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Powerpoint presentation from Dennis Embry. Presented at the 2010 Research to Practice Conference

Powerpoint presentation from Dennis Embry. Presented at the 2010 Research to Practice Conference

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  • 1. Using Evidence-Based Kernels: The DNA for Prevention, Intervention & Treatment Dennis D. Embry, Ph.D., Senior Scientist and President, PAXIS Institute Co-Investigator, Promise Neighborhood Research Consortium, ORI 1 Objectives today Identify what kernels are or are not and the types of kernels What behavior would you like to change? Work through several examples of applying kernels to common problems Make a plan to use a kernel to influence a behavior of concern to the participants 2 Darwin Meets Mendel Darwin documented the big picture. Mendel documented the two types of genes— qualitative and quantitative. Nobody paid any attention to quantitative genes until the early 1990s. Now, we know them as polygenetics and epigenesis. Biology has the genome and proteinomics. Physics has periodic table. What does behavioral science have? 3 Homo influencer? Do humans influence each other? Why do we influence each other? How long have we been influencing each other? Is there a science of influencing other humans? What are the tools that we influence each other? 4Thursday, December 2, 2010
  • 2. Other Humans are principal source of safety. Other Humans are principal vertebrate predator. The Unique Human Evolutionary Niche 5 How do humans influence each other to be How do humans influence each other for more protective of one another? harm to other? 6 What are the fundamental units of behavioral influence used by modern humans? 7 What were the fundamental units of behavioral influence used by humans 40,000 years ago? About 40,000 years ago, with the appearance of the Cro- Magnon culture, tools became markedly more sophisticated, incorporating a wider variety of raw materials such as bone and antler. They also included new implements for making clothing, engravings, and sculptures. Fine artwork, in the form of decorated tools, beads, ivory carvings of humans and animals, clay figurines, musical instruments, and cave paintings, appeared over the next 20,000 years. 8Thursday, December 2, 2010
  • 3. 9 10 11 FREE DOWNLOAD Embry, D. D., & Biglan, A. (2008). Evidence-Based Kernels: Fundamental Units of Behavioral Influence. Clinical Child & Family Psychology Review, 39. Download at: www.pubmed.govDescribed in the 2009 IOM Report, p. 210 12Thursday, December 2, 2010
  • 4. What is a kernel? Is the smallest unit of scientifically proven behavioral influence. • Is indivisible; that is, removing any part makes it inactive. Produces quick easily measured change that can grow much bigger change over time. Can be be used alone OR combined with other kernels to create new programs, strategies or policies. • Are the active ingredients of evidence-based programs • Can be spread by word-of-mouth, by modeling, by non professionals. • Can address historic disparities without stigma, in part because they are often found in cultural wisdom. 13 Relational Antecedent Reinforcement Physiological Frame Kernel Kernel Kernel Kernel Changes Creates verbal Happens BEFORE Happens AFTER the biochemistry of relations for the the behavior behavior behavior behavior Embry, D. D., & Biglan, A. (2008). Evidence-Based Four Types of Kernels Kernels: Fundamental Units of Behavioral Influence. Clinical Child & Family Psychology Review, 39. 14 What are these? What are these? How might these be selected by consequences? 15 What are these? What are these? How might these be selected by consequences? 16Thursday, December 2, 2010
  • 5. 52 Examples of Kernels Antecedents Reinforcements Physiological Relational frames 17 = Public Posting Kernel Antecedent Kernel Happens BEFORE the behavior = radar 18 Kernel Description Behaviors Affected References Combinations of visual, kinesthetic and/or auditory Non-verbal cues that single shifting attention or task in Reduces dawdling, increases time on task or Rosenkoetter, & Fowler, 1986; Krantz, & Risley, 1977; Abbott et al., 1998; transition cues patterned way, coupled with praise or occasional engaged learning; gives more time for instruction Embry et al., 1996 rewards. Antecedent Stop lights in Traffic light signals when behavior is appropriate/ (Cox, Cox, & Cox, 2000; Jason & Liotta, 1982; Jason, Neal, & Marinakis, desirable or inappropriate/undesirable in real time, Decreases noise, off task behavior, or increases Kernel school settings or traffic settings and connected to some kind of occasional stopping in dangerous intersections 1985; Lawshe, 1940; Medland & Stachnik, 1972; Van Houten & Malenfant, 1992; Van Houten & Retting, 2001; Wasserman, 1977) reinforcement. These may be lines or other cues such as ropes or Decreases dangerous behavior; decreases Boundary cues and (Carlsson & Lundkvist, 1992; Erkal & Safak, 2006; Marshall, et al., 2005; rails that signal where behavior is safe, acceptable pushing and shoving; increases waiting behavior railings or desired in a queue; reduces falls Nedas, Balcar, & Macy, 1982; Sorock, 1988) Happens Cooperative, Planned activities happen during children play time Decreases aggression and increases social competence; also affects body mass index, and (Bay-Hinitz, Peterson, & Quilitch, 1994; Leff, Costigan, & Power, 2004;BEFORE the Structured peer play that involve rules, turn taking, social competencies, and cooperation with or without “soft competition.” appears to reduce ADHD symptoms, and increase academics afterwards; reduces social rejection in Mikami, Boucher, & Humphreys, 2005; Murphy, et al., 1983; Ridgway, Northup, Pellegrin, LaRue, & Hightsoe, 2003) behavior middle school (Barker & Jones, 2006; Ben Shalom, 2000; Bray & Kehle, 2001; Buggey, 2005; Clare, Drawn, photographic or video model viewer/listener Increases academic engagement; increases attention; Jenson, Kehle, & Bray, 2000; Clark, Beck, Sloane, Goldsmith, & et al., 1993; Clark, Kehle, increases recall and long term memory; improves behavior; Jenson, & Beck, 1992; Clement, 1986; R. A. Davis, 1979; Dowrick, 1999; Dowrick, Kim- Self-modeling engaging targeted behavior, receiving rewards or reduces dangerous behavior; increases social competence; Rupnow, & Power, 2006; Elegbeleye, 1994; Hartley, Bray, & Kehle, 1998; Hartley, Kehle, & recognition. improved sports performance; reduced health problems Bray, 2002; Hitchcock, Prater, & Dowrick, 2004; Houlihan, Miltenberger, Trench, Larson, & et al., 1995; Kahn, Kehle, Jenson, & Clark, 1990; Kehle, Bray, Margiano, Theodore, & Zhou, 2002; Law & Ste-Marie, 2005; Lonnecker, Brady, McPherson, & Hawkins, 1994; Meharg & (Agran, et al., 2005; Blick & & Woltersdorf, 1990; Owusu-Bempah& Frank, 1990; Buggey, 1995; Lipsker, 1991; Meharg Test, 1987; Boyle & Hughes, 1994; Brown & Howitt, 1985; Owusu- Reductions in alcohol, tobacco use; reductions in illness Buggey, Toombs, Gardener, & Cervetti, 1999; Burch, Clegg, & Bailey, 1987; Carr & Punzo, 1993; Cavalier, Coding target behavior with a relational frame, which symptoms from diabetes; increased school achievement; changes Bempah & Hodges, 1983;Clare, et al., 2000;McLoughlin,Kehle, & Truscott, 2001; Dalton, Martella, & Ferretti, & Howitt, 1997; Possell, Kehle, Clarke, Bray, & Bray, 1999; Ram & McCullagh, 2003; Reamer, Brady, & Hawkins, 1998; Rickards-Schlichting, Kehle, & Bray, 2004; Rickel & Fields, Self-monitoring is often charted or graphed for public or semi-public in other social competencies or health behaviors; reductions in Marchand-Martella, 1999; de Haas-Warner, 1991; R. M. Foxx & Axelroth, 1983; Glasgow, Klesges, Godding, & Gegelman, 1983; Glasgow, Klesges, & Vasey, 1983; Gray & & Simon, 1997; Walker & 1983; Schunk & Hanson, 1989; Schwartz, Houlihan, Krueger, Shelton, 1992; Hall & Zentall, display, occasioning verbal praise from others ADHD, Tourettes and other DSM-IV disorder; improvement in 2000; K. R. Harris, Friedlander, 1992; Wedel & Fowler, 1984; Woltersdorf, 1992) 1990; Hitchcock, Clement, Saddler, Frizzelle, & Graham, 2005; Hertz & McLaughlin, brain injured persons et al., 2004; Hughes, et al., 2002; Kern, Dunlap, Childs, & Clarke, 1994; Martella, Leonard, Marchand- Martella, & Agran, 1993; M. Y. Mathes & Bender, 1997; McCarl, Svobodny, & Beare, 1991; McDougall & Brady, 1995; McLaughlin, Krappman, & Welsh, 1985; Nakano, 1990; OReilly, et al., 2002; Petscher & Bailey, 2006; Possell, et al., 1999; Rock, 2005; Selznick & Savage, 2000; Shabani, Wilder, & Flood, 2001; After hearing or seeing some content, person is told Shimabukuro, Prater, Jenkins, & Edelen-Smith, 1999; Stecker, Whinnery, & Fuchs, 1996; Thomas, Paragraph Abrams, & Johnson, 1971; Todd, Horner, &G. Mathes, Fuchs, Fuchs, Henley,Winn, Skinner, (Bean & Steenwyk, 1984; P. Sugai, 1999; Trammel, Schloss, & Alper, 1994; & et al., to “shrink” meaning to 8-10 words, full sentence; Improved reading responses and retention Allin, & Hawkins, 2004; Wood, Murdock, & Cronin, 2002; Wood, Murdock, Cronin, Dawson, & Kirby, 1998) Shrinking praise typically happens for good summaries. 1994; Spencer, Scruggs, & Mastropieri, 2003) 19 Prize Bowl/Mystery Motivator KernelReinforcement KernelHappens AFTER the behavior 20 Thursday, December 2, 2010
  • 6. Kernel Description Behaviors Affected References Person or group receives spoken (or Examples: Cooperation, social competence, academic (Leblanc, Ricciardi, & Luiselli, 2005; Lowe & McLaughlin, 1974; Marchant engagement, academic achievement, positive-parent child signed) recognition for engagement in & Young, 2001; Marchant, Young, & West, 2004; Martens, Hiralall, & Verbal Praise target acts, which may be descriptive or interactions, positive marital relations, better sales Bradley, 1997; Matheson & Shriver, 2005; C. M. Robinson & Robinson, performance; reduced disruptive or aggressive behavior; 1979; S. Scott, Spender, Doolan, Jacobs, & Aspland, 2001) simple acknowledgements reduced DSM-IV symptomsReinforcement Peer-to-peer written A pad or display of decorative notes are Examples: social competence, academic (Cabello & Terrell, 1994; Embry, Flannery, Vazsonyi, Powell, & Atha, 1996; praise--“Tootle” Notes, posted on a wall, read aloud, or placed in a Kernel compliments books/ photo type album in which behaviors achievement, work performance, violence, Farber & Mayer, 1972; Heap & Emerson, 1989; Mayer, Butterworth, Nafpaktitis, & Sulzer-Azaroff, 1983; Mayer, Mitchell, Clementi, Clement- aggression, physical health, vandalism Robertson, & et al., 1993; Skinner, Cashwell, & Skinner, 2000) praise notes receive written praise from peers Tokens or symbolic rewards for positive behavior result in random rewards from Academic achievement, disruptive behavior, (Thorpe, Darch, & Drecktrah, 1978; Thorpe, Principal Lottery status person (e.g., principal, authority aggression Drecktrah, & Darch, 1979) figures) such as positive phone calls homeHappens AFTER Safety or Tokens or reward tickets given out for Safety behaviors, accident reduction, (Geller, Johnson, & Pelton, 1982; Putnam, Handler, Ramirez- Performance observed safety or performance behavior, Platt, & Luiselli, 2003; Roberts & Fanurik, 1986; Saari & the behavior Lottery which are entered into lottery improved sales or work performance Latham, 1982) Music is played or stopped in real time, Increased weight gain of babies, improved baby (Allen & Bryant, 1985; Barmann & Croyle-Barmann, 1980; Barmann, Croyle-Barmann, & McLain, 1980; Bellamy & Sontag, 1973; Blumenfeld & Eisenfeld, 2006; Cevasco & Grant, 2005; Cook & Freethy, 1973; development possibly, work performance, academic Contingent music based on observed behavior of the achievement, attention and focus (ADHD symptoms Cotter, 1971; W. B. Davis, Wieseler, & Hanzel, 1980; Dellatan, 2003; Deutsch, Parks, & Aylesworth, 1976; Eisenstein, 1974; Harding & Ballard, 1982; Hill, Brantner, & Spreat, 1989; Holloway, 1980; Hume & Crossman, 1992; Jorgenson, 1974; Larson & Ayllon, 1990; Madsen, 1982; McCarty, McElfresh, Rice, & individual or group. down); reduced aggression Wilson, 1978; McLaughlin & Helm, 1993; Standley, 1996, 1999; Wilson, 1976; D. E. Wolfe, 1982) Improved academic engagement and achievement, (Beersma, et al., 2003; Hoigaard, S?fvenbom, & Soft Team Groups compete on some task, reduced disruptive behavior, increased sales, increased funding raising, increased safety; reduced Tonnessen, 2006; Kivlighan & Granger, 2006; Koffman, competition performance, or game. smoking; changed brain chemistry favoring attention Lee, Hopp, & Emont, 1998; Neave & Wolfson, 2003; and endurance Tingstrom, Sterling-Turner, & Wilczynski, 2006) Peer-to-peer Increased academic achievement; reduced (Allsopp, 1997; Delquadri, Greenwood, Stretton, & Hall, 1983; Dyad or triad take turns asking questions, ADHD and conduct problems; long-term DuPaul, Ervin, Hook, & McGoey, 1998; Fantuzzo & Ginsburg-Block, tutoring give praise or points and corrective effects on school engagement; decreased 1998; Greenwood, 1991a, 1991b; Maheady, Harper, & Sacca, feedback 1988; Maheady, Sacca, & Harper, 1988; Sideridis, et al., 1997) special education needs. 21 Omega 3 kernel 30% Physiological Percentage with Psychosis at 12 months Kernel 27.5% 24% 18% Changes 12%biochemistry of behavior 6% 4.9% 0% Omega-3 Placeo Psychosis Amminger, G. P., M. R. Schafer, et al. (2010). "Long-Chain {omega}-3 Fatty Acids for Indicated Prevention of Psychotic Disorders: A Randomized, Placebo-Controlled Trial." Arch Gen Psychiatry 67(2): 146-154. 22 Reduced  Felony  Violent  Offences  Among  Prisoners   with  recommended  daily  amounts  of  vitamins,  minerals  and  essen=al  fa>y  acids Ratio of Disciplinary Incidents Supplementation/Baseline 1.00 Ac=ve  -­‐37.0% Placebo  -­‐10.1% 0.75  p  ‹  0.005  p  =  ns 0.50 Active 0.25 Placebo 0 Before supplementation During supplementation UK  maximum  security  prison  -­‐  338  offences  among  172  prisoners  over  9  months  treatment  in  a  compared  to  9   months  baseline.   Gesch  et  al.    Br  J  Psychiatry  2002,  181:22-­‐28 23 Consilience Issues (pardon a digression) Parsimony or Occams’ Razor: "Pluralitas non est ponenda sine neccesitate" or "plurality should not be posited without necessity." The words are those of the medieval English philosopher and Franciscan monk William of Ockham (ca. 1285-1349). Links to meta theories versus depending on mezzo-theories—e.g., “selection by consequences that embraces evolution, neural plasticity, and principles of reinforcement.” 24 Thursday, December 2, 2010
  • 7. 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/-.5 “Risky” Beh. Evolution Neonates Breast Milk & Mismatch In the Rife Valley, the Successful human American infants have human brain evolution neonates born with been getting steadily less Theory the result of eating fish 60-day supply of omega-3 (n3) and more Almost all adolescent pro-inflammatory risky behaviors have now high in omega-3 not omega-3 in omega-6 (n6) in breast been documented to be savannah animals subcutaneous fat from milk related to low n3 and mother’s diet high n6 in US diet See Broadhurst, Cunnane, & See HIbbeln et al. (2007).Maternal seafood change in last 50 years Crawford (1998). Rift Valley lake fish See Ailhaud et al. (2006).Temporal changes consumption in pregnancy and in dietary fats: Role of n6 and shellfish provided brain-specific neurodevelopmental outcomes in childhood Hibbeln et al. (2006). Healthy intakes of n-3 polyunsaturated fatty acids in excessive nutrition for (ALSPAC study): an observational cohort adipose tissue and n-6 fatty acids: estimations considering early Homo study worldwide diversity. development and relationship to obesity 25 Kernel Description Behaviors Affected References Pleasant greeting with Affects donations; social status an Friendly physical and verbal perceptions of safety or harm; affects (Edwards & Johnston, 1977; Ferguson, 1976; T. Field, 1999; Fry, or without positive 1987; Howard, 1990; la Greca & Santogrossi, 1980; Schloss, gestures, on a frequent basis. behavior streams of aggression, hostility or Schloss, & Harris, 1984) physical touch politeness Physiological (Diego, et al., 2002; T. Field, N. Grizzle, et al., 1996; T. Field, Kilmer, Massage, Any method of rubbing, stroking Reduces aggression, arousal, cortisol, Kernel brushing or and therapeutic touch applied to depressive symptoms, PTSD Hernandez-Reif, & Burman, 1996; T. Field, Seligman, Scafidi, & Schanberg, 1996; T. M. Field, 1998; T. M. Field, Grizzle, Scafidi, & Schanberg, 1996; Jones, Field, & Davalos, 1998; Scafidi & Field, stroking the body symptoms, and pain 1996) Using a turtle metaphor, child holds self, Turtle verbal frame, breaths through nose, and Reduces arousal and aggression (Heffner, Greco, & Eifert, 2003; Robin, engage in sub-verbal or verbal self- against peers or adults Schneider, & Dolnick, 1976) Technique coaching, with peer or adult reinforcement Changes “Rough and Tumble” Several times per week child or adolescent Reduces aggression, teaches self-control, may improve status among same-sex peers; changes c-fos gene expression in (Boulton & Smith, 1989; Gordon, Kollack-Walker, Akil, & engages in rough and tumble play, causing Panksepp, 2002; Hines & Kaufman, 1994; Jacklin, DiPietro, &biochemistry of Free Play with higher status conspecific increased arousal and self-control mediated laboratory animals; the behavior may be especially important to the development of positive behavior among boys and unique Maccoby, 1984; Paquette, 2004; Pellegrini & Smith, 1998; by status adult or peer Reed & Brown, 2001; E. Scott & Panksepp, 2003) behavior contribution of fathering (Antunes, Stella, Santos, Bueno, & de Mello, 2005; Atlantis, Chow, Kirby, & Singh, 2004; Aerobic play Daily or many times per week child or adult Reduces ADHD symptoms, reduces depression; engage running or similar aerobic solitary reduces stress hormones; may increase cognitive Berlin, Kop, & Deuster, 2006; Blue, 1979; Blumenthal, et al., 2005; Crews, Lochbaum, & Landers, 2004; Doyne, Chambless, & Beutler, 1983; Dunn, Trivedi, Kampert, Clark, & Chambliss, 2005; Dunn, Trivedi, & ONeal, 2001; Dustman & et al., 1984; Khatri, et al., 2001; or behavior activities, game, or food gathering behavior function; decreases PTSD Kubesch, et al., 2003; Manger & Motta, 2005; Marin & Menza, 2005; Phillips, Kiernan, & King, 2003; M. B. Stein, 2005; Stella, et al., 2005) Progressive Person tenses and relaxes sequence of Reduces panic, fear, anxiety; decreases negative (Larsson, Carlsson, Fichtel, & Melin, 2005; Norlander, Mo?s, muscles in combination with anxiety attributions; decreases phobic responses with & Archer, 2005; Pawlow & Jones, 2005; Wencai, Xinhu, Kele, muscle relaxation evoking stimulus paired with evoking stimuli & Yiyuan, 2005) Zinc Evolving evidence shows that the addition of zinc (Akhondzadeh, Mohammadi, & Khademi, 2004; Arnold, et al., 15 mg per day eaten or to the diet or by supplementation increases the 2005; Arnold & DiSilvestro, 2005; Bilici, et al., 2004; McGee, supplementation or effectiveness of drug treatment and/or may Williams, Anderson, McKenzie-Parnell, & Silva, 1990; dietary consumption supplemented prevent ADHD symptoms. Sandyk, 1990) 26 Motivational (values expression) kernel Relational A Simple Gift Example: My Values1 Please provide responses to questions about your ideas, your beliefs, and your life. Please bear in mind that, Frame there are no right or wrong answers. There are just answers important to you. Please circle the 1st, 2nd and 3rd most important value from this list Kernel Athletic ability 1 2 3 Being good at art 1 2 3 Being smart or getting good grades 1 2 3 Creativity 1 2 3 Independence 1 2 3 Living in the moment 1 2 3 Membership in a social group (such as your community, racial group or club) 1 2 3 Music 1 2 3 Creates verbal Politics 1 2 3 Relationships with friends or family 1 2 3 relations for the Religious values 1 2 3 Sense of humor 1 2 3 behavior Please look at the values you picked as most important to you, and to think about times when these values were important to you. Please describe in a few sentences why the selected values are important to you. Focus on your thoughts and feelings, and don’t worry about spelling, grammar, or how well written it is. Please list the top two reasons why the values you selected are important to you: Reason #1: Cohen, G. L., J. Garcia, et al. (2009). "Recursive Processes in Self-Affirmation: Intervening to Close the Minority Achievement Gap." Science 324(5925): 400-403. 27 Reason # 2: Please indicate your level of agreement with four easy-to-agree-with statements concerning the selected values. Strongly Strongly Agree Unsure Disagree Agree Disagree Kernel These values have influenced my life In general, I try to live up to these values. Description SA SA A A U U Behaviors Affected D D SD SD References These values are an important part of who I am. SA A U D SD I care about these values. SA A U D SD 1 Increased rule governed behavior; (Choenarom, Williams, & Hagerty, 2005; Adjectival Noun for conducted with minority underachieving 7_____”completing this activity with longitudinal follow up for nearly two years on This is based on an experiment Verbal phrase “I am/we graders, is paired th academic achievement. The study was published in Science, a prestigious peer-reviewed journal. Cohen GL,increases behavior associated with the Relational Belonging to Status with status, belonging, protection or Garcia J, Apfel N, Master A. Reducing the Racial Achievement Gap: A Social-Psychological Intervention. Science 2006; 313(5791):1307-1310. Of the 7th grade minority students who wrote about their own Embry, et al., 1996; Gaskell & Smith, personal values in this 15-minute activity, 50% FEWER received average grades of “D” or below in 9th grade,named group; decreases aggression safety Group compared to those who did a similar exercise Frame within group; may affect physical health writing about what other people might think about their important values. No one but the students saw what they wrote. 1986; Ju?rez, 2002; Mishima, 2003) Kernel Public Individuals sign or pledge self to Voting, contributing money, collective behavior (Burns & Oskamp, 1986) Commitment recycling, Individuals or groups are divided into Increase aggression and (Roos, 2005; Sherif, 1958, 1968, 1970; “US” and “THEM” two groups, with differences highlighted Creates verbal framed around clothing, adornment, violence by each group toward Sherif, Hogg, & Abrams, 2001; Sherif, Role Framing language, social position, etc. each other White, & Harvey, 1955)relations for the (Collier, Czuchry, Dansereau, & Pitre, 2001; Czuchry & Dansereau, 1996, 1999, 2003; behavior Graphic/ node A graphic organizer for goal-based Increased sobriety and goal Czuchry, Dansereau, Dees, & Simpson, 1995; Dansereau, Dees, Greener, & Simpson, 1995; Dansereau, Joe, & Simpson, 1993; Dees, Dansereau, & Simpson, 1994; Joe, Dansereau, maps behavior, guided by other status completion; increased treatment Pitre, & Simpson, 1997; Joe, Dansereau, & Simpson, 1994; Melville, Davis, Matzenbacher, & Clayborne, 2004; Newbern, Dansereau, Czuchry, & Simpson, 2005; Newbern, Dansereau, & individuals compliance Pitre, 1999; Pitre, Dansereau, & Joe, 1996; Pitre, Dansereau, Newbern, & Simpson, 1998; Pitre, Dansereau, & Simpson, 1997) Verbal questioning by status individual Reduction in substance abuse, increase in social (Bernstein, et al., 2005; Burke, Arkowitz, & Motivational around major goals of target person, competences and related goals; reduction in Menchola, 2003; Resnicow, et al., 2001; Rusch & Interviewing with clarifying questions about injuries or antisocial behaviors; increase in Corrigan, 2002; D. K. Smith, 2004; Sobell, et al., interferring behaviors. healthy behaviors (Monti, et al., 1999) 2003; L. A. R. Stein, et al., 2006) Media associating Reduces sexually transmitted (Beyth-Marom, Austin, Fischhoff, Palmgren, & et Media (TV, video, radio) showing behavior with al., 1993; Downs, et al., 2004; Pechmann, 2001; “immediate” negative behavior results in social rejection or diseases; reduces alcohol, Pechmann & Ratneshwar, 1994; Pechmann, social outcomes escape from social rejection tobacco and other drug use Zhao, Goldberg, & Reibling, 2003) 28 Thursday, December 2, 2010
  • 8. !"##$#%&()*+&,-./012!/3&0/4415-6&72!&/33& & !"#$%&(&)*"+,$%&!"#$%&-.&/%01%$&234$435&.-0&6%$%73%89&:1847"3%8&"18&214;%0<"$& =0%;%134-1& );48%17%>?"<%8& 6%$%73%8& :1847"3%8& 214;%0<"$& /%01%$& Treatment =0%;%134-1& Intervention =0%;%134-1& Prevention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hat is a behavioral vaccine? It is a simple procedure (a kernel or a recipe of kernels) that, when used repeatedly, reduce morbidity and mortality and/or increase wellbeing or health. Behavioral vaccines can be used by individuals, families, schools, businesses, organizations to produce rapid population level change. Embry, D. D. (2004). "Community-Based Prevention Using Simple, Low-Cost, Evidence-Based Kernels and Behavior Vaccines." Journal of Community Psychology 32(5): 575. 31 “Behavioral health could learn from public health in endorsing a population health perspective”—(IOM, page 19). “Families and children have ready access to the best available evidence-based prevention interventions, delivered in their own communities…in a respectful non-stigmatizing The story of the Broad Street water pump during way”—(IOM, page 387). the cholera epidemic in London. 32Thursday, December 2, 2010
  • 9. What is a public-health approach? Potential harm is universal, Personal or Group Risk is Common, Stigmatizing Persons or Groups At Risk Reduces Prevention Results, and/or More Cost Efficient to Reach All Above “Case Finding.” 33 Community reinforcement case study 34 PeaceBuilders School-Community Reinforcement Study Positive Peer-to-Peer Social Home Notes Notes Competence Violence 35 Injury Prevention Study Using Positive Reinforcement 60% 50% Change in Nurses’ 40% Office Visits from 30% Year to Year 20% 10% 0% -10% -20% All Visits Injury Viists Non-Injuries Fighting Injuries Non-Fighting Injuries Control/Wait List Intervention Krug, E. G., N. D. Brener, et al. (1997). "The impact of an elementary school-based violence prevention program on visits to the school nurse." American Journal of Preventive Medicine 13(6): 459-463. 36Thursday, December 2, 2010
  • 10. Reward & Reminder case study on tobacco 37 38 39 Reward & Reminder: Logic model 40Thursday, December 2, 2010
  • 11. Baseline After Reward and Reminder 60% Wyoming Percentage of Illegal or Non-Compliant Tobacco Sales to Minors 50% 40% Reward & 30% 20% Reminder Impact 10% on Access 0% 60% 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Wisconsin 50% 40% 30% 20% 10% 0% 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Data Source: Synar Report, SAMSA 41 Reward & Reminder: Impact on prevalence Source: Youth Risk Behavior Survey (YRBS), Centers for Disease Control 42 Good Behavior Game Case Study 43 Why not turn about the lives of high risk primary grade children using a teacher invented procedure?Muriel Saunders, the teacher 44 Thursday, December 2, 2010
  • 12. Kernel or Useful Component of PAX Good Behavior Game Kernel or Component RationaleResponse cost for negative behavior (e.g., Conyers et al., 2004) Easier to use and effective for ADHD like behaviorsTeam competition (e.g., Beersma et al., 2003) Creates positive peer pressure, and reduces negative peer attentionPublic posting of results (e.g., Parsons, 1982) Increases performance and peer pressureTeam Rotations (deemed critical but no study) Reduces bullying and peer rejectionLow emotional response to negative behaviors (e.g., Abromowitz et al., 1987) Reduces accidental attention to negative behavior by adultThree games per day (deemed critical but no study) Improves maintenance of skillUse of timer (e.g., Adams & Drabman, 1995) Creates pressure to succeed and excitementSecret Game (unannounced) – indescriminable contingency – (Freeland & Noel, 2002) Increases generalization to non-game timesLower points to win (e.g., Harris & Sherman, 1973) Causes more rapid improvementStudent help design game rules (e.g., Fishbein & Wasik, 1981) Improves acceptance by students and occasions correspondenceRelational frame language correspondence training (e.g., “I’m a PAX Leader) (Embry et al., 1996) Improves generalization of rule governed behaviorUse of Premack Principle for prizes (e.g., Browder et al., 1984) Improves acceptability of game by students and adultsNon-verbal cues (e.g., Rosenkoetter & Fowler, 1986; Cox, Cox, & Cox, 2000) Accelerates generalization and adoption of the gameMeaningful roles as DRO (e.g., Rutter, 1981) Increases attention to positive behavior; reduces problem actionsSetting generalization — recipe for carrying over the Game to hallways, restrooms, cafeteria, etc. Improves generalization by students and acceptability of game by adults(e.g., Fishbein & Wasik, 1981)Symbolic self-modeling (e.g., Embry et al., 1996) Improves imitation of behaviorSchool-home note (e.g., Kelley et al., 1988) Prompts family reinforcement and generalization of behavior to homePeer-to-peer praise notes (e.g., Embry et al., 1996; Skinner et al., 2000) Improves social competence and reduces negative peer attentionSelf-monitoring by teacher (e.g., Agran et al., 2005) Improves mastery of skill and results by teacherGood behavior lottery (e.g.. Putman et all, 2003 Improves generalization when not playing the game 45 PAX GBG Implementation Rubric PAX Game Coaching Observation Kernel or Component Highest Score High Score Moderate Score Poor No Use for Success 4 3 2 1 0 Preparing the All of the following: Four of the following: Three of the following: Less than Three of the Teacher does not attempt Students for the -Teacher gets the children’s -Teacher gets the -Teacher gets the following: to prepare the students Game attention before starting the children’s attention before children’s attention before -Teacher gets the children’s for the game game (e.g. uses PAX Quiet) starting the game (e.g. starting the game (e.g. attention before starting the -or- - Gives clear directions for uses PAX Quiet) uses PAX Quiet) game (e.g. uses PAX Quiet) Teacher does not play (PAX Quiet Kernel) the activity the children will be - Gives clear directions for - Gives clear directions for - Gives clear directions for the game during the completing during the game. the activity the children will the activity the children will the activity the children will be scheduled observation - Identifies/references the be completing during the be completing during the completing during the game. spleems that will be counted game. game. - Identifies/references the during this game. - Identifies/references the - Identifies/references the spleems that will be counted - Sets timer in full view of spleems that will be spleems that will be during this game. children and announces that counted during this game. counted during this game. - Sets timer in full view of they will be playing the game - Sets timer in full view of - Sets timer in full view of children and announces that for _____ minutes. children and announces children and announces they will be playing the game -Announces that “the game that they will be playing the that they will be playing the for _____ minutes. starts NOW.” game for _____ minutes. game for _____ minutes. -Announces that “the game -Announces that “the game -Announces that “the game starts NOW.” starts NOW.” starts NOW.” Choice of Activity Teacher has chosen an Teacher has chosen a Teacher has chosen a Teacher has chosen a No activity chosen- appropriate activity for the semi-appropriate activity for partially-appropriate activity inappropriate activity for the students are not given a (Appropriateness of students to complete while the students to complete for the students to students to complete while task to complete while task setting for playing the game while playing the game complete while playing the playing the game playing the game All of the following: Two of the following: game None of the following: -or- Game) -teacher is able to be an -teacher is able to be an One of the following: -teacher is able to be an Teacher does not play observer observer (does not need to -teacher is able to be an observer (does not need to the game during the -Appropriate skill level; not interact with students) observer (does not need to interact with students) scheduled observation too easy or difficult for -Appropriate skill level; not interact with students) -Appropriate skill level; not students too easy or difficult for -Appropriate skill level; not too easy or difficult for -Educational purpose tied to students too easy or difficult for students curriculum (not just -Educational purpose tied students -Educational purpose tied to busywork) to curriculum (not just -Educational purpose tied curriculum (not just busywork) to curriculum (not just busywork) busywork) Timing the Game Timer is used to time the Timer is used to time the Timer is used to time the Teacher attempts to use the No timer used game game game timer but does not follow -or- (Beat the Timer And both of the following: And one of the following: And neither of the through (i.e. sets the timer Teacher does not play Kernel) -Timer is placed in a -Timer is placed in a following: but never acknowledges the game during the visible/auditory location visible/auditory location -Timer is placed in a when it goes off) scheduled observation where it can be heard by all where it can be heard by all visible/auditory location -or- -Time is referred to during the -Time is referred to during where it can be heard by all Teacher times the game game (i.e. 3 minutes left or the game (i.e. 3 minutes -Time is referred to during using another device (e.g. !"#$%&#()*)*)+(+ ,$-&( 46 Her invention immediately increases time to learn 47 Why not turn about the lives of high risk primary grade children using a teacher invented procedure? 48Thursday, December 2, 2010
  • 13. 49 Safe Playing Case Study 50 A environmental policy case study in reducing early rebelliousness, risk taking and sensation seeking This risk factor can be easily measured in early-childhood, and it predicts lifetime injuries, delinquency, alcohol/drug abuse abuse, and school difficulties. 51 Contextual example of such risk 52Thursday, December 2, 2010
  • 14. Oh,prior prevention efforts in Sweden had resulted in more fatalities… 53 Safe Playing Self-Modeling Books 54 55 56Thursday, December 2, 2010
  • 15. Safe Playing Boundary Lines 57 Safe Playing Beat the Timer 58 Safe Playing Verbal Praise/Stickers 59 Safe Playing Sit and Watch Sit and Watch 60Thursday, December 2, 2010
  • 16. Conduct small single subject studies first to test tools Use the first studies to identify sources of variation 61 62 Let’s apply kernels to some behaviors you are concerned about, discuss research agendas, and experimental designs? 63 For more information Contact: Dennis D. Embry, Ph.D. PAXIS Institute PO 31205 Tucson, AZ 85751 Ph: 520-299-6770 See for more presentations, papers and videos 64Thursday, December 2, 2010