Rapid Results with Evidence Based Kernels in North Carolina

Rapid

Using Evidence Base Kernels for Prevention, Intervention and Treatment

by Dennis D. Embry, Ph.D. • PAXIS Institute • April 13, 2011

Thursday, April 14, 2011 1

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 bipolar addictions
problems? disorder? or suicidal problem?
actions?


How many here think it is acceptable that at least every other
American child will be affected by MEB’s before age 18?

This happens for every social class in America…
Among your family, your child’s classmates, your neighbors, at church, and at work…every family.


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 MEB prevention saves Social MEB prevention
helps national helps US global Security & heals past
security. success. Medicare. inequities.


TUV"2003"4-/(560,"2(7-"W0&'"#(56)=&"X&*7('0,""
Estimates Possible Benefits of Universal GBG Implementation in First Grade by State

Select State:
North Carolina
9,222,414 Estimated Total Population 2006
If every cohort of
first-graders receives
36
138,336 Estimated No. of 1st Graders in 2006
Adjust for Percent of 1st Graders Protected by Good
100 100% 138,336 Estimated 1st Graders Reached

the Good Behavior
Behavior Game in the State
Adust to reflect average cost per student for education
20 100% $8,701
compared to national average Average Cost Per Student Per Year

Game just in first
!"#$%&#!"#$%&'()*(+",-&-(,./"&/01&"'/('"'/-"2003"4-/(560,"2(7-"82429":-3$.-&"'/-";,-5(+-).-"0<"'/-"<0++016)=";,0%+-7&"%>"?@"'0"@ABC"D6&,$;*0)&"(,-"'>6.(++>",-3$.-3"%>"
@AB"'0"E@B"0<"'/-"%(&-+6)-"0,"%-<0,-"242"1(&"&'(,'-3C"F/6&"-&*7('0,".07;$'-&"%-)-G'&"$&6)="242"H$&'"6)"I6,&'"2,(3-J"+6K-"'/-"+0)=L'-,7"&'$36-&"
'(&)"*+,-(&!"F/-"G,&'"&'-;&"6)50+56)="(3H$&*)=">0$,"(&&$7;*0)&C"
M9"#-+-.'"'/-"&'('-">0$"(,-"<0.$&-3"0)"6)"'/-";$++"301)N"?9"#-+-.'"'/-";-,.-)'(=-"0<"M&'"=,(3-,&">0$"6)'-)3"'0",-(./"6)">0$,"&'('-N"O9"'/-)"(3H$&'"'/-"&+63-,&"<0,"'/-";-,.-)'(=-&"
0<"67;(.'">0$"/0;-"'0"(./6-5-P,-7-7%-,6)="242",-3$.-&";,0%+-7&"%>"('"+-(&'"?@BN"Q9"'/-)"(3H$&'"'/-".0&'"0<"'/-";,0%+-7&">0$"(,-"',>6)="'0";,-5-)'"6)">0$"(,-(C""F/-"
+01-&'"+-5-+"6&"("3-<($+'".0&'"0<"'/-";,0%+-7C"":-7-7%-,J"'/-".0&'"0<"RSF"306)="()>"'/6)="6&"($'07(*.(++>".07;$'-3C" grade, the good
Estimated Adjust for
Current Impact of Prevalence
Population the Good After
Adjust for
Average
Cost of
Adjusted Average Annual
Average
Annual
Total Cost of
the Problem
Estimated Per
Year Costs
people of North
Carolina will save
Prevalence Behavior Universal Problem Cost of Behavior With SAVINGS for
of Problem Game on 1st Grade Per Child Problem NOT DOING Percent of 1st
or Behavior Problem Delivery Per Year Per Child GBG Graders Reached
Move slider (or per each

$250 million for each
Move slider 100%
left if think right if think disruption)
Child, Adolescent & Adult will less be problem costs
effective more
Problems

group of kids when
Total daily disruptions in state $1.0
4,565,095 70000.00% 1,369,528 $0.01 $8,217,171 $5,752,020
before GBG
ADHD 3rd Grade
2 7.00% 3000.00% 3.00% $750 $7,262,651 $4,150,086

they are young
Oppositional Defiance 3rd Grade
3 5.00% 2700.00% 2.30% $900 $6,225,129 $3,361,570

Adolescent Conduct Disorder
4 14.00% 5600.00% 8.40% $1,400 $27,113,897 $10,845,559

Special Education 1st-Grade 12
5 7.00% 2200.00% 4.80% 500.00% $435 $4,212,822 $1,324,030
Adult Criminal Behavior
Serious Adult Drug Addictions
6

7
12.00%
20.00%
1200.00%
800.00%
10.80%
12.00%
45000.00%
4900.00%
$4,500
$490
$74,701,553
$13,556,949
$7,470,155
$5,422,779 adults.
Teen/Adult Suicidal Ideations
8 14.00% 7000% 7.00% $992 $7,684,853 $3,842,427

Total Minimum Estimated Child, Adolescent and Adult Morbibity Costs for Each First Grade
Cohort if Nothing is Done New Each Year: $148,975,025

Esimtated Cost of the Good Behavior Game Per First Grader as Behavioral Vaccine (this
includes local staff, materials, incentives, training, technical support, and overhead)
$62.00 This is less than cost of most
childhood disease vaccines.
Over the next 10
years, that’s $2.5
Esimtated Cost of Implementing the Good Behavior Game Per Classroom $1,550

Cost per 1st Grade Cohort Based on Percentage of Students Reached: $8,576,845

billion.
Return on
Investment

Net Profit at Start of 2nd Grade Per 1st Grade Cohort: $931,003 11%

Net Profit at 6th Grade Per 1st Grade Cohort: $32,517,918 379%

Net Profit at 12th Grade Per 1st Grade Cohort: $110,701,906 1291%

Net Profit at the 29th Year of Life Per 1st Grade Cohort: $247,316,107 2884% The cost? $62 per
first grader.
Note: Over a Decade of 1st Grade Cohorts Getting GBG, these numbers would be x10:

References:
1 Tingstrom DH, Sterling-Turner HE, Wilczynski SM. The Good Behavior Game: 1969-2002. Behavior Modification
2006;30:225-53.
2
van Lier PAC, Muthen BO, van der Sar RM, Crijnen AAM. Preventing Disruptive Behavior in Elementary Schoolchildren:
Impact of a Universal Classroom-Based Intervention. Journal of Consulting & Clinical Psychology 2004;72(3):467-78.
3 Ibid.

4 Ialongo N, Poduska J, Werthamer L, Kellam S. The distal impact of two first-grade preventive interventions on conduct
problems and disorder in early adolescence. Journal of Emotional & Behavioral Disorders 2001;9(3):146-60.

National Media
And “Good News…” State/local Business Donors/
Health Care Reform Act

agency grants Sponsors
Local/Regional Media

These types of
Local
Family Private Health Social Media
Prevention
Foundations Donors
prevention strategies
Insurers Scoreboard
Consumer Prevention Products

can be sustained and
(Retail & Online)
United Way and/or Property/Auto &
National
Community
grow because of laws Foundations Life Insurers
Foundations
School Personnel Local, State
and regulations… and
State Health Local Health Local NGO: Private Providers National
Authority Professional
Authority Prevention for Groups
If we collectively act for Everyone* Agency Providers

the future of all our Local Gov'ts (prenatal thru age 21)
Voluntary & Faith Groups
children’s futures here Center for Medicaid Services FQHC &
Lookalikes
in this room.
(Medicaid Administrative Match) Americorps, County
Suppliers of Evidence-
Teacher Extension
Based Prevention
Tribal Governments Corps
Products or Tech. Asst.
Other Federal Funds Dept. of Defense

Example Enabling Regulations Universities &
Comm. Colleges
Preventive services Rehabilitative services
(Act, 42 C.F.R. 440.130 (c), 2004) (Act, 42 C.F.R. 440.130 (d), 2004)
Private Scientiﬁc Orgs
Early and Periodic Screening, Medical Services under the Individuals
Diagnostic, and Treatments with Disabilities Education Act *Can be existing entities (e.g.,
Services (IDEA, 2004) DFC's, non-proﬁts)


Consumer approach to prevention
Car seats
Bike helmets Prevention Store
Safety gates
Electric socket covers
BUT WHAT ABOUT…
Depression
ADHD
Suicide
Substance abuse
Obesity


But at the new North Carolina prevention store
Omega 3 @ $70 a year to
Prevention Store prevent multiple mental,
emotional and behavioral
illnesses
Dialogic storybooks to
prevent behavior
problems @ $86 per year
Good Behavior Game for
Teachers @ $54 per child
per year to prevent
mental/health emotional
problems
Families United @ $4 per
child per year to prevent
conduct disorders,
suicide, ATOD


Obesity
Conduct
Disorders

Homicide
& Suicide

Depression

Oppositional/
Addictions ADHD

Aggression

Self
harm

ANXIETY


Nearly 75 percent of the nation's 17- to 24-year-olds a
ineligible for service

• Medical/physical problems, 35
percent.

• Illegal drug use, 18 percent.
• Mental Category V (the lowest 10
percent of the population), 9
percent.

• Too many dependents under age
18, 6 percent.

• Criminal record, 5 percent.

Army Times, Nov 5, 2009 • www.missionreadiness.org/PAEE0609.pd


The US has
75 million
children and
teens.
40.4 million
are on
psychotropic
medications
Wall Street Journal, 12-28-2010


2009:
Institute of Medicine Report
provides a concise review of
the prevention of mental,
emotional, and behavioral
disorders.


America’s rate of mental,
emotional and behavioral
disorders is about twice that
of the United Kingdom which
is twice that of many other
rich democracies.


Silo busting ideas in prevention science

ADHD ODD Depression Obesity Injury Control


What message do we need to promote?


Reaching the faithful
๏ Tell stories of how faith-based groups can use
proven prevention strategies
๏ Pastor Smith uses Triple P to counsel his parishioners
having common problems with their children. “It’s very
easy for me to relate Triple P strategies to Scripture.”

๏ St. John’s uses the Good Behavior Game. “The Game
helps us not only with behavior and academics, but
also helping students understand how early Christians
had to cooperate.”


Reaching businesses
๏ Give examples of immediate beneﬁts to
productivity. “Having workplace Triple P has
reduced our employees having to take time off
for dealing with problems of their children.”
๏ Link business competition. “Other rich
democracies have extensive universal
prevention, and those countries have more
viable small business sector than the US.”
๏ Link to major cost of business, such as
depression is now major cause of disability.


Like the Inuksuk,

Reaching the traditional practices often
point to the right way

Tribes
๏ Link key cultural wisdom to proven
science of prevention, such as:
๏ the use of omega-3 was discovered by the
Arctic peoples

๏ the Good Behavior Game mimics common
traditional practices of assuring cooperation
among children


Reach to the political right
๏ Universal access to prevention enables individual
responsibility; rationing limits it.
๏ Use the metaphor of accepted prevention
practices like universal inoculations of childhood
diseases or car safety seats.
๏ Link to balancing budgets, national security and
global competition.


CEPR An International Comparison of Small Business Employment !"8

Key message by showing global competion
!"#$%&'!(%$)*#+)#,%-''#$)*$.&.+,$,#/0123#&$.4$)*5#-%!)6#*7$#18#4!9)*.+$,#"!.#:7+47#*7$#;<=>#7-,#
+)*$.)-*+!)-''(#4!%&-.-?'$#@-*-2##

#
FIGURE 3
Manufacturing, Employment in Enterprises with fewer than 500 Employees, 2001

LE7/BA4< )!#% All of these other rich
F/4<9 )'#%
democracies have nearly
3K4.- )$#(
J4K4- &+#)
universal access to prevention for
G0/I07<4-15 &%#" MEBs, compared to the rationing
6700=0 &!#" model in the US.
G0:2H04<4-1 &'#+
GE7:49 &$#$
Having “ﬁtter” employees allows
F70<4-1 &"#'
CB5/7.4 &*#+
these countries to have higher
,-./012D.-A1E8 %&#( paying manufacturing jobs and
CB5/74<.4 %!#) compete globally.
@0<A.B8 %!#(
>0-847? %!
;74-=0 %'#&
;.-<4-1 !&#!
3:010- !%#&
60784-9 !%#%
,-./0123/4/05 !"#$

* $! !* &! "**
!"#$"%&'()'*+%,)+$&,#-%.'"*/0(1*"%&

Source: Authors’ analysis of OECD data.
Thursday, April 14, 2011 # 29

Explain universal prevention in terms of national security
America’s retired 4-start generals ﬁnd…
Nearly 75 percent of the nation's 17- to 24-year-olds are ineligible for service
• Medical/physical problems, 35
percent.
• Illegal drug use, 18 percent.
• Mental Category V (the lowest 10
percent of the population), 9
percent.
• Too many dependents under age
18, 6 percent.
• Criminal record, 5 percent.

Army Times, Nov 5, 2009 • www.missionreadiness.org/PAEE0609.pd


Reach to the political left
๏ Explain universal prevention as remedying
historic disparities such as:
๏ Good Behavior Game increases high-school
graduation and college entry rates and reduces
lifetime incarceration rates of inner city kids.

๏ Omega-3 improves IQ and reduces effects of poverty
on children lives


Explain how prevention for our kids protects elders

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…


Reach to the center
๏ Emphasize that MEB’s affect every family, every
school, every neighborhood, and every
business.
๏ Example: “How many of you know a reasonably
OK middle class or upper class family with a
child or teen with a mental illness, learning
disability or addictions problem?”


Reach state legislators,
county & city leaders
๏ Show how prevention for everyone will help
balance the local budget and keep it balanced
over time—use example estimators.
๏ Show data how universal access to prevention
will help the jurisdiction speciﬁcally
๏ Share such data with advocates for local
emotional impact


Key message for every group
“Mental illness is preventable,
just like many childhood diseases,
tra c injuries or even addictions
are preventable.”
In every communication say…
๏ Mental, emotional and behavioral disorders are
preventable like most childhood diseases and
childhood injuries.
๏ MEB’s harm and kill more children, youth and
“Yes, it is preventable.
Read all about it,
in the ‘09 IOM Report

young adults than any childhood diseases, and on the Prevention of
Mental, Emotional, &
Behavioral Disorders.
the prevention of MEB’s is less expensive than We’ve been conditioned
to think these were

childhood medical vaccines.
just manageable…”
O'Connell, M. E., T. Boat, et al., Eds. (2009). Preventing Mental,
Emotional, and Behavioral Disorders Among Young People:
Progress and Possibilities. . Committee on the Prevention of Mental
Disorders and Substance Abuse Among Children, Youth and Young
Adults: Research Advances and Promising Interventions.
Washington, DC, Institute of Medicine; National Research Council.

TO READ THE IOM REPORT, GO TO: http://bit.ly/IOMPREV


Redness, rubor, a response of body tissues to
injury or irritation; characterized by pain and
swelling and redness and heat.
Excitation, excitement, fervor, fervour the state
of being emotionally aroused and worked up
Inflaming arousal to violent emotion
Firing, ignition, kindling, lighting
the act of setting on fire or catching fire

Hypothesis: Evolutionary “inflammatory” processes


Human Infectious/Biological Threats Human Predatory Threats

Evolutionary Adaptive Responses Evolutionary Adaptive Responses
(Simplified) Neuro-Hormones (Simplified)

Mood
Modulators

Reward Threat Attributional
Delay Intra-Group
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.

K R
Path Path

Evolutionary Path
of a Child’s Life

Probability of short-life and doubtful
Probability of long-life and
reproductive success
reproductive success
R-Path can be triggered by
evolutionary mismatch in social
or physical environment.


Obesity
Conduct
Disorders

Homicide
& Suicide

Depression

Oppositional/
Addictions ADHD

Aggression

Self
harm

ANXIETY

R PATH = Risky behaviors or health

Substance Work Obesity,
Early Mental Illness Violence Cancer School
Abuse Problems etc
Sex Failure

Mood Reward Executive Behavioral
Attention
Stability Delay Function Competencies
Immune-
STD’s Motor Healing Special
Skills Multi-Inﬂammatory Threat Reaction Functions Ed

Major Ecologic Causes of the Dual Inﬂammatory Threats to Children & Youth

Physiological Antecedents Reinforcement Verbal Relations


Cultural Trend:
Sleep Deprivation
IOM Report (IOM, page 212)


Parental Monitoring and
Parental Networking
(IOM, page 168, 171, 189)


Peer, Family, & Cultural Rewards
for NOT breaking rules
IOM Report (page 165, 170,171, 181)


What are the social rewards for these behaviors?

Billy Good Billy Bad

Constant (k) affected by physiology (e.g., diet, perceived stress and threats, exercise,
medications, substance abuse) and genes

Rate inﬂuenced by: Rate inﬂuenced by:
•Reinforcements •Reinforcement
•Antecedents •Antecedents
•Relational-frames •Relational-frames


Diet change in
essential “brain food”
IOM Report (page 211-2)


Data on “Brain Food”:
Omega-3 deﬁciency


Apparent consumption o inoleic acid (% of dietary energy) among
Australia, Canada, UK and USA for the years 1961–2000

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“Risky” Beh.
Evolution Neonates Breast Milk
& Mismatch
In the Rife Valley, the Successful human American infants have
human brain evolution neonates born with been getting steadily Theory
the result of eating 60-day supply of less omega-3 (n3) and Almost all adolescent
fish high in omega-3 omega-3 in more pro-inflammatory risky behaviors have
omega-6 (n6) in breast now been documented
not savannah animals subcutaneous fat from
milk to be related to low n3
mother’s diet
and high n6 in US diet
See Broadhurst, Cunnane, &
Crawford (1998). Rift Valley lake fish
See HIbbeln et al. (2007).Maternal
seafood consumption in pregnancy and
See Ailhaud et al. (2006).Temporal change in last 50 years
changes in dietary fats: Role of n6
and shellfish provided brain-specific neurodevelopmental outcomes in Hibbeln et al. (2006). Healthy intakes of
polyunsaturated fatty acids in excessive
nutrition for childhood (ALSPAC study): an adipose tissue n-3 and n-6 fatty acids: estimations
early Homo observational cohort study considering worldwide diversity.
development and relationship to obesity


Syndemic = reverse of synergies


If we just hit the
problem harder…


Reduce Omega 3 Brain Deﬁciency
in baby’s brain


The beneﬁts to the baby and society
Verbal Suboptimal Prosocial Suboptimal
A 35 C 15
children suboptimum (%)

30

Verbal IQ

10
25

Prosocial
20
5

15
n=584 n=3493 n=1330 n=739 n=4260 n=1583
0 0

B 35
Fine Motor Skills Suboptimal D 35 Social Development Suboptimal
30 30

Social development
Fine motor

25 25

20 20

15 15
n=875 n=4923 n=1798 n=875 n=4919 n=1798
0 0
None 0–340 g >340 g None 0–340 g >340 g
per week per week per week per week
Maternal seafood consumption in pregnancy Maternal seafood consumption in pregnancy


Why not reproduce the rapid
results in North Carolina to
prevent multiple mental,
emotional and behavioural
It costs about $70 per person per year.


1.0

Inpatient
Discharge

0.8

0.6
Survival
Probability

0.4

High
DHA

(n=16)

Low

DHA

(n=17)

0.2 (median
split
of
plasma
phospholipid
%
fa1y
acids)

0

0 200 400 600 800

Time
to
First
Suicide
A1empt
(days)

Suble&e,
Hibbeln
et
al
Am
J
Psychiatry
2006;163:
1100-‐1102


The same universal works for
high risk youth…
30%
Percentage with Psychosis at 12 months

27.5%
24%

18%

12%

6%
4.9%
0%
Omega-3 Placeo
Psychosis

Amminger, G. P., M. R. Schafer, et al. (2010). "Long-Chain {omega}-3 Fatty Acids for Indicated
Prevention of Psychotic Disorders: A Randomized, Placebo-Controlled Trial." Arch Gen
Psychiatry 67(2): 146-154.

Rapid

Other rapid results to consider…


Young children


Early stories and reading


Why not distribute specially
constructed books for
parents with young children…
Reduce dangerous,
impulsive, disturbing
behavior quickly?
Increase social-
competence quickly?
Improve school
readiness quickly?

Embry, D. D. and L. Peters (1985). A three-city evaluation of the diffusion of a pedestrian-safety
injury control intervention. R. S. Division, New Zealand Ministry of Transport, Wellington, NZ.

PeaceBuilders School-Community Reinforcement Study

Positive Peer-to-Peer Social
Home Notes Notes Competence Violence


Promote the Triple P (Positive Parenting Program)


Substantiated Child Maltreatment
16

Control Counties
Rates per 1,000 Children (0-8 Years)

15

13

Triple P Counties
12

10

Pre Post
Two Years Later
Prinz et al., 2009, Prevention Science


Child Abuse Hospital Injuries
1.80

1.68 Control Counties
1.55

1.43 Triple P Counties
1.30

Post
Pre
Two Years Later



Child Out-of-Home Placements
Control Counties
4.50

4.13

3.75
Triple P Counties

3.38

3.00
Post
Pre
Two Years Later



Classrooms

Muriel Saunders


C linical C hild and Family P sychology R eview, Vol. 5, N o. 4, D ecember 2002 ( C 2002)
pages 273-297

T he G ood B ehavior G ame: A B est P ractice C andidate
as a U niversal B ehavioral V accine

Key findings in the first 50 D ennis D . E mbry1

A “ behavioral vaccine” provides an inoculation against morbidity or mortality, impactingphys-

studies of the GBG
ical, mental, or behavior disorders. A n historical example of a behavioral vaccine is antiseptic
hand washing to reduce childbed fever. I n current society, issues with high levels of morbidity,

LY
such as substance abuse, delinquency, youth violence, and other behavioral disorders ( multi-
problems) , cry out for a low-cost, widespread strategy as simple as antiseptic hand washing.
C ongruent research findings from longitudinal studies, twin studies, and other investigations

N
suggest that a possibility might exist for a behavioral vaccine for multiproblem behavior. A

O
simple behavioral strategy called the G ood B ehavior G ame ( G B G ) , which reinforces inhibi-
tion in a group context of elementary school, has substantial previous research to consider
its use as a behavioral vaccine. T he G B G is not a curriculum but rather a simple behavioral
procedure from applied behavior analysis. A pproximately 20 independent replications of the
G B G across different grade levels, different types of students, different settings, and some
with long-term follow-up show strong, consistent impact on impulsive, disruptive behaviors
of children and teens as well as reductions in substance use or serious antisocial behaviors.
T he G B G , named as a “ best practice” for the prevention of substance abuse or violent be-
havior by a number of federal agencies, is unique because it is the only practice implemented
by individual teachers that is documented to have long-term effects. Presently, the G B G is

๏ This was the first widely replicated scientific
only used in a small number of settings. H owever, near universal use of the G B G , in major
political jurisdictions during the elementary years, could substantially reduce the incidence of
substance use, antisocial behavior, and other adverse developmental or social consequences
at a very modest cost, with very positive cost-effectiveness ratios.
K E Y W O R D S: substance abuse prevention; violence prevention; public policy; best practice.

demonstration that disturbing, disruptive, INT R OD U CT ION

A behavioral vaccine is a simple, scientifically
I n the late 1840s, D r I gnaz Semmelweis worked in
the maternity wards of a V ienna hospital. B y metic-
ulous observation, he discovered that the mortality

destructive and inattentive behaviors of
proven routine or practice put into widespread daily rate in a delivery room staffed by medical students
use that reduces morbidity and mortality. A powerful was up to three times higher than in a second deliv-
example comes from an epidemic that occurred 150 ery room staffed by midwives. Semmelweis postulated
years ago. that the students might be carrying the infection from

children from preschool through secondary
D uring the nineteenth century, women died in their dissections to mothers giving birth. H e tested the
childbirth at alarming rates in E urope and the U nited hypothesis by having doctors and medical students
States. U p to 25% of women who delivered their ba- wash their hands with a chlorinated solution before
bies in hospitals died from childbed fever ( puerperal examining women in labor. T he mortality rate in his
sepsis) , discovered later to be caused by Streptococcus maternity wards eventually dropped to less than 1% .

education could be reliably reduced by
pyogenes bacteria. Washing of hands with antiseptic solution—a behav-
ioral vaccine—now saves millions of lives every year.
1 PA
X I S I nstitute, PO B ox 68494, Tucson, A rizona 85737; e-mail: Today, the C enters of D isease C ontrol and Prevention
dde@paxis.org. ( C D C ) web site states, “ [A ntiseptic] hand washing is

individual teachers using a simple recipe for a 273
1096-4037/02/1200-0273/0 C 2002 Plenum Publishing C orporation

3x daily behavioral vaccine. Embry, D. D. (2002). The Good Behavior Game: a best practice
candidate as a universal behavioral vaccine. Clinical Child &
Family Psychology Review, 5(4), 273-297.


Behavior Tracking Results in Baltimore 150+ classrooms
No or Low Implementation High Implementation
of PAX (Good Behavior) Game of PAX (Good Behavior) Game

17 per/hr X 5.5
class hours X 30
students =
2,805 disruptions 6 per/hr X 5.5
per school day class hours X 30
per classroom students =
990 disruptions
per school day
per classroom


PAX
GBG
decreased
distracLon
in
classrooms
by
an
average
of

86%
aQer
only
one
month

2011 Replication in rural
Tennessee by coaches
trained just like you…

Baseline
DisrupIons

Six
1st-‐grade
classrooms
averaged

136
per
hour
before
coaching

PAX
Introduced
The
distracLons
per
hour
decreased

by
56%
with
the
introducLon
of
the

PAX
environment
of
PAX
language

and
several
PAX
kernels.

PAX
GBG
Played
DisrupLons
per
hour
decreased
an

addiLonal

30%

aQer
learning
to

play
PAX
GBG
.


Johns Hopkins Centre for
Prevention and Early
Intervention
๏ Five longitudinal studies of the effects of the Good
Behavior Game now being studied
๏ All involve random assignment of teachers in schools and
schools to use or not use GBG
๏ Here are data from Cohort 1 and 2 studies showing
effects 20 years later, after just getting GBG in 1st grade
ONLY


3 GBG games a day in just ﬁrst grade
during your normal teaching…
๏ Reduces disturbing, disruptive and destructive
behaviors by 75%
๏ Prevents ADHD and other mental illnesses-
without medication or therapy
๏ Prevents lifetime crime, violence and drug
addiction
๏ Increases high-school graduation & college entry


Timeline of benefits from PAX GBG
Age of Child Benefits
75% reduction in disturbing, disruptive and destructive behavior;
1st Grade 25% increase academic achievement--especially in reading if played well

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; major reduction in
6th grade bullying 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

Age 29 Lifetime reduction in violent crime, suicide, psychiatric diagnoses, and lifetime addictions


Adolescents


Why not invite families to
promise clear rules about
alcohol, tobacco & drugs if…
It produces a 23% reduction binge drinking and
27% reduction delinquency rates among 7th
graders in 2 years and this has been adopted
nationally by Sweden and being adopted by the
State of Tennessee?

PS. Effect sizes were 0.35 for drunkenness
and 0.38 for delinquency.

Koutakis, N., H. Stattin, et al. (2008). "Reducing youth alcohol drinking through a parent-targeted intervention:
the Orebro Prevention Program." Addiction 103(10): 1629-1637.

What is Families Together?
A set of simple, proven, and
powerful tools to protect all our
children from the leading causes
of lifetime suffering, illness,
disability and death—securing all
our futures.


What do Families Together do?
Increase Family Positive Monitoring.
Parental & family clarity and commitment to
their child about risky or disturbing behaviors
such as not using alcohol, tobacco and drugs
(ATOD) and about that child’s friends’ not using
of alcohol, tobacco and drugs.
The type of monitoring changes by age of child.


Reward Not Using or Breaking 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.
The rewards and recognition increase 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.


Reduce Sleep Deprivation. Ensuring a child
has good sleep patterns, by reducing access to
electronic media before bedtime.
Sleep deprivation is the silent but deadly cause
of many behavioral, school and health problems
—including addictions.


Change Brain Food or Fatty Acid 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 ATOD as well as
other problematic behaviors including
depression and 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.


Increase Parent Networking to
Adolescents’ Friends Families. Sharing and
communicating the above with ﬁve of the
parents of one’s child’s friends.


Rapid Results with Evidence Based Kernels in North Carolina

Rapid Results with Evidence Based Kernels in North Carolina

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