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Preventing Mental, Emotional and Behavioral Disorders Part 2

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This continues the workshop where practical applications to Oklahoma were discussed

This continues the workshop where practical applications to Oklahoma were discussed

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  • Please see http://en.wikipedia.org/wiki/1854_Broad_Street_cholera_outbreak\n\nThis story is about how Dr. John Snow did a major public health change by removing the pump handle on the pump on Broadwick Street, thereby dramatically reducing cholera. \n\nWe need to remove the pump handles of current epidemics affecting America’s children, youth and young adults.\n
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  • Please see http://en.wikipedia.org/wiki/1854_Broad_Street_cholera_outbreak\n\nThis story is about how Dr. John Snow did a major public health change by removing the pump handle on the pump on Broadwick Street, thereby dramatically reducing cholera. \n\nWe need to remove the pump handles of current epidemics affecting America’s children, youth and young adults.\n
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  • Our rationale is below:\n\nIn March of 2009, the Institute of Medicine issued a new report on the Prevention of Mental, Emotional and Behavioral Disorders Among Young People.1 Fundamentally, the report calls for ending the ration of prevention of mental, emotional and behavioral disorders among America’s youth and young adults. Continued rationing of access to scientifically proven prevention causes a serious threat to the country’s national security2 and to our economic competitiveness compared to 22 other rich countries.3 Such mental, emotional and behavioral disorders are also the leading preventable cost center for local, state and the federal government.1 4 These are the disorders that cause our health-care costs to continue to spiral up and up.\nThe IOM Report calls for a public-health health approach to mental, emotional and behavioral disorders—basically like how America dealt with the polio epidemic, measles, mumps, car passenger injuries to children, and accidental poisoning from medications and toxic chemicals. Why is this necessary? America’s rates of some of these mental, emotional and behavioral problems are worse than other developed countries,5 6 and rates of some of these problems have objectively increased over the past 50 years in America.7 A public-health approach begins with key facts: \n1) Potential harm to the population is high; \n2) Individual risk is widespread; \n3) Everyone deserves protection; \n4) Stigmatizing people or groups reduces engagement in prevention; and \n5) Universal approaches are cost-effective. \nThis document cites multiple examples of how a public health approaches can and have reduced or prevented mental, emotional and behavioral disorders for less per child than being spent for medical vaccines for childhood diseases. Many of these prevention approaches are being used by America’s economic competitors, an ironic event since the approaches were largely developed and tested in America. This document suggest several key policy actions to improve America’s by: \n1)Unleashing consumer access to behavioral prevention strategies like car seats, \n2)Creating third-party reimbursements that would reduce health-care costs, \n3)Initiating public/private prevention mobilizations, \n4)Using proven, powerful marketing campaign strategies, and \n5)Creating cost-saving estimators like business software to calculate profit/loses from prevention strategies.\n\n
  • Uniting All Families to Protect All Our Youth\nFamilies United will reduce the rising rates of youth alcohol, tobacco, and drug use, delinquency, violence, poor academics, and mental illnesses by:\nIncreasing Positive Family Monitoring. By clear voice of positive commitment to children about not using alcohol, tobacco and other drugs (ATOD) and equally clear expectation about a child’s friends.\nRewarding Not Using nor Breaking Rules. By rewarding youth for doing the right thing (e.g., not using ATOD or deviant acts) reduces problems more than punishments. \nReducing Sleep Deprivation. By limiting access to electronic media before bedtime protects against ATOD use, school failure, family problems, mental illness, aggression and obesity. \nChanging Fatty Acid Ratios in a Child’s Diet. By providing more “brain food” (omega-3 found in fish oil) to protect children’s brains from depression, aggression and suicide. (See Institute of Medicine report).\nIncreasing Parent Networking Among the Families of Children’s Friends. By sharing the strategies with 5 other families. \nGovernors’ and Mayors’ first spouses will convene Families United in every state.\n\n
  • Rationale\nA previous scientific study of 7th graders demonstrated that a blunt, clear statement by parents in a broad community context and campaign actually did reduce both serious binge drinking and alcohol use as well as delinquency arrests by about 25% (Koutakis, Stattin et al. 2008).\nAdolescents undermine their parents’ resolve by arguing that other parents are more permissive through a variety of tactics, which cannot be easily refuted in the absence of a robust community norming effort that a vast majority of parents do not want their children using ATOD.\nAdolescent ATOD use today is different than 20 years ago in a number of ways: \nuse is not casual and simply social as one might find an adult party; and\ncurrent adolescent culture and use is deliberately focused on getting seriously drunk, stoned, or high. For example, binge drinking is not just a few drinks, as it might have been previously. Youth may drink 10 beers today, for example. \nDrinking and drugging today among many adolescents is not “to relax”; “to chill”; or “reduce stress.” The emphasis on excess is not just illegal or a violation of parental rules; it is exceeding dangerous in terms of fatal or serious accidents, rape, exposure to gun violence, suicide, or accidental death from overdoses. \nSuch behavior also can significantly affect the child’s entry into college, professions or military. Such excess behavior is quite common among middle-class and upper-class youth, because such groups have the financial and transportation resources to secure the quantities of alcohol and drugs.\nBibliography\nKoutakis, N., H. Stattin, et al. (2008). "Reducing youth alcohol drinking through a parent-targeted intervention: the Orebro Prevention Program." Addiction 103(10): 1629-1637.\n\n\n
  • Rationale\n\nThe more families notice their children doing the right thing, the more right things the children do. Without being noticed for the right things, children tend to seek out being notice for doing the wrong things—often in the wrong places with the wrong people at the wrong times. It is the being noticed that counts, and you have complete control over what you notice in your child—for the good or the bad.\n\nSuch simple, positive reinforcement for not using ATOD is clearly proven to reduce ATOD use significantly in multiple studies,(Cumsille, Darling, & Martinez, 2009) and is especially potent as a strategy once a child or adult has initiated use(Corby, Roll, Ledgerwood, & Schuster, 2000; Diamond, et al., 2002; Kaminer, 2000) (which is true of 15% to 45% of most American youth, depending on grade and community). Thus, a substantial percentage of current American parents need a practical strategy that works to stop current ATOD use of their children, not just prevent initiation of use.\n\nParental reinforcement of children doing the right thing increases perceived warmth by child from parent, which in turns increases disclosure of behaviors by the child (Cumsille, et al., 2009; Daddis & Randolph, 2009; Eaton, Krueger, Johnson, McGue, & Iacono, 2009; Frijns, Keijsers, Branje, & Meeus, 2009; Masche, 2009; Smetana, Villalobos, Tasopoulos-Chan, Gettman, & Campione-Barr, 2009; Tilton-Weaver, et al., 2009). Such child disclosure turns out to be vital for effective parental monitoring during adolescence, more than parental quizzing or threats of punishment.\n\nBibliography\nCorby, E. A., Roll, J. M., Ledgerwood, D. M., & Schuster, C. R. (2000). Contingency management interventions for treating the substance abuse of adolescents: A feasibility study. Experimental & Clinical Psychopharmacology, 8(3), 371-376. \nCumsille, P., Darling, N., & Martinez, M. L. (2009). Shading the truth: The patterning of adolescents' decisions to avoid issues, disclose, or lie to parents. J Adolesc. doi: S0140-1971(09)00131-6 [pii] 10.1016/j.adolescence.2009.10.008 [doi]\nDaddis, C., & Randolph, D. (2009). Dating and disclosure: Adolescent management of information regarding romantic involvement. J Adolesc. doi: S0140-1971(09)00063-3 [pii]\n10.1016/j.adolescence.2009.05.002 [doi]\nDiamond, G., Godley, S. H., Liddle, H. A., Sampl, S., Webb, C., Tims, F. M., et al. (2002). Five outpatient treatment models for adolescent marijuana use: A description of the Cannabis Youth Treatment Interventions. Addiction, 97(Suppl1), 70-83. \nEaton, N. R., Krueger, R. F., Johnson, W., McGue, M., & Iacono, W. G. (2009). Parental monitoring, personality, and delinquency: Further support for a reconceptualization of monitoring. [doi:10.1016/j.jrp.2008.10.006]. Journal of Research in Personality, 43(1), 49-59. doi: 10.1016/j.jrp.2008.10.006\nFrijns, T., Keijsers, L., Branje, S., & Meeus, W. (2009). What parents don't know and how it may affect their children: Qualifying the disclosure-adjustment link. J Adolesc. doi: S0140-1971(09)00068-2 [pii]\n10.1016/j.adolescence.2009.05.010 [doi]\nKaminer, Y. (2000). Contingency management reinforcement procedures for adolescent substance abuse. Journal of the American Academy of Child & Adolescent Psychiatry, 39(10), 1324-1326. \nMasche, J. G. (2009). Explanation of normative declines in parents' knowledge about their adolescent children. J Adolesc. doi: S0140-1971(09)00120-1 [pii]10.1016/j.adolescence.2009.08.002 [doi]\nSmetana, J. G., Villalobos, M., Tasopoulos-Chan, M., Gettman, D. C., & Campione-Barr, N. (2009). Early and middle adolescents' disclosure to parents about activities in different domains. J Adolesc, 32(3), 693-713. doi: S0140-1971(08)00062-6 [pii] 10.1016/j.adolescence.2008.06.010 [doi]\nTilton-Weaver, L., Kerr, M., Pakalniskeine, V., Tokic, A., Salihovic, S., & Stattin, H. (2009). Open up or close down: How do parental reactions affect youth information management? J Adolesc. doi: S0140-1971(09)00106-7 [pii] 10.1016/j.adolescence.2009.07.011 [doi]\n\n
  • Rationale\nSleep deprivation—rapidly increasing in children and teens—by virtue of electronic media (e.g., cellphones, instant messaging, TV’s and electronic games in children’s bedrooms) is now firmly linked to increased risk of ATOD use and other problematic behaviors for multiple biological, media modeling, and adverse norming reasons.\nOur children today sleep a lot less than children just 10-20 years ago. The lack of sleep, even as a young child, significantly predicts getting drunk, stoned, or in trouble with the law including for violence as well as doing poorly in school (Chervin, Dillon, Archbold, & Ruzicka, 2003; Dworak, Schierl, Bruns, & Str¸der, 2007; Meijer, 2008; Owens, et al., 1999; Wong, Brower, Fitzgerald, & Zucker, 2004). The reason is not more homework or family stress. The reason is simple: Children’s bedrooms today are like electronic super-stores—often with a TV, a computer, electronic games, and now cell phones (Borzekowski & Robinson, 2005; Dworak, et al., 2007; Johnson, Cohen, Kasen, First, & Brook, 2004; Paavonen, Pennonen, Roine, Valkonen, & Lahikainen, 2006; Suganuma, et al., 2007; Tazawa & Okada, 2001; Thompson & Christakis, 2005; Toyran, Ozmert, & Yurdakok, 2002; Jan Van den Bulck, 2003; J. Van den Bulck, 2004). These electronic things are a lot more exciting and sleep depriving than reading a book under the covers with a flashlight (Suganuma, et al., 2007). When parents significantly reduce use of these things—especially in children’s bedrooms—children and teens are healthier, less irritable, do better in school and less likely to get into all manner of trouble (Barkin, et al., 2008; Gorin, Raynor, Chula-Maguire, & Wing, 2006). There are some strategies to slim your child’s media diet if families are unsure what to do (Jordan, Hersey, McDivitt, & Heitzler, 2006).\nBibliography\nBarkin, S. L., Finch, S. A., Ip, E. H., Scheindlin, B., Craig, J. A., Steffes, J., et al. (2008). Is Office-Based Counseling About Media Use, Timeouts, and Firearm Storage Effective? Results From a Cluster-Randomized, Controlled Trial. Pediatrics, 122(1), e15-25. doi: 10.1542/peds.2007-2611\nBorzekowski, D. L. G., & Robinson, T. N. (2005). The Remote, the Mouse, and the No. 2 Pencil: The Household Media Environment and Academic Achievement Among Third Grade Students. Arch Pediatr Adolesc Med, 159(7), 607-613. doi: 10.1001/archpedi.159.7.607\nChervin, R. D., Dillon, J. E., Archbold, K. H., & Ruzicka, D. L. (2003). Conduct problems and symptoms of sleep disorders in children. Journal of the American Academy of Child & Adolescent Psychiatry, 42(2), 201-208. \nDworak, M., Schierl, T., Bruns, T., & Str¸der, H. K. (2007). Impact of singular excessive computer game and television exposure on sleep patterns and memory performance of school-aged children. Pediatrics, 120(5), 978-985. doi: 10.1542/peds.2007-0476\nGorin, A., Raynor, H., Chula-Maguire, K., & Wing, R. (2006). Decreasing household television time: A pilot study of a combined behavioral and environmental intervention. Behavioral Interventions, 21(4), 273-280. doi: 10.1002/bin.221\nJohnson, J. G., Cohen, P., Kasen, S., First, M. B., & Brook, J. S. (2004). Association between television viewing and sleep problems during adolescence and early adulthood.[see comment]. Archives of Pediatrics & Adolescent Medicine, 158(6), 562-568. \nJordan, A. B., Hersey, J. C., McDivitt, J. A., & Heitzler, C. D. (2006). Reducing Children's Television-Viewing Time: A Qualitative Study of Parents and Their Children. Pediatrics, 118(5), e1303-1310. doi: 10.1542/peds.2006-0732\nMeijer, A. M. (2008). Chronic sleep reduction, functioning at school and school achievement in preadolescents. Journal of Sleep Research, 17(4), 395-405. doi: 10.1111/j.1365-2869.2008.00677.x\nOwens, J., Maxim, R., McGuinn, M., Nobile, C., Msall, M., & Alario, A. (1999). Television-viewing habits and sleep disturbance in school children. Pediatrics, 104(3), e27. \nPaavonen, E. J., Pennonen, M., Roine, M., Valkonen, S., & Lahikainen, A. R. (2006). TV exposure associated with sleep disturbances in 5- to 6-year-old children. Journal of Sleep Research, 15(2), 154-161. \nSuganuma, N., Kikuchi, T., Yanagi, K., Yamamura, S., Morishima, H., Adachi, H., et al. (2007). Using electronic media before sleep can curtail sleep time and result in self-perceived insufficient sleep. Sleep and Biological Rhythms, 5(3), 204-214. doi: 10.1111/j.1479-8425.2007.00276.x\nTazawa, Y., & Okada, K. (2001). Physical signs associated with excessive television-game playing and sleep deprivation. Pediatrics International, 43(6), 647-650. \nThompson, D. A., & Christakis, D. A. (2005). The association between television viewing and irregular sleep schedules among children less than 3 years of age. Pediatrics, 116(4), 851-856. \nToyran, M., Ozmert, E., & Yurdakok, K. (2002). Television viewing and its effect on physical health of schoolage children. Turkish Journal of Pediatrics, 44(3), 194-203. \nVan den Bulck, J. (2003). Text messaging as a cause of sleep interruption in adolescents, evidence from a cross-sectional study. Journal of Sleep Research, 12(3), 263-263. \nVan den Bulck, J. (2004). Television viewing, computer game playing, and Internet use and self-reported time to bed and time out of bed in secondary-school children.[see comment]. Sleep, 27(1), 101-104. \nWong, M. M., Brower, K. J., Fitzgerald, H. E., & Zucker, R. A. (2004). Sleep problems in early childhood and early onset of alcohol and other drug use in adolescence. Alcoholism: Clinical & Experimental Research, 28(4), 578-587. \n\n
  • Rationale\nEssential brain chemistry and development is being disrupted or deficient from two major sources in in America. These disruptions and deficiencies have greatly accelerated the risk of substance abuse, mental illness and delinquent behavior in America’s youth. Two changeable causes exist:\nBased on scientific studies conducted under the auspices of the National Institutes of Health, abrupt changes in the dietary ratios of essential fatty acids (omega 3 to omega 67) of Americans (particularly children and youth) compared to other nations has increased the biological, mental health and behavioral risks associated with ATOD use.6 Changing the current US dangerous ratio of omega-6 to omega-3 from 25-to-1 to the healthy ratio of 4-to-1 would significantly improve the biological and behavioral risk and protective factors associated with ATOD use and related problems.6 8 Remember how parents and grandparents of years back used to tell their children and grandchildren to take cod-liver oil? Yes, it tasted yucky, and that cod-liver oil contained enough omega-3 to keep every child in America smarter, safer, less susceptible to addictions or mental illnesses, and healthier.54-57 Increasing omega-3 and reducing omega-6 (found in cottonseed oil, corn oil, soybean oil, etc.) would also help reduce the obesity and diabetes epidemic among youth.9-11\nAnother essential brain deficiency comes from the lack of movement. Without extensive physical activity—running and playing outside, active sports, jogging, etc. every day, humans do not generate enough Brain Derived Neuro-Factor—“brain-fertilizer” for short. BNDF is essential for sleep, positive mood, memory and learning.52 53 BNDF helps brains learn to avoid or stay away from harmful things like getting drunk, high, stoned or in trouble with the law as well as learning how to get the good things in life.46 47 Scientists believe today that well-proven effects on exercise improving depression (as much as medications) and improving memory in children and adults works by increasing BDNF.48-51\n
  • This is a key aspect of the highly successful Parents Movement. Please see http://www.enotes.com/drugs-alcohol-encyclopedia/parent-movement.\n\nPenney, A. and E. Garfield (1984). "Parent groups in drug abuse prevention: Is this the constituency we've been waiting for?" The Journal of Primary Prevention 4(3): 173-179.\nPrevention, although always intended to be a focus of community mental health centers, has suffered from lack of a defined constituency. In lean economic years when federal policy dictates private sector support, these resources become critical. For prevention of drug abuse, concerned parents across the country have joined together to form support groups. Are these parents groups the resource that mental health professionals need? Does this new breed of parent groups want to be one of our constituencies? Are mental health professionals willing to make the necessary adjustments in attitudes, management styles, and programs to reap the benefits of these new groups? This article explores experiences of working with a few parent groups in two different areas of the country in an effort to encourage prevention professionals to strengthen collaborative ties.\n
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  • There are five stages of implementing Families United that happen at every level—states, regions, communities, local organizations and even in families: \n1.Explore the Vision – The stages helps begins moving people in the community, region or state are unaware or under-aware of the problems and possibilities in their community that could be addressed by Families United. During this phase, a small group of pioneers who are aware of the issues and vision bring information to community leaders from many walks of life that are concerned about and entrusted with the future of the area. These community leaders can then elect to join the vision and recruit others for the next bigger step.\n2.Plant Change Seeds —The stage engages many in the community, region or state are aware of the concerns addressed by Families United. This growing group gathers data, resources and strategies related to Families United, and this growing group begin serious plans for how the area can sow the evidence-based kernel for change in the area for big change to benefit all.\n3.Prepare to Advance Change—The stage combines intention and behavioral activities to prepare for the adoption, implementation and maintenance of the work of Families United. Communities, regions or states in this stage intend to take action soon, typically within 2-to-10 months.\n4.Act for Change— The stage mobilizes organizations and individuals to modify and improve local behaviors, experiences, or environments for as many families as possible to adopt and to implement Families United. These actions involve overt behavioral changes and require commitment of time, money and energy from many for a focused period of time. \n5.Maintain and Grow— The stage keeps citizens and organizations working to keep Families United productive, preventing the return to the same problems and consolidate the gains and cost-efficiencies attained during action for sustainable change. For Families United, this extends from six months to an indeterminate period beyond the launch of Families United. Typically “boosters” happen from time to time every year to keep the efforts salient, fresh and effective. Change grows more over time.\nThe figure below shows the five stages of implementing Families United, which combines elements of the SPF-SIG or Communities That Care model with the Stages of Change. The Families United change model is a true public-health community change model, much like what has happened years ago, addressing such things as making sure that every child had a car safety seat and/or was protected against the adverse effects of lead paint. \n\n
  • 1.Exploring the Vision is about getting your team of early pioneers together to bring the idea and possibility for big change in your community. The early pioneers find out about the science behind Families United; form a preliminary plan; identify and share information some key individuals who might further champion the idea; and recruit an initial steering group to set the path and hold the course for all families to be united in protecting all the community’s children for all our futures. Here are steps:\n•Get information at www.SimpleGifts.com/familiesunited:\noRead current synopsis for the community efforts\noWatch and/or download videos\noDownload PowerPoints\noDownload handouts and read\noDownload research documentation to read, if desired.\nPotential communities are strongly urged to discuss their interest with the technical support entity (PAXIS Institute) for community implementation of Families United. Please contact Miriam@paxis.org. She will provide interface with your needs with www.SimpleGifts.com/Families.\n\n•Share information with others who could speak up persuasively to diverse groups, entities, and leaders to create a broader commitment to plan real seeds of change in the community.\noSelect important and diverse individuals who have wisdom and skills to convene the attention of key “movers and shakers” in:\n♣Locally-owned businesses,\n♣National owned businesses vested in the community. \n♣Government agencies, \n♣Elected officials, \n♣Schools, higher education (if present in the community),\n♣Churches, Temples or Mosques, \n♣Advocacy groups, \n♣Neighborhood groups, \n♣Law enforcement, \n♣Medical entities, \n♣Civic organization, \n♣United Way or funders, or\n♣Local media\noMake 15 to 60-minutes presentations (depending on audience) using the materials provided, with adaptations suitable to your community and audience.\n♣Ask potential guides and advocates of Families United what they would like to see increase and decrease among the children and youth in the community.\n♣Link those answers to the goals and purposes of Families United in brief introduction.\n♣Show brief video on computer, Ipod or cell phone.\n♣Ask person(s) if they would be willing to help make Families United happen in the community.\n♣Identify needed tasks and explore other ways that people can help as part of the group of pioneers.\n♣Ask who else you should connect with to advance the goals.\n•Find some early, strong allies (at least 6 to 12) who can now go out and repeat the vision and possibilities to others, recruiting 4-6 other people willing to commit to the core idea. Establish a tentative time to launch Families United with in 12 months or less.\n\n
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  • 1.Planting Seeds involves three key activities in order to move closer to a success with Families United. Each of these steps is reviewed in greater detail at www.SimpleGifts.com/familiesunited. Here is a summary.\n•Find and share some local data. Having some local data to talk about helps mobilize the community. The idea of these data is NOT to prove there is a problem. Pretty much everyone in America knows our children and youth have higher morbidity and mortality from a variety of mental, emotional and behavioral disorders than in the past and even compared to other countries. The website provide comparative data to illustrate key points, such as the burden and need for psychotropic medications among children and teens in the United States compared to other rich countries that make simple prevention tools accessible to every parent.\nHere are some key data to collect for your planting seeds, in the table below.\nTable 1: Example Data for Planting Seeds (Please See Website for Other Examples & Updates)\nDataPurposeOther Info\nChildren 3-5 in your censusNecessary for planning if doing Families United for families with 3-5 year oldsIdentify how many organized early childhood centers; in family daycare \nChildren in elementary school (census)Necessary for planning if doing Families United with elementary studentsIdentify how many schools (public, charter, private, and faith affiliated); identify multiple districts as needed\nEarly adolescents in middle school or junior high or K-8 based on censusNecessary for planning if doing Families United with early adolescentsIdentify how many schools (public, charter, private, alternative, home school, and faith affiliated); identify multiple districts as needed\nHigh-school age students based on censusNecessary for planning if doing Families United with this age groupIdentify how many schools (public, charter, private, alternative, incarcerated, home school, and faith affiliated); identify multiple districts as needed\nMonthly or quarterly juvenile arrest data by jurisdiction, in table and graph for 3-5 yearsThis is a key measure of change to reduce. Graphic monthly or quarterly over 3-5 years helps see trends and oddities of data not clear in annual numbers.Total arrests\nTickets for speeding (important proxy of dangerous impulsivity and Alcohol or Drug Use)\nAnnual or bi-annual student self-report data on ATOD or problematic behaviors\nKey dependent measure if available. \nIf non available, investigate using Pride Survey—which is reliable, predictive, short and inexpensive with quick feedback.\nSince almost every adult in your community already knows a family with a child, teen or young adult with trouble with behavior problems, school difficulties, addictions, mental illness, trouble with the law, difficulty at work, or serious conflict with other family members, the data you gather serves several purposes beyond “awareness of the problem”. Common data collected in almost every community…\n□Provide the baseline from which to put into a spreadsheet to estimate the possible range of benefits from successes with Families United.\n□Give numbers to calculate costs, resources and activities to adopt, implement and maintain Families United\n□Establish reference points to celebrate early wins and longer-term successes as Families United spreads in the community.\n•Sign up partners for change. Spreading Families United is not about having to train many people in complex programs or therapeutic strategies. It is more like organizing a barn raising. Somebody has draw up the plan. Some people have to haul the wood. Some people have to cut the wood. Some people have to carry the wood. Some people have nail the wood together. Some people have to make sure people have the right tools or supplies. Some people have to feed all others, while some people have to deal with unexpected events that happen. A few people have to measure to see that the barn is being built properly and so on. This phase of effort is about getting the right people to form the backbone of the barn raising, who then recruit others to do the lion’s share in the work to potentially engage hundreds of locations in the community.\n•Share benefits & science of change. Families United is not per se about the problems of America affecting our children and youth. Rather, Families United is about what five Simple Gift can do as seed of change to help all our children and youth thrive. For example, these Simple Gifts could reduce the number of children who engage in binge drinking and delinquent acts by 25%—just like the simple gift of washing our hands helps prevent the flu. There are some specific tools on the website for you presentations about planting seeds of change:\noThere will a web-based spreadsheet at www.SimpleGifts.com/FamiliesUnited for you estimate the impact of Families United on multiple outcomes, based on your scope of how many children or youth you are reaching and their ages.\noA flash-based tool that allows you print out what federal initiatives and common state or local initiatives that Families United impacts. This information helps you speak to the needs of the community and stakeholders.\n\n
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  • Preparing to Advance Change is the nuts and bolts download able plan that will be on the web that allows you make a concrete plan implement Families United. It is the actions in the plan that will make a real difference, and the planning focuses on actions you can make happen rather than just talking about the problem.\n•Open doors for collaboration. The planning documents online contains sample MOUs, letters of cooperation or support, sponsorship or braided funding agreements, formula for distribution and presentations partners to families and much more based on the network of collaborating communities, regions and states.\n•Put behavior change pieces together. Families United is not a dribble by dribble approach. Rather, Families United is more like a product launch or big community event—reaching many people as possible in a compressed time such as 30-60 days. Families may then, of course, pursue addition support and information available from local sponsoring entities or visit www.SimpleGifts.com for additional supports, some of which are free or others that may involve evidence-based kernels beyond the scope of Families United. Putting these pieces together for planning involves:\noSelecting generic materials or specially imprinted materials with sponsors’ information or logos (an extra cost, of course).\noDeveloping a schedule and calendar of main events for Families United, to be promoted including times, places, capacity, hosts, parking, AV needs, refreshments (if planned), etc.\noDeveloping proclamations and other public norms for Families United.\noPlanning delivery of materials and supplies as well as other logistics.\noDeveloping strategies to reach families at multiple levels of risk, but not focusing as a campaign on “those families, those children, those neighborhoods, etc.”\noDeveloping promotion efforts and timing of announcement of the participation thermometer (like United Way’s fundraising except for pledges).\noHaving launch events for high visibility and modeling of high-prestige people using Families United with their own children or grandchildren.\noSetting up reminders via email or other services to prompt people about their roles and responsibilities.\noEntering data to record participation and commitments\noCelebrating and reinforcing people and organizations who help each week during the efforts.\noPlanning other details such as meetings to train Captains for their mobilization efforts in their settings, organizations or neighborhoods.\n•Mobilize captains for action. Captains have the role of mobilizing the “troops” in their respective fields to hold or have Family United events—which can happen at schools, at community buildings, at faith-based organizations, at workplaces, and even in private homes. By using this type of model, the developers of Family United were able get 37%, 47% and 55% of all parents in three different communities to participate use materials that change risky behaviors predicting problems.\n\n
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  • 1.\n\nActing for Behavior Change is the actual launch during the calendar window of Families United, such as the month of September or October. This period is filled with actual activity for as many as people as possible to learn about, adopt and use Families United, with the target age groups. During this time, a great deal of “buzz” happens about Families United at schools, workplaces, after school programs, children’s sporting events, at faith-based entities and on the media, \n•Organize school, neighborhood or other teams for behavior change. Captains do not deliver Families United directly, typically. Rather, they make sure their team members have their printed supplies, understand using the web videos and other tools need to for the team members to reach Families in their areas. Captains are coaches for Families United in the field during the play. Other partners must be very active about the publicity and promotions to make sure the word is out about where Families United events are happening.\n•Deliver behavior change tools and events. There are materials, supplies and equipment that may need to be delivered, depending on the size of events. These have to be coordinated to assure success. The larger the community, the more complicated the logistics. When an event is finished, the participation rates of families need to be confirmed and supplied either returned to central deployment or stored for the next event in the same or nearby locations.\n•Measure changes and shout out successes. Every day during the campaign window there will be many opportunities measure changes and celebrate successes, including rewarding and recognizing people and organizations that make successes happen such as increasing numbers of families participating. Early wins or successes might include:\noThe first neighborhood to break 25% and 50% participation rates.\noThe first business of different categories to reach 90% of all parents committed to Families United.\noThe churches, temples and mosques that have 25%, 50%, 75% and 90% or more of target families committing to Families United.\noThe schools that have 25%, 50%, 75% and 90% of parents committing to Families United.\noArchival data that would signals success could include:\n♣Reductions in teen arrests by neighborhood.\n♣Reductions in teen car crashes by neighborhood.\n\n
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  • 1.\n\nMaintaining and Growing is the time in which community organizers continue background efforts sustain success between campaign windows. These efforts include:\n•Improve continuously. This would include reviews of the campaign to determine what produced the most participation and engagement in actual Families United strategies. This might include debriefing and feedback on materials, activities and strategies that worked to www.SimpleGifts.com, as well as to local entities and conveners.\n•Celebrate successes. There will be immediate successes in terms of participation rates, involvement, sponsorships, support of logistics. These must be noted and celebrated as a part of the sustainability. Testimonials from families and others must be collected and publicized when possible.\n•Keep moving forward. Families United is a behavioral vaccine like hand-washing. People have to keep doing it. There are new kids, new challenges. Planning for the next year needs to be initiated at least 6 months beforehand.\nA Regional or State Implementation\nThere five stages of implementing Families United are fundamentally the same for large regions or states, but the five steps will have to be computed for the largest unit and the smaller units in order to work out all the elements of implementation. The reminder of the five steps or phases are:\n1.Exploring the Vision \n2.Planting Seeds\n3.Preparing to Advance Change \n4.Acting for Behavior Change\n5.Maintaining and Growing \n\n
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Transcript

  • 1. Raising Healthy Kids: Strategies for Whole Communities Preventing Mental, Emotional & Behavioral Disorders - Pt. 2 Oklahoma Mental Health Conference - December, 2010 Seewww.paxis.orgwww.youtube. by Dennis D. Embry, Ph.D. com/ PAXIS Institutedrdennisembry December, 2010 Copyright © 2010, PAXIS Institute, All rights reserved. May be shared in its entirety with notice and attribution.
  • 2. What is a behavioralvaccine?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-BasedPrevention Using Simple, Low-Cost, Evidence-Based Kernels and Behavior Vaccines." Journal of Community Psychology 32(5): 575.
  • 3. If kernels are so good…
  • 4. If kernels are so good…
  • 5. www.GiveSimpleGifts.com Login | SitemapThe new idea You can better your world, and you can better yourself with the evidence-based kernels found in Simple Gifts. Watch and learn how. Dennis D. Embry, Ph.D. News & Events Praise Back Stories New York State Prevention conference to feature kernels to The Prize Bowl worked to help my achieve widespread prevention on November 17... more ➝ son kick his drug addiction and stay in recovery... more ➝ Baltimore School District teachers involved in large study on the use of kernel to reduce problem behavior and increase academic We used the secret PAX-It notes for very difficult kids in our school, What are evidence-based kernel? achievement. The study is by Johns Hopkins and is funded by the Insitute on Education... more ➝ and... more ➝ Florida Governor’s Office promotes evidence-based kernels to Brain on The Ball really helped our twins do so much better in prevent child abuse and related problems... more ➝ their classes, and it improved the academics just like the research Alaska State Government holds training on apply Simple Gifts / indicated... more ➝ How are Simple Gifts Created? kernels to reduce delinquency and mental illness... more ➝ After being on meds for so long, I How to use this site? decided to use Happy Brain kernel with omega-3... more ➝ Who can use this site? Help picking Simple Gifts? Partners in Simple Gifts? Site Map | Values Commitment | Kernel Submissions / Opportunities Terms of Use | Privacy Policy | Contact Us Copyright © 2008 PAXIS Institute XHTML 1.0 Valid | CSS Valid
  • 6. Behavior influence as consumer products…
  • 7. “Behavioral health could learn from public health in endorsing a population health perspective”—(IOM, page 19). “Families and children have ready access to the best available evidence-based prevention interventions, The story of the delivered in their ownBroad Street water pump during the communities…in a respectfulcholera epidemic in non-stigmatizing way”—(IOM, London. page 387).
  • 8. What is a public-health approach? Potential harm is universal, Personal or Group Risk is Common, Stigmatizing Persons or Groups At Risk Reduces Prevention Results, and/or More Cost Efficient to Reach All Above “Case Finding.”
  • 9. A environmentalpolicy case study inreducing earlyrebelliousness, risktaking andsensation seekingThis risk factor can be easily measured inearly-childhood, and it predicts lifetimeinjuries, delinquency, alcohol/drug abuseabuse, and school difficulties.
  • 10. Contextual example of such risk
  • 11. So, what would be your prevention approach to prevent young children dashing into the street or parking lots?PS.This was onethe top 3-5causes ofdeath in OECDcountries from1960s-1980s.
  • 12. Oh,prior prevention efforts in Swedenhad resulted in more fatalities…
  • 13. A book about “me” being a SafePlayer
  • 14. Adults defining boundaries of safeplay
  • 15. Adults setting timer to watch safeplay in child
  • 16. Parent praising safe play withstickers
  • 17. Child removed from play if unsafethen given quick chance to be safe 2-minute Sit and Watch, if unsafe
  • 18. Study 1 showed preschoolintervention alone had short-termbenefits
  • 19. Study 1 showed preschoolintervention alone had short-termbenefitsStudy 2 showed preschool plusparenting intervention had long-termbenefits
  • 20. Study 1 showed preschoolintervention alone had short-termbenefitsStudy 2 showed preschool plusparenting intervention had long-termbenefitsStudy 3 showed strategy could beimplemented in 35 Head Startsnationally
  • 21. Study 1 showed preschoolintervention alone had short-termbenefitsStudy 2 showed preschool plusparenting intervention had long-termbenefitsStudy 3 showed strategy could beimplemented in 35 Head StartsnationallyStudy 4 showed parents couldchange child’s behavior from specialstory workbook
  • 22. Study 1 showed preschoolintervention alone had short-termbenefitsStudy 2 showed preschool plusparenting intervention had long-termbenefitsStudy 3 showed strategy could beimplemented in 35 Head StartsnationallyStudy 4 showed parents couldchange child’s behavior from specialstory workbookStudy 5 showed behavior change forover 100 preschoolers, with noadverse effect.
  • 23. Study 1 showed preschoolintervention alone had short-termbenefitsStudy 2 showed preschool plusparenting intervention had long-termbenefitsStudy 3 showed strategy could beimplemented in 35 Head StartsnationallyStudy 4 showed parents couldchange child’s behavior from specialstory workbookStudy 5 showed behavior change forover 100 preschoolers, with noadverse effect.Study 6 showed effort could besuccessful in a 3-city multiple baselinein New Zealand
  • 24. Study 1 showed preschoolintervention alone had short-termbenefitsStudy 2 showed preschool plusparenting intervention had long-termbenefitsStudy 3 showed strategy could beimplemented in 35 Head StartsnationallyStudy 4 showed parents couldchange child’s behavior from specialstory workbookStudy 5 showed behavior change forover 100 preschoolers, with noadverse effect.Study 6 showed effort could besuccessful in a 3-city multiple baselinein New ZealandStudy 7 is national campaign,adopted by 50% of New Zealandfamilies
  • 25. Study 1 showed preschoolintervention alone had short-termbenefitsStudy 2 showed preschool plusparenting intervention had long-termbenefitsStudy 3 showed strategy could beimplemented in 35 Head StartsnationallyStudy 4 showed parents couldchange child’s behavior from specialstory workbookStudy 5 showed behavior change forover 100 preschoolers, with noadverse effect.Study 6 showed effort could besuccessful in a 3-city multiple baselinein New ZealandStudy 7 is national campaign,adopted by 50% of New ZealandfamiliesStudy 8 replicates city results in US
  • 26. Kernels and 4-P’s used in multi-city/national Safe Playing campaign
  • 27. Kernels and 4-P’s used in multi-city/national Safe Playing campaign Proclamations in cities and nationally
  • 28. Kernels and 4-P’s used in multi-city/national Safe Playing campaign Proclamations in cities and nationally Endorsements/Sponsorships by prestige organizations AND businesses
  • 29. Kernels and 4-P’s used in multi-city/national Safe Playing campaign Proclamations in cities and nationally Endorsements/Sponsorships by prestige organizations AND businesses Media models of adoption by high-status people
  • 30. Kernels and 4-P’s used in multi-city/national Safe Playing campaign Proclamations in cities and nationally Endorsements/Sponsorships by prestige organizations AND businesses Media models of adoption by high-status people Media models showing rapid results/benefits
  • 31. Kernels and 4-P’s used in multi-city/national Safe Playing campaign Proclamations in cities and nationally Endorsements/Sponsorships by prestige organizations AND businesses Media models of adoption by high-status people Media models showing rapid results/benefits Public posting of rates of adoption/use
  • 32. Kernels and 4-P’s used in multi-city/national Safe Playing campaign Proclamations in cities and nationally Endorsements/Sponsorships by prestige organizations AND businesses Media models of adoption by high-status people Media models showing rapid results/benefits Public posting of rates of adoption/use Competitions between cities on adoptions
  • 33. Kernels and 4-P’s used in multi-city/national Safe Playing campaign Proclamations in cities and nationally Endorsements/Sponsorships by prestige organizations AND businesses Media models of adoption by high-status people Media models showing rapid results/benefits Public posting of rates of adoption/use Competitions between cities on adoptions Placement in supermarket or other easy venues
  • 34. Kernels and 4-P’s used in multi-city/national Safe Playing campaign Proclamations in cities and nationally Endorsements/Sponsorships by prestige organizations AND businesses Media models of adoption by high-status people Media models showing rapid results/benefits Public posting of rates of adoption/use Competitions between cities on adoptions Placement in supermarket or other easy venues Price free after filling out Safe Playing Promise (with address, etc.)
  • 35. Kernels and 4-P’s used in multi-city/national Safe Playing campaign Proclamations in cities and nationally Endorsements/Sponsorships by prestige organizations AND businesses Media models of adoption by high-status people Media models showing rapid results/benefits Public posting of rates of adoption/use Competitions between cities on adoptions Placement in supermarket or other easy venues Price free after filling out Safe Playing Promise (with address, etc.) Promotion for every family who wants their child to be safe
  • 36. Kernels and 4-P’s used in multi-city/national Safe Playing campaign Proclamations in cities and nationally Endorsements/Sponsorships by prestige organizations AND businesses Media models of adoption by high-status people Media models showing rapid results/benefits Public posting of rates of adoption/use Competitions between cities on adoptions Placement in supermarket or other easy venues Price free after filling out Safe Playing Promise (with address, etc.) Promotion for every family who wants their child to be safe Product promises child will be safer in two weeks when steps followed
  • 37. 5.0% 2.0% 0.0% 18.0% Wisconsin Wisconsin 40.0% 16.0% 35.0% 14.0% 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% 20.0% 6.0% 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 Why not publicize and reward clerks and stores for not selling tobacco or alcohol to minors if…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.
  • 38. Families United case studyA plan to address statewide risk and protective factors trends among youth
  • 39. Calculating RE-AIM for population- level change (PC) REACH = Total population being IMPLEMENTATION = The percent RE-AIM MATH targeted (see census data) of persons/entities who actually Reach, Efficacy, adopted kernel who actually use Adoption, EFFICACY = The effect size it (needs to be at least 40% toImplementation, & difference produced by the kernel Maintenance 60%). or collection of kernels. MAINTENANCE = This is the ADOPTION = The percent of percent of people or settings who reach actually choose to use the keep doing the kernel over time. kernel or collection of kernels (must be above 20%-25% to achieve population-level change. Change = R * E * A * I * M for more info, visit www.re-aim.org
  • 40. Reach Reach is the absolute number, Representativeness refers to proportion (percent), and whether participants have representativeness of individuals characteristics that reflect the target populations characteristics. who participate in a given strategy. If the intent is to increase physical activity in sedentary people between the ages of 35 and 70, you wouldnt test your program on triathletes or toddlers.
  • 41. Reach Reach is the absolute number, Representativeness refers to proportion (percent), and whether participants have representativeness of individuals characteristics that reflect the target populations characteristics. who participate in a given strategy. 0% to 100%—higher number, leverages more result If the intent is to increase physical activity in sedentary people between the ages of 35 and 70, you wouldnt test your program on triathletes or toddlers.
  • 42. Efficacy Efficacy/Effectiveness is the impact of this of this measured ability to pr a strategy on important outcomes. the change if used—from none t This includes potential negative highly potent. effects, quality of life, and costs or increase in positive outcomes. Think of Be mindful that all strategies have negative effects that subtract from the good effects.
  • 43. Efficacy Efficacy/Effectiveness is the impact of this of this measured ability to pr a strategy on important outcomes. the change if used—from none t This includes potential negative highly potent. effects, quality of life, and costs or increase in positive outcomes. Think of Higher efficacy X more reach = more leverage Be mindful that all strategies have negative effects that subtract from the good effects.
  • 44. Adoption Adoption is the absolute number, Notice there can be multiple leve proportion, and representativeness of people or settings who must ado people, settings and/or staff who are the strategy to achieve results. willing to offer a strategy.
  • 45. Adoption Adoption is the absolute number, Notice there can be multiple leve proportion, and representativeness of people or settings who must ado people, settings and/or staff who are the strategy to achieve results. willing to offer a strategy. Hi efficacy X large reach X many adoptions = more leverage
  • 46. Implementation Implementation, at a setting level the strategy that is recommended o (home, clinic, office, business, etc), proven. This includes consistency o refers to how closely the user or delivery as intended and the time agents (e.g., staff members) follow and cost of the program.
  • 47. Implementation Implementation, at a setting level the strategy that is recommended o (home, clinic, office, business, etc), proven. This includes consistency o refers to how closely the user or delivery as intended and the time agents (e.g., staff members) follow and cost of the program.(efficacy X reach X adoptions) X robust implementation = Hi leverag
  • 48. Maintenance Maintenance is the extent to which At the individual level, maintenance a strategy, program or policy is the long-term effects on becomes routine or stable outcomes after 6 or more months organizationally. after adoption and implementation.
  • 49. “Behavioral health could learn from public health in endorsing a population health perspective”—(IOM, page 19). “Families and children have ready access to the best available evidence-based prevention interventions, The story of the delivered in their ownwater pump during the cholera communities…in a respectful epidemic in non-stigmatizing way”—(IOM, London. page 387).
  • 50. What is a public health approach?
  • 51. The first breakthrough will be FamiliesUnited… Launching this year Using all modern Internet tools to create a national mobilization Using powerful public health/social marketing tools Applying IOM findings Creating universal consumer access to proven behavioral prevention Combining common sense, good science, low cost with sustainability
  • 52. What is Families United?A set of simple, proven,and powerful tools toprotect all our childrenfrom the leadingcauses of lifetimesuffering, illness,disability and death—securing all our futures.
  • 53. Kernel #1 for United Families Relational Increase Family Positive Frame Monitoring. Parental & family Kernel clarity and commitment to their child about risky or disturbing behaviors such as Creates verbal not using alcohol, tobaccorelations for the and drugs (ATOD) and about behavior that child’s friends’ not using of alcohol, tobacco and drugs. The type of monitoring changes by age of child.
  • 54. Kernel # 2 for United Families Reward Not Using or BreakingReinforcement Kernel Rules. Family recognition and reinforcement of children and teens doing the right thing (e.g., not using ATOD or not engaging in deviant or risky behaviors. HappensAFTER the The rewards and recognition increase behavior intrinsic motivation to do the right thing, and cost little or no money The rewards and recognition create perceived warmth by children from parents and family.
  • 55. Kernel # 3 for United Families. Reduce Sleep Deprivation. Antecedent Kernel Ensuring a child has good sleep patterns, by reducing access to electronic media before bedtime. HappensBEFORE the Sleep deprivation is the silent behavior but deadly cause of many behavioral, school and health problems—including addictions.
  • 56. Kernel #4 for United Families. Physiological Change Brain Food or Fatty Acid Kernel Ratios in Child’s Diet. Increasing children’s “brain food” (omega-3 found in fish oil) protects a child’s basic brain function, brain receptors and brain chemistry from the risk of Changes ATOD as well as other problematicbiochemistry of behaviors including depression and behavior aggression. The main biological factor that has radically changed in the last 20 years, dramatically affecting behavior, mental health and physical health of our children.
  • 57. Kernel # 5 of Families United. Relational Increase Parent Networking Frame to Child’s Friends Families. Kernel Sharing and communicating the above with five of the parents of one’s child’s friends. Creates verbalrelations for the behavior
  • 58. Families United get Families United for all our children, for all our youth, for all our futures… !"#$%&())*+,-%&,+&.)#$,/&0/,+12&34#+&/55&(*$&4,56$#+&/+6& Families Un A Families United Promise %(*-4&/$#7& 4#/5-4%&,+&8(6%2& For Your C ited ity /County/S Card, as do many people 4#/5-4%&,+&),+62& tate P 4#/5-4%&,+&19,$,-2&/+6& lease join 4#/5-4%&,+&8#4/",($: Families U from all walks of life in the United is nited. Fam a gift to yo ilie ;4#+&4,56$#+&/+6&%(*-4&/$#&4#/5-4%&,+&8(6%2&),+62&19,$,-2&/+6& and other u, your fam s 8#4/",($2&</),5,#1&/$#&4/99,#$2&())*+,-,#1&/$#&1/<#$2&8*1,+#11#1& families in ily, Together, this comm community. 9$(19#$2&/+6&.)#$,/&,1&)($#&1#*$#&/+6&9$#9/$#6&<($&-4#&<*-*$#: =/),5,#1&>+,-#6&,1&/"/,5/85#&<($&#"#$%&</),5%2&4#59,+0&9$(-#-&#"#$%& children an we Families U can use the Simple nited to m ake unity. Gifts in 4,56&/+6&%(*-4&<$()&())(+&4/$)1&(<&/5(4(52&-(8/(2&/+6&(-4#$& d teens hav sure all our healthier, e a better, 6$*01?&14,#56&-4#)&<$()&6#9$#11,(+&/+6&(-4#$&())(+&&,551&(<& safer and more prod )(6#$+&1(,#-%?&/+6&0*/$6&/0/,+1-&#@9(1*$#&-(&6/+0#$(*1&/-1&(<& To redeem uctive live your gift, s. A Families United Gift card (-4#$12&",(5#+#&($&,+A*$,#1:&& =/),5,#1&>+,-#6&4#591&#"#$%&4,56&($&%(*-4&6(&8#--#$&,+&14((5&/+6& Go to www please… .SimpleGif ts.com Click on th to access a website, gives /4,#"#&4#/$-<#5-&0(/51&<($&-4#&<*-*$#:& BC3#&9$(),1#&5#/$+&)($#&/8(*-&=/),5,#1&>+,-#6&/-& Scratch off e Families the PIN n United bo x Simple Gif umber on them the tools to act— the 333:D,)95#E,<-1:()C=/),5,#1&>+,-#6: ts card, an the card n d enter it BC3#&9$(),1#&-(&14/$#&-4#&8#+#<,-1&(<&=/),5,#1&>+,-#6&-(&(-4#$12& umber. with 34(&,+&-*$+&/+&14/$#&-4#&8#+#<,-1&-(&&)($#&9#(95#: Make you videos, downloads and BC3#&9$(),1#&-(&/995%F/1&/99$(9$,/-#&-(&)%C(*$&</),5%F-4#& 9$("#+&D,)95#&E,<-1&-(&9$(-#-&/55&(*$&4,56$#+2&(*$&%(*-42&/+6& r co Families U mmitment to suppo nited in yo ur commu rt Browse an nity. more. (*$&<*-*$#1: !"#$%&! you and y d use the our childre Simple Gif n or teens. ts for ()%*+%,-."$/ 0"/1!/*/%2"-34&%5*/% Families U n ited An explanatory flyer. 67*")"#& G4#H&,<&3/+-& #& G4#H&,<&3/+-& #)/,5&*96/-#1 +/)#&9(1-#6 The above can have local sponsors on the materials for sustainability.
  • 59. Families United Communities Use the website to create a community network, nested inside a national movement. (Website being created by leading Web company in the US). Families learn and share how to use the evidence-based kernels to help their own children and their children’s friends.
  • 60. New sustainability mechanisms Other Individual Buyers United Way 9% 28% 6%Child Services 8% Blue Cross 9% Private Sector 17% Board of Supervisors 23%
  • 61. Binghamton New York
  • 62. Binghamton New York
  • 63. Explore the Vision Plant Seeds for Change Prepare to Move Change Act for Behavior Change Maintain and Grow Change
  • 64. Explore the Vision of FamiliesUnited
  • 65. Exploring the Vision of Families United Download or watch videos and other materials Explore the Vision Share info with others who can speak persuasively to • Get or download information • Share information with others diverse groups and leader by using your broad social • Find some early allies (6 to 12) network. Send hyperlink, call them, make Get info Share info presentations to them. Choose broad stakeholder & Find allies groups in the future of your community. Find some early, strong allies (at least 6 to 12) who can now go out and repeat the vision and possibilities and who can commit to help launch Families United in less than 12 months. NOTE: We will send you the hyperlink for downloads
  • 66. 1+2343-9$$ A.3/->$Supportive materials provided to you *,-;-.?=.$Q=9/$D+;3.P9$W9?2+/=,$T=,$/8-$A.3/->$D/+/-9$ Estimates Possible Benefits of Population-Wide Prevention for Children and Youth by State Select State: Alabama 1 4661900 Total <18 Age >65 Age Population Estimate Estimate Percent of US Popultion 2008 Census Estimate 4,661,900 1,142,166 652,666 1.53% (#3.5#6&7-8592$*2"&(#5#2(:;&$+<&5;+<5&.9&.5&4+55.8"#&9+&(#%-:#&32$=&4(#)#$928"#&4(+8"#35&23+$/&:;."%(#$&2$%&=+-9;&-5.$/&"+<>:+59& 59(29#/.#5?&.@&9;+5#&59(29#/.#5&2(#&32%#&-$.)#(52""=&2::#55.8"#&9+&@23.".#5?&9#2:;#(5?&2$%&+9;#(5A&B;.5&#5*329+(&5;+<5&:+59>#C:.#$9&(#5-"95A& Prevalence After Population- Adjusted Wide Adjuster for Average Current Prevention Average Cost Annual Cost Population Families of Problem of Problem Average Annual Estimated Annual Prevalence United Per Child Per Child Total Costs Costs Averted Child and Adolescent Problem Learning Disabilities 9.70% 9.22% $1,422 $157,543,456 $7,877,173 ADHD 7.00% 5.95% $1,200 $95,941,902 $14,391,285 Conduct Disorders 3.00% 2.82% $2,300 $78,809,420 $4,728,565 9.00% 8.55% $900 $92,515,406 $4,625,770 Policy brief Depression Bipolar Disorder 2.00% 1.88% $3,300 $75,382,923 $4,522,975 Child Psychotropic Use 7.00% 6.65% $2,200 $175,893,487 $8,794,674 Substantiated Child Maltreatment 0.15% 0.15% $9,184 $15,906,688 $318,134 Drunkeness, Drugs and Delinquency 7% 6.16% $991 $31,692,808 $3,803,137 Total Annual Estimated Child and Adolescent Morbibity Costs $723,686,089 Total Gross Estimated Annual Averted Costs Via Families United Population Wide Prevention: $49,061,714 Materials to explore the Estimated Prevention Expenditures per Child per Year for Families United: $9.27 Total Prevention Costs Per Year: $6,050,214 Net Annual Prevention Savings: $43,011,500 Percentage Amount vision Example Prevention Funding Mix: 100.0% $6,050,214 K;#&D,23.".#5&E$.9#%D&255-3#5&$#2(&-$.)#(52"&2::#55&9+& "+<>:+59?&#F#:*)#&4(#)#$*+$&59(29#/.#5G(29;#(&9;2$& Parent & Family Purchases: 20.0% $1,210,043 4(#)#$.+$&(2*+$.$/&@+(&9;#&@#<A&& Private Insurance: 10.0% $605,021 Foundations, United Ways, etc. 5.0% $302,511 B;.5&3+%#"&.5&&3+(#&".H#&9;#&:;."%&52@#9=&4(#)#$*+$& Private Sector Sponsorships: 2.0% $121,004 3+)#3#$9&825#%&+$&)#(=&/++%&(#5#2(:;A&B+%2=?& Public Insurance (i.e., Medicaid): 12.0% $726,026 .$%.).%-2"5&+(&@23.".#5&:2$&8-=&8.H#&;#"3#95?&:2(&52@#9=& Substance Abuse Prev. & Treat. Block Grant 8.0% $484,017 5#295?&2$%&2$=&$-38#(&+@&(#92."&825#%&4(+%-:95&9;29& Section 96.124c Pregn. Women & Children: 1.0% $60,502 .34(+)#3&4#(5+$2"?&;+3#&2$%&:+33-$.9=&52@#9=A&&B;#& Public Heath: 5.0% $302,511 :;."%&52@#9=&3+)#3#$9&2"5+&.$)+")#5&32$=&%.F#($9& Protective Services: 6.0% $363,013 +(/2$.I2*+$5&<;+&32=&4(+3+9#&9;+5#&52@#9=&3#25-(#5& Several videos Juvenile Justice: 6.0% $363,013 25&<#""&25&5-85.I#&9;#&52@#9=&4(+%-:95&@+(&@23."".#5&+(& Safe & Drug Free Schools (Gov.s Portion): 0.9% $54,452 5.9-2*+$5A&&B;-5?&2&5929#&2/#$:=&3./;9&4(+3+9#&2$%& Safe & Drug Free Schools (Schools Portion): 2.0% $121,004 /.)#&2<2=&.$@2$9&52@#9=&5#295A&&J&4(.)29#&;#2"9;& State Childrens Health Program (SCHIP): 2.0% $121,004 .$5-(2$:#&:+342$=&3./;9&%+&5+A&&J&;+54.92"&3./;9& Child Abuse Prev. & Treat. Act: 0.1% $6,050 4(+).%#&#)#(=&$#<&3+9;#(&<.9;&2$&.$@2$9&:2(&52@#9=& Comm. Mental Health Serv. Block Grant: 1.0% $60,502 %#).:#A&&&K(&/(2$%42(#$95&+(&42(#$95&3./;9&;2)#& Social Services Block Grant: 1.0% $60,502 4-(:;25#%&+$#A& Mobilizing tools Maternal & Child Health Block Grant: 2.0% $121,004 Child Care & Dev. Block Grant: 1.5% $90,753 (#)#$*+$&@+(&3#$92"?&#3+*+$2"&2$%&8#;2).+(2"& Special Education: 2.0% $121,004 4(+8"#35&:2$&8#&4(+3+9#%&.$&9;.5&523#&<2=&825#%&+$& Local United Ways/Community Foundations: 4.0% $242,009 4+4-"2*+$&"#)#"&4(#:#%#$9&59-%.#5A& Municipalities & Counties: 4.0% $242,009 Other: 4.5% $272,260 !"#$%#%&(#)#$*+$&,-$%.$/&01234"#& *+,-./$0$1+2345$*6,78+9-9:$ Early planning tools, *,3;+/-$<.96,+.7-:$ 1=6.>+?=.9@$A.3/->$B+59@$-/7C$ *,3;+/-$D-7/=,$DE=.9=,983E9:$ &#$ )#$ *6F437$<.96,+.7-$G3C-C@$H->37+3>I:$ )#$ !"#$ D6F9/+.7-$JF69-$$*,-;C$0$K,-+/C$L4=7M$N,+./$ including community !#$ D-7?=.$O(C%!)7$*,-P.C$B=2-.$0$Q834>,-.:$ !#$ !#$ *6F437$R-+/8:$ %#$ *,=/-7?;-$D-,;37-9:$ %#$ "#$ !#$ S6;-.34-$S69?7-:$ !#$ D+T-$0$U,6P$1,--$D78==49$GN=;CV9$*=,?=.I:$ benefit estimator %#$ %"#$ D+T-$0$U,6P$1,--$D78==49$GD78==4V9$*=,?=.I:$ D/+/-$Q834>,-.V9$R-+4/8$*,=P,+2$GDQR<*I:$ (#$ Q834>$JF69-$*,-;C$0$K,-+/C$J7/:$ Q=22C$H-./+4$R-+4/8$D-,;C$L4=7M$N,+./:$ &#$ (#$ D=73+4$D-,;37-9$L4=7M$N,+./:$ !#$ H+/-,.+4$0$Q834>$R-+4/8$L4=7M$N,+./:$ &#$ Q834>$Q+,-$0$U-;C$L4=7M$N,+./:$ %#$ %!#$ DE-73+4$W>67+?=.:$ How the effort can be #$ X=7+4$A.3/->$B+59YQ=226.3/5$1=6.>+?=.9:$ H6.373E+43?-9$0$Q=6.?-9:$ Z/8-,:$ evaluated using existing Preapared by PAXIS Institute, Tucson, AZ Copyright© 2009. For educational and policy use only data
  • 67. Plant Seeds for Change
  • 68. Planting Seeds of Change for Families United Find and share simple local data to estimate costs, provide baseline to measure “early wins” and bigger Plant Seeds changes• Find and share some local data• Sign up partners for change• Share benefits & science of change Share benefits and the science of Families United via Get local data Sign up partners the brief videos, printed synopses and publications (as needed). Sign up partners for change who can lend a hand from from every walk of life, occupation, neighborhood Sharebenefits & Science or organization who shares the vision of improving the futures of all our children. for change
  • 69. Prepare to Advance Change
  • 70. Preparing to Advance Change for Families United Open doors for collaboration. The planningPrepare to Advance Change documents online contains sample MOUs, • Open doors for collaboration • Put behavior change pieces together sponsorship or braided funding agreements, • Mobilize captains for action formula for distribution and presentations. Mobilize captains for Put all the Open doors for Put behavior change pieces together. Families collaboration action pieces together for United is like a product launch or big community behavior event—reaching many people as possible in change 30-60 days. Mobilize captains for action. Captains have the role of mobilizing the “troops” in their respective fields to hold or have Family United events in diverse settings.
  • 71. Act for Behavior Change
  • 72. Acting for Behavior Change for Families United Act school, neighborhood or other teams for Behavior Organize school, neighborhood or other teams for• Organize behavior change. Team members need web tools• Deliver behavior change tools and events for the team members to reach families in their• Measure changes and shout out successes areas. Shout out successes Deliver behavior change tools and events. There are materials, supplies and equipment that may Deliver change need to be delivered, depending on the size of Organize teams for events. behavior change Measure changes and shout out successes. Every day during the campaign window there will be many opportunities measure changes and Measure Changes celebrate successes.
  • 73. Maintain and Grow the Change
  • 74. Maintaining and Growing Families United Improvecontinuously Improve continuously. This includes reviews of the Keep moving campaign to determine what produced the most forward Celebrate successes participation and engagement in actual Families United strategies. Celebrate successes. Immediate successes of participation rates, involvement, sponsorships, support of logistics need to be celebrated. Testimonials from families Maintain and Grow and others must be collected and publicized. • Improve continuously • Celebrate successes Keep moving forward. Families United is a behavioral • Keep moving forward vaccine like hand-washing. People have to keep doing it; next year needs to be initiated at least 6 months beforehand.
  • 75. Dennis D. Embry, Ph.D. President/CEO PAXIS Institute PO 31205, Tucson, AZ 85751 Ph: 520-299-6770 dde@paxis.org Bea Ramirez, Executive Assistantpresentation available at:www.paxtalk.com bea@paxis.org.