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Washington State Educational Service District #113 had an exciting event in which virtually every level of community and government was present to learn how to apply evidence-based kernels and ...

Washington State Educational Service District #113 had an exciting event in which virtually every level of community and government was present to learn how to apply evidence-based kernels and behavioral vaccines across the board to achieve large benefits in reducing or preventing mental, emotional, behavioral, and related physical health problems. This even was the first to engage in helping Dr. Embry write a new book for chaining

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    New prevention for everyone washington state aug 2011 copy New prevention for everyone washington state aug 2011 copy Presentation Transcript

    • Prevention for Everyone Averting America’s epidemic of mental, emotional, mental and related behavioral disorders Dennis D. Embry, Ph.D. • President/Senior Scientist, PAXIS Institute Presentation for ESD #113, Tumwater, WA, August 11, 2011Friday, August 12, 11 1
    • Welcome introductions and housekeepingFriday, August 12, 11 2
    • What will we pack in our young people’s suitcases for their whole lives?Friday, August 12, 11 3
    • What bricks—heavy objects of pain, injury, illness, or problems —do you NOT want in young people’s suitcases for life?Friday, August 12, 11 4
    • Ask the suitcase questions of 30 people: some republicans, some democrats, some independents and some who are apolitical.Friday, August 12, 11 5
    • What do you want to happen and not happen for our elders?Friday, August 12, 11 6
    • Bi-directional Wealth and Wellbeing Transfer 5-Year 65-Year Olds OldsFriday, August 12, 11 7
    • Bi-directional Wealth and Wellbeing Transfer 5-Year 65-Year Olds Olds Who are living longer though get progressively sicker…Friday, August 12, 11 7
    • Bi-directional Wealth and Wellbeing Transfer Requiring more wealth transfer 5-Year 65-Year Olds Olds Who are living longer though get progressively sicker…Friday, August 12, 11 7
    • Bi-directional Wealth and Wellbeing Transfer Requiring more wealth transfer 5-Year 65-Year Olds Olds Who are living Who are less longer though get and less able… progressively sicker…Friday, August 12, 11 7
    • Bi-directional Wealth and Wellbeing Transfer Requiring more wealth transfer 5-Year 65-Year Olds But elders voting to stop funds to kids Olds Who are living Who are less longer though get and less able… progressively sicker…Friday, August 12, 11 7
    • Friday, August 12, 11 8
    • Our Own Children’s FutureFriday, August 12, 11 9
    • Our Own Children’s Future ADHD stealing aggression asthma depression learning disabilities obesity cancer bipolar depression hi-blood pressure heart-disease violence tobacco suicide diabetes alcohol crime drugs dangerous actsFriday, August 12, 11 10
    • Friday, August 12, 11 11
    • Washington State’s Future Children Children Children Ages 0-5 Ages 6-18 Ages 0-18 457,269 1,129,723 1,586,991Friday, August 12, 11 12
    • What happens if we pack every Washington state first grader’s life suitcase well? Universal Behavioral First Grad Vaccine Cost Net Economic Cohort X ($150 each) = Benefit for All 76,211 $11,431,718 $1,094,244,047Friday, August 12, 11 13
    • Why prevention for everyone? Shouldn’t we focus on the people at risk?Friday, August 12, 11 14
    • The nation faced a national epidemic of polio. Emergency wards were filled with iron lungs. Children died or crippled. The nation was terrified. Who should be given the vaccine? Only the frail or “at risk”? Or, all children?Friday, August 12, 11 15
    • The Epidemic Today? Mental, Emotional, Behavioral, and Related Physical IllnessesFriday, August 12, 11 16
    • The Epidemic Today? Mental, Emotional, Behavioral, and Related Physical Illnesses Do you know a middle class family with a child with a MEB?Friday, August 12, 11 16
    • 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 YearsFriday, August 12, 11 17
    • 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 YearsFriday, August 12, 11 17
    • 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 YearsFriday, August 12, 11 17
    • 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 YearsFriday, August 12, 11 17
    • 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 YearsFriday, August 12, 11 17
    • Youth MEB Prevalence Rate Comparison 4x 2x USA United Kingdom OECDFriday, August 12, 11 18
    • Depression by JobsFriday, August 12, 11 19
    • Nearly 3 out of 4 of the nations 17- to 24-year-olds are ineligible for military service for based on national epidemiological 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.pdFriday, August 12, 11 20
    • Cumulative prevalence of psychiatric disorders by young adulthood: a prospective cohort analysis from the Great Smoky Mountains Study. By 21 years of age, 61.1% of participants had met criteria for a well- specified psychiatric disorder. An additional 21.4% had met criteria for a not otherwise specified disorder only, increasing the total cumulative prevalence for any disorder to 82.5%.Friday, August 12, 11 21
    • The US has 75 million children and teens. 40.4 million are on psychotropic medications Wall Street Journal, 12-28-2010Friday, August 12, 11 22
    • Friday, August 12, 11 23
    • Why are these trends happening in Washington State and the United States?Friday, August 12, 11 23
    • What should the people Why are these trends happening Washington State do to protect all in Washington State and the of its children from the epidemic of United States? mental, emotional, behavioral and related physical disorders?Friday, August 12, 11 23
    • Major Ecologic Causes of the Dual Inflammatory Threats to Children & Youth Reinforcement Antecedents Physiological Verbal RelationsFriday, August 12, 11 24
    • Multi-Inflammatory Threat Reaction Major Ecologic Causes of the Dual Inflammatory Threats to Children & Youth Reinforcement Antecedents Physiological Verbal RelationsFriday, August 12, 11 24
    • Mood Reward Executive Behavioral Attention Stability Delay Function Competencies Immune- Motor Healing Skills Multi-Inflammatory Threat Reaction Functions Major Ecologic Causes of the Dual Inflammatory Threats to Children & Youth Reinforcement Antecedents Physiological Verbal RelationsFriday, August 12, 11 24
    • 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 Reinforcement Antecedents Physiological Verbal RelationsFriday, August 12, 11 24
    • Evolutionary Mismatch How have the changes in modern human ecology for which were were evolved and adapted affected Sleep Eating Mental health Problem behaviors Physical Health Sexual maturityFriday, August 12, 11 25
    • What are the social rewards for these behaviors? Billy Good Billy BadFriday, August 12, 11 26
    • What are the social rewards for these behaviors? Billy Good Billy BadFriday, August 12, 11 26
    • GGGCCGCCGCATTCGT-3 and 5 - AGGGA-3 ; 661-nt product; ref. 20) CGTACTGTGCGGCCTCAACGA-CTGCGTGATGT-3 ; 705-nt product r some amplifications of the VNTR, Fig. 3. Proposed o were used (2). The alternative primers sity. A simplified m repeat sequence e VNTR to minimize out-of-register with only major re indicated (Fig. 2). T ation. PCRs were conducted in 25- l 7R alleles are show minor 3R, 5R, and in gray along with f genomic DNA, 200 M dXTPs, 0.5 origins by unequa arrows). Large red buffer (Qiagen, Chatsworth, CA), 1 Text putative multistep lele. The adjacent p .625 units of Taq DNA polymerase S1), exon 1 (L2 S2) A-C) polymorphism s performed by using Perkin–Elmer strong linkage of polymorphisms wit c, 96°C hot start was used followed by is noted.nd 68°C for 1 min. After a 4-min chase Fig. 1. Diagrammatic representation of the human DRD4 gene region. Exon Standard methods of estimating coalescence time for these alleles are not applicable, given the repetitive nature of the region and high high fitness if almost everyone is meek but might r when very common, because aggressive individuae eliminated with 0.5 units of shrimp positions are indicated by blocks (yellow, noncoding; orange, coding). The recombination frequency. However, calculations of allele age based on the relatively high worldwide population frequency of the DRD4 penalties of frequent conflict. This type of freq selection might be expected to apply to many type Amersham Pharmacia), 0.1 unit of approximate positions of a 120-bp promoter region duplication (blue trian- 4R and 7R alleles suggest that these alleles are ancient ( 300,000 years old; refs. 25 and 26; see Methods). On the other hand, variation, including those associated with this part gle), an exon 1 12-bp duplication (blue triangle), an exon 3 VNTR (blue mitter receptor (4–9). ham Pharmacia), and 1 SAP buffer calculations of allele age based on the observed intraallelic vari- Alternative explanations to the proposed posit triangle), and two intron 3 SNPs are indicated. 2R–11R variants of the VNTR are ability (refs. 26 and 27; see Methods) suggest that the 7R allele is as recent random bottlenecks, population expan e SAP Exo I reaction was carried out 5–10-fold ‘‘younger’’ (30,000–50,000 years old). Such large discrep- ulation admixture (24) are less likely to account indicated below exon 3 (blue) along with their worldwide population fre- ancies between allele ages calculated by these two methods usually 15-min heat inactivation at 72°C. The quencies determined by PCR analysis (3, 17). are taken as evidence that selection has increased the frequency of results. Bottlenecks certainly have occurred duri tion and evolution (33–35) and undoubtedly ha the allele to higher levels than expected by random genetic drift reaction was used directly for DNA (26). The absolute values of these estimates are greatly affected by current worldwide DRD4 allele frequency. Num studies on other genes (24, 33, 35) have shown the assumptions used in their computations, for example the uals, the two allelic PCR products first assumed recombination frequency (26). We have used conservative Africa’’ constriction of allele diversity (and an incr occurred. In the present study, a greater diversit estimates of recombination frequency based on the average ob- rose gels. DNA cycle sequencing was majority of individuals were heterozygotes, and the two allelic PCR served for the terminal 20 megabases of 11p (31). Given the was found for African DRD4 4R alleles in co remainder of our population sample, which is co observed high recombination at this locus (Table 1 and Fig. 3), itniques using ABI 377 and 3700 auto- products could be separated by gel electrophoresis before sequenc- is likely that the actual age of the 7R allele is even younger, and out-of-Africa hypothesis (24). Although one the 7R allele frequency was increased by ch further LD analysis will refine these estimates. The important out-of-Africa expansion, this theory does not ex ing, providing unambiguous haplotypes. Altogether, we screened conclusion, however, is that regardless of the parameters assumed, the relative age differences for the 4R and 7R alleles calculated lack of diversity in African 7R alleles. The mo 7R(1-2-6-5-2-5-4)-A-C haplotype (Fig. 3) is fou over 450,000 bp of genomic DNA and 2,968 48-bp repeats. from intraallelic variability remains large, whereas their population comparable to those found worldwide ( 85%) ions. Ka Ks ratios were calculated by frequency suggests they are both ancient. imagine what type of bottleneck could produce In the 600 chromosomes sequenced, 56 different haplotypes The simplest hypothesis to account for (i) the observed bias in strong worldwide LD for a single allele (DRD4 7R . Putative recombinant haplotypes were found (Table 1). These haplotypes were composed of 35 nucleotide changes (Ka Ks), (ii) the unusual sequence organization of the DRD4 7R allele, and (iii) the strong LD surrounding this the remaining alleles. A model that is consistent results is the ‘‘weak Garden of Eden’’ hypothesispendent events. Allele age calcula- distinct 48-bp variant motifs (Fig. 2), 19 of which were reported allele is that the 7R allele arose as a rare mutational event (or events) that nevertheless increased to high frequency by positive DRD4 4R allele would be hypothesized to be an Friday, August 12, 11 selection. Advantageous alleles usually take a long time to reach a in indigenous populations, whereas the 7R 27 allele
    • Reinforcement Reinforcement Adult Behavior & for “Good” for “Bad” coercion the Matching In one hour of school, In one hour of school, Law how often do peers how often do peers How often might adults Example reinforce the “good” in reinforce the “bad” in in authority exert The probability of human behavioral choice Evolutionary school? school? perceived threats of “matches” this saturation Mismatch How often by adults How often by adults coercion in school, at formula in the classroom, at school? at school? home, or in the home and community, How often at home or How often at home or community in a single and Matching Law works day? community in a day? community in a day? for all vertebrate creaturesFriday, August 12, 11 28
    • What happens if you change the Matching Law (the Good Behavior Game) in a classroom?Friday, August 12, 11 29
    • CDC Nurses Office Study 60% 50% Percentage Change 40% 30% 20% 10% 0% -10% -20% All Visits Injury Viists Non-Injuries Fighting Non-Fighting Injuries Injuries Control/Wait List PeaceBuilders What happens if you teach students to praise each other for “peaceability”Friday, August 12, 11 30
    • DRI = Differential DRO = Differential Reinforcement of Reinforcement of Other Incompatible Behaviors BehaviorsFriday, August 12, 11 31
    • Molecular Psychiatry (2000) 5, 467–475  2000 Macmillan Publishers Ltd All rights reserved 1359-4184/00 $15.00 www.nature.com/mp MILLENNIUM ARTICLE Is there an evolutionary mismatch between the normal physiology of the human dopaminergic system and current environmental conditions in industrialized countries? L Pani CNR Center for Neuropharmacology, ‘BB Brodie’ Department of Neuroscience, University of Cagliari and Neuroscienze Scarl, Cagliari, Italy A large body of evidence has recently defined a field theory known as ‘evolutionary mismatch’, which derives its attributes largely from the fact that current environmental conditions are completely different from those in which the human central nervous system evolved. Current views on the evolutionary mismatch theory lack, however, any attempts to define which brain areas or neuronal circuits should be mostly involved in coding such misevolved traits and to what extent our neurobiological knowledge can be applied to the topographical localization of a specific psychopathology. In this respect the mesocorticolimbic dopaminergic circuits have long been misconceptualized as simple reward or reinforcement systems. Instead, they motivate and coordinate the functions of the higher brain areas that mediate planning and foresight and direct finalized movement in both animals and humans. These systems make animals intensely interested in exploring the world around them, but by the same means they also make them susceptible to the environmental stimuli that have been sought and con- sumed. It is has been speculated that the cortical dopamine targets that developed most recently in phylogeny are of particular functional value, and that the mesocorticolimbic dopa- minergic system is involved in more complex integrative functions than previously assumed. In the present paper I will argue that some mental disorders may have their deep roots in the evolutionary mismatch between the normal physiology of the mesocorticolimbic dopami- nergic system and the current environmental conditions in affluent societies. Molecular Psy- chiatry (2000) 5, 467–475. Keywords: evolution; limbic system; dopamine; stress; depression; emotions; Darwinian medicineFriday, August 12, 11 Introduction Table 1 Steps in brain evolution with increasing environ- 32
    • Changes in antecedents of life? TV’s in bedrooms Text Electronic games Computers, social mediaFriday, August 12, 11 33
    • Social Network & Sleep Deprivation Text Social Network & Marijuana UseFriday, August 12, 11 34
    • Apparent consumption o inoleic acid (% of dietary energy) among Australia, Canada, UK and USA for the years 1961–2000 10 Australia Canada UK USA Apparent consumption of linoleic acid 9 8 7 (% energy) 6 5 4 3 2 1 0 1960 1965 1970 1975 1980 1985 1990 1995 2000 “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 Example high in omega-3 not omega-3 in omega-6 (n6) in breast been documented to be savannah animals subcutaneous fat from Evolutionary milk related to low n3 and mother’s diet high n6 in US diet Physiology See Broadhurst, Cunnane, & change in last 50 years Mismatch See HIbbeln et al. (2007).Maternal seafood 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 obesityFriday, August 12, 11 35
    • 30% Percentage with Psychosis at 12 months 27.5% 24% 18% 12% 6% 4.9% 0% Omega-3 Placeo PsychosisFriday, August 12, 11 36
    • Evolutionary Mismatch Language of belonging and dangerFriday, August 12, 11 37
    • K R R Path Path Path Evolutionary Path of a Child’s Life Probability of long-life and Probability of short-life and reproductive success doubtful reproductive successFriday, August 12, 11 38
    • K R R Path Path Path Evolutionary Path of a Child’s Life Probability of long-life and Probability of short-life and reproductive success doubtful reproductive success R-Path can be triggered by evolutionary mismatch in social or physical environment.Friday, August 12, 11 38
    • Human Infectious/Biological Threats Human Predatory ThreatsFriday, August 12, 11 39
    • Human Infectious/Biological Threats Human Predatory Threats Evolutionary Adaptive Responses (Simplified) Generalized Localized Inflammatory Inflammatory Response Response Anti-Inflammatory RegulatorsFriday, August 12, 11 39
    • Human Infectious/Biological Threats Human Predatory Threats Evolutionary Adaptive Responses Evolutionary Adaptive Responses (Simplified) (Simplified) Intra-Group Threat Attributional Generalized Localized Affiliation Bias (Inflammatory) Inflammatory Inflammatory (Anti-Inflammatory) Out-Group Response Response Aggress. (Inflammatory) Intra-Group Cooperation Tit-for-Tat Beh. Bias Anti-Inflammatory Regulators (Anti-Inflammatory) (Inflammatory)Friday, August 12, 11 39
    • Human Infectious/Biological Threats Human Predatory Threats Evolutionary Adaptive Responses Evolutionary Adaptive Responses (Simplified) Neuro-Hormones (Simplified) Mood Modulators Reward Delay Intra-Group Threat Attributional Generalized Localized Modulators Affiliation Bias (Inflammatory) Inflammatory Inflammatory (Anti-Inflammatory) Out-Group Response Response Stress Aggress. (Inflammatory) Modulators Intra-Group Cooperation Tit-for-Tat Beh. Bias Anti-Inflammatory Regulators Puberty/Sex (Anti-Inflammatory) Modulators (Inflammatory)Friday, August 12, 11 39
    • Human Infectious/Biological Threats Human Predatory Threats Evolutionary Adaptive Responses Evolutionary Adaptive Responses (Simplified) Neuro-Hormones (Simplified) Mood Modulators Reward Delay Intra-Group Threat Attributional Generalized Localized Modulators Affiliation Bias (Inflammatory) Inflammatory Inflammatory (Anti-Inflammatory) Out-Group Response Response Stress Aggress. (Inflammatory) Modulators Intra-Group Cooperation Tit-for-Tat Beh. Bias Anti-Inflammatory Regulators Puberty/Sex (Anti-Inflammatory) Modulators (Inflammatory) Modern culture commonly produces multiple evolutionary mismatches triggering multiple inflammatory responses.Friday, August 12, 11 39
    • Obesity Conduct Disorders Homicide & Suicide Depression Oppositional/ Addictions ADHD Aggression Self harm ANXIETY R PATH = Risky behaviors or healthFriday, August 12, 11 40
    • How many of you know a regular American family with a child with… a mental, emotional or behavioral disorder?Friday, August 12, 11 41
    • How many of you know a regular American family with a child with… a mental, emotional or behavioral disorder? Like a more Like ADHD or Like learning or serious mental Like a serious behavior developmental illness like addictions problems? disorder? bipolar or problem? suicidal actions?Friday, August 12, 11 41
    • Key messages about mental, emotional & behavioral disorders…Friday, August 12, 11 42
    • Key messages about mental, emotional & behavioral disorders… MEB’s are preventable.Friday, August 12, 11 42
    • Key messages about mental, emotional & behavioral disorders… MEB’s are Break-even for preventable. MEB prevention is one year.Friday, August 12, 11 42
    • Key messages about mental, emotional & behavioral disorders… MEB’s are Break-even for MEB prevention preventable. MEB prevention balances is one year. budgets.Friday, August 12, 11 42
    • Key messages about mental, emotional & behavioral disorders… MEB’s are Break-even for MEB prevention MEB prevention preventable. MEB prevention balances improves US is one year. budgets. business.Friday, August 12, 11 42
    • Key messages about mental, emotional & behavioral disorders… MEB’s are Break-even for MEB prevention MEB prevention preventable. MEB prevention balances improves US is one year. budgets. business. Effective MEB prevention helps national security.Friday, August 12, 11 42
    • Key messages about mental, emotional & behavioral disorders… MEB’s are Break-even for MEB prevention MEB prevention preventable. MEB prevention balances improves US is one year. budgets. business. Effective MEB MEB prevention prevention helps helps US global national security. success.Friday, August 12, 11 42
    • Key messages about mental, emotional & behavioral disorders… MEB’s are Break-even for MEB prevention MEB prevention preventable. MEB prevention balances improves US is one year. budgets. business. MEB prevention Effective MEB MEB prevention saves Social prevention helps helps US global Security & national security. success. Medicare.Friday, August 12, 11 42
    • Key messages about mental, emotional & behavioral disorders… MEB’s are Break-even for MEB prevention MEB prevention preventable. MEB prevention balances improves US is one year. budgets. business. MEB prevention Effective MEB MEB prevention saves Social MEB prevention prevention helps helps US global Security & heals past national security. success. Medicare. inequities.Friday, August 12, 11 42
    • Friday, August 12, 11 43
    • Mental, emotional, behavioral and health disorders are preventable by our own hands—right here in Washington State.Friday, August 12, 11 44
    • 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 and Embry. Nurturing Environments and the Next Generation of Prevention Research and Practice for the American PsychologistFriday, August 12, 11 45
    • 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. Good B e h a v i o r a l Vac c i n e s an d Evidence-Based Kernels: Nonpharmaceutical Behavioral vaccines for disease control A p p ro a c h e s f o r th e P re v e n t i o n o f M e n t a l , Embry, D. D. 2011. Behavioral vaccines and evidence-based kernels: Emotional, and B e h a v i o r a l D i s o rd e r s non-pharmaceutical approaches for the prevention of mental, emotional, Dennis D. Embry, PhD and behavioral disorders. Psychiatr Clin North Am 34 (1):1-34. KEYWORDSFriday, August 12, 11 46
    • 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.Friday, August 12, 11 47
    • 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.Friday, August 12, 11 48
    • 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; OReilly, 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)Friday, August 12, 11 49
    • = Public Posting Kernel Antecedent Kernel Happens BEFORE the behavior = radarFriday, August 12, 11 50
    • 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.Friday, August 12, 11 51
    • Survival analysis to show long-term advantage of prize bowl kernel Standard Community Treatment Prize Bowl for RecoveryFriday, August 12, 11 52
    • Survival analysis to show long-term advantage of prize bowl kernel 100 Percent Not Using Drugs 75 50 25 Standard Community Treatment Prize Bowl for Recovery 0 Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8Friday, August 12, 11 52
    • Survival analysis to show long-term advantage of prize bowl kernel 100 Percent Not Using Drugs 75 50 25 Standard Community Treatment Prize Bowl for Recovery 0 Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8Friday, August 12, 11 52
    • Survival analysis to show long-term advantage of prize bowl kernel 100 Percent Not Using Drugs 75 50 25 Standard Community Treatment Prize Bowl for Recovery 0 Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8Friday, August 12, 11 52
    • 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, & ONeal, 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)Friday, August 12, 11 53
    • Physiological Kernel: Omega-3 30% Percentage with Psychosis at 12 months 27.5% 24% Why not help 18% This cost $12 at-risk young adults to 12% prevent 6% psychosis? 0% 4.9% Omega-3 Placeo Amminger, G. P., M. R. Schafer, et al. (2010). "Long-Chain {omega}-3 Fatty Acids Psychosis for Indicated Prevention of Psychotic Disorders: A Randomized, Placebo- Controlled Trial." Arch Gen Psychiatry 67(2): 146-154. See p.214, IOM ReportFriday, August 12, 11 54
    • Reduced  Felony  Violent  Offenses  Among  Prisoners   with  recommended  daily  amounts  of  vitamins,  minerals  and  essen=al  fa>y  acids Ratio of Disciplinary Incidents Supplementation/Baseline 1.00 Ac=ve  -­‐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-­‐28Friday, August 12, 11 55
    • 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)Friday, August 12, 11 56
    • 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.Friday, August 12, 11 57
    • 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.Friday, August 12, 11 57
    • 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.Friday, August 12, 11 57
    • 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.Friday, August 12, 11 57
    • Kernels are building blocks 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.Friday, August 12, 11 58
    • Trend-line for humorous warnings on binge drinking by women of child-rearing age No Warnings Humorous Warnings Antecedent KernelFriday, August 12, 11 59
    • Trend-line for humorous warnings on binge drinking by women of child-rearing age No Warnings Humorous Warnings 20 Antecedent Kernel 16 Percentage 12 8 4 0 1995 1997 1999 2001 2002 2003 2004 2005 2006 2007Friday, August 12, 11 59
    • Trend-line for humorous warnings on binge drinking by women of child-rearing age No Warnings Humorous Warnings 20 Antecedent Kernel 16 Percentage 12 8 4 0 1995 1997 1999 2001 2002 2003 2004 2005 2006 2007Friday, August 12, 11 59
    • Trend-line for humorous warnings on binge drinking by women of child-rearing age No Warnings Humorous Warnings 20 Antecedent Kernel 16 Percentage 12 8 4 0 1995 1997 1999 2001 2002 2003 2004 2005 2006 2007Friday, August 12, 11 59
    • What is a behavioural vaccine? It is a simple procedure (a kernel or a recipe of kernels) that, when used repeatedly, reduce morbidity and mortality and/or increase wellbeing or health. Such behavioural vaccines can become cultural practices. Embry, D. D. (2004). "Community-Based Prevention Using Simple, Low-Cost, Evidence-Based Kernels and Behavior Vaccines." Journal of Community Psychology 32(5): 575.Friday, August 12, 11 60
    • Why not turn about the lives of high risk primary grade children using a teacher kernel recipe?Muriel Saunders, the teacherFriday, August 12, 11 61
    • Group Alerts/ Beat the Soft Team Response Mystery Timer Competition Cost Motivator Antecedent Antecedent Reinforcement Reinforcement kernel Antecedent kernel kernel kernel KernelFriday, August 12, 11 62
    • Her invention immediately increases time to learnFriday, August 12, 11 63
    • Why not turn about the lives of high risk primary grade children using a teacher invented procedure?Friday, August 12, 11 64
    • Publication: Prinz, Sanders, Shapiro, Lutzker & Whitaker (2009).  Population-based prevention of child maltreatment:  The U.S. Triple P System Population Trial. Volume 10, March Issue, Prevention Science. http://www.springerlink.com/content/104965/ Funded by the US Centers for Disease Control, Grant # U17/CCU42231 to Dr. Ron Priinz, and Dr.Matt SandersFriday, August 12, 11 65
    • Why not launch a marketing campaign to get families to use Triple P when in two years…Friday, August 12, 11 66
    • Substantiated Child Maltreatment 16 Rates per 1,000 Children (0-8 Years) 15 13 12 10 Pre Post Prinz et al., 2009, Prevention ScienceFriday, August 12, 11 67
    • Substantiated Child Maltreatment 16 Control Counties Rates per 1,000 Children (0-8 Years) 15 13 12 10 Pre Post Prinz et al., 2009, Prevention ScienceFriday, August 12, 11 67
    • Substantiated Child Maltreatment 16 Control Counties Rates per 1,000 Children (0-8 Years) 15 13 Triple P Counties 12 10 Pre Post Prinz et al., 2009, Prevention ScienceFriday, August 12, 11 67
    • Child Abuse Hospital Injuries 1.80 Rates per 1,000 Children (0-8 Years) 1.68 1.55 1.43 1.30 Pre Post Prinz et al., 2009, Prevention ScienceFriday, August 12, 11 68
    • Child Abuse Hospital Injuries 1.80 Rates per 1,000 Children (0-8 Years) 1.68 Control Counties 1.55 1.43 1.30 Pre Post Prinz et al., 2009, Prevention ScienceFriday, August 12, 11 68
    • Child Abuse Hospital Injuries 1.80 Rates per 1,000 Children (0-8 Years) 1.68 Control Counties 1.55 1.43 Triple P Counties 1.30 Pre Post Prinz et al., 2009, Prevention ScienceFriday, August 12, 11 68
    • Child Out-of-Home Placements 4.50 Rates per 1,000 Children (0-8 Years) 4.13 3.75 3.38 3.00 Pre Post Prinz et al., 2009, Prevention ScienceFriday, August 12, 11 69
    • Child Out-of-Home Placements Control Counties 4.50 Rates per 1,000 Children (0-8 Years) 4.13 3.75 3.38 3.00 Pre Post Prinz et al., 2009, Prevention ScienceFriday, August 12, 11 69
    • Child Out-of-Home Placements Control Counties 4.50 Rates per 1,000 Children (0-8 Years) 4.13 Triple P Counties 3.75 3.38 3.00 Pre Post Prinz et al., 2009, Prevention ScienceFriday, August 12, 11 69
    • Long-term GBG outcomes from inoculation in just first grade Increase in high-school entry Increase in college entry Reduced special education service needs Lifetime reduction of tobacco use by 25% to 50% Lifetime reduction of psychiatric diagnoses Lifetime reduction of antisocial behavior and arrests Lifetime reduction in all serious addictions Lifetime reduction in suicidal actionsFriday, August 12, 11 70
    • Timeline of benefits from PAX GBG Age of Child Benefits 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 6th grade in bullying or harassment behaviors 8th Grade 75%r reduction in serious drug use and engagement in delinquent acts 12th Grade Major increase in high-school graduation; lower utilization of special services Early 20’s Increase in college entry; Major reductions drug use; reductions in prison time Lifetime reduction in violent crime, suicide, psychiatric diagnoses, and lifetime Age 29 addictionsFriday, August 12, 11 71
    • 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 Effectt Friday, August 12, 11 72
    • Public-health kernel case studyFriday, August 12, 11 73
    • 30.0% 12.0% 25.0% 10.0% 20.0% 8.0% 15.0% 6.0% 10.0% 4.0% 5.0% 2.0% 0.0% 18.0% United States United States 40.0% 16.0% 35.0% 14.0% 30.0% 12.0% 25.0% 10.0% 20.0% 8.0% 15.0% 6.0% 10.0% 4.0% 5.0% 2.0% Source: YRBS, US Centers for Disease Control Source: YRBS, US Centers for Disease Control 0.0% 0.0% 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 Embry, D. D. and A. Biglan (2009). Reward and Reminder: An Environmental Strategy for Population-Level Prevention. National Registry of Effective Programs and Practices, Substance Abuse and Mental Health Administration.Friday, August 12, 11 74
    • 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 Baseline Reward and Reminder Baseline Reward and Reminder 45.0% 18.0% 10.0% Wyoming 4.0% Wyoming 40.0% 16.0% 5.0% 35.0% 2.0% 14.0% 30.0% 12.0% 0.0% 25.0% 10.0% 18.0% 20.0% 8.0% United States United States 40.0% 15.0% 16.0% 6.0% 10.0% 4.0% 35.0% 5.0% 14.0% 2.0% 0.0% 30.0% 12.0% 18.0% Wisconsin Wisconsin 40.0% 16.0% 25.0% 10.0% 35.0% 14.0% 20.0% 30.0% 8.0% 12.0% 25.0% 10.0% 15.0% 6.0% 20.0% 8.0% 10.0% 15.0% 4.0% 6.0% 10.0% 4.0% 5.0% 5.0% 2.0% 2.0% Source: YRBS, US Centers for Disease Control Source: YRBS, US Centers for Disease Control 0.0% 0.0% 0.0% 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 Embry, D. D. and A. Biglan (2009). Reward and Reminder: An Environmental Strategy for Population-Level Prevention. National Registry of Effective Programs and Practices, Substance Abuse and Mental Health Administration.Friday, August 12, 11 74
    • 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 Embry, D. D. and A. Biglan (2009). Reward and Reminder: An Environmental Strategy for Population-Level Prevention. National Registry of Effective Programs and Practices, Substance Abuse and Mental Health Administration.Friday, August 12, 11 74
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    • Kernels lower cost of training, support & change… Kernels provide robustness, cost-efficiency and community sustainability across syndemics and multi-problem behaviors.Friday, August 12, 11 76
    • Tactics of Scientific Evaluating MURRAY Understanding fundamental issues of scientific design and testing of behavioral influenceFriday, August 12, 11 77
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    • Muir KA, Milan MA J Appl Behav Anal. 1982 Fall;15(3): 455-60.Parent reinforcement for child achievement: the use of a lottery to maximize parent training effects. .Friday, August 12, 11 79
    • Survival Analyses Examples Wilcox, H. C., Kellam, S., Brown, C. H., Poduska, J., Ialongo, N., Wang, W., & Anthony, J. (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.Friday, August 12, 11 80
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    • If kernels are so good…Friday, August 12, 11 82
    • If kernels are so good…Friday, August 12, 11 82