Nat'l Experts Meeting: From Science to Practice, Taking Behavioral Health Prevention and Promotion to Scale


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The Institute of Medicine’s 2009 report, Preventing Mental, Emotional, and Behavioral Disorders among Young People: Progress and Possibilities, documents that an increasing number of mental, emotional, and behavioral problems in young people are in fact preventable. The report calls for the establishment of new national priorities that emphasize the prevention of mental, emotional, and behavioral disorders and promotion of behavioral health as a national priority; the infusion of evidence-based interventions in a range of family, school and community settings; and the expansion of the existing research base. The report’s conclusions are very well aligned with the goals and strategies called for in the Affordable Care Act, highlighting the critical need for a more proactive, preventive focus on mental, emotional, and behavioral health.

Unfortunately, neither the general public nor even the State, Community, and Tribal leaders charged with behavioral health promotion, prevention, and service delivery seem to be aware of the key messages the report outlines or the appropriate steps to take to implement its recommendations. There is an urgent need to broaden awareness of this report and support state and local leaders in developing well considered strategies to implement its recommendations.

My presentation addressed many issues raised at the SAMSHA meeting

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Nat'l Experts Meeting: From Science to Practice, Taking Behavioral Health Prevention and Promotion to Scale

  1. 1. Taking behavioral health promotion to national scale SAMSHA, December 9, 2010 Dennis D. Embry, Ph.D. senior scientist/president PAXIS InstituteThursday, December 9, 2010 1
  2. 2. Key messages… Break-even for MEB MEB MEB’s are MEB prevention prevention preventable. prevention is balances gov’t improves US one year. budgets. business. Effective MEB MEB MEB prevention MEB prevention prevention saves Social prevention helps national helps US global Security & heals past security. success. Medicare. inequities.Thursday, December 9, 2010 2
  3. 3. Key message by showing dollar benefits 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.Thursday, December 9, 2010 3
  4. 4. Key message by showing dollar benefits Show long-term benefits, tooThursday, December 9, 2010 4
  5. 5. Key message by showing dollar benefits Allow people to see benefits of universal access versus rationing of prevention Show multiple outcomes to unite stakeholders Show costs of doing nothing Show break-even point and ROI over short, medium and long termThursday, December 9, 2010 5
  6. 6. Key message by showing clear visual results 30% Why not help Percentage with Psychosis at 12 months 27.5% our serious 24% at-risk 18% This cost $12 to children with 12% achieve omega-3 to prevent 6% 4.9% psychosis? 0% Amminger, G. P., M. R. Schafer, et al. (2010). Omega-3 Placeo "Long-Chain {omega}-3 Fatty Acids for See p.214, IOM Report Psychosis Indicated Prevention of Psychotic Disorders: A Randomized, Placebo-Controlled Trial." Arch Gen Psychiatry 67(2): 146-154.Thursday, December 9, 2010 6
  7. 7. Reaching the faithful ๏ Tell stories of how faith-based groups can use IOM cited prevention strategies ๏ Pastor Smith uses Triple P to counsel his parishioners having common problems with their children. “It’s very easy for me to relate Triple P strategies to Scripture.” ๏ St. John’s uses the Good Behavior Game. “The Game helps us not only with behavior and academics, but also helping students understand how early Christians had to cooperate.”Thursday, December 9, 2010 7
  8. 8. Reaching businesses ๏ Give examples of immediate benefits to productivity. “Having workplace Triple P has reduced our employees having to take time off for dealing with problems of their children.” ๏ Link business competition. “Other rich democracies have extensive universal prevention, and those countries have more viable small business sector than the US.” ๏ Link to major cost of business, such as depression is now major cause of disability.Thursday, December 9, 2010 8
  9. 9. Reaching the First Peoples ๏ Link key cultural wisdom to proven science of prevention, such as: ๏ the use of omega-3 sources by virtually First Peoples—and discovered by the Arctic peoples ๏ the Good Behavior Game mimics common traditional practices of assuring cooperation among childrenThursday, December 9, 2010 9
  10. 10. Reaching the right ๏ Universal access enables individual responsibility; rationing limits it. ๏ Link to accepted prevention practices like universal inoculations of childhood diseases or access to car safety seats. ๏ Link to balancing budgets, national security and global competition.Thursday, December 9, 2010 10
  11. 11. CEPR An International Comparison of Small Business Employment !"8 Key message by showing global competion !"#$%&!(%$)*#+)#,%-#$)*$.&.+,$,#/0123#&$.4$)*5#-%!)6#*7$#18#4!9)*.+$,#"!.#:7+47#*7$#;<=>#7-,# +)*$.)-*+!)-(#4!%&-.-?$#@-*-2## # FIGURE 3 Manufacturing, Employment in Enterprises with fewer than 500 Employees, 2001 LE7/BA4< )!#% All of these other rich F/4<9 )#% democracies have nearly 3K4.- )$#( J4K4- &+#) universal access to prevention for G0/I07<4-15 &%#" MEBs, compared to the rationing 6700=0 &!#" model in the US. G0:2H04<4-1 &#+ GE7:49 &$#$ Having “fitter” employees allows F70<4-1 &"# CB5/7.4 &*#+ these countries to have higher ,-./012D.-A1E8 %&#( paying manufacturing jobs and CB5/74<.4 %!#) compete globally. @0<A.B8 %!#( >0-847? %! ;74-=0 %#& ;.-<4-1 !&#! 3:010- !%#& 60784-9 !%#% ,-./0123/4/05 !"#$ * $! !* &! "** !"#$"%&()*+%,)+$&,#-%."*/0(1*"%& Source: Authors’ analysis of OECD data.Thursday, December 9, # 2010 11
  12. 12. Nearly 75 percent of the nations 17- to 24-year-olds are ineligible for service • Medical/physical problems, 35 percent. • Illegal drug use, 18 percent. • Mental Category V (the lowest 10 percent of the population), 9 percent. • Too many dependents under age 18, 6 percent. • Criminal record, 5 percent. Army Times, Nov 5, 2009 •, December 9, 2010 12
  13. 13. Reaching to the left ๏ Link prevention to remedying historic disparities such as: ๏ Good Behavior Game increases high-school graduation and college entry rates and reduces lifetime incarceration rates of inner city kids. ๏ Will help with maintaining Social Security, Medicare and MedicaidThursday, December 9, 2010 13
  14. 14. Key message by showing age dependencies 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…Thursday, December 9, 2010 14
  15. 15. Reaching to the center ๏ Emphasize that MEB’s affect every family, every school, every neighborhood, and every business. ๏ Example: “How many of you know a reasonably OK middle class or upper class family with a child or teen with a mental illness, learning disability or addictions problem?”Thursday, December 9, 2010 15
  16. 16. Reaching state legislators, county & city leaders ๏ Show how prevention for everyone will help balance the local budget and keep it balanced over time. ๏ Show data how universal access to prevention will help the jurisdiction specifically ๏ Share such data with advocates for local emotional impactThursday, December 9, 2010 16
  17. 17. Promote existing prevention sustainability mechanisms Existing laws and policies have been and can be used prevent MEB’s using featured IOM strategies such as Triple P for parents, Good Behavior Game for teachers, and omega-3 for children to adults.Thursday, December 9, 2010 17
  18. 18. Key message for every sector “Mental illness is preventable, just like many childhood diseases, tra c injuries or even addictions are preventable.” In every communication say… ๏ Mental, emotional and behavioral disorders are preventable like most childhood diseases and childhood injuries. ๏ MEB’s harm and kill more children, youth and “Yes, it is preventable. Read all about it, in the ‘09 IOM Report young adults than any childhood diseases, and on the Prevention of Mental, Emotional, & Behavioral Disorders. the prevention of MEB’s is less expensive than We’ve been conditioned to think these were just manageable…” childhood medical vaccines. OConnell, M. E., T. Boat, et al., Eds. (2009). Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities. . Committee on the Prevention of Mental Disorders and Substance Abuse Among Children, Youth and Young Adults: Research Advances and Promising Interventions. Washington, DC, Institute of Medicine; National Research Council. TO READ THE IOM REPORT, GO TO:, December 9, 2010 18
  19. 19. My perspective Full disclosure as a prevention scientist and advocate Born premature, exposed Parents hospitalized for Gay man in to alcohol & tobacco and diagnosed mental illness and 20-year relationship Descendent of a freed slave educably mentally retarded die of addictionsThursday, December 9, 2010 19
  20. 20. thank you If not not now, when… If not us, who…Thursday, December 9, 2010 20