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Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
Women In Medicine University of Kansas
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Women In Medicine University of Kansas

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Specific Learning Objectives: …

Specific Learning Objectives:

1. Learning the four key malleable factors for preventing multiple, interrelated mental, emotional, behavioral and physical disorders that are epidemic in America


2. 2. . Learning how to move from rationing of prevention to universal access to simple, scientifically proven strategies (e.g., evidence-based kernels and behavioral vaccines) that prevent the most costly burdens affecting children, youth, and adults.

3. 3. Learning actual examples that can be applied to improve practice, applied science and basic science as well as for personal or family benefit

Abstract:

“How are the children?” goes the greeting when chiefs of aboriginal peoples meet. The question is not about the chiefs’ own children, but about all the children of the tribe. The children and young adults today are not all right. The 2009 IOM Report on the Prevention of Mental, Emotional and Behavioral Disorders (and related physical disorders) shows that the prevalence rates in the US are the worst among the rich democracies, and continuing to get worse. These trends imperil the future security, safety, economic, and political stability of America.

Just as John Snow showed how the Cholera epidemic could be stopped by a simple strategy that provided “prevention for everyone,” so are there very simple strategies from robust science called “evidence-based kernels” and “behavioral vaccines” that prevent, avert or reduce almost every mental, emotional, behavior and related physical disorders. Prevailing scientific dogma, political policies, and mega-marketing by pharmaceutical companies obscures the clear potential to achieve major shifts in morbidity and mortality for the whole country.

This presentation show real world scientifically validated examples, many of which amusingly have significant histories from science at the University of Kansas over the past 45 years. Examples will be presented to show clinical, scientific and personal applications.

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  • MISSION: READINESS\nIn a study being released Thursday Nov 5, 2009 in Washington, Education Secretary Arne Duncan and a group of retired military officers led by former Army Gen. Wesley Clark will sound the alarm bells and call young Americans’ relative lack of overall fitness for military duty a national security threat. The group, Mission: Readiness, will release a report that draws on Pentagon data showing that 75 percent of the nation’s 17- to 24-year-olds are ineligible for service for a variety of reasons.\n\nPut another way, only 4.7 million of the 31.2 million 17- to 24-year-olds in a 2007 survey are eligible to enlist, according to a periodic survey commissioned by the Pentagon. This group includes those who have scored in the top four categories on the Armed Forces Qualification Test, or AQFT; eligible college graduates; and qualified college students.\n\nAccording to the Pentagon, the ineligible population breaks down this way:\n\n•Medical/physical problems, 35 percent.\n•Illegal drug use, 18 percent.\n•Mental Category V (the lowest 10 percent of the population), 9 percent.\n•Too many dependents under age 18, 6 percent.\n•Criminal record, 5 percent.\n
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  • Barrish, H. H., M. Saunders, et al. (1969). "Good behavior game: Effects of individual contingencies for group consequences on disruptive behavior in a classroom." Journal of Applied Behavior Analysis 2(2): 119-124.\nStudied out-of-seat and talking-out behaviors in 24 4th graders including 7 "problem children". After base-line rates of the inappropriate behaviors were obtained, the class was divided into 2 teams "to play a game." Each out-of-seat and talking-out response by a S resulted in a mark being placed on the chalkboard, which meant a possible loss of privileges by all members of the S's team. In this manner a contingency was arranged for the inappropriate behavior of each S while the consequence (possible loss of privileges of the S's behavior was shared by all members of the team. The privileges were events which are available in almost every classroom, i.e., extra recess, 1st to line up for lunch, time for special projects, stars and name tags, and winning the game. The individual contingencies for the group consequences were successfully applied 1st during math period and then during reading period. The experimental analysis involved elements of both reversal and multiple base-line designs\n
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  • Here are relevant studies, most of which are available from PAXIS Institute or at www.pubmed.gov\n\nBradshaw, C. P., J. H. Zmuda, et al. (2009). "Longitudinal Impact of Two Universal Preventive Interventions in First Grade on Educational Outcomes in High School." Journal of Educational Psychology 101(4): 926-937.\n\nWilcox, H. C., S. Kellam, et al. (2008). "The impact of two universal randomized first- and second-grade classroom interventions on young adult suicide ideation and attempts." Drug & Alcohol Dependence 95(Suppl 1): 60-73\n\nPoduska, J. M., S. G. Kellam, et al. (2008). "Impact of the Good Behavior Game, a universal classroom-based behavior intervention, on young adult service use for problems with emotions, behavior, or drugs or alcohol." Drug and Alcohol Dependence 95(Suppl1): S29-S44.\n\nPetras, H., S. Kellam, et al. (2008). "Developmental epidemiological courses leading to antisocial personality disorder and violent and criminal behavior: Effects by young adulthood of a universal preventive intervention in first- and second-grade classrooms." Drug & Alcohol Dependence 95(Suppl 1): 45-59.\n\nMiller, T. R. and D. Hendrie (2008). Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis. C. f. S. A. Prevention.\n\nKellam, S., C. H. Brown, et al. (2008). "Effects of a universal classroom behavior management program in first and second grades on young adult behavioral, psychiatric, and social outcomes,." Drug & Alcohol Dependence(Special Issue): 24.\n\nvan Lier, P. A. C., B. O. Muthen, et al. (2004). "Preventing Disruptive Behavior in Elementary Schoolchildren: Impact of a Universal Classroom-Based Intervention." Journal of Consulting & Clinical Psychology 72(3): 467-478.\n\nFurr-Holden, C. D., N. S. Ialongo, et al. (2004). "Developmentally inspired drug prevention: middle school outcomes in a school-based randomized prevention trial." Drug & Alcohol Dependence 73(2): 149-158.\n\nIalongo, N., J. Poduska, et al. (2001). "The distal impact of two first-grade preventive interventions on conduct problems and disorder in early adolescence." Journal of Emotional & Behavioral Disorders 9(3): 146-160.\n\nIalongo, N. S., L. Werthamer, et al. (1999). "Proximal impact of two first-grade preventive interventions on the early risk behaviors for later substance abuse, depression, and antisocial behavior." American Journal of Community Psychology 27(5): 599-641.\n
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  • Transcript

    • 1. Prevention for EveryoneAverting America’s epidemic of mental, emotional, mental and related behavioral disordersDennis D. Embry, Ph.D. • President/Senior Scientist, PAXIS InstituteThe University of Kansas Medical Center WIMS Conference, August 18th & 19, 2011
    • 2. Horace Crandell EmbryNear the end of medical school,Kansas City Medical College, 1909Dr. Horace Crandell EmbryLast year of his life, Great Bend, Kansas, 1947
    • 3. Horace Crandell EmbryNear the end of medical school,Kansas City Medical College, 1909Dr. Horace Crandell EmbryLast year of his life, Great Bend, Kansas, 1947 About 10 years ago, we learned my grandfather, Dr. H.C. Embry was the son of freed slave. He would have lied on his admission papers about his origin, and he lied on the death certificate of his father and my great- grandfather by signing “white”. He and his father passed in the era of the one-drop rule. Today, he is free of the family secret.
    • 4. Considering whywe should haveprevention foreveryone?
    • 5. The nation faceda nationalepidemic of polio.Emergencywards were filledwith iron lungs.Children died orcrippled. Thenation wasterrified.
    • 6. The nation faceda nationalepidemic of polio.Emergencywards were filledwith iron lungs.Children died orcrippled. Thenation wasterrified.Which children inAmerica got thePolio Vaccine duringthe Polio Epidemic?
    • 7. WhichF(4,*7"*=($#:&4,*6,:*844,-*G44:*>6HH$,6$",-I children should have these vaccinations? J4;% 786!98:6; J$K !=> L> <<L >6&$H4##6 J4;D J!> <=>. DE4* 0%$+"("(/!1 ($)")%*(+,! "%"+-./,!! Haemophilus influenzae!"#$%!& !"#$" 2-%.345455+6! 54-7.8+"% >4"+?(*./ 9%+/6%/,!3.3$/,! *.&%66+ :)(5;%-$4< 0%$+"("(/!= 0.3+-!$+$(664@ 3+?(*./ 9%-(-845455+6! 54-7.8+"% 1,234,56 $%*".//(/ %$&( )*+",(- (1–2 mos) 1 .*+",(- 2 2 /*+",(- 0)*+",(- 4 (15–18 mos) (12–15 mos) (6–18 mos) (12–15 mos) (12–15 mos) (2 doses given 0O*+",(- (6–18 mos) (12–15 mos) 6 mos apart at age 12–23 mos) 0B*+",(- 3 5 5 Catch-up5 Catch-up5 Catch-up Catch-up 0C?)A*+",(- Catch-up5 (to 5 years) Catch-up5 (to 5 years) (given each fall or winter to children ages .?/*@46&- 6 mos–18 yrs) Catch-up5 M?0N*@46&- Catch-up5 Catch-up5 6 Catch-up5 Catch-up5 Catch-up5 00?0)*@46&- Tdap Catch-up5 Catch-up5,6 Catch-up5,7 0A?0B*@46&- (Tdap/Td) 1. Your infant may not need a dose of HepB at age 4 months depending on the type of vaccine that 5. If your child’s vaccinations are delayed or missed entirely, they should be given as soon as your healthcare provider uses. possible.
    • 8. Who pays for children’s,teen’s, and adult’svaccinations inAmerica?
    • 9. Who pays for children’s,teen’s, and adult’svaccinations inAmerica?How good of an idea would it be to stopfunding these vaccines to save money topay down the Federal, state, and localgovernment debt?
    • 10. The Epidemic Today?Mental, Emotional, Behavioral,and Related Physical Illnesses
    • 11. The Epidemic Today?Mental, Emotional, Behavioral,and Related Physical Illnesses Do you know a middle class family with a child with a MEB?
    • 12. Depression by Jobs
    • 13. Lifetime Prevalence of Disorders in US Adolescents (N=10,123)Merikangas et al., 2010 40% 35% 30% 25% 20% 15% 10% 5% 0% 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Age in Years
    • 14. Lifetime Prevalence of Disorders in US Adolescents (N=10,123)Merikangas et al., 2010 40% 35% Anxiety 33% 30% 25% 20% 15% 10% 5% 0% 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Age in Years
    • 15. Lifetime Prevalence of Disorders in US Adolescents (N=10,123)Merikangas et al., 2010 40% 35% Anxiety 33% 30% 25% Behavior 22% 20% 15% 10% 5% 0% 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Age in Years
    • 16. Lifetime Prevalence of Disorders in US Adolescents (N=10,123)Merikangas et al., 2010 40% 35% Anxiety 33% 30% 25% Behavior 22% 20% Mood 18% 15% 10% 5% 0% 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Age in Years
    • 17. Lifetime Prevalence of Disorders in US Adolescents (N=10,123)Merikangas et al., 2010 40% 35% Anxiety 33% 30% 25% Substance 24% Behavior 22% 20% Mood 18% 15% 10% 5% 0% 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Age in Years
    • 18. Cumulative prevalence of psychiatric disorders byyoung adulthood: a prospective cohort analysis fromthe Great Smoky Mountains Study.By 21 years of age, 61.1% ofparticipants had met criteria for a well-specified psychiatric disorder. Anadditional 21.4% had met criteria for anot otherwise specified disorder only,increasing the total cumulativeprevalence for any disorder to 82.5%.
    • 19. Nearly 3 out of 4 of the nations 17- to 24-year-olds areineligible for military service for based on nationalepidemiological data • Medical/physical problems, 35 percent. • Illegal drug use, 18 percent. • Mental Category V (the lowest 10 percent of the population), 9 percent. • Too many dependents under age 18, 6 percent. • Criminal record, 5 percent. Army Times, Nov 5, 2009 • www.missionreadiness.org/PAEE0609.pd
    • 20. The US has 75million childrenand teens.40.4 million areon psychotropicmedications Wall Street Journal, 12-28-2010
    • 21. Youth MEB Prevalence Rate Comparison 50% 25%What do these comparisons imply about the preventionof mental, emotional, and behavioral disorders?
    • 22. Youth MEB Prevalence Rate Comparison 50% 25% USA United Kingdom OECD NordicWhat do these comparisons imply about the preventionof mental, emotional, and behavioral disorders?
    • 23. Youth MEB Prevalence Rate Comparison 50% 25% USA United Kingdom OECD NordicWhat do these comparisons imply about the preventionof mental, emotional, and behavioral disorders?
    • 24. Youth MEB Prevalence Rate Comparison 50% 25% USA United Kingdom OECD NordicWhat do these comparisons imply about the preventionof mental, emotional, and behavioral disorders?
    • 25. Youth MEB Prevalence Rate Comparison 50% 25% USA United Kingdom OECD NordicWhat do these comparisons imply about the preventionof mental, emotional, and behavioral disorders?
    • 26. Youth MEB Prevalence Rate Comparison ? 50% 25% USA United Kingdom OECD NordicWhat do these comparisons imply about the preventionof mental, emotional, and behavioral disorders?
    • 27. Youth MEB Prevalence Rate Comparison ? ? 50% 25% USA United Kingdom OECD NordicWhat do these comparisons imply about the preventionof mental, emotional, and behavioral disorders?
    • 28. What happen if rates of MEB’s could be cut 25-50%?
    • 29. Suicidal acts/thoughts? Child maltreatment?ADHD?Oppositional Defiant Disorders? Major Depression? Anxiety Disorders?Conduct Disorders? Psychosis onset?Tobacco addiction? Learning Disorders/Disabilities?Alcohol abuse?Drug abuse rates? School failure/dropping out?Drug abuse?
    • 30. What would happen in the US, inthis state, and in this community ifthe rates of the following were cut Suicidal acts/thoughts?25% to 50%… Child maltreatment?ADHD?Oppositional Defiant Disorders? Major Depression? Anxiety Disorders?Conduct Disorders? Psychosis onset?Tobacco addiction? Learning Disorders/Disabilities?Alcohol abuse?Drug abuse rates? School failure/dropping out?Drug abuse?
    • 31. The call“How are the children?” Hongi After the challenge warning, the eldest woman calls forth the women and children. Two chiefs meet Tamariki Wairua “The children are the gift of the gods held in common.” Turia te marae e tamara ma, Now take your stand on the marae. Whaikorero kae i te pa-uauatanga, Share your concerns about the state of affairs, I puta ai to ihu ki Rangiatea, Let your wisdom lead us into the light, I mau ai te puni wahine, Let it be as a mantle over the assembly of women, Te tira taitama, the band of young people;
    • 32. Key messages about mental, emotional & behavioral disorders…
    • 33. Key messages about mental, emotional & behavioral disorders… MEB’s arepreventable.
    • 34. Key messages about mental, emotional & behavioral disorders… MEB’s are Break-even forpreventable. MEB prevention is one year.
    • 35. Key messages about mental, emotional & behavioral disorders… MEB’s are Break-even for MEB preventionpreventable. MEB prevention balances is one year. budgets.
    • 36. Key messages about mental, emotional & behavioral disorders… MEB’s are Break-even for MEB prevention MEB preventionpreventable. MEB prevention balances improves US is one year. budgets. business.
    • 37. Key messages about mental, emotional & behavioral disorders… MEB’s are Break-even for MEB prevention MEB preventionpreventable. MEB prevention balances improves US is one year. budgets. business. Effective MEBprevention helpsnational security.
    • 38. Key messages about mental, emotional & behavioral disorders… MEB’s are Break-even for MEB prevention MEB preventionpreventable. MEB prevention balances improves US is one year. budgets. business. Effective MEB MEB preventionprevention helps helps US globalnational security. success.
    • 39. Key messages about mental, emotional & behavioral disorders… MEB’s are Break-even for MEB prevention MEB preventionpreventable. MEB prevention balances improves US is one year. budgets. business. MEB prevention Effective MEB MEB prevention saves Socialprevention helps helps US global Security &national security. success. Medicare.
    • 40. Key messages about mental, emotional & behavioral disorders… MEB’s are Break-even for MEB prevention MEB preventionpreventable. MEB prevention balances improves US is one year. budgets. business. MEB prevention Effective MEB MEB prevention saves Social MEB preventionprevention helps helps US global Security & heals pastnational security. success. Medicare. inequities.
    • 41. Introducing “behavioral vaccines” Behavioral vaccines are a simple procedure that, when used repeatedly, reduce morbidity and mortality and/or increase wellbeing or health. Such behavioral vaccines can become cultural practices.• Embry, D. D. (2011). "Behavioral Vaccines and Evidence-Based Kernels: Non-pharmaceutical Approaches for the Prevention of Mental, Emotional, and Behavioral Disorders." Psychiatric Clinics of North America 34(March): 1-34• Embry, D. D. (2004). "Community-Based Prevention Using Simple, Low-Cost, Evidence-Based Kernels and Behavior Vaccines." Journal of Community Psychology 32(5): 575.• 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.
    • 42. Brushing teeth Watching TV in 3x per day bedroom Yes Yes No No Buckling a child 30 minutes of in a car seat physical activity per day Yes Yes No NoChecking for understanding:Which are “behavioral vaccines”?
    • 43. Evidence-Based Kernels… Is the smallest unit of scientifically proven behavioral influence. • Is indivisible; that is, removing any part makes it inactive. Produces quick easily measured change that can grow much bigger change over time. Can be be used alone OR combined with other kernels to create new programs, strategies or policies. • Are the active ingredients of evidence-based programs • Can be spread by word-of-mouth, by modeling, by non professionals. • Can address historic disparities without stigma, in part because they are also found in cultural wisdom.
    • 44. Further reading…Clin Child Fam Psychol RevDOI 10.1007/s10567-008-0036-xEvidence-based Kernels: Fundamental Units of BehavioralInfluence Fundamental unites of behavior changeDennis D. Embry Æ Anthony Biglan Embry, D. D. and A. Biglan (2008). "Evidence-Based Kernels: Fundamental Units of Behavioral Influence." Clinical Child & FamilyÓ The Author(s) 2008. This article is published with open access at Springerlink.comAbstract This paper describes evidence-based kernels, This paper presents an analysis of fundamental units of Psychology Review 11(3): 75-113.fundamental units of behavioral influence that appear to behavioral influence that underlie effective prevention andunderlie effective prevention and treatment for children, treatment. We call these units kernels. They have twoadults, and families. A kernel is a behavior–influence defining features. First, in experimental analysis,procedure shown through experimental analysis to affect a researchers have found them to have a reliable effect on A R T I C L E COMMUNITY-BASED Creating population change PREVENTION USING SIMPLE, Embry, D. D. (2004). "Community-Based Prevention Using Simple, LOW-COST, EVIDENCE-BASED KERNELS AND BEHAVIOR Low-Cost, Evidence-Based Kernels and Behavior Vaccines." VACCINES Dennis D. Embry PAXIS Institute Journal of Community Psychology 32(5): 575. A paradox exists in community prevention of violence and drugs. Good B e h a v i o r a l Vac c i n e s an d Evidence-Based Kernels: Nonpharmaceutical Behavioral vaccines for disease control A p p ro a c h e s f o r th e Prevention of Mental, Embry, D. D. 2011. Behavioral vaccines and evidence-based kernels: Emotional, and non-pharmaceutical approaches for the prevention of mental, emotional, B e ha vi ora l D is o rd er s and behavioral disorders. Psychiatr Clin North Am 34 (1):1-34. Dennis D. Embry, PhD KEYWORDS
    • 45. Packing our youngpeople’s suitcases for their whole lives…
    • 46. Ask the suitcase questions of 30 people: somerepublicans, some democrats, some independentsand some who are apolitical.
    • 47. Bi-directional Wealth and Wellbeing Transfer 5-Year 65-Year Olds Olds
    • 48. Bi-directional Wealth and Wellbeing Transfer 5-Year 65-Year Olds Olds Who are living longer though get progressively sicker…
    • 49. Bi-directional Wealth and Wellbeing Transfer Requiring more wealth transfer 5-Year 65-Year Olds Olds Who are living longer though get progressively sicker…
    • 50. Bi-directional Wealth and Wellbeing Transfer Requiring more wealth transfer 5-Year 65-Year Olds Olds Who are living Who are less longer though get and less able… progressively sicker…
    • 51. Bi-directional Wealth and Wellbeing Transfer Requiring more wealth transfer 5-Year 65-Year Olds But elders voting to stop funds to kids Olds Who are living Who are less longer though get and less able… progressively sicker…
    • 52. Meet Muriel Saunders, the 4th-grade teacher who invented the Good Behavior Game in 1967 JOURNAL OF APPLIED BEHAVIOR ANALYSIS 1969, 2, 119-124 NUMBER 2 (SUMMER 1969) GOOD BEHAVIOR GAME: EFFECTS OF INDIVIDUAL CONTINGENCIES FOR GROUP CONSEQUENCES ON DISRUPTIVE BEHAVIOR IN A CLASSROOM HARRIET H. BARRISH, MURIEL SAUNDERS, AND MONTROSE M. WOLF UNIVERSITY OF KANSAS Out-of-seat and talking-out behaviors were studied in a regular fourth-grade class that in- cluded several "problem children". After baseline rates of the inappropriate behaviors were obtained, the class was divided into two teams "to play a game". Each out-of-seat and talking- out response by an individual child resulted in a mark being placed on the chalkboard, which meant a possible loss of privileges by all members of the students team. In this manner a contingency was arranged for the inappropriate behavior of each child while the consequence (possible loss of privileges) of the childs behavior was shared by all members of this team as a group. The privileges were events which are available in almost every classroom, such as extra recess, first to line up for lunch, time for special projects, stars and name tags, as well as winning the game. The individual contingencies for the group consequences were successfully applied first during math period and then during reading period. The experi- mental analysis involved elements of both reversal and multiple baseline designs. Researchers have recently begun to assess Hall and Broden, 1967; Becker, Madsen, the effectiveness of a variety of behavioral Arnold, and Thomas, 1967; Hall, Lund, and procedures for management of disruptive class- Jackson, 1968; Thomas, Becker, and Arm- room behavior. Some investigators have ar- strong, 1968; Madsen, Becker, and Thomas, ranged token reinforcement contingencies for 1968). Even so, at least one group of investi- appropriate classroom behavior (Birnbrauer, gators (Hall et al., 1968) encountered a teacher Wolf, Kidder, and Tague, 1965; OLeary and who apparently did not have sufficient social Becker, 1967; Wolf, Giles, and Hall, 1968). reinforcers in her repertoire to apply social However, these token reinforcers often have reinforcement procedures successfully. The been dependent upon back-up reinforcers that present study investigated the effects of a class- were unnatural in the regular classroom, such room behavior management technique based as candy and money. On the other hand, on reinforcers natural to the classroom, other several investigators have utilized a reinforcer than teacher attention. The technique was intrinsic to every classroom, i.e., teacher at- designed to reduce disruptive classroom be- tention (Zimmerman and Zimmerman, 1962; havior through a game involving competition for privileges available in almost every class- This study is based upon a thesis submitted by the room. The students were divided into two senior author to the Department of Human Develop- teams and disruptive behavior by any member ment in partial fulfillment of the requirements for the of a team resulted in possible loss of privileges Master of Arts degree. The research was supported by for every member of his team. a Public Health Service Fellowship IFI MH-36, 964-01 from the National Institute of Mental Health and by a grant (HD 03144) from the National Institute of METHOD Child Health and Human Development to the Bureau of Child Research and the Department of Human Subjects and Setting Development, University of Kansas. The authors wish The study was conducted in a fourth-grade to thank Drs. Donald M. Baer and Don Bushell, Jr., for helpful suggestions in preparation of the manu- classroom of 24 students. Seven of the students script; Mr. Rex Shanks, Mr. Frank A. Branagan, and had been referred several times by the teacher Mrs. Betty Roberts for their invaluable help in con- to the school principal for such problems as ducting the study; and Mrs. Susan Zook, Mrs. Sue out-of-seat behavior, indiscriminate noise and Chen, and Mr. Jay Barrish for their contributions of talking, uncooperativeness, and general class- time for reliability checks. Reprints may be obtained from the authors, Department of Human Development, room disruption. Further, the school principal University of Kansas, Lawrence, Kansas 66044. reported that a general behavior management 119Barrish, H. H., Saunders, M., & Wolf, M. M. (1969). Good behavior game: Effects of individual contingencies for group consequences on disruptive behavior in a classroom. Journal of Applied Behavior Analysis, 2(2), 119-124
    • 53. Meet Muriel Saunders, the 4th-grade teacher who invented the Good Behavior Game in 1967 JOURNAL OF APPLIED BEHAVIOR ANALYSIS 1969, 2, 119-124 NUMBER 2 (SUMMER 1969) GOOD BEHAVIOR GAME: EFFECTS OF INDIVIDUAL CONTINGENCIES FOR GROUP CONSEQUENCES ON DISRUPTIVE BEHAVIOR IN A CLASSROOM HARRIET H. BARRISH, MURIEL SAUNDERS, AND MONTROSE M. WOLF UNIVERSITY OF KANSAS Out-of-seat and talking-out behaviors were studied in a regular fourth-grade class that in- cluded several "problem children". After baseline rates of the inappropriate behaviors were obtained, the class was divided into two teams "to play a game". Each out-of-seat and talking- out response by an individual child resulted in a mark being placed on the chalkboard, which meant a possible loss of privileges by all members of the students team. In this manner a contingency was arranged for the inappropriate behavior of each child while the consequence (possible loss of privileges) of the childs behavior was shared by all members of this team as a group. The privileges were events which are available in almost every classroom, such as extra recess, first to line up for lunch, time for special projects, stars and name tags, as well as winning the game. The individual contingencies for the group consequences were successfully applied first during math period and then during reading period. The experi- mental analysis involved elements of both reversal and multiple baseline designs. Researchers have recently begun to assess Hall and Broden, 1967; Becker, Madsen, the effectiveness of a variety of behavioral Arnold, and Thomas, 1967; Hall, Lund, and procedures for management of disruptive class- Jackson, 1968; Thomas, Becker, and Arm- room behavior. Some investigators have ar- strong, 1968; Madsen, Becker, and Thomas, ranged token reinforcement contingencies for 1968). Even so, at least one group of investi- appropriate classroom behavior (Birnbrauer, gators (Hall et al., 1968) encountered a teacher Wolf, Kidder, and Tague, 1965; OLeary and who apparently did not have sufficient social Becker, 1967; Wolf, Giles, and Hall, 1968). reinforcers in her repertoire to apply social However, these token reinforcers often have reinforcement procedures successfully. The been dependent upon back-up reinforcers that present study investigated the effects of a class- were unnatural in the regular classroom, such room behavior management technique based as candy and money. On the other hand, on reinforcers natural to the classroom, other several investigators have utilized a reinforcer than teacher attention. The technique was intrinsic to every classroom, i.e., teacher at- designed to reduce disruptive classroom be- tention (Zimmerman and Zimmerman, 1962; havior through a game involving competition for privileges available in almost every class- room. The students were divided into two The first whole classroom This study is based upon a thesis submitted by the senior author to the Department of Human Develop- teams and disruptive behavior by any member ment in partial fulfillment of the requirements for the of a team resulted in possible loss of privileges Master of Arts degree. The research was supported by for every member of his team. a Public Health Service Fellowship IFI MH-36, 964-01 from the National Institute of Mental Health and by a grant (HD 03144) from the National Institute of METHOD Child Health and Human Development to the Bureau study of behavioral of Child Research and the Department of Human Subjects and Setting Development, University of Kansas. The authors wish The study was conducted in a fourth-grade to thank Drs. Donald M. Baer and Don Bushell, Jr., for helpful suggestions in preparation of the manu- classroom of 24 students. Seven of the students script; Mr. Rex Shanks, Mr. Frank A. Branagan, and had been referred several times by the teacher Mrs. Betty Roberts for their invaluable help in con- to the school principal for such problems as ducting the study; and Mrs. Susan Zook, Mrs. Sue out-of-seat behavior, indiscriminate noise and psychology in the world Chen, and Mr. Jay Barrish for their contributions of talking, uncooperativeness, and general class- time for reliability checks. Reprints may be obtained from the authors, Department of Human Development, room disruption. Further, the school principal University of Kansas, Lawrence, Kansas 66044. reported that a general behavior management 119Barrish, H. H., Saunders, M., & Wolf, M. M. (1969). Good behavior game: Effects of individual contingencies for group consequences on disruptive behavior in a classroom. Journal of Applied Behavior Analysis, 2(2), 119-124
    • 54. 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 classhours X 30 students =2,805 disruptions per school day per classroom
    • 55. 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 classhours X 30 students =2,805 disruptions per school day per classroom 6 per/hr X 5.5 class hours X 30 students = 990 disruptions per school day per classroom
    • 56. incur a checkmark, lessening In 1985, Dr. Kellam and colleagues 29 percent who played the GBG reported abuse and dependence. Teachers gave out the Dr. Kellam and colleagu ’ chances for prizes. identified three to four schools in each of stickers and other token rewards and penalties dinal study of the GBG wh Universme is played for brief intervals at five demographically distinct neighbor- hoods, ranging more than mostly In 1985, in ethnicity from MALES BENEFIT ACROSS THE AS THE TWIG IS BENT Young adults who had played the Good ship witme and frequency are gradually BOARD As they grew, boys who had partici- Behavior Game in first and second grade were less likely to smoke ciga- Public Sd as the children gain practice 1,000 children from African-American to mostly White and in pated in the Good Behavior Game in first and rettes or abuse drugs than those who hadn’t played the game. Males Kellam ng their behaviors. Eventually, economic status from very low to moder- second grade in 1985–1986 used fewer social whose first-grade teachers identified them as aggressive and disruptive constant attentiveness to 41 first-grade classes ate income. Altogether, more than 1,000 services than a control group. benefited the most. activity spectrum e behavior, the teacher stops in 19 from 41 first-grade classes in 19 children schools either efits by s Good Behavior Game Control g when the game is in play and schools either used the GBG or served as Game used the GBG or Players Controls olds awa prizes to successful teams only controls in the study. 70% disrupti servedthe first weeks of in as controls school, Prevalence of Problem Behaviors at Age 19–21h of a GBG period. During School 60% have lon G was devised in the 1960s the study. teachers in both the GBG and the control Services* 9% 14% precurso H. Barrish, Muriel Saunders, classes assessed each student’s behav- 50% adolesce Mental Health or comes. T ose M. Wolf at the University ior; about 12 percent of the males and 3 Medical Services 13% 18% Its underlying concept is that These results are percent of the females were classified as 40% the GBG only aga bers, wanting to win, will pres- longitudinal results at aggressive and disruptive. Teachers in the Drug Abuse Treatment 4% 9% 30% and dep help—each other to meet the game-playing classrooms divided these objectives. age 21 from the high-risk students roughly equally among 20% against t Social antisoci kids come to school, they often study. the teams. Services 1% 6% 10% der, andw how to behave like students. The teachers using the GBG began by to be taught. It’s not intuitive, implementing the game for 10 minutes Criminal Justice 0 12% 20% HOW TO System Drug Abuse Smoking Drug Abuse Smoking Drug Abuse Smoking n’t always get it, and teachers three times a week; they then increased its Teach All Males Males Disruptive in First Grade g trained to deal with it,” says frequency and duration as the school year *For problems with behavior, emotions, drugs, or alcohol. All Females of the ga . “This is the issue the GBG progressed. The same children contin-o address.” ued to play the GBG or serve as controls stakes are high: Children who through second grade. The game did not drug use disorder, compared with 68 per- pt to the student role early in ol careers risk rejection by Example long-term results of a behavior vaccine cut into instructional time because it took cent of controls (see graph, page 1). place when students were at their desks “We did not anticipate that a single ure to achieve academically, reading, completing work assignments, or intervention a universal classroom behavior management program in first and second Kellam, S., C. H. Brown, et al. (2008). "Effects of would have such a major t with their teachers and other engaging in other quiet activities. grades on young adult behavioral, psychiatric,says Dr. Kellam, who led Drug & Alcohol Dependence(Special Issue): 24. impact,” and social outcomes,." the igures. The consequences of About 15 years later, the researchers study. “The key to the GBG’s efficacy lems in the teen years include located and interviewed approximately 75 seems to be its effect on aggressive and
    • 57. Timeline of benefits from PAX GBG Ageof Child Benefits 75% reduction in disturbing, disruptive and destructive behavior; 1st Grade 25% increase academic achievement; less bullying and intimidation 43% reduction in ADHD diagnoses; 33% reduction in Oppositional Defiant 3rd Grade Disorder; 30%+ reduction special services needs; 50%+ reduction in conduct disorders; 25% to 50% reduction tobacco 6th grade use; reduction in bullying or harassment behaviors 8th Grade 75%r reduction in serious drug use and engagement in delinquent acts Major increase in high-school graduation; lower utilization of special 12th Grade services Increase in college entry; Major reductions drug use; reductions in prison Early 20’s time Lifetime reduction in violent crime, suicide, psychiatric diagnoses, and Age 29 lifetime addictions
    • 58. Lessons learnedClass-wide peer from one-roomtutoring process Kansas school houses Children have lifetime achievement gains from rapid paced, daily process of tutoring each other developed and tested at the University of Kansas
    • 59. Table 1. Methodologically Rigorous Evidence (Randomized Trials) Supporting the Efficacy of CWPT Citation Description Indicator Effect Size1. Greenwood, Delquadri, & Hall (1989) Prospective, Longitudinal Reading Achievement 0.57(Note. These four peer-reviewed publications Randomized CWPT trial, Language Achievement 0.60report the longitudinal achievement, behavior 1st-4th Grades (N = 416) Arithmetic Achievement 0.37and life event effects of a single CWPT trial) AcademicEngagement 1.412. Greenwood (1991a) Multiyear Behavioral Trajectories, Academic Engagement 0.63 1st-3th Grades (N = 115) Task Management 0.61 Inappropriate Behavior 0.833. Greenwood, Terry, Utley et al. (1993) Follow-up at 7th Grade Reading Achievement 0.39 (N = 303) Language Achievement 0.35 Arithmetic Achievement 0.57 Social Studies Achievement 0.39 Science Achievement 0.48 Reduction in SPED Services 0.54* Less Restrictiveness Services 0.73*4. Greenwood, & Delquadri (1995) Follow-up at 12th Grade (N = 231) Reduction in School Dropout 0.66*Mathes, Howard, Allen, & Fuchs (1998) (N = 96) Randomized PALS Trial, Grade K Woodcock Word ID 0.70 Woodcock Word Attack 0.78 Woodcock Comprehension 0.27 CBM (Low Achievers) .03-1.35Fuchs, Fuchs, Thompson et al. (2001) (N = 379) Randomized PALS trial, Grade K Segmentation, Blending 0.45-2.1 Alphabetics 0.02 -1.96Fuchs, Fuchs, Phillips, et al. (1995) (N = 120) Randomized PALS Trial, 2-4 Grades Math Achievement 0.34Fuchs, Fuchs, Mathes & Simmons (1997) (N = 120) Randomized PALS trial, 2-6 Grades Reading Achievement 0.22-0.56Note. Effects sizes are Cohens d ; *= effect size calculated from Chi-square as w
    • 60. Language development
    • 61. Special “Me” Books, andevidence-based kernel:Can change parent and child behavior,as well as language development.Twelve such books can affect earlyliteracy, too.
    • 62. What happens if you teach students to praise each other for “peaceability” CDC Nurses Office Study 60% 50% Percentage Change 40% 30% 20% 10% 0% -10% -20% All Visits Injury Viists Non-Injuries Fighting Non-Fighting Injuries Injuries Control/Wait List PeaceBuildersA “Tootle” is the opposite of a tattle.
    • 63. Hope for Our Futures:Preventing Child Maltreatment & Adverse Childhood Experiences
    • 64. JOURNAL OF APPLIED BEHAVIOR ANALYSIS 1972, 530 139-149 TRAINING PARENTS AS BEHAVIOR MODIFIERS: SELF-RECORDING OF CONTINGENT ATTENTION NUMBER 2 (SUMMER 1972) Behaviorally Based Parenting Supports: Triple P Intervention Studies EMILY W. HERBERT AND DONALD M. BAER UNIVERSITY OF KANSAS Two mothers of deviant young children were instructed to count their episodes of attention to appropriate child behavior in their homes, using wrist counters. Attention and appropriate child behavior were defined before counting began. Independent ob- servations of parent-child interactions showed that, for each mother-child pair, the percentage of maternal attention given following appropriate child behavior increased, as did the childs appropriate behavior. Removal of the counters did not produce a reversal of the behaviors; instead the increased level stabilized. One mother was then instructed to count her attention to inappropriate child behavior and to decrease it. This instruction had little effect on her attention, and her childs behavior did not change. !"#$%&(&)) 8+%9&.:) When both parents were again instructed to count their episodes of attention to ap- propriate behavior, further improvements in both mothers, and in their children resulted. These results were obtained despite inaccurate parent self-recording. Follow-up observations made over the next five months showed these behavioral gains to be !"#"$%&()*+,)+-)./01$()2)345(/(4&+4)65"70(8) *+,)-+&&./)) ;<+)*+$<+%&./#) durable. A third parent and his child were unaffected by this training procedure. Thus, there are instances in which self-recording may function as an effective and economical parent-training technique for effecting improvements in child behavior. 0.1&./) #!" =+1("9) 234$&./) NumzER4 (wiN-r 1972) C30:"?:=@/3"A" 2,($>+%&./) 5%+&./) 1972, 59 405-420 !!"JOURNAL OF APPLIED BEHAVIOR ANALYSIS R THE ORGANIZATION OF DAY-CARE ENVIRONMENTS: REQUIRED VS. OPTIONAL ACTIVITIES ?:=@/3"A"B39>"0" 7893:801580/" 2,+/+.) *+,)9-)85"70(8) LARRY A. DOKE AND TODD R. RISLEY 40.3" D3B08" 6.($+/)2$&$+#) &!" UNIVERSITY OF KANSAS 2(.1&?4%+) Measures of group participation were used in an experimental analysis of the effects of 7&.&/&) @&?&.)) two preschool activity schedules. Childrens participation in preschool activities remained as high when children were allowed no options but were required to follow a schedule ,-.-/0123"456" of activities in sequence, as when they were free to choose between several optional activ- %!" 5%&.) ities. However, this was only true: (1) when a child was not forced to wait until all other 7893:238158" children had finished, but could start the next required activity individually as soon as ;9-<=3>" he had finished the preceding one, and (2) when there was an abundance of materials in each required activity. When there were not adequate materials in each activity, childrens participation was disrupted unless they were free to choose among several 7"%&3&4) A4.1)B4.1) optional activities. Thus, in order to maintain high levels of participation in preschool $!" play activities, it is not necessary to allow children to choose among several alternative activities. High participation may be more efficiently maintained by providing a supply of materials that is adequate to occupy all children in each of a sequence of required activities and staffing by at least two teachers, so that while one teacher is supervising children still finishing one activity another teacher can supervise children who are ready to start the next. #!" !"#$%&(&)) 8+%9&.:) !" *+,)-+&&./)) ;<+)*+$<+%&./#) ( " ( " ( " ( " ( " ( " ( " ( " ( " ( " ( " ( " ( " ( " ( " ( " ( " ( " ( " #! " #! " #! " #! " #! " #! " #! " #! " #! " " &! & &# &) &$ &* &% &+ && &( (! ( (# () ($ (* (% (+ (& (( !! ! !# !) !$ !* !% !+ !& 0.1&./) ( =+1("9) :(%/) 234$&./) 2,($>+%&./) 5%+&./) 2,+/+.) 6.($+/)2$&$+#) 2(.1&?4%+) 7&.&/&) @&?&.)) 5%&.) 7"%&3&4) A4.1)B4.1)
    • 65. Substantiated Child Maltreatment 16 Rates per 1,000 Children (0-8 Years) 15 13 12 10 Pre Post Prinz et al., 2009, Prevention Science
    • 66. Substantiated Child Maltreatment 16 Control Counties Rates per 1,000 Children (0-8 Years) 15 13 12 10 Pre Post Prinz et al., 2009, Prevention Science
    • 67. Substantiated Child Maltreatment 16 Control Counties Rates per 1,000 Children (0-8 Years) 15 13 Triple P Counties 12 10 Pre Post Prinz et al., 2009, Prevention Science
    • 68. Child Abuse Hospital Injuries 1.80Rates per 1,000 Children (0-8 Years) 1.68 1.55 1.43 1.30 Pre Post Prinz et al., 2009, Prevention Science
    • 69. Child Abuse Hospital Injuries 1.80Rates per 1,000 Children (0-8 Years) 1.68 Control Counties 1.55 1.43 1.30 Pre Post Prinz et al., 2009, Prevention Science
    • 70. Child Abuse Hospital Injuries 1.80Rates per 1,000 Children (0-8 Years) 1.68 Control Counties 1.55 1.43 Triple P Counties 1.30 Pre Post Prinz et al., 2009, Prevention Science
    • 71. Child Out-of-Home Placements 4.50Rates per 1,000 Children (0-8 Years) 4.13 3.75 3.38 3.00 Pre Post Prinz et al., 2009, Prevention Science
    • 72. Child Out-of-Home Placements 4.50 Control CountiesRates per 1,000 Children (0-8 Years) 4.13 3.75 3.38 3.00 Pre Post Prinz et al., 2009, Prevention Science
    • 73. Child Out-of-Home Placements 4.50 Control CountiesRates per 1,000 Children (0-8 Years) 4.13 Triple P Counties 3.75 3.38 3.00 Pre Post Prinz et al., 2009, Prevention Science
    • 74. Apparent consumption o inoleic acid (% of dietary energy) among Australia, Canada, UK and USA for the years 1961–2000 #" +651.-:8- A-0-;- BC BD+2 +,,-./012340567,1840 492:804:/83 -38; $ & <=2/0/.>?@ ( % * ) ! # " #$(" #$(% #$" #$% #$&" #$&% #$$" #$$% !""" E/-.5Susan Elaine Carlson, PhDAJ Rice Professor of Evolution Neonates Breast Milk “Risky” BehaviorNutritionKU Department of Dietetics In the Rife Valley, the Successful human American infants have Almost all adolescentand NutritionUniversity of Kansas human brain evolution neonates born with been getting steadily less risky behaviors have nowMedical Center 60-day supply of omega-3 (n3) and more been documented to be the result of eating pro-inflammatory omega-6 related to low n3 and fish high in omega-3 omega-3 in (n6) in breast milk high n6 in US diet not savannah animals subcutaneous fat from See Ailhaud et al. (2006).Temporal changes change in last 50 years mother’s diet in dietary fats: Role of n6 See Broadhurst, Cunnane, & Hibbeln et al. (2006). Healthy intakes of n-3 polyunsaturated fatty acids in excessive Crawford (1998). Rift Valley lake fish and n-6 fatty acids: estimations considering See HIbbeln et al. (2007).Maternal seafood adipose tissue worldwide diversity. and shellfish provided brain-specific consumption in pregnancy and development and relationship to obesity nutrition for neurodevelopmental outcomes in childhood early Homo (ALSPAC study): an observational cohort study
    • 75. Physiological Kernel: Omega-3 30%Why not help Percentage with Psychosis at 12 months 27.5%at-risk young 24%adults to 18% This cost $12prevent to achievepsychosis? 12% 6% 4.9% 0% Amminger, G. P., M. R. Schafer, et al. Omega-3 Placeo (2010). "Long-Chain {omega}-3 Fatty Acids Psychosis for Indicated Prevention of Psychotic Disorders: A Randomized, Placebo- Controlled Trial." Arch Gen Psychiatry 67(2): 146-154. See p.214, IOM Report
    • 76. Omega-3 Intake and developmental outcomes Reduction in ADHD-related Symptoms DSM Combined-type DSM Hyperactivity DSM Inattention Conners Global Index CG Emotional Lability CG Restless-Impulsive Conners Index Social Problems Perfectionism Anxiety Hyperactivity Cognitive Problems Opposition -0.15 0 0.150.300.450.60 Treatment Effect Size (Mean change 0-3m / Pooled Baseline SD) Placebo (N=52) Active (N=50) Richardson and Montgomery 2005Text
    • 77. Reduced
Felony
Violent
Offenses
Among
Prisoners
with
recommended
daily
amounts
of
vitamins,
minerals
and
essen=al
fa>y
acids Ratio of Disciplinary Incidents Supplementation/Baseline Ac=ve
‐37.0% 
p
‹
0.005 1.00 Placebo
‐10.1% 0.75 
p
=
ns 0.50 0.25 0 Before supplementation During supplementation Active Placebo UK
maximum
security
prison
‐
338
offences
among
172
prisoners
over
9
months
treatment
in
a
compared
to
9
 months
baseline.
 Gesch
et
al.

Br
J
Psychiatry
2002,
181:22‐28
    • 78. Increase nurturance of prosociality for persons of all ages This can be individual, family, school and/or community action Reduce toxic influences of all ages This can be at an individual, family, school and/or community level Increase psychological flexibility among people of all ages This can be achieved across settings, as the above.From Biglan, Flay and Embry. Nurturing Environments and the Next Generation of Prevention Research and Practice for the American Psychologist
    • 79. Relational Antecedent Reinforcement Physiological Frame Kernel Kernel Kernel Kernel Changes Creates verbal Happens BEFORE Happens AFTER the biochemistry of relations for the the behavior behavior behavior behavior Embry, D. D., & Biglan, A.Four Types of Evidence- (2008). Evidence-Based Kernels: Fundamental Units of Behavioral Influence. ClinicalBased Kernels (4 types) Child & Family Psychology Review, 39.
    • 80. !"##$#%&()*+&,-./012!/3&0/4415-6&72!&/33& &Kernels lower cost of training, support & change… !"#$%&(&)*"+,$%&!"#$%&-.&/%01%$&234$435&.-0&6%$%73%89&:1847"3%8&"18&214;%0<"$& =0%;%134-1& Evidence- );48%17%>?"<%8& Selected 6%$%73%8& Targeted :1847"3%8& Universal 214;%0<"$& Based Kernel /%01%$& Intervention =0%;%134-1& Intervention Targeted =0%;%134-1& Prevention Universal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ernels provide=I#$47&,-<341F& !(*">(&>=??"#$@P& 1?K;=L(&K;=EB(?)@$>& !(*">(&$?K"BF$L(&=;& robustness, cost-efficiency and community sustainability across syndemics and multi-problem behaviors. :)#@(>(*(#@&A(;#(BC& $BB(%)B&E()L$=;F9VVD& E()L$=;&$#& ;$FAP&E()L$=;F&$#& 9V9D&9JV& @(;)K("@$>& %(#(;)B&
    • 81. Kernels lower cost of training, support & change…
    • 82. Population level example of use of kernelsEmbry, D. D. and A. Biglan (2009). Reward and Reminder: An Environmental Strategy for Population-Level PreventNational Registry of Effective Programs and Practices, Substance Abuse and Mental Health Administration.
    • 83. 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%Population level example of use of kernelsEmbry, D. D. and A. Biglan (2009). Reward and Reminder: An Environmental Strategy for Population-Level PreventNational Registry of Effective Programs and Practices, Substance Abuse and Mental Health Administration.
    • 84. What will happen There are 20 years from 29,000 first now? graders in Kansas each Is the predicted year future acceptable? What will theirfutures be under existing conditions?
    • 85. What happens if we pack every US and Kansas first grader’s life suitcase well? Universal Behavioral First Grad Vaccine Cost Net Economic Cohort X ($150 each) = Benefit for All USA 4,300,000 $650 Million $59 Billion Kansas 29,007 $4.3 Million $416 MillionCalculations based on the Washington State Institute for Policy Research Report, July 2011:Return on Investment; Evidence-Based Options to Improve Statewide Outcomeswww.wsipp.wa.gov
    • 86. A proposal for the FirstFutures FundEvery First Grader in Kansas will receive thesebehavioral vaccines and evidence-based kernels,most of which were developed or expanded, atthe University of Kansas.Cost: $300 per childSustainable funding from 3rd partyreimbursements and sponsorshipsFounding funding via Social Impact bonds
    • 87. If these ideas are so good…
    • 88. If these ideas are so good…
    • 89. For more info,Dennis D. Embry, Ph.D.dde@paxis.org520-299-6770www.slideshare.net/drdennisembry

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