Who Smoked Every Day the Last 30 Days Baseline Reward and Reminder Reward and Reminder 45.0% Baseline Reward and Reminder 18.0% Baseline Reward and Reminder 10.0% 45.0% Wyoming 4.0% 18.0% Wyoming 40.0% Wyoming 16.0% Wyoming 40.0% 16.0% 5.0% 35.0% 2.0% 14.0% 35.0% 14.0% 30.0% 12.0% 0.0% 30.0% 12.0% 25.0% 10.0% 25.0% 18.0% 10.0% 20.0% 8.0% 20.0% United States 8.0% United States 40.0% 15.0% 15.0% 16.0% 6.0% 6.0% 10.0% 4.0% 10.0% 4.0% 35.0% 5.0% 14.0% 2.0% 5.0% 2.0% 0.0% 30.0%0.0% 12.0% 18.0% 18.0% Wisconsin Wisconsin Wisconsin 40.0% Wisconsin 16.0% 25.0% 40.0% 10.0% 16.0% 35.0% 35.0% 14.0% 14.0% 20.0% 30.0% 30.0% 8.0% 12.0% 12.0% 25.0% 25.0% 10.0% 10.0% 15.0% 6.0% 20.0% 20.0% 8.0% 8.0% 10.0% 15.0% 15.0% 4.0% 6.0% 6.0% 10.0% 10.0% 4.0% 4.0% 5.0%5.0% 5.0% 2.0% 2.0% 2.0% Source: YRBS, US Centers for Disease Control Source: YRBS, US Centers for Disease Control 0.0% 0.0% 0.0% 0.0% 18.0% 1995 1997 1999 2001 2003 2005 2007 1995 1997 1999 2001 2003 2005 2007 = Trend = Wyoming = Wisconsin =United States Population level example of use of kernels for big changeEmbry, 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.
  • 30.0% 12.0% 25.0% 10.0% 20.0% 8.0% 15.0% Youth Who Smoked During the Last 30 Days 6.0% Youth Who Smoked Every Day the Last 30 Days Youth Who Smoked During the Last 30 Days Baseline Youth Who Smoked Every Day the Last 30 Days Baseline Reward and Reminder Reward and Reminder 45.0% Baseline Reward and Reminder 18.0% Baseline Reward and Reminder 10.0% 45.0% Wyoming 4.0% 18.0% Wyoming 40.0% Wyoming 16.0% Wyoming 40.0% 16.0% 5.0% 35.0% 2.0% 14.0% 35.0% 14.0% 30.0% 12.0% 0.0% 30.0% 12.0% 25.0% 10.0% 25.0% 18.0% 10.0% 20.0% 8.0% 20.0% United States 8.0% United States 40.0% 15.0% 15.0% 16.0% 6.0% 6.0% 10.0% 4.0% 10.0% 4.0% 35.0% 5.0% 14.0% 2.0% 5.0% 2.0% 0.0% 30.0%0.0% 12.0% 18.0% 18.0% Wisconsin Wisconsin Wisconsin 40.0% Wisconsin 16.0% 25.0% 40.0% 10.0% 16.0% 35.0% 35.0% 14.0% 14.0% 20.0% 30.0% 30.0% 8.0% 12.0% 12.0% 25.0% 25.0% 10.0% 10.0% 15.0% 6.0% 20.0% 20.0% 8.0% 8.0% 10.0% 15.0% 15.0% 4.0% 6.0% 6.0% 10.0% 10.0% 4.0% 4.0% 5.0%5.0% 5.0% 2.0% 2.0% 2.0% Source: YRBS, US Centers for Disease Control Source: YRBS, US Centers for Disease Control 0.0% 0.0% 0.0% 0.0% 18.0% 1995 1997 1999 2001 2003 2005 2007 1995 1997 1999 2001 2003 2005 2007 = Trend = Wyoming = Wisconsin =United States Population level example of use of kernels for big changeEmbry, 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.
  • 30.0% 12.0% 25.0% 10.0% 20.0% 8.0% 15.0% Youth Who Smoked During the Last 30 Days 6.0% Youth Who Smoked Every Day the Last 30 Days Youth Who Smoked During the Last 30 Days Baseline Youth Who Smoked Every Day the Last 30 Days Baseline Reward and Reminder Reward and Reminder 45.0% Baseline Reward and Reminder 18.0% Baseline Reward and Reminder 10.0% 45.0% Wyoming 4.0% 18.0% Wyoming 40.0% Wyoming 16.0% Wyoming 40.0% 16.0% 5.0% 35.0% 2.0% 14.0% 35.0% 14.0% 30.0% 12.0% 0.0% 30.0% 12.0% 25.0% 10.0% 25.0% 18.0% 10.0% 20.0% 8.0% 20.0% United States 8.0% United States 40.0% 15.0% 15.0% 16.0% 6.0% 6.0% 10.0% 4.0% 10.0% 4.0% 35.0% 5.0% 14.0% 2.0% 5.0% 2.0% 0.0% 30.0%0.0% 12.0% 18.0% 18.0% Wisconsin Wisconsin Wisconsin 40.0% Wisconsin 16.0% 25.0% 40.0% 10.0% 16.0% 35.0% 35.0% 14.0% 14.0% 20.0% 30.0% 30.0% 8.0% 12.0% 12.0% 25.0% 25.0% 10.0% 10.0% 15.0% 6.0% 20.0% 20.0% 8.0% 8.0% 10.0% 15.0% 15.0% 4.0% 6.0% 6.0% 10.0% 10.0% 4.0% 4.0% 5.0%5.0% 5.0% 2.0% 2.0% 2.0% Source: YRBS, US Centers for Disease Control Source: YRBS, US Centers for Disease Control 0.0% 0.0% 0.0% 0.0% 18.0% 1995 1997 1999 2001 2003 2005 2007 1995 1997 1999 2001 2003 2005 2007 = Trend = Wyoming = Wisconsin =United States Population level example of use of kernels for big changeEmbry, 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.
  • B e h a v i o r a l Vac c i n e s an dEvidence-Based Kernels:NonpharmaceuticalA p p ro a c h e s f o r th eP re v e n t i o n o f M e n t a l ,Emotional, andB e h a v i o r a l D i s o rd e r sDennis D. Embry, PhD KEYWORDS  Evidence-based kernels  Behavioral vaccines  Prevention  Public health Available at: www.slideshare.net/drdennisembry
  • Clin Child Fam Psychol Rev DOI 10.1007/s10567-008-0036-x Evidence-based Kernels: Fundamental Units of Behavioral Influence Basic understanding of kernels Embry, D. D. and A. Biglan (2008). "Evidence-Based Kernels: Dennis D. Embry Æ Anthony Biglan Fundamental Units of Behavioral Influence." Clinical Child & Family Psychology Review 11(3): 75-113. Ó The Author(s) 2008. This article is published with open access at Springerlink.com Abstract This paper describes evidence-based kernels, This paper presents an analysis of fundamental units of fundamental units of behavioral influence that appear to behavioral influence that underlie effective prevention and underlie effective prevention and treatment for children, treatment. We call these units kernels. They have two adults, and families. A kernel is a behavior–influence defining features. First, in experimental analysis, procedure shown through experimental analysis to affect a researchers have found them to have a reliable effect on Using kernels for population change A R T I C L E COMMUNITY-BASED PREVENTION USING SIMPLE, LOW-COST, EVIDENCE-BASED Embry, D. D. (2004). "Community-Based Prevention Using Simple, KERNELS AND BEHAVIOR VACCINES Low-Cost, Evidence-Based Kernels and Behavior Vaccines." Dennis D. Embry PAXIS Institute Journal of Community Psychology 32(5): 575. A paradox exists in community prevention of violence and drugs. GoodC 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 andidate Behavioral vaccines for disease controlas a U niversal B ehavioral V accineD ennis D . E mbry1 Embry, D. D. (2002). "The Good Behavior Game: A Best Practice A “ behavioral vaccine” provides an inoculation against morbidity or mortality, impactingphys- Candidate as a Universal Behavioral Vaccine." Clinical Child & Family Psychology Review 5(4): 273-297. ical, mental, or behavior disorders. A n historical example of a behavioral vaccine is antiseptic hand washing to reduce childbed fever. I n current society, issues with high levels of morbidity, LY 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 investigations N suggest that a possibility might exist for a behavioral vaccine for multiproblem behavior. A O simple 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 consider its use as a behavioral vaccine. T he G B G is not a curriculum but rather a simple behavioral
  • 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.
  • Relational Antecedent Reinforcement Physiological Frame Kernel Kernel Kernel Kernel Changes Creates verbalHappens BEFORE Happens AFTER the biochemistry of relations for the the behavior behavior behavior behavior Embry, D. D., & Biglan, A. (2008). Evidence-BasedFour Types of Kernels Kernels: Fundamental Units of Behavioral Influence. Clinical Child & Family Psychology Review, 39.
  • Kernels are buildingblocks of behavior change Humans survive individually and collectively by influencing the behavior or other humans The 2008 paper by Embry and Biglan identifies 52 evidence based kernels that can be used to design or or improve programs.
  • What is a behavioral vaccine?It is a simple procedure (a kernel or arecipe of kernels) that, when usedrepeatedly, reduce morbidity and mortalityand/or increase wellbeing or health.Behavioral vaccines can be used byindividuals, families, schools, businesses,organizations to produce rapid populationlevel 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.
  • Increase nurturance of prosociality for persons of all ages This can be individual, family, school and/or community action Reduce toxic influences of all ages This can be at an individual, family, school and/or community level Increase psychological flexibility among people of all ages This can be achieved across settings, as the above.From Biglan, Flay, Embry, and Sandler. Nurturing Environments and the Next Generation of Prevention Research and Practice
  • Trend-line for humorous warnings on binge drinking by women of child-rearing age No Warnings Humorous WarningsAntecedent Kernel
  • Trend-line for humorous warnings on binge drinking by women of child-rearing age No Warnings Humorous Warnings 20Antecedent Kernel 16 Percentage 12 8 4 0 1995 1997 1999 2001 2002 2003 2004 2005 2006 2007
  • Trend-line for humorous warnings on binge drinking by women of child-rearing age No Warnings Humorous Warnings 20Antecedent Kernel 16 Percentage 12 8 4 0 1995 1997 1999 2001 2002 2003 2004 2005 2006 2007
  • Trend-line for humorous warnings on binge drinking by women of child-rearing age No Warnings Humorous Warnings 20Antecedent Kernel 16 Percentage 12 8 4 0 1995 1997 1999 2001 2002 2003 2004 2005 2006 2007
  • Population level effort to prevent childmaltreatment - in two years
  • Substantiated Child Maltreatment 16 Rates per 1,000 Children (0-8 Years) 15 13 12 10 Pre Post Two Years Later Prinz et al., 2009, Prevention Science
  • Substantiated Child Maltreatment 16 Control Counties Rates per 1,000 Children (0-8 Years) 15 13 12 10 Pre Post Two Years Later Prinz et al., 2009, Prevention Science
  • Substantiated Child Maltreatment 16 Control Counties Rates per 1,000 Children (0-8 Years) 15 13 Triple P Counties 12 10 Pre Post Two Years Later Prinz et al., 2009, Prevention Science
  • Child Abuse Hospital Injuries 1.80Rates per 1,000 Children (0-8 Years) 1.68 1.55 1.43 1.30 Post Pre Two Years Later Prinz et al., 2009, Prevention Science
  • Child Abuse Hospital Injuries 1.80Rates per 1,000 Children (0-8 Years) 1.68 Control Counties 1.55 1.43 1.30 Post Pre Two Years Later Prinz et al., 2009, Prevention Science
  • Child Abuse Hospital Injuries 1.80Rates per 1,000 Children (0-8 Years) 1.68 Control Counties 1.55 1.43 Triple P Counties 1.30 Post Pre Two Years Later Prinz et al., 2009, Prevention Science
  • Child Out-of-Home Placements 4.50Rates per 1,000 Children (0-8 Years) 4.13 3.75 3.38 3.00 Post Pre Two Years Later Prinz et al., 2009, Prevention Science
  • Child Out-of-Home Placements Control Counties 4.50Rates per 1,000 Children (0-8 Years) 4.13 3.75 3.38 3.00 Post Pre Two Years Later Prinz et al., 2009, Prevention Science
  • Child Out-of-Home Placements Control Counties 4.50Rates per 1,000 Children (0-8 Years) 4.13 3.75 Triple P Counties 3.38 3.00 Post Pre Two Years Later Prinz et al., 2009, Prevention Science
  • Grandmothers’ wisdom
  • Reduce Omega 3 Brain Deficiency in baby’s brain
  • Reduce Omega 3 Brain Deficiency in baby’s brain
  • The benefits to the baby and society Verbal Suboptimal Prosocial Suboptimal A 35 C 15 children suboptimum (%) 30 children suboptimum (%) Verbal IQ 10 25 Prosocial 20 5 15 n=584 n=3493 n=1330 n=739 n=4260 n=1583 0 0 B 35 Fine Motor Skills Suboptimal D 35 Social Development Suboptimal 30 30 children suboptimum (%) children suboptimum (%) Social development Fine motor 25 25 20 20 15 15 n=875 n=4923 n=1798 n=875 n=4919 n=1798 0 0 None 0–340 g >340 g None 0–340 g >340 g per week per week per week per week Maternal seafood consumption in pregnancy Maternal seafood consumption in pregnancy
  • Before Omega 3 Omega-3 can improve school grades and success Omega 3 Placebo 7 These were gains in 6After Omega 3 academics after 3 5 months of exposure 4 to fish oil. 3 2 1 0 -1 -2 Reading Spelling See www.durhamtrial.org/
  • Why not help our high-riskchildren & youth withomega-3? 30% Percentage with Psychosis at 12 months 27.5% 24% 18% 12% 6% 4.9% 0% Omega-3 Placeo PsychosisAmminger, G. P., M. R. Schafer, et al. (2010). "Long-Chain {omega}-3 Fatty Acids for IndicatedPrevention of Psychotic Disorders: A Randomized, Placebo-Controlled Trial." Arch GenPsychiatry 67(2): 146-154.
  • Reduced Felony Violent Offences Among Prisonerswith recommended daily amounts of vitamins, minerals and essential fatty acids Ratio of Disciplinary Incidents Supplementation/Baseline 1.00 Active -37.0% Placebo -10.1% 0.75 p ‹ 0.005 p = ns 0.50 Active 0.25 Placebo 0 Before supplementation During supplementation UK maximum security prison - 338 offences among 172 prisoners over 9 months treatment in a compared to 9 months baseline. Gesch et al. Br J Psychiatry 2002, 181:22-28
  • Matsuoka BioPsychoSocial Medicine 2011, 5:3 http://www.bpsmedicine.com/content/5/1/3 REVIEW Open Access Clearance of fear memory from the hippocampus through neurogenesis by omega-3 fatty acids: a novel preventive strategy for posttraumatic stress disorder? Yutaka Matsuoka1,2 Abstract Not only has accidental injury been shown to account for a significant health burden on all populations, regardless of age, sex and geographic region, but patients with accidental injury frequently present with the psychiatric condition of posttraumatic stress disorder (PTSD). Prevention of accident-related PTSD thus represents a potentially Clearance of fear memory from the hippocampus important goal. Physicians in the field of psychosomatic medicine and critical care medicine have the opportunity through neurogenesis by omega-3 fatty acids: a novel to see injured patients in the immediate aftermath of an accident. This article first briefly reviews the prevalence preventive strategy for posttraumatic stress disorder? and associated factors of accident-related PTSD, then focuses on a conceptual model of fear memory and Matsuoka proposes a new, rationally hypothesized translational preventive intervention for PTSD through promoting hippocampal neurogenesis by omega-3 fatty acid supplementation. The results of an open-label pilot trial of Matsuoka BioPsychoSocial Medicine 2011, 5:3 http://www.bpsmedicine.com/content/5/1/3 (8 February 2011) injured patients admitted to the intensive care unit suggest that omega-3 fatty acid supplementation immediately after accidental injury can reduce subsequent PTSD symptoms.Omega-3 for PTSD symptoms could help ourreturning vets from 10 years of war…
  • ClassroomsMuriel Saunders
  • Instant change in disturbing or disruptive behaviours
  • PAX GBG decreased distraction in classrooms by an average of 86% after only one month2011 Replication in rural Tennessee by coaches trained just like you…
  • PAX GBG decreased distraction in classrooms by an average of 86% after only one month 2011 Replication in rural Tennessee by coaches trained just like you…Baseline DisruptionsSix 1st-grade classroomsaveraged 136 per hour beforecoaching
  • PAX GBG decreased distraction in classrooms by an average of 86% after only one month 2011 Replication in rural Tennessee by coaches trained just like you…Baseline DisruptionsSix 1st-grade classroomsaveraged 136 per hour beforecoachingPAX IntroducedThe distractions per hourdecreased by 56% with theintroduction of the PAXenvironment of PAX languageand several PAX kernels.
  • PAX GBG decreased distraction in classrooms by an average of 86% after only one month 2011 Replication in rural Tennessee by coaches trained just like you…Baseline DisruptionsSix 1st-grade classroomsaveraged 136 per hour beforecoachingPAX IntroducedThe distractions per hourdecreased by 56% with theintroduction of the PAXenvironment of PAX languageand several PAX kernels.PAX GBG PlayedDisruptions per hourdecreased an additional 30%after learning to play PAXGBG .
  • Timeline of benefits from PAX GBGAge of BenefitsChild 75% reduction in disturbing, disruptive and destructive behavior;1st Grade 25% increase academic achievement; less bullying and intimidation 43% reduction in ADHD diagnoses; 33% reduction in Oppositional Defiant Disorder;3rd Grade 30%+ reduction special services needs; 50%+ reduction in conduct disorders; 25% to 50% reduction tobacco use; reduction in6th grade bullying or harassment behaviors8th Grade 75%r reduction in serious drug use and engagement in delinquent acts12th Grade Major increase in high-school graduation; lower utilization of special servicesEarly 20’s Increase in college entry; Major reductions drug use; reductions in prison timeAge 29 Lifetime reduction in violent crime, suicide, psychiatric diagnoses, and lifetime addictions
  • Kellam et al., Addiction Science & Clinical Practice; 6:73-84, 2011
  • GBG delaysvaginal sex bytwo yearsamong high-risk males
  • Would happen if every first grader in Keene had the Good Behavior Game? Good Behavior Game Universal Behavioral Net Economic Number of Vaccine Cost Benefit for All 1st ($150 each Taxpayers & the Graders child X 282) Children 282 = $42,360 = $4,054,699 (Total Cost of (Total Benefit of Lifetime Prevention) Lifetime Prevention)Source: Washington State Institute for Public Policy (July, 2011),Return on Investment:Evidence-Based Options to Improve Statewide Outcomes
  • "Prevention for Planner for Population Level Change everyone…" Using Evidence-Based Kernels* 1. Total number of people (ages) 2. How will your plan get at least Who might to be reached in the 25% of the reached population sponsor the Start population (www.census.gov): to adopt the kernel? 2b. effort? Baseline This is the number to be reached. Data 3. What are the ways actual implementation of the kernel will be promoted, reinforced and supported: What is the monitoring for % adoption? 2c. What is the monitoring for 3b. implementation? 4. How will individuals, groups and organizations use of the kernel be maintained over time? 5. 6. How will changes in behavior be measured each day, week or How will change be celebrated? month and reported as a public scoreboard?* Embry DD. Community-Based Prevention Using Simple, Low-Cost, Evidence-Based Kernels and Behavior Vaccines. Journal of Community Psychology 2004;32(5):575. Embry DD, Biglan A. Evidence-Based Kernels: Funda uence. Prevention Science revised and re-submitted.
  • Authors personal copy Behavioral Vaccines and Evidence-Based Kernels 11From Embry DD, Biglan A. Evidence-Based Kernels: Fundamental Units of Behavioral Influence. Clinical Child & Family Psychology Review. Accepted for publication. Table 1Table 2: Example Kernel Utility Across Age Groups Example of kernel utility for selected, indicated, and universal preventionLegend: NA = not applicable, * = experimental evidence, P = predicted utility Evidence-Based Infants Children Teens AdultsVerbal Praise * * * * Kernel Selected Prevention Indicated Prevention Universal PreventionPeer-to-peer written praise--“Tootle” Notes, NA * * * Prize bowl/mystery Reduce alcohol, Reduce problem Improve engagedcompliments books/ praise notesBeat the timer or beat the buzzer * * * * motivator tobacco or drug behavior in high- learning of wholeMystery motivators/ Grab Bag/ Prize Bowl/ Game P * * * (reinforcement use161,163,164 risk children or class and reduceof Life kernel) Improve engagement youth222–224 disruptions ofPublic posting (graphing) of feedback of a NA * * *targeted behavior in treatment whole class225–227Principal Lottery NA * * goals169,170Safety or Performance Lottery NA * * *Contingent music * * * * Goal/node mapping Reduce relapse or Prevent use rates of Increase academicTeam competition NA * * * (relational frame recidivism alcohol, tobacco, success or cognitiveSpecial Play * *Choral responding * * P P kernel) rates228,229 and other processes233–236Mystery shopper/Reward & Reminder NA P P Improve recovery230 drugs228,231Peer-to-peer tutoring NA * * * Improve attainmentComputer action game P * * *Correspondence training, “Say-Do” NA * * P of therapeuticCorrespondence training, “Do-Say” NA * * P goals231,232Time out * *Sit and Watch, Contingent Observation or * * * * Omega-3 fatty acid Treat depression, Prevent emergence of Improve children’sResponse Lock Out supplementation borderline and/or psychotic episodes cognitiveTaxation on consumptive behaviors NA NA * *Positive Note Home for Inhibition NA * * (physiological bipolar disorder70 in prodromal performance andTimed Rewards for Inhibition (DRO) * * * * kernel) Reduce autism adolescents47 prevent behavioralPremack Principle * * * * symptoms71,142 disorders69,237–239Response-cost (point loss) P * * *Low emotion or “Private” reprimands * * * * Public posting Reduce community Improve problematic Reduce impulsive orStop Clock NA * * * (antecedent illegal behavior in risky behaviors inLaw enforcement fine or citation NA NA * *Over-correction or Positive Practice * * * * kernel) behaviors100,101,120 therapeutic general“Buzzer/Noise Training” P * * settings240,241 population242,243Non-verbal transition cues * * * * ImprovedStop lights in school settings or traffic settings NA * * *Boundary cues and railings * * * * academics244–246Cooperative, Structured peer play P * * PromotingSelf-modeling P * * * participation orSelf-monitoring NA * * *Paragraph Shrinking NA * * P communityErrorless Discrimination Training * * * * goods247,248Adjectival Noun for Belonging to Status Group P * * * 1 POLICY ACTIONS The IOM Reportpp388–92 notes that other rich countries are far more advanced in applying prevention science, with the irony that most of the research for these efforts comes from the United States, and is even true for northern neighbors Canada. For example, the
  • Multi-Inflammatory Brain & Body ResponseMajor Connected Ecologic Causes of the Adverse Trends to Children, Youth and Adults Reinforcement Antecedents Physiological Verbal Relationsmore for anti-social cue anti-social influences trigger occasion perceived than prosocial more than prosocial adverse biological threats and related behaviors behaviors mechanisms reactions
  • Mood Lo Reward Lo Executive Lo Behavioral Inattention Delay Function Instability Competencies Poor Immune- Motor Healing Skills Multi-Inflammatory Brain & Body Response DysfunctionMajor Connected Ecologic Causes of the Adverse Trends to Children, Youth and Adults Reinforcement Antecedents Physiological Verbal Relationsmore for anti-social cue anti-social influences trigger occasion perceived than prosocial more than prosocial adverse biological threats and related behaviors behaviors mechanisms reactions
  • Substance Work Obesity, Early Mental Illness Violence Cancer School Abuse Problems etc Sex Failure Mood Lo Reward Lo Executive Lo Behavioral Inattention Delay Function Instability Competencies Poor Immune-STD’s Motor Healing Special Skills Multi-Inflammatory Brain & Body Response Dysfunction Ed Major Connected Ecologic Causes of the Adverse Trends to Children, Youth and Adults Reinforcement Antecedents Physiological Verbal Relations more for anti-social cue anti-social influences trigger occasion perceived than prosocial more than prosocial adverse biological threats and related behaviors behaviors mechanisms reactions
  • Our Own Children’s or Loved-ones’ Futures
  • Our Own Children’s and Loved-ones’ Futures ADHD stealing aggression asthma depression learning disabilities obesity cancer depression hi-blood pressure heart-disease violence bipolar suicide diabetes alcohol crime drugs tobacco dangerous acts
  • Lifetime Prevalence of Disorders in US Adolescents (N=10,123)Merikangas et al., 2010 40% 35% 30% 25% 20% 15% 10% 5% 0% 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Age in Years
  • Lifetime Prevalence of Disorders in US Adolescents (N=10,123)Merikangas et al., 2010 40% 35% Anxiety 30% 25% 20% 15% 10% 5% 0% 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Age in Years
  • Lifetime Prevalence of Disorders in US Adolescents (N=10,123)Merikangas et al., 2010 40% 35% Anxiety 30% 25% Behavior 20% 15% 10% 5% 0% 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Age in Years
  • Lifetime Prevalence of Disorders in US Adolescents (N=10,123)Merikangas et al., 2010 40% 35% Anxiety 30% 25% Behavior 20% Mood 15% 10% 5% 0% 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Age in Years
  • Lifetime Prevalence of Disorders in US Adolescents (N=10,123)Merikangas et al., 2010 40% 35% Anxiety 30% 25% Substance Behavior 20% Mood 15% 10% 5% 0% 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Age in Years
  • Depression by Jobs
  • Nearly 3 out of 4 of the nations 17- to 24-year-olds areineligible for military service for based on nationalepidemiological data • 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
  • Cumulative prevalence of psychiatric disorders byyoung adulthood: a prospective cohort analysis fromthe Great Smoky Mountains Study.By 21 years of age, 61.1% ofparticipants had met criteria for a well-specified psychiatric disorder. Anadditional 21.4% had met criteria for anot otherwise specified disorder only,increasing the total cumulativeprevalence for any disorder to 82.5%.
  • The US has 75million childrenand teens.40.4 million areon psychotropicmedications Wall Street Journal, 12-28-2010
  • If we just hit theproblem harder…
  • Policy Action and Lessons from Manitoba
  • Manitoba is using new word prompt generalizationof behaviors to support healthy children & adults…
  • We need to spread health & wellbeing like dandelions
  • How come we are just hearing about this now…
  • How come we are just hearing about this now…
  • My perspective Full disclosure as a prevention scientist and advocate Born premature, exposed Parents hospitalized for Gay man in to alcohol & tobacco and diagnosed mental illness and 20-year relationshipDescendent of a freed slaves educably mentally retarded die of addictions
  • Thank you,Dennis D. Embry, Ph.D.dde@paxis.orgph: 520-299-6770www.paxis.orgwww.slideshare.net/drdennisembry