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Upstream alcohol prevention rowan university

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Something has been happening in America. More and more young people are showing up with various mental, emotional, and behavioral disorders—based on the 2009 Institute of Medicine Report on the …

Something has been happening in America. More and more young people are showing up with various mental, emotional, and behavioral disorders—based on the 2009 Institute of Medicine Report on the Prevention of Mental, Emotional, and Behavioral Disorders Among Young People. These disorders—from alcohol addiction to other serious mental and behavioral problems—are not just happening in K-12 education: they are fully present in larger numbers on college and university campuses. And, even more importantly, they are now epidemic in our broader society, causing untold damage to the fiscal stability of America, its national security, and global economic competitiveness.
Oddly, it is American institutions of higher learning that have pioneered the world’s best science why and how this epidemic is happening and what can be done to avert the problems. Still more oddly, it is not American institutions of higher learning leading the charge on applying that science—something at odds with the unique heritage of America applying science to better the world. Other rich democracies now lead in applying prevention science for the protection of their future generations.
American Colleges and Universities can become one of the drivers of great carbon revolution, not just a revolution in silicon technology. By a carbon revolution, this means resolving the problems of human behavior that are the largest burdens of social and economic pain and suffering.
In my presentations, I intend to outline how the youthful energies of our young people might be combined with prevention science for population-level prevention and protection against mental, emotional, behavioral and related physical disorders plaguing our futures.
• First, the presentation is aimed at evoking understanding of how these problems have arisen from fundamental evolutionary mismatch—something that my colleagues in the evolutionary sciences have started to map well.
• Second, the presentation gives concrete examples of how prevention science can be scaled to a public-health model to protect our young people and our broader society.
• Third, the presentation outlines how colleges and universities—students, faculty and staff—might have a leadership role in changing the trajectory of these problems rapidly.
• Fourth, the presentation maps how all this can be funded in a politically powerful way, which will in turn strengthen colleges and universities by reducing the huge rise in tuition and other costs that have well outpaced inflation. Indeed, the cost of higher education is now significantly higher in the US proportionately than that of other rich democracies.
I realize that this not a standard presentation about addictions among our college-age youth, decrying the alcohol industry or arguing over the age of drinking or the legalization of marijuana. I believe we must have a much bigger solution, not just for the sake of the young people on our campuses—but for all o

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  • 1. Upstream Prevention of Alcohol and Related Problems among America’s Young People: Reclaiming America’s Promise An  inquiry  into  possibili/es Dennis D. Embry, Ph.D. President/Senior Scientist West  Windsor,  NJ  •  Nov  14,  2012 PAXIS InstituteWednesday, November 14, 12
  • 2. A recent webinar experience on preventionWednesday, November 14, 12
  • 3. Wednesday, November 14, 12
  • 4. How early is this prevention?Wednesday, November 14, 12
  • 5. Wednesday, November 14, 12
  • 6. Is this early prevention?Wednesday, November 14, 12
  • 7. Wednesday, November 14, 12
  • 8. Is this early prevention?Wednesday, November 14, 12
  • 9. Wednesday, November 14, 12
  • 10. Is this early prevention?Wednesday, November 14, 12
  • 11. Thinking way upstream What might be the early malleable predictors? What if universities started here with early prevention?Wednesday, November 14, 12
  • 12. Thinking way upstream What might be the early malleable predictors? Could we actually change those predictors easily and reliably? And what else might change as a consequence of the prevention or protection strategies? That is, how and why are these human problems so deeply connected?Wednesday, November 14, 12
  • 13. Wednesday, November 14, 12
  • 14. 15 Will have Eating Disorders Sexual Weapons 28 Violence Will have Sexual Crimes Out of 100 Violent Physical Weapons Substance Bullying Assaults Violence Fighting Felonies Abuse SexualViolent Abuse Crimes Disorder 20 Antisocial Violence Bullying Bullying Assaults Weapons Fighting Felonies Physical Fighting Abuse Crimes Will have Bullying Violent youth will… Depression Assaults Assaults Fighting Felonies Crimes Physical Weapons Abuse Violent Sexual Physical Felonies Abuse Violence 37 Will engage in Risky Sexual 37% BehaviorWednesday, November 14, 12
  • 15. 15 Will have Eating 14 Will have Eating Disorders Disorders 28 33 Sexual Violence Weapons Will have Unprotected Sex Sexual Crimes Out of 100 Violent Physical Weapons Substance Bullying Assaults Violence Fighting Felonies Abuse SexualViolent Abuse Crimes Disorder Out of 100 Teen Pregnancy Multiple Partners Will have Unprotected Sex AIDS HIV EarlyUnprotected Sex Sex Substance 20 Antisocial Violence Bullying Bullying Assaults Weapons Fighting Felonies Physical Fighting Abuse Crimes 23 Youth doing Teen Pregnancy Multiple Partners Abuse Disorder Teen Pregnancy Multiple Partners Will have Bullying Violent HIV AIDS Will have Early Sex Unprotected Sex youth will… Depression Assaults Assaults Fighting Felonies Crimes Physical Weapons Abuse Depression Risky Sex Early Sex HIV AIDS Violent Teen Pregnancy Multiple Partners Sexual Physical Felonies HIV AIDS Abuse Early Sex Violence 37 Will engage in Risky Sexual 30 Will have 37% Antisocial Behavior BehaviorWednesday, November 14, 12
  • 16. 15 Will have Eating 14 Will have Eating Disorders Disorders 28 33 Sexual Violence Weapons Will have Unprotected Sex Sexual Crimes Out of 100 Violent Physical Weapons Substance Bullying Assaults Violence Fighting Felonies Abuse SexualViolent Abuse Crimes Disorder Out of 100 Teen Pregnancy Multiple Partners Will have Unprotected Sex AIDS HIV EarlyUnprotected Sex Sex Substance 20 Antisocial Violence Bullying Bullying Assaults Weapons Fighting Felonies Physical Fighting Abuse Crimes 23 Youth doing Teen Pregnancy Multiple Partners Abuse Disorder Teen Pregnancy Multiple Partners Will have Bullying Violent HIV AIDS Will have Early Sex Unprotected Sex youth will… Depression Assaults Assaults Fighting Felonies Crimes Physical Weapons Abuse Depression Risky Sex Early Sex HIV AIDS Violent Teen Pregnancy Multiple Partners Sexual Physical Felonies HIV AIDS Abuse Early Sex Violence 37 Will engage in 14 will have 30 Will have Risky Sexual 37% Behavior Eating Disorders 30Will have Antisocial Behavior Antisocial Poly Drug Addiction Behavior 18 Poly Drug Addiction Tobacco Addiction Alcohol Abuse Prescription Drug Abuse Out of 100 Poly Drug Addiction Prescription Drug Abuse Tobacco Addiction 100e Illegal Drug Abus Prescription Drug Abuse Drug Abuse Illegal Will have Alcohol Abuse Addiction Depression Substance Poly Drug Tobacco Addiction Illegal DrugTobacco Addiction Abuse Users… Alcohol Abuse Prescription Drug Abuse Poly Drug Illegal Drug Abuse Addiction Alcohol Abuse 38 Will engage in Risky Sexual BehaviorWednesday, November 14, 12
  • 17. 15 Will have Eating 14 Will have Eating Disorders Disorders 28 33 Sexual Violence Weapons Will have Unprotected Sex Sexual Crimes Out of 100 Violent Physical Weapons Substance Bullying Assaults Violence Fighting Felonies Abuse SexualViolent Abuse Crimes Disorder Out of 100 Teen Pregnancy Multiple Partners Will have Unprotected Sex AIDS HIV EarlyUnprotected Sex Sex Substance 20 Antisocial Violence Bullying Bullying Assaults Weapons Fighting Felonies Physical Fighting Abuse Crimes 23 Youth doing Teen Pregnancy Multiple Partners Abuse Disorder Teen Pregnancy Multiple Partners Will have Bullying Violent HIV AIDS Will have Early Sex Unprotected Sex youth will… Depression Assaults Assaults Fighting Felonies Crimes Physical Weapons Abuse Depression Risky Sex Early Sex HIV AIDS Violent Teen Pregnancy Multiple Partners Sexual Physical Felonies HIV AIDS Abuse Early Sex Violence 37 Will engage in 14 will have 30 Will have 23 Will have Antisocial 20 Will have Substance Risky Sexual 37% Behavior Eating Disorders 30Will have Antisocial Behavior Behavior Abuse Disorder Antisocial Eating Disorders Poly Drug Addiction Behavior Out of 100 Eating Disorders Eating Disorders 18 Poly Drug Addiction Tobacco Addiction Alcohol Abuse Prescription Drug Abuse Eating disorders Eating Disorders Eating Disorders Eating Disorders Out of 100 Poly Drug Addiction Prescription Drug Abuse Tobacco Addiction 100e Illegal Drug Abus YouthDisorders 26 Eating DisordersEating with Eating Disorders Eating DIsorders Eating Disorders Prescription Drug Abuse Drug Abuse Illegal Will have Alcohol Abuse Addiction Substance Poly Drug Eating Disorders S Eating Disorders Depression Tobacco Addiction Illegal DrugTobacco Addiction Abuse eating Disorders Risky Eating Disorders Eating Disorders Eating Will engage in Users… Alcohol Abuse Prescription Drug Abuse disorders DisordersSexual Eating Eating Disorders behavior Poly Drug Illegal Drug Abuse Addiction Alcohol Abuse 31 Will have Depression 38 Will engage in Risky Sexual BehaviorWednesday, November 14, 12
  • 18. 15 Will have Eating 14 Will have Eating Disorders And, how are Disorders 28 33 Sexual Weapons Unprotected Sex these connected? Violence Will have Sexual Crimes Out of 100 Violent Physical Weapons Substance Bullying Assaults Violence Fighting Felonies Abuse SexualViolent Abuse Crimes Disorder Out of 100 Teen Pregnancy Multiple Partners Will have Unprotected Sex AIDS HIV EarlyUnprotected Sex Sex Substance 20 Antisocial Violence Bullying Bullying Assaults Weapons Fighting Felonies Physical Fighting Abuse Crimes 23 Youth doing Teen Pregnancy Multiple Partners Abuse Disorder Teen Pregnancy Multiple Partners Will have Bullying Violent HIV AIDS Will have Early Sex Unprotected Sex youth will… Depression Assaults Assaults Fighting Felonies Crimes Physical Weapons Abuse Depression Risky Sex Early Sex HIV AIDS Violent Teen Pregnancy Multiple Partners Sexual Physical Felonies HIV AIDS Abuse Early Sex Violence 37 Will engage in 14 will have 30 Will have 23 Will have Antisocial 20 Will have Substance Risky Sexual 37% Behavior Eating Disorders 30Will have Antisocial Behavior Behavior Abuse Disorder Antisocial Eating Disorders Poly Drug Addiction Behavior Out of 100 Eating Disorders Eating Disorders 18 Poly Drug Addiction Tobacco Addiction Alcohol Abuse Prescription Drug Abuse Eating disorders Eating Disorders Eating Disorders Eating Disorders Out of 100 Poly Drug Addiction Prescription Drug Abuse Tobacco Addiction 100e Illegal Drug Abus YouthDisorders 26 Eating DisordersEating with Eating Disorders Eating DIsorders Eating Disorders Prescription Drug Abuse Drug Abuse Illegal Will have Alcohol Abuse Addiction Substance Poly Drug Eating Disorders S Eating Disorders Depression Tobacco Addiction Illegal DrugTobacco Addiction Abuse eating Disorders Risky Eating Disorders Eating Disorders Eating Will engage in Users… Alcohol Abuse Prescription Drug Abuse disorders DisordersSexual Eating Eating Disorders behavior Poly Drug Illegal Drug Abuse Addiction Alcohol Abuse 31 Will have Depression 38 Will engage in Risky Sexual BehaviorWednesday, November 14, 12
  • 19. 15 Will have Eating 14 Will have Eating Disorders And, how are Disorders 28 33 Sexual Weapons Unprotected Sex these connected? Violence Will have Sexual Crimes Out of 100 Violent Physical Weapons Substance Bullying Assaults Violence Fighting Felonies Abuse SexualViolent Abuse Crimes Disorder Out of 100 Teen Pregnancy Multiple Partners Will have Unprotected Sex AIDS HIV EarlyUnprotected Sex Sex Substance 20 Antisocial Violence Bullying Bullying Assaults Weapons Fighting Felonies Physical Fighting Abuse Crimes 23 Youth doing Teen Pregnancy Multiple Partners Abuse Disorder Teen Pregnancy Multiple Partners Will have Bullying Violent HIV AIDS Will have Early Sex Unprotected Sex youth will… Depression Assaults Assaults Fighting Felonies Crimes Physical Weapons Abuse Depression Risky Sex Early Sex HIV AIDS Violent Teen Pregnancy Multiple Partners Sexual Physical Felonies HIV AIDS Abuse Early Sex Violence 37 Will engage in 14 will have 30 Will have 23 Will have Antisocial 20 Will have Substance These are examples 30Will have of interrelated multi-problem behaviors. Risky Sexual Eating 37% Behavior Abuse Antisocial Behavior Disorders Disorder Behavior Antisocial Eating Disorders Poly Drug Addiction Behavior Out of 100 Eating Disorders Eating Disorders 18 Poly Drug Addiction Tobacco Addiction Alcohol Abuse Prescription Drug Abuse Eating disorders Eating Disorders Eating Disorders Eating Disorders Out of 100 Poly Drug Addiction Prescription Drug Abuse Tobacco Addiction 100e Illegal Drug Abus YouthDisorders 26 Eating DisordersEating with Eating Disorders Eating DIsorders Eating Disorders Prescription Drug Abuse Drug Abuse Illegal Will have Alcohol Abuse Addiction Substance Poly Drug Eating Disorders S Eating Disorders Depression Tobacco Addiction Illegal DrugTobacco Addiction Abuse eating Disorders Risky Eating Disorders Eating Disorders Eating Will engage in Users… Alcohol Abuse Prescription Drug Abuse disorders DisordersSexual Eating Eating Disorders behavior Poly Drug Illegal Drug Abuse Addiction Alcohol Abuse 31 Will have Depression 38 Will engage in Risky Sexual BehaviorWednesday, November 14, 12
  • 20. A question about genes (biology) and jeans (environment)? How much evidence is there for genes predicting risk of mental, emotional, and behavioral disorders?Wednesday, November 14, 12
  • 21. A question about genes (biology) and jeans (environment)? How much evidence is there for genes predicting risk of mental, emotional, and behavioral disorders? A lot Some A little NoneWednesday, November 14, 12
  • 22. A question about genes (biology) and jeans (environment)? How much evidence is there for genes predicting risk of mental, emotional, and behavioral disorders? A lot Some A little None How much evidence is there for environmental prediction risk of mental, emotional, & behavioral disorders? A lot Some A little NoneWednesday, November 14, 12
  • 23. Wednesday, November 14, 12
  • 24. What became the principal vertebrate predator of humans after the invention of stone tools? My hypothesis emerges from a What became the principal source of safety for humans after series of questions? that fierce predator appeared of humans? What are the unique, innate (evolutionarily selected) “tool kits” that humans have to cooperate with other humans?Wednesday, November 14, 12
  • 25. Some example evolutionary “tool kits”: Use of arbitrary sounds and symbols to influence each others’ behavior. Bi-directional “wealth” transfer between generations. Ability to form “teams” of non-related humans for group advantage and reinforcers. Ability to plan modifications of environment for common gain.Wednesday, November 14, 12
  • 26. Social Biological Epigenesis Environmental Inputs Genesis Nurturing or Toxic Epigenetics are Environments, These heritable Disease, or polygenes Threats changes in can be gene expression “added”, caused by “subtracted”, M mechanisms g “divided”, or or lin Phosphorlyation ph other than “multiplied.” na og Acetylation Sig en changes in the Methylation sis underlying DNA Histone Remodeling Chromatin Stucture Changes sequence. Development Immunity Stem Cell Changes Imprinting These changes Parent, can pass Three 1st Generation through multiple Generation Baby, 2nd Generation Effects generations. Reproductive Cells, 3rd GenerationWednesday, November 14, 12
  • 27. Evolutionary Path of a Child’s LifeWednesday, November 14, 12
  • 28. K R Path Path Evolutionary Path of a Child’s Life Probability of short-life and Probability of long-life and doubtful reproductive success reproductive successWednesday, November 14, 12
  • 29. Multi-Inflammatory Brain & Body Response Toxic Influences of the Adverse Trends Predicting MEBs & Related Illnesses Toxic Reinforcement Toxic Antecedents Toxic Physiological Toxic Verbal Relations more for anti-social cue anti-social influences trigger occasion perceived than prosocial acts and threats adverse biological threats and related behaviors mechanisms reactions The Same Toxic Conditions Predict Multiple DisordersWednesday, November 14, 12
  • 30. Mood Lo Reward Lo Executive Lo Behavioral Inattention Function Instability Delay Competencies Poor Immune- Motor Healing Skills Multi-Inflammatory Brain & Body Response Dysfunction Toxic Influences of the Adverse Trends Predicting MEBs & Related Illnesses Toxic Reinforcement Toxic Antecedents Toxic Physiological Toxic Verbal Relations more for anti-social cue anti-social influences trigger occasion perceived than prosocial acts and threats adverse biological threats and related behaviors mechanisms reactions The Same Toxic Conditions Predict Multiple DisordersWednesday, November 14, 12
  • 31. Substance Work Obesity, Early Mental Illness Violence Cancer School Abuse Problems etc Sex Failure Mood Lo Reward Lo Executive Lo Behavioral Inattention Function Instability Delay Competencies Poor Immune- STD’s Motor Healing Special Skills Multi-Inflammatory Brain & Body Response Dysfunction Ed Toxic Influences of the Adverse Trends Predicting MEBs & Related Illnesses Toxic Reinforcement Toxic Antecedents Toxic Physiological Toxic Verbal Relations more for anti-social cue anti-social influences trigger occasion perceived than prosocial acts and threats adverse biological threats and related behaviors mechanisms reactions The Same Toxic Conditions Predict Multiple DisordersWednesday, November 14, 12
  • 32. Multi Anti-Inflammatory Brain & Body Response Nurturing Environments Protecting the Futures of Children, Youth and Adults Nur. Reinforcement Nur. Antecedents Nur. Physiological Nur. Verbal Relations more for prosocial cue prosocial influences trigger occasion perceived behaviors behaviors protective biological efficacy, safety and mechanisms affiliation The Same Nurturing Conditions Protect and PreventWednesday, November 14, 12
  • 33. Mood Hi Reward Hi Executive Hi Behavioral Attention Delay Stability Function Competencies Good Immune- Motor Healing Skills Multi Anti-Inflammatory Brain & Body Response Efficiency Nurturing Environments Protecting the Futures of Children, Youth and Adults Nur. Reinforcement Nur. Antecedents Nur. Physiological Nur. Verbal Relations more for prosocial cue prosocial influences trigger occasion perceived behaviors behaviors protective biological efficacy, safety and mechanisms affiliation The Same Nurturing Conditions Protect and PreventWednesday, November 14, 12
  • 34. Heart Low Work Low Delayed Mental health Prosociality Success Health Hi Sch. Addictions etc Cancer Sex Grad Mood Hi Reward Hi Executive Hi Behavioral Attention Delay Stability Function Competencies Good Immune- Low Motor Healing Higher Injuries Skills Multi Anti-Inflammatory Brain & Body Response Efficiency Ed Nurturing Environments Protecting the Futures of Children, Youth and Adults Nur. Reinforcement Nur. Antecedents Nur. Physiological Nur. Verbal Relations more for prosocial cue prosocial influences trigger occasion perceived behaviors behaviors protective biological efficacy, safety and mechanisms affiliation The Same Nurturing Conditions Protect and PreventWednesday, November 14, 12
  • 35. Principles for Increasing Nurturing Environments Minimize toxic social and biological conditions Promote and richly reinforce diverse forms of prosocial behavior Limit opportunities for problem behavior Promote psychological flexibility—a mindful approach to pursuing one’s valuesWednesday, November 14, 12
  • 36. Let’s survey current “toxic” conditionsWednesday, November 14, 12
  • 37. Lifetime Prevalence of Disorders in US Adolescents (N=10,123) 35% 30% 25% 20% 15% 10% 5% Merikangas et al., 2010 0% 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Age in YearsWednesday, November 14, 12
  • 38. Lifetime Prevalence of Disorders in US Adolescents (N=10,123) 35% Anxiety 30% 25% 20% 15% 10% 5% Merikangas et al., 2010 0% 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Age in YearsWednesday, November 14, 12
  • 39. Lifetime Prevalence of Disorders in US Adolescents (N=10,123) 35% Anxiety 30% 25% Behavior 20% 15% 10% 5% Merikangas et al., 2010 0% 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Age in YearsWednesday, November 14, 12
  • 40. Lifetime Prevalence of Disorders in US Adolescents (N=10,123) 35% Anxiety 30% 25% Behavior 20% Mood 15% 10% 5% Merikangas et al., 2010 0% 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Age in YearsWednesday, November 14, 12
  • 41. Lifetime Prevalence of Disorders in US Adolescents (N=10,123) 35% Anxiety 30% 25% Substance Behavior 20% Mood 15% 10% 5% Merikangas et al., 2010 0% 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Age in YearsWednesday, November 14, 12
  • 42. The US has 75 million children and teens. 40.4 million are on psychotropic medications Wall Street Journal, 12-28-2010Wednesday, November 14, 12
  • 43. Cumulative prevalence of psychiatric disorders by young adulthood By 21 years of age, 61.1% of participants had met criteria for a well-specified psychiatric disorder. An additional 21.4% had met criteria for a not otherwise specified disorder only, increasing the total cumulative prevalence for any disorder to 82.5%. a prospective cohort analysis from the Great Smoky Mountains Study.Wednesday, November 14, 12
  • 44. The US has 75 million children and teens. Wall Street Journal, 12-28-2010Wednesday, November 14, 12
  • 45. The US has 75 million children and teens. 40.4 million kids had one psychotropic med in 2009 Wall Street Journal, 12-28-2010Wednesday, November 14, 12
  • 46. So can we actually impact these toxic trends? Perhaps, with some non- pharmaceutical, universal “behavioral vaccines”Wednesday, November 14, 12
  • 47. What are behavioral vaccines? Read more about the science at www.PubMed.govWednesday, November 14, 12
  • 48. Muriel Saunders invented the Game in 1967 as a first-year, 4th grade teacher. Harriet Barrish Montrose Wolf These two scientists publishedCopyright © 2011-12, PAXIS Institute. Only for use by accredited PAX GBG Coaches and licensed by PAXIS. the first proof of the Game in 1969.Wednesday, November 14, 12
  • 49. Longitudinal Johns Hopkins Studies of GBG Kindergarden Every child rated by teachersWednesday, November 14, 12
  • 50. Longitudinal Johns Hopkins Studies of GBG Kindergarden Every child rated by teachersWednesday, November 14, 12
  • 51. Longitudinal Johns Hopkins Studies of GBG Kindergarden First Grade Every GBG child rated by teachers NO GBG Tested in 41 first- and second-grade classrooms within 19 elementary schools with two consecutive groups of first graders.Wednesday, November 14, 12
  • 52. Longitudinal Johns Hopkins Studies of GBG Grades 2 thru 12 Kindergarden First Grade Follow Up Every GBG No More GBG child rated by teachers NO GBG No GBG Tested in 41 first- Purpose: To find out if and second-grade GBG affected their classrooms within 19 adolescent lives. elementary schools Note: Some kids got GBG with two consecutive in 1st Grade only, and groups of first some in both 1st & 2nd graders. grade,Wednesday, November 14, 12
  • 53. Longitudinal Johns Hopkins Studies of GBG Grades 2 thru 12 Young Adulthood Kindergarden First Grade Follow Up Follow Up GBG Age Age Age Every No More GBG child 19-21 26 30 rated by Age Age Age teachers NO GBG No GBG 19-21 26 30 Tested in 41 first- Purpose: To find out if Purpose: To find out if and second-grade GBG affected their GBG affected their classrooms within 19 adolescent lives. adult lives. elementary schools Note: Some kids got GBG with two consecutive in 1st Grade only, and groups of first some in both 1st & 2nd graders. grade,Wednesday, November 14, 12
  • 54. They teach children a vision of a wonderful schoolWednesday, November 14, 12
  • 55. To create more good, By sweeping away the called “PAX” “bad”, called “Spleems”Wednesday, November 14, 12
  • 56. Playing the PAX Game by Teams: During any regular teaching & learning activity The Blue Team The Red Team The Yellow TeamWednesday, November 14, 12
  • 57. Their Team Aim: to Win PAX Not OK Ms. Dion Jan 23 Spleems are counted and marked with neutralNo Spleems Blue tone for the team, not the individual child.Peeling cards up is a spleem for your team Red Teams who have 3 or fewer Spleems win. Yellow Winning teams earn a “Granny’s Wacky Prize”. Team having 4 or more Spleems lose that game. PAX Minutes = winning teams x minutes played.Wednesday, November 14, 12
  • 58. Their Team Aim: to Win PAX Not OK Ms. Dion Jan 23 Spleems are counted and marked with neutralNo Spleems Blue tone for the team, not the individual child.Peeling cards up is a spleem for your team Red Teams who have 3 or fewer Spleems win. Yellow Winning teams earn a “Granny’s Wacky Prize”. Team having 4 or more Spleems lose that game. PAX Minutes = winning teams x minutes played.Wednesday, November 14, 12
  • 59. Their Team Aim: to Win PAX Not OK Ms. Dion Jan 23 Spleems are counted and marked with neutralNo Spleems Blue tone for the team, not the individual child.Peeling cards up is a spleem for your team Red Teams who have 3 or fewer Spleems win. Yellow Winning teams earn a “Granny’s Wacky Prize”. Team having 4 or more Spleems lose that game. 20 40 PAX Minutes = winning teams x minutes played.Wednesday, November 14, 12
  • 60. Their Team Aim: to Win PAX Not OK Ms. Dion Jan 23 Spleems are counted and marked with neutralNo Spleems Blue tone for the team, not the individual child.Peeling cards up is a spleem for your team Red Teams who have 3 or fewer Spleems win. Yellow Winning teams earn a “Granny’s Wacky Prize”. Team having 4 or more Spleems lose that game. 20 40 PAX Minutes = winning teams x minutes played.Wednesday, November 14, 12
  • 61. Their Team Aim: to Win PAX Not OK Ms. Dion Jan 23 Spleems are counted and marked with neutralNo Spleems Blue tone for the team, not the individual child.Peeling cards up is a spleem for your team Red Teams who have 3 or fewer Spleems win. Yellow Winning teams earn a “Granny’s Wacky Prize”. Team having 4 or more Spleems lose that game. 20 20 40 60 PAX Minutes = winning teams x minutes played.Wednesday, November 14, 12
  • 62. Winning teams get “Granny’s Wacky Prizes” Brief (30 seconds or so) activity rewards for winning game Start and stop with non-verbal cue Based on mystery motivator and Premack Principle Function as “intrinsic motivators”Wednesday, November 14, 12
  • 63. The PAX Game teaches Individual and group goal orientation/ dependency Voluntary control over attention Self-regulation, self-calming under excitement Self-regulation during failure or disappointment Delay of gratification Cooperation to achieve a bigger goal How to ignore accidental attention to negative behavior from peers Mild sanctions for anti-social acts by othersWednesday, November 14, 12
  • 64. Relational Antecedent Reinforcement Physiological Frame Kernels Kernels Kernel Kernel Creates verbal Happens BEFORE the Happens AFTER the Changes biochemistry relations for the behavior behavior of behavior behaviorWednesday, November 14, 12
  • 65. Relational Antecedent Reinforcement Physiological Frame Kernels Kernels Kernel Kernel Creates verbal Happens BEFORE the Happens AFTER the Changes biochemistry relations for the behavior behavior of behavior behavior PAX Quiet, PAX Voices, PAX Hands, PAX Lines, PAX StixWednesday, November 14, 12
  • 66. Relational Antecedent Reinforcement Physiological Frame Kernels Kernels Kernel Kernel Creates verbal Happens BEFORE the Happens AFTER the Changes biochemistry relations for the behavior behavior of behavior behavior PAX Quiet, Granny’s PAX Voices, Wacky Prizes, PAX Hands, Tootle Notes, PAX Lines, PAX It Notes PAX StixWednesday, November 14, 12
  • 67. Relational Antecedent Reinforcement Physiological Frame Kernels Kernels Kernel Kernel Creates verbal Happens BEFORE the Happens AFTER the Changes biochemistry relations for the behavior behavior of behavior behavior PAX Quiet, Wonderful Granny’s PAX Voices, School, Wacky Prizes, PAX Hands, PAX OK, Tootle Notes, PAX Lines, Spleems Not PAX It Notes PAX Stix OKWednesday, November 14, 12
  • 68. Relational Antecedent Reinforcement Physiological Frame Kernels Kernels Kernel Kernel Creates verbal Happens BEFORE the Happens AFTER the Changes biochemistry relations for the behavior behavior of behavior behavior PAX Quiet, Wonderful Granny’s PAX Voices, School, Wacky Prizes, PAX Hands, PAX OK, Tootle Notes, PAX Lines, Spleems Not PAX It Notes PAX Stix OKWednesday, November 14, 12
  • 69. Seine River Manitoba Pilot Demonstration April, 2011 – Principals and key staff trained for two days for all 12 schools. 45% April, 2011 – First grade classrooms then trained that week April through May – Each successive month other grades trained, including 8th grade classes.Wednesday, November 14, 12
  • 70. Timeline of Benefits…Wednesday, November 14, 12
  • 71. Timeline of Benefits… First Month More time for Less stress for teaching and learning Staff & Students First Year Better Fewer Fewer Service Less Happier Less Better Attendance Referrals Needs Illness Families Vandalism Academics 2nd & 3rd Years ADHD Oppositional Special Education Averted Defiance Averted Averted 5-15 Years No Less Less Conduct Less Less Crime, High School Tobacco Alcohol Disorders Depression Violence, Suicide Grad & UniversityWednesday, November 14, 12
  • 72. HS Long term impact of GBG on School Graduation Academic Outcomes GBG Control 80% 73.6% 64% 53.3% 58.6% 48% 40.3% 44.8% 32% 26% 26.4% 16% 12.8% 0% Boys HS Graduation Girls HS Graduation Boys Univ. Entrance Girls Univ. Entrace Source: Bradshaw, C. P., J. H. Zmuda, et al. (2009). "Longitudinal Impact of Two Universal Preventive Interventions in First Grade on Educational Outcomes in High School." Journal of Educational Psychology 101(4): 926-937.Wednesday, November 14, 12
  • 73. Impact on special education use thru Grade 12 GBG Control 50% 40% 43.2% 30% 24.6% 19.5% 26.2% 20% 10% 0% Boys SPED Use Girls SPED Use Source: Bradshaw, C. P., J. H. Zmuda, et al. (2009). "Longitudinal Impact of Two Universal Preventive Interventions in First Grade on Educational Outcomes in High School." Journal of Educational Psychology 101(4): 926-937.Wednesday, November 14, 12
  • 74. First graders exposed to GBG for one year had these benefits at age 21. SOURCE: Kellam, S. G., Mackenzie, A. C., Brown, C. H., Poduska, J. M., Wang, W., Petras, H., & Wilcox, H. C. (2011). The good behavior game and the future of prevention and treatment. Addict Sci Clin Pract, 6(1), 73-84. Read this and other studies about the Good Behavior Game at www.pubmed.govWednesday, November 14, 12
  • 75. Cost Savings How much might PAX GBG save for New Jersey’s future? To do PAX GBG will cost about $150 to protect our children for life from mental illnesses, behavioral problems, drug addictions, becoming a criminal, trying suicide, dying from tobacco or alcohol related illnesses. And, it increases their academic success—including university entry. PAX GBG pays back $4637 to individuals, taxpayers, and others per student exposed in First Grade over 15 years. Assuming 116,000 First Graders each year in the the state, that saves $522 million every First Grade cohort by age 21, after an investment of $17 million (less after first five years) Source: Aos, S., Lee, S., Drake, E., Pennucci, A., Klima, T., Miller, M., et al. (2011). Return on Investment: Evidence-Based Options to Improve Statewide Outcomes. (July), 8. Retrieved from http://www.wsipp.wa.gov/rptfiles/11-07-1201.pdWednesday, November 14, 12
  • 76. Cost Savings How much might PAX GBG save for America’s future? To do PAX GBG will cost about $150 to protect our children for life from mental illnesses, behavioral problems, drug addictions, becoming a criminal, trying suicide, dying from tobacco or alcohol related illnesses. And, it increases their academic success—including university entry. PAX GBG pays back $4637 to individuals, taxpayers, and others per student exposed in First Grade over 15 years. Assuming 4,000,000 First Graders each year in the US, that saves $18 billion every First Grade cohort by age 21, after an investment of $600 million (less after first five years) Source: Aos, S., Lee, S., Drake, E., Pennucci, A., Klima, T., Miller, M., et al. (2011). Return on Investment: Evidence-Based Options to Improve Statewide Outcomes. (July), 8. Retrieved from http://www.wsipp.wa.gov/rptfiles/11-07-1201.pdWednesday, November 14, 12
  • 77. Action steps to bring PAX to your jurisdictions Create a rapid pilot in your area with willing and Average Distractions Per Hour "Spleems" able school partners like the Seine River Rapid Pilot in Manitoba. 120 100 Use independent “Before” and “After” observations 108 of impact like 18 SAMHSA sites in America. 81.5 96 Capture video testimonials from participating Baseline No Intervention 84 teachers, students, parents, and administrators. 72 After Learning Concepts Take civic leaders and stakeholders on “tour” to After Intervention But Not Playing 60 42.6 Games see PAX in action. 39 After Intervention While Playing 48 Game Give leaders & stakeholder research summaries, 36 21 20.5 including cost savings for each first-grade cohort 24 by age 21. 12 11 9.5 0 1st Grade 2nd GradeWednesday, November 14, 12
  • 78. What if we provided parenting supports for every family?Wednesday, November 14, 12
  • 79. Substantiated Child Maltreatment 16 Rates per 1,000 Children (0-8 Years) 15 13 12 10 Pre Post Two Years Later Prinz et al., 2009, Prevention ScienceWednesday, November 14, 12
  • 80. Substantiated Child Maltreatment 16 Rates per 1,000 Children (0-8 Years) 15 Control Counties 13 12 10 Pre Post Two Years Later Prinz et al., 2009, Prevention ScienceWednesday, November 14, 12
  • 81. Substantiated Child Maltreatment 16 Rates per 1,000 Children (0-8 Years) 15 Control Counties 13 Triple P Counties 12 10 Pre Post Two Years Later Prinz et al., 2009, Prevention ScienceWednesday, November 14, 12
  • 82. Child Abuse Hospital Injuries 1.80 Rates per 1,000 Children (0-8 Years) 1.68 1.55 1.43 1.30 Post Pre Two Years Later Prinz et al., 2009, Prevention ScienceWednesday, November 14, 12
  • 83. Child Abuse Hospital Injuries 1.80 Rates per 1,000 Children (0-8 Years) Control Counties 1.68 1.55 1.43 1.30 Post Pre Two Years Later Prinz et al., 2009, Prevention ScienceWednesday, November 14, 12
  • 84. Child Abuse Hospital Injuries 1.80 Rates per 1,000 Children (0-8 Years) Control Counties 1.68 1.55 1.43 Triple P Counties 1.30 Post Pre Two Years Later Prinz et al., 2009, Prevention ScienceWednesday, November 14, 12
  • 85. Child Out-of-Home Placements 4.50 Rates per 1,000 Children (0-8 Years) 4.13 3.75 3.38 3.00 Post Pre Two Years Later Prinz et al., 2009, Prevention ScienceWednesday, November 14, 12
  • 86. Child Out-of-Home Placements Control Counties 4.50 Rates per 1,000 Children (0-8 Years) 4.13 3.75 3.38 3.00 Post Pre Two Years Later Prinz et al., 2009, Prevention ScienceWednesday, November 14, 12
  • 87. Child Out-of-Home Placements Control Counties 4.50 Rates per 1,000 Children (0-8 Years) 4.13 3.75 Triple P Counties 3.38 3.00 Post Pre Two Years Later Prinz et al., 2009, Prevention ScienceWednesday, November 14, 12
  • 88. What do these results mean fiscally?Wednesday, November 14, 12
  • 89. Building models policy change 11/14/12 4:12 AMWednesday, November 14, 12
  • 90. Building models policy change 11/14/12 4:12 AM Use personalized business models to communicate to cost-efficiency and benefits.Wednesday, November 14, 12
  • 91. Building models policy change 11/14/12 4:12 AM Use personalized business models to communicate to cost-efficiency and benefits. Show short-term benefitsWednesday, November 14, 12
  • 92. Building models policy change 11/14/12 4:12 AM Use personalized business models to communicate to cost-efficiency and benefits. Show short-term benefits Allow decision makers and advocates to adjust cost savings to their location.Wednesday, November 14, 12
  • 93. What parent doesn’t need know how to solve meltdowns? PS. Children who don’t learn to self-regulate well tend to have many problems as teens and adults.Wednesday, November 14, 12
  • 94. How many parents have to deal with a very aggressive child? PS. Children who have such aggress problems when young tend to develop more serious problems as adolescents.Wednesday, November 14, 12
  • 95. Consider these common problems experience by families everywhere… • Children who won’t go to bed and • Children who are chronically afraid to stay in bed. try anything new. • Children who won’t get ready for • Children who throw screaming fits school. while shopping. • Children who deliberately engage in • And what else? dangerous behavior. • Children who refuse to do their school work or homework.Wednesday, November 14, 12
  • 96. 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.Wednesday, November 14, 12
  • 97. Lifespan examples for prevention and promotion Physiological Kernels Changes biochemistry of behaviorWednesday, November 14, 12
  • 98. An Anthropological ExampleWednesday, November 14, 12
  • 99. Wednesday, November 14, 12
  • 100. Before Omega 3 Omega-3 can improve school grades and success Omega 3 Placebo 7 These were gains in 6 After Omega 3 academics after 3 5 months of exposure 4 to fish oil. 3 2 1 0 -1 -2 Reading Spelling See www.durhamtrial.org/Wednesday, November 14, 12
  • 101. Using kernels to build population-level change… Problem Kernel #1 Observed Proximal Observed Effect Kernel Proximal Kernel #2 Effect Kernel Big Kernel #3 Change Effect Observed Proximal EffectWednesday, November 14, 12
  • 102. Moving everyone in the community…Wednesday, November 14, 12
  • 103. Note: Behavioral Vaccines Create policy & Yes, there is a funding supports TH Vaccine cacy, logic model for Identify (organizational, List local, local and/or state Adoption, Behaviors guiding local, Reduced state and Implementation, & national Maintenance state and federal policies Cultivate some policy makers to positively current or impacted or achieve Psychinfo Identify lled by prospective early www.pubmed.gov Behaviors adopters for population-level ERIC Increased recipe testimonials Lo Hi prevention. NTIS Cite relevant Evaluation & User T Cite relevant endorsements Outcome Local Impacting Values studies or standards Monitoring State National Population Targeting -A - Daily, Weekly B Developmen Birth Childhood ta l stages Low catchy positive What the or Monthly Adolescence Intensity Adulthood Hi name (meme) ts are Feedback reach Multiple Fa Sc ls m ho ilie e Settings o lev Or - Where/ s ga ls - What A Co ni mm atio ch un ns how to get the costs of use rea itie s C recipe are ty/ Recognition/Rewards si en for Successs Int - Relational framing High Intensity Low reach Support & Training resWednesday, November 14, 12
  • 104. Wednesday, November 14, 12
  • 105. Wednesday, November 14, 12
  • 106. Wednesday, November 14, 12
  • 107. Youth Who Smoked During the Last 30 Days Youth Who Smoked Every Day the Last 30 Days Baseline Reward and Reminder Baseline Reward and Reminder 45.0% 18.0% Wyoming Wyoming 40.0% 16.0% 35.0% 14.0% 30.0% 12.0% 25.0% 10.0% 20.0% 8.0% 15.0% 6.0% 10.0% 4.0% 5.0% 2.0% 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% 6.0% 10.0% 4.0% 5.0% 2.0% 0.0% 18.0% United States United States Source: Youth Risk Behavior Survey (YRBS), Centers for Disease Control 40.0% 16.0% 35.0% 14.0% 30.0% 12.0%Wednesday, November 14, 12
  • 108. Youth Who Smoked During the Last 30 Days Youth Who Smoked Every Day the Last 30 Days Baseline Reward and Reminder Baseline Reward and Reminder 45.0% 18.0% Wyoming Wyoming 40.0% 16.0% 35.0% 14.0% 30.0% 12.0% 25.0% 10.0% 20.0% 8.0% 15.0% 6.0% 10.0% 4.0% 5.0% 2.0% 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% 6.0% 10.0% 4.0% 5.0% 2.0% 0.0% 18.0% United States United States Source: Youth Risk Behavior Survey (YRBS), Centers for Disease Control 40.0% 16.0% 35.0% 14.0% 30.0% 12.0%Wednesday, November 14, 12
  • 109. Yes, there are even innovative funding models to achieve population-level prevention.Wednesday, November 14, 12
  • 110. • Business competitiveness? What will the impact of these • Health care costs? data be on Federal & State • Public safety & national security costs? • Social Security? Governments on: • Global Competitiveness?Wednesday, November 14, 12
  • 111. Humans are the only species with bi-directional wealth and wellbeing transfer across generations Our Our Adults & Children EldersWednesday, November 14, 12
  • 112. Humans are the only species with bi-directional wealth and wellbeing transfer across generations Our Our Adults & Children adults and elders invest in children EldersWednesday, November 14, 12
  • 113. Humans are the only species with bi-directional wealth and wellbeing transfer across generations Youth return the favor as adults Our Our Adults & Children adults and elders invest in children EldersWednesday, November 14, 12
  • 114. We are the first civilization to abandon what Mother Nature, Evolution & God gifted us… 5-Year 65-Year Olds OldsWednesday, November 14, 12
  • 115. We are the first civilization to abandon what Mother Nature, Evolution & God gifted us… 5-Year 65-Year Olds Olds Who are living longer though get progressively sicker…Wednesday, November 14, 12
  • 116. We are the first civilization to abandon what Mother Nature, Evolution & God gifted us… Requiring more wealth transfer 5-Year 65-Year Olds Olds Who are living longer though get progressively sicker…Wednesday, November 14, 12
  • 117. We are the first civilization to abandon what Mother Nature, Evolution & God gifted us… Requiring more wealth transfer 5-Year 65-Year Olds Olds Who are living Who are less longer though get and less able… progressively sicker…Wednesday, November 14, 12
  • 118. We are the first civilization to abandon what Mother Nature, Evolution & God gifted us… 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…Wednesday, November 14, 12
  • 119. We are the first civilization to abandon what Mother Nature, Evolution & God gifted us…Wednesday, November 14, 12
  • 120. We are the first civilization to abandon what Mother Nature, Evolution & God gifted us… 5-Year 65-Year Olds OldsWednesday, November 14, 12
  • 121. We are the first civilization to abandon what Mother Nature, Evolution & God gifted us… 65-Year OldsWednesday, November 14, 12
  • 122. We are the first civilization to abandon what Mother Nature, Evolution & God gifted us…Wednesday, November 14, 12
  • 123. Key message about global competition… Manufacturing, Employment in Enterprises with <= 20 Employees, 2006 Among Rich Democracies Using OECD Data The USA has 4.6 million small businesses under 25 employees.Wednesday, November 14, 12
  • 124. Key message about global competition… Manufacturing, Employment in Enterprises with <= 20 Employees, 2006 Among Rich Democracies Using OECD Data . How competitive will the USA be if 75% of our pool of employees have a mental, The USA has emotional, 4.6 million behavioral or small related physical businesses disorder? under 25 employees.Wednesday, November 14, 12
  • 125. Key message about global competition… Many of these other rich democracies have nearly universal Manufacturing, Employment in Enterprises with <= 20 Employees, 2006 access to prevention of and protection Among Rich Democracies Using OECD Data from mental, emotional, behavioral and related physical disorders. The USA rations prevention of and protection all these disorders. . How competitive will the USA be if 75% of our pool of employees have a mental, The USA has emotional, 4.6 million behavioral or small related physical businesses disorder? under 25 employees.Wednesday, November 14, 12
  • 126. Creating the First Carbon Valley… Not Just Another Silicon Valley With university leadership Our problems are not silicon based in America…Wednesday, November 14, 12
  • 127. 50% 50% 40% Prize 30% Bowl + 20% Standard 18% Treatment 10% Standard Treatment 0% Abstinent for 10 WeeksWednesday, November 14, 12
  • 128. What colleges & universities can do to promote & profit by upstream prevention: Teach and coach the next generation of Teach and coach more students to use single- teachers and educational leaders how to use subject designs for human problems. strategies that actually alter outcomes Join with organizations like PAXIS who are efficiently. intent on making an industry out of solving Teach and coach human service provider human behavior problems as potent as the graduates how to implement low-cost, Silicon Valley. powerful strategies that treat or reduce mental, Participate in larger efforts for population level emotional, or behavioral disorders faster and prevention and research, using innovative with more long-term cost-effectiveness designs (e.g., factorial) and novel funding (e.g., Social Impact Bonds).Wednesday, November 14, 12
  • 129. Follow up: Dennis D. Embry, Ph.D. dde@paxis.org 1-877-GO-PAXIS For slides: www.slideshare.net/drdennisembryWednesday, November 14, 12

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