Keynote talk: Vermont Assn. for Mental Health and Friends of Recovery Annual Conference

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Dear Attendees of the Vermont Association for Mental Health and Friends of Recovery Annual Conference,

I am delighted to be participating at your event about the very real possibility of preventing mental illness at a population level in Vermont, based on the world-class research reviewed in the 2009 Institute of Medicine Report on the Prevention of Mental, Emotional, and Behavioral Disorders in Young People.

Vermont is in a unique position in the history of America to implement strategies that could catapult our country into unparalleled wellbeing. During my work with you on Thursday, October 27, I will be discussing how the State can use the opportunity of its Health Care Initiative to do what impeccable science (and a good dose of grand-motherly wisdom) show is within our grasp:

• Prevent, avert, and/or reduce most mental, emotional, and behavioral disorders.
• Promote mental, emotional, and behavioral wellbeing that improves educational and workplace productivity.

When these are changed, the state’s economic wellbeing will be improved on multiple fronts, since these problems are the biggest cost centers of local, state and business operations.

If Vermont can do this, then its success can help move America into a place of greater fiscal and political safety for all our futures.

Thus, I join you with a spirit of practical optimism on Thursday, and invite you to download and share two recent papers related to our work together.

(Use this tiny hyperlink: http://bit.ly/IOM-EMBRY)

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.
The Institute of Medicine Report on the Prevention of Mental, Emotional and Behavioral Disorders Among Young People1 (IOM Report) provides a powerful map for how the United States might significantly prevent mental illnesses and behavioral disorders like alcohol, tobacco, and other drug use among America’s youth. This document is already shaping United States policies, and will almost certainly affect Canada and other countries’ policies. Mental, emotional, and behavioral disorders (MEBs) among America’s youth and young adults present a serious threat to the country’s national security2 and to our economic competitiveness compared with 22 other rich countries.3–7 Such MEBs are also the leading preventable cost center for local, state, and the federal governments.1,4 Further, safe schools, healthy working environments, and public events or places are seriously compromised by MEBs as well.

(Use this tiny hyperlink: http://bit.ly/EmbryBiglanKernels)
Embry, D. D. and A. Biglan (2008). "Evidence-Based Kernels: Fundamental Units of Behavioral Influence." Clinical Child & Family Psychology Review 11(3): 75-113.
This paper describes evidence-based kernels, fundamental units of behavioral influence that appear to u

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Keynote talk: Vermont Assn. for Mental Health and Friends of Recovery Annual Conference

  1. 1. Preventing Mental, Emotional and Behavioral Disorders Vermont Association for Mental Health and Friends of Recovery Vermont 73rd Annual Conference • Montpelier, Vermont • October 27, 2011 by Dennis D. Embry, Ph.D. Sunday, October 30, 11
  2. 2. Sunday, October 30, 11
  3. 3. Key messages… Sunday, October 30, 11
  4. 4. Key messages… MEB’s are preventable. Sunday, October 30, 11
  5. 5. Key messages… MEB’s are preventable. Break-even for MEB prevention is 1-2 years. Sunday, October 30, 11
  6. 6. Key messages… MEB’s are preventable. Break-even for MEB prevention is 1-2 years. MEB prevention balances gov’t budgets. Sunday, October 30, 11
  7. 7. Key messages… MEB’s are preventable. Break-even for MEB prevention is 1-2 years. MEB prevention improves US business. MEB prevention balances gov’t budgets. Sunday, October 30, 11
  8. 8. Key messages… MEB’s are preventable. Break-even for MEB prevention is 1-2 years. MEB prevention improves US business. Effective MEB prevention helps national security. MEB prevention balances gov’t budgets. Sunday, October 30, 11
  9. 9. Key messages… MEB’s are preventable. Break-even for MEB prevention is 1-2 years. MEB prevention improves US business. Effective MEB prevention helps national security. MEB prevention helps US global success. MEB prevention balances gov’t budgets. Sunday, October 30, 11
  10. 10. Key messages… MEB’s are preventable. Break-even for MEB prevention is 1-2 years. MEB prevention improves US business. Effective MEB prevention helps national security. MEB prevention helps US global success. MEB prevention balances gov’t budgets. MEB prevention saves Social Security & Medicare. Sunday, October 30, 11
  11. 11. Key messages… MEB’s are preventable. Break-even for MEB prevention is 1-2 years. MEB prevention improves US business. Effective MEB prevention helps national security. MEB prevention helps US global success. MEB prevention balances gov’t budgets. MEB prevention saves Social Security & Medicare. MEB prevention heals past inequities. Sunday, October 30, 11
  12. 12. January 8, 2011 The Shootings in Tucson Sunday, October 30, 11
  13. 13. Sunday, October 30, 11
  14. 14. Sunday, October 30, 11
  15. 15. What will we pack in our Vermont’s young people’s suitcases for their whole lives? Sunday, October 30, 11
  16. 16. What bricks—heavy objects of pain, injury, illness, or problems —do you NOT want in young people’s suitcases for life? Sunday, October 30, 11
  17. 17. Ask the suitcase questions of 30 people: some republicans, some democrats, some independent s and some who are apolitical. Sunday, October 30, 11
  18. 18. What do you want to happen and not happen for our elders? Sunday, October 30, 11
  19. 19. Bi-directional Wealth and Wellbeing Transfer 5-Year Olds 65-Year Olds Sunday, October 30, 11
  20. 20. Bi-directional Wealth and Wellbeing Transfer 5-Year Olds 65-Year Olds Who are living longer though get progressively sicker… Sunday, October 30, 11
  21. 21. Bi-directional Wealth and Wellbeing Transfer 5-Year Olds 65-Year Olds Who are living longer though get progressively sicker… Requiring more wealth transfer Sunday, October 30, 11
  22. 22. Bi-directional Wealth and Wellbeing Transfer 5-Year Olds 65-Year Olds Who are less and less able… Who are living longer though get progressively sicker… Requiring more wealth transfer Sunday, October 30, 11
  23. 23. Bi-directional Wealth and Wellbeing Transfer 5-Year Olds 65-Year Olds Who are less and less able… Who are living longer though get progressively sicker… Requiring more wealth transfer But elders voting to stop funds to kids Sunday, October 30, 11
  24. 24. Sunday, October 30, 11
  25. 25. Our Own Children’s or Loved-ones’ Futures Sunday, October 30, 11
  26. 26. depression bipolar drugs tobacco alcohol ADHD aggression learning disabilities stealing suicide depression crime violence dangerous acts asthma obesity cancer heart-disease diabetes hi-blood pressure Our Own Children’s and Loved-ones’ Futures Sunday, October 30, 11
  27. 27. Sunday, October 30, 11
  28. 28. Lifetime Prevalence of Disorders in US Adolescents (N=10,123) 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 Merikangas et al., 2010 Sunday, October 30, 11
  29. 29. Lifetime Prevalence of Disorders in US Adolescents (N=10,123) 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 Anxiety Merikangas et al., 2010 Sunday, October 30, 11
  30. 30. Lifetime Prevalence of Disorders in US Adolescents (N=10,123) 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 Anxiety Behavior Merikangas et al., 2010 Sunday, October 30, 11
  31. 31. Lifetime Prevalence of Disorders in US Adolescents (N=10,123) 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 Anxiety Behavior Mood Merikangas et al., 2010 Sunday, October 30, 11
  32. 32. Lifetime Prevalence of Disorders in US Adolescents (N=10,123) 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 Anxiety Substance Behavior Mood Merikangas et al., 2010 Sunday, October 30, 11
  33. 33. Youth MEB Prevalence Rate Comparison USA United Kingdom OECD 4x 2x Sunday, October 30, 11
  34. 34. Depression by Jobs Sunday, October 30, 11
  35. 35. Nearly 3 out of 4 of the nation's 17- to 24-year-olds are ineligible for military service for based on national epidemiological 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 Sunday, October 30, 11
  36. 36. Cumulative prevalence of psychiatric disorders by young adulthood: a prospective cohort analysis from the Great Smoky Mountains Study. By 21 years of age, 61.1% of participants had met criteria for a well- specified psychiatric disorder. An additional 21.4% had met criteria for a not otherwise specified disorder only, increasing the total cumulative prevalence for any disorder to 82.5%. Sunday, October 30, 11
  37. 37. The US has 75 million children and teens. 40.4 million are on psychotropic medications Wall Street Journal, 12-28-2010 Sunday, October 30, 11
  38. 38.    FIGURE 3 Manufacturing, Employment in Enterprises with fewer than 500 Employees, 2001                                             Source: Authors’ analysis of OECD data.    Key message about global competition Many of these other rich democracies have nearly universal access to prevention for MEBs, compared to the rationing model in the US. Having “fitter” employees allows these countries to have higher paying manufacturing jobs and compete globally. Sunday, October 30, 11
  39. 39. PhysiologicalReinforcement Antecedents Verbal Relations Major Ecologic Causes of the Trends to Children, Youth and Adults Sunday, October 30, 11
  40. 40. Multi-Inflammatory Brain & Body Response PhysiologicalReinforcement Antecedents Verbal Relations Major Ecologic Causes of the Trends to Children, Youth and Adults Sunday, October 30, 11
  41. 41. Mood Stability Attention Reward Delay Executive Function Behavioral Competencies Motor Skills Immune- Healing FunctionsMulti-Inflammatory Brain & Body Response PhysiologicalReinforcement Antecedents Verbal Relations Major Ecologic Causes of the Trends to Children, Youth and Adults Sunday, October 30, 11
  42. 42. Mood Stability Attention Reward Delay Executive Function Behavioral Competencies Motor Skills Immune- Healing FunctionsMulti-Inflammatory Brain & Body Response PhysiologicalReinforcement Antecedents Verbal Relations Major Ecologic Causes of the Trends to Children, Youth and Adults Mental Illness Substance Abuse Violence Work Problems Obesity, etc CancerEarly Sex School Failure STD’s Special Ed Sunday, October 30, 11
  43. 43. Essential Brain Nutrient Deficiencies Essential Movement Deficiencies Essential Reinforcement Deficiencies Essential Behavioral Deficiencies All Our Futures in Vermont’s Children, Youth, and Adults Being Affected by… Sunday, October 30, 11
  44. 44. Essential Brain Nutrient Deficiencies Essential Movement Deficiencies Essential Reinforcement Deficiencies Essential Behavioral Deficiencies Impacted By… All Our Futures in Vermont’s Children, Youth, and Adults Being Affected by… Sunday, October 30, 11
  45. 45. Essential Brain Nutrient Deficiencies Essential Movement Deficiencies Essential Reinforcement Deficiencies Essential Behavioral Deficiencies Impacted By… Cultural Toxins All Our Futures in Vermont’s Children, Youth, and Adults Being Affected by… Sunday, October 30, 11
  46. 46. Essential Brain Nutrient Deficiencies Essential Movement Deficiencies Essential Reinforcement Deficiencies Essential Behavioral Deficiencies Physical Toxins Impacted By… Cultural Toxins All Our Futures in Vermont’s Children, Youth, and Adults Being Affected by… Sunday, October 30, 11
  47. 47. Essential Brain Nutrient Deficiencies Essential Movement Deficiencies Essential Reinforcement Deficiencies Essential Behavioral Deficiencies Physical Toxins Policy Toxins Impacted By… Cultural Toxins All Our Futures in Vermont’s Children, Youth, and Adults Being Affected by… Sunday, October 30, 11
  48. 48. Essential Brain Nutrient Deficiencies Essential Movement Deficiencies Essential Reinforcement Deficiencies Essential Behavioral Deficiencies Physical Toxins Policy Toxins Biological Toxins Impacted By… Cultural Toxins All Our Futures in Vermont’s Children, Youth, and Adults Being Affected by… Sunday, October 30, 11
  49. 49. Essential Brain Nutrient Deficiencies Essential Movement Deficiencies Essential Reinforcement Deficiencies Essential Behavioral Deficiencies Based on Fundamental Evolutionary “Mis-Match” of Mechanisms of Human Evolution Physical Toxins Policy Toxins Biological Toxins Impacted By… Cultural Toxins All Our Futures in Vermont’s Children, Youth, and Adults Being Affected by… Sunday, October 30, 11
  50. 50. Evolutionary Mismatch Changes in modern human ecology for which were were evolved and adapted now affecting… Sleep Eating Mental health Problem behaviors Physical Health Sexual maturity Sunday, October 30, 11
  51. 51. If we just hit the problem harder… Sunday, October 30, 11
  52. 52. Sunday, October 30, 11
  53. 53. Sunday, October 30, 11
  54. 54. Sunday, October 30, 11
  55. 55. Sunday, October 30, 11
  56. 56. Reduce Omega 3 Brain Deficiency Sunday, October 30, 11
  57. 57. 0 0.25 0.50 0.75 1.00 Before supplementation During supplementation RatioofDisciplinaryIncidentsSupplementation/Baseline Active Placebo Reduced  Felony  Violent  Offences  Among  Prisoners   with  recommended  daily  amounts  of  vitamins,  minerals  and  essen=al  fa>y  acids 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 Ac=ve  -­‐37.0%  p  ‹  0.005 Placebo  -­‐10.1%  p  =  ns Sunday, October 30, 11
  58. 58. Why not reproduce the rapid results in Vermont to get a 37% reduction in jail violence? It cost the Brits 19¢ per day or $69.35 per year. Sunday, October 30, 11
  59. 59. 0 Time  to  First  Suicide  A1empt  (days) 0 200 400 600 800 Survival  Probability 0.2 0.4 0.6 0.8 1.0 High  DHA    (n=16) Low    DHA    (n=17) (median  split  of  plasma  phospholipid  %  fa1y  acids) Inpatient Discharge Suble>e,  Hibbeln  et  al  Am  J  Psychiatry  2006;163:  1100-­‐1102   Sunday, October 30, 11
  60. 60. Omega-3 Status and US Military Suicide Deaths Suicide Deaths of Active-Duty US Military and Omega-3 Fatty-Acid Status: A Case-Control Comparison Michael D. Lewis, MD; Joseph R. Hibbeln, MD; Jeremiah E. Johnson, RD; Yu Hong Lin, PhD; Duk Y. Hyun, BS; and James D. Loewke, BS ABSTRACT Background: The recent escalation of US military suicide deaths to record numbers has been a sentinel for impaired force efficacy and has accelerated the search for reversible risk factors. Objective: To determine whether deficiencies of neuroactive, highly unsaturated omega-3 essential fatty acids (n-3 HUFAs), in particular docosahexaenoic acid (DHA), are associated with increased risk of suicide death among a large random sample of active-duty US military. Method: In this retrospective case-control study, serum fatty acids were quantified as a percentage of total fatty acids among US military suicide deaths (n=800) and controls (n=800) matched for age, date of collection of sera, sex, rank, and year of incident. Participants were active-duty US military personnel (2002–2008). For cases, age at death ranged from 17–59 years (mean=27.3 years, SD=7.3 years). Outcome measures included death by suicide, postdeployment health assessment questionnaire (Department of Defense Form 2796), and ICD-9 mental health diagnosis data. Results: Risk of suicide death was 14% higher per SD of lower DHA percentage (OR=1.14; 95% CI, 1.02–1.27; P<.03) in adjusted logistic regressions. Among men, risk of suicide death was 62% greater with low serum DHA status (adjusted OR=1.62; 95% CI, 1.12–2.34; P<.01, comparing DHA below 1.75% [n=1,389] to DHA of 1.75% and above [n=141]). Risk of suicide death was 52% greater in those who reported having seen wounded, dead, or killed coalition personnel (OR=1.52; 95% CI, 1.11–2.09; P<.01). Suicide rates among active-duty US military have increased to re- cord numbers, doubling since the inception of Operation Enduring Freedom (Afghanistan) and Operation Iraqi Freedom and rivaling the battlefield in toll on the US military.1 Army Vice–Chief of Staff General Peter W. Chiarelli described the record suicide rate as “horrible” and voiced frustration that “the Army has not yet been able to identify any causal links among the suicide cases.”2(pA2) Deficiencies of nutrients critical for brain function may be a signifi- cant contributing risk factor for psychiatric pathology, especially suicide and stress-related psychiatric symptoms.3 Highly unsaturated omega-3 essential fatty acids (n-3 HUFAs), in particular docosahexaenoic acid (DHA), are selectively concentrated in neural tissues and are required for optimal neural function.4 These fatty acids cannot be made de novo but are available only from dietary sources, with seafood being the richest source. Nutritional deficiencies in n-3 HUFAs may increase vulnerabil- ity to combat deployment stress, manifesting as psychiatric symptoms including adjustment disorders, major depression, impulsive violence, and suicide.5 In civilian populations, observational studies indicate that low fish consumption is associated with increased risk of completed sui- cides6,7 and greater suicidal ideation.8 Low DHA status was associated with increased risk of past suicide attempts9 and future suicide attempts.10 In comparison to placebo, 2 grams per day of n-3 HUFA reduced suicidal thinking and depressive symptoms and reduced the perception of stress among subjects (n=49) with deliberate self-harm.11 These findings suggest that low DHA levels may be a contributing factor for adverse psychiatric symptoms. In this study, we posited that low DHA status would be associated with increased risk of suicide death among military personnel. Prospectively collected serum and supporting data were available from the Armed Forces Health Surveillance Center (AFHSC) for a large number of active-duty suicide deaths (n=800) and matched controls (n=800). To our knowledge, this is the largest study of Sunday, October 30, 11
  61. 61. Why not help our high-risk children & youth with omega-3? 0% 6% 12% 18% 24% 30% Psychosis Omega-3 Placeo 27.5% 4.9% PercentagewithPsychosisat12months 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. Sunday, October 30, 11
  62. 62. Sunday, October 30, 11
  63. 63. Reduce Omega 3 Brain Deficiency in baby’s brain Sunday, October 30, 11
  64. 64. Sunday, October 30, 11
  65. 65. Reduce Omega 3 Brain Deficiency in baby’s brain Sunday, October 30, 11
  66. 66. The benefits to the baby and society Maternal seafood consumption in pregnancy C D 0 5 10 n=739 laicosorP )%(mumitpobusnerdlihc n=4260 n=1583 15 0 15 20 25 30 n=875 None 0–340 g per week >340 g per week tnempolevedlaicoS )%(mumitpobusnerdlihc n=4919 n=1798 35 0 15 20 25 30 n=584 QIlabreV )%(mumitpobusnerdlihc n=3493 n=1330 35A B 0 15 20 25 30 n=875 rotomeniF )%(mumitpobusnerdlihc n=4923 n=1798 35 Prosocial Suboptimal Social Development Suboptimal Verbal Suboptimal Fine Motor Skills Suboptimal Maternal seafood consumption in pregnancy None 0–340 g per week >340 g per week Sunday, October 30, 11
  67. 67. Omega-3 can improve school grades and success -2 -1 0 1 2 3 4 5 6 7 Reading Spelling Omega 3 Placebo These were gains in academics after 3 months of exposure to fish oil. Before Omega 3 After Omega 3 See www.durhamtrial.org/ Sunday, October 30, 11
  68. 68. REVIEW Open Access Clearance of fear memory from the hippocampus through neurogenesis by omega-3 fatty acids: a novel preventive strategy for posttraumatic stress disorder? Yutaka Matsuoka1,2 Abstract Not only has accidental injury been shown to account for a significant health burden on all populations, regardless of age, sex and geographic region, but patients with accidental injury frequently present with the psychiatric condition of posttraumatic stress disorder (PTSD). Prevention of accident-related PTSD thus represents a potentially important goal. Physicians in the field of psychosomatic medicine and critical care medicine have the opportunity to see injured patients in the immediate aftermath of an accident. This article first briefly reviews the prevalence and associated factors of accident-related PTSD, then focuses on a conceptual model of fear memory and proposes a new, rationally hypothesized translational preventive intervention for PTSD through promoting hippocampal neurogenesis by omega-3 fatty acid supplementation. The results of an open-label pilot trial of injured patients admitted to the intensive care unit suggest that omega-3 fatty acid supplementation immediately after accidental injury can reduce subsequent PTSD symptoms. Matsuoka BioPsychoSocial Medicine 2011, 5:3 http://www.bpsmedicine.com/content/5/1/3 Clearance of fear memory from the hippocampus through neurogenesis by omega-3 fatty acids: a novel preventive strategy for posttraumatic stress disorder? Matsuoka Matsuoka BioPsychoSocial Medicine 2011, 5:3 http://www.bpsmedicine.com/content/5/1/3 (8 February 2011) Omega-3 for PTSD symptoms could be used for the patients evacuated from the State Hospital Sunday, October 30, 11
  69. 69. Why not reproduce the rapid results in Vermont to get a significant reduction in psychosis, bipolar relapse, depression, and maybe even suicides plus increase the competences of future generations quickly. Sunday, October 30, 11
  70. 70. Young children Sunday, October 30, 11
  71. 71. Early stories and reading Sunday, October 30, 11
  72. 72. Why not distribute specially constructed books for parents with young Reduce dangerous, impulsive, disturbing behavior quickly? Increase social- competence quickly? Improve school readiness quickly? Embry, D. D. and L. Peters (1985). A three-city evaluation of the diffusion of a pedestrian-safety injury control intervention. R. S. Division, New Zealand Ministry of Transport, Wellington, NZ. Sunday, October 30, 11
  73. 73. Peer-to-Peer Notes Positive Home Notes Social Competence Violence PeaceBuilders School-Community Reinforcement Study Sunday, October 30, 11
  74. 74. Promote the Triple P (Positive Parenting Program) Sunday, October 30, 11
  75. 75. 10 12 13 15 16 Ratesper1,000Children(0-8Years) Substantiated Child Maltreatment Pre Post Prinz et al., 2009, Prevention Science Two Years Later Sunday, October 30, 11
  76. 76. 10 12 13 15 16 Ratesper1,000Children(0-8Years) Substantiated Child Maltreatment Control Counties Pre Post Prinz et al., 2009, Prevention Science Two Years Later Sunday, October 30, 11
  77. 77. 10 12 13 15 16 Ratesper1,000Children(0-8Years) Substantiated Child Maltreatment Control Counties Triple P Counties Pre Post Prinz et al., 2009, Prevention Science Two Years Later Sunday, October 30, 11
  78. 78. Child Abuse Hospital Injuries 1.30 1.43 1.55 1.68 1.80 Ratesper1,000Children(0-8Years) Pre Post Two Years Later Prinz et al., 2009, Prevention Science Sunday, October 30, 11
  79. 79. Child Abuse Hospital Injuries 1.30 1.43 1.55 1.68 1.80 Ratesper1,000Children(0-8Years) Control Counties Pre Post Two Years Later Prinz et al., 2009, Prevention Science Sunday, October 30, 11
  80. 80. Child Abuse Hospital Injuries 1.30 1.43 1.55 1.68 1.80 Ratesper1,000Children(0-8Years) Control Counties Triple P Counties Pre Post Two Years Later Prinz et al., 2009, Prevention Science Sunday, October 30, 11
  81. 81. Child Out-of-Home Placements 3.00 3.38 3.75 4.13 4.50 Ratesper1,000Children(0-8Years) Pre Post Two Years Later Prinz et al., 2009, Prevention Science Sunday, October 30, 11
  82. 82. Child Out-of-Home Placements 3.00 3.38 3.75 4.13 4.50 Ratesper1,000Children(0-8Years) Control Counties Pre Post Two Years Later Prinz et al., 2009, Prevention Science Sunday, October 30, 11
  83. 83. Child Out-of-Home Placements 3.00 3.38 3.75 4.13 4.50 Ratesper1,000Children(0-8Years) Control Counties Triple P Counties Pre Post Two Years Later Prinz et al., 2009, Prevention Science Sunday, October 30, 11
  84. 84. Classrooms Muriel Saunders Sunday, October 30, 11
  85. 85. Instant change in disturbing or disruptive behaviours Sunday, October 30, 11
  86. 86. PAX  GBG  decreased  distracOon  in  classrooms  by  an  average  of    86%  aPer  only  one  month 2011 Replication in rural Tennessee by coaches trained just like you… Sunday, October 30, 11
  87. 87. PAX  GBG  decreased  distracOon  in  classrooms  by  an  average  of    86%  aPer  only  one  month Baseline  Disrup=ons   Six  1st-­‐grade  classrooms  averaged   136  per  hour  before  coaching 2011 Replication in rural Tennessee by coaches trained just like you… Sunday, October 30, 11
  88. 88. PAX  Introduced The  distracOons  per  hour  decreased   by  56%  with  the  introducOon  of  the   PAX  environment  of  PAX  language   and  several  PAX  kernels. PAX  GBG  decreased  distracOon  in  classrooms  by  an  average  of    86%  aPer  only  one  month Baseline  Disrup=ons   Six  1st-­‐grade  classrooms  averaged   136  per  hour  before  coaching 2011 Replication in rural Tennessee by coaches trained just like you… Sunday, October 30, 11
  89. 89. PAX  Introduced The  distracOons  per  hour  decreased   by  56%  with  the  introducOon  of  the   PAX  environment  of  PAX  language   and  several  PAX  kernels. PAX  GBG  Played DisrupOons  per  hour  decreased  an   addiOonal    30%    aPer  learning  to   play  PAX  GBG  . PAX  GBG  decreased  distracOon  in  classrooms  by  an  average  of    86%  aPer  only  one  month Baseline  Disrup=ons   Six  1st-­‐grade  classrooms  averaged   136  per  hour  before  coaching 2011 Replication in rural Tennessee by coaches trained just like you… Sunday, October 30, 11
  90. 90. Why not turn about the lives of high risk primary grade children using a teacher invented procedure? Sunday, October 30, 11
  91. 91. Timeline of benefits from PAX GBG Age of Child Benefits 1st Grade 75% reduction in disturbing, disruptive and destructive behavior; 25% increase academic achievement; less bullying and intimidation 3rd Grade 43% reduction in ADHD diagnoses; 33% reduction in Oppositional Defiant Disorder; 30%+ reduction special services needs; 6th grade 50%+ reduction in conduct disorders; 25% to 50% reduction tobacco use; reduction in bullying or harassment behaviors 8th Grade 75%r reduction in serious drug use and engagement in delinquent acts 12th Grade Major increase in high-school graduation; lower utilization of special services Early 20’s Increase in college entry; Major reductions drug use; reductions in prison time Age 29 Lifetime reduction in violent crime, suicide, psychiatric diagnoses, and lifetime addictions Sunday, October 30, 11
  92. 92. Why not reproduce the rapid results in Vermont of the Good Behavior Game for EVERY first grader, since break-even is in one year? Sunday, October 30, 11
  93. 93. Reinforcement for “Bad” In one hour of school, how often do peers reinforce the “good” in school? How often by adults at school? How often at home or community in a day? Reinforcement for “Good” How often might adults in authority exert perceived threats of coercion in school, at home, or in the community in a single day? Adult coercion The probability of human behavioral choice “matches” this saturation formula in the classroom, home and community, and Matching Law works for all vertebrate creatures Behavior & the Matching Law Example Evolutionary Mismatch In one hour of school, how often do peers reinforce the “bad” in school? How often by adults at school? How often at home or community in a day? Sunday, October 30, 11
  94. 94. -20% -10% 0% 10% 20% 30% 40% 50% 60% PercentageChange All Visits Injury Viists Non-Injuries Fighting Injuries Non-Fighting Injuries CDC Nurses Office Study Control/Wait List PeaceBuilders What happens if you teach students to praise each other for “peaceability” Sunday, October 30, 11
  95. 95. -20% -10% 0% 10% 20% 30% 40% 50% 60% PercentageChange All Visits Injury Viists Non-Injuries Fighting Injuries Non-Fighting Injuries CDC Nurses Office Study Control/Wait List PeaceBuilders What happens if you teach students to praise each other for “peaceability” Same Type of “Kernel” as Camp Sunday, October 30, 11
  96. 96. What if these happened everywhere in Vermont? Sunday, October 30, 11
  97. 97. Why not use simple public written reinforcements that reduce violent injuries, early delinquency and improve social competence in school age children? Sunday, October 30, 11
  98. 98. Why not use the low-cost ($200 to $400) best practice from NIDA that dramatically reduces all addictions among virtually every group of people? Barry, D., B. Sullivan, et al. (2009). "Comparable efficacy of contingency management for cocaine dependence among African American, Hispanic, and White methadone maintenance clients." Psychology of Addictive Behaviors 23(1): 168-174. Sunday, October 30, 11
  99. 99. Youth Who Smoked Every Day the Last 30 Days 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% 14.0% 16.0% 18.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% 14.0% 16.0% 18.0% Baseline Reward and Reminder Wyoming Wisconsin 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0% 45.0% 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0% Wyoming Wisconsin Youth Who Smoked During the Last 30 Days Baseline Reward and Reminder Why not publicize and reward clerks and stores for not selling tobacco or alcohol to minors if… 0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% 14.0% 16.0% 18.0% 1995 1997 1999 2001 2003 2005 2007 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% Source:YRBS,USCentersforDiseaseControl UnitedStates 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0% 1995 1997 1999 2001 2003 2005 2007 UnitedStates Source:YRBS,USCentersforDiseaseControl =Trend =Wyoming =Wisconsin =UnitedStates Embry, D. D. and A. Biglan (2009). Reward and Reminder: An Environmental Strategy for Population-Level Prevention. National Registry of Effective Programs and Practices, Substance Abuse and Mental Health Administration. Sunday, October 30, 11
  100. 100. Why not spread motivational goal map to reduce youth and young adult mental, emotional & behavioral problems? Sunday, October 30, 11
  101. 101. Sunday, October 30, 11
  102. 102. Acceptance & Commitment Therapy Kernels Sunday, October 30, 11
  103. 103. Make promotion & prevention universally accessible Local Stores Sunday, October 30, 11
  104. 104. Do these preventive strategies make ¢ents? Sunday, October 30, 11
  105. 105. Key message by showing dollar benefits Sunday, October 30, 11
  106. 106. Use personalized business models to communicate to cost-efficiency and benefits. Key message by showing dollar benefits Sunday, October 30, 11
  107. 107. Use personalized business models to communicate to cost-efficiency and benefits. Key message by showing dollar benefits Show short- term benefits Sunday, October 30, 11
  108. 108. Use personalized business models to communicate to cost-efficiency and benefits. Allow decision makers and advocates to adjust cost savings to their location. Key message by showing dollar benefits Show short- term benefits Sunday, October 30, 11
  109. 109. Show multiple outcomes to unite stakeholders Allow people to see benefits of universal access versus rationing of prevention Show costs of doing nothing Show break-even point and ROI over short, medium and long term Key message by showing dollar benefits Sunday, October 30, 11
  110. 110. Sunday, October 30, 11
  111. 111. Social and physical environment expresses genes Sunday, October 30, 11
  112. 112. Policy Action and Lessons from Manitoba Sunday, October 30, 11
  113. 113. Manitoba is using new word prompt generalization of behaviors to support healthy children & adults… Sunday, October 30, 11
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  127. 127. We need to spread health & wellbeing like dandelions Sunday, October 30, 11
  128. 128. This can be individual, family, school and/or community action Increase nurturance of prosociality for persons of all ages This can be at an individual, family, school and/or community level Reduce toxic influences of all ages This can be achieved across settings, as the above. Increase psychological flexibility among people of all ages From Biglan, Flay, Embry, and Sandler. Nurturing Environments and the Next Generation of Prevention Research and Practice Sunday, October 30, 11
  129. 129. O N LY Clinical Child and Family Psychology R eview, Vol. 5, No. 4, D ecember 2002 ( C 2002) T he G ood B ehavior G ame: A B est Practice Candidate as a U niversal B ehavioral Vaccine D ennis D. E mbry1 A “behavioral vaccine” providesaninoculationagainstmorbidity or mortality, impactingphys- ical, mental, or behavior disorders. A n historical example of a behavioral vaccine is antiseptic hand washing to reduce childbed fever. I n current society, issues with high levels of morbidity, such as substance abuse, delinquency, youth violence, and other behavioral disorders (multi- problems), cry out for a low-cost, widespread strategy as simple as antiseptic hand washing. Congruent research findings from longitudinal studies, twin studies, and other investigations suggest that a possibility might exist for a behavioral vaccine for multiproblem behavior. A simple behavioral strategy called the G ood B ehavior G ame (G B G ), which reinforces inhibi- tion in a group context of elementary school, has substantial previous research to consider its use as a behavioral vaccine. The G B G is not a curriculum but rather a simple behavioral Evidence-based Kernels: Fundamental Units of Behavioral Influence Dennis D. Embry Æ Anthony Biglan Ó The Author(s) 2008. This article is published with open access at Springerlink.com Abstract This paper describes evidence-based kernels, fundamental units of behavioral influence that appear to underlie effective prevention and treatment for children, adults, and families. A kernel is a behavior–influence procedure shown through experimental analysis to affect a This paper presents an analysis of fundamental units of behavioral influence that underlie effective prevention and treatment. We call these units kernels. They have two defining features. First, in experimental analysis, researchers have found them to have a reliable effect on Clin Child Fam Psychol Rev DOI 10.1007/s10567-008-0036-x COMMUNITY-BASED PREVENTION USING SIMPLE, LOW-COST, EVIDENCE-BASED KERNELS AND BEHAVIOR VACCINES Dennis D. Embry PAXIS Institute Ⅲ A paradox exists in community prevention of violence and drugs. Good A R T I C L E Embry, D. D. and A. Biglan (2008). "Evidence-Based Kernels: Fundamental Units of Behavioral Influence." Clinical Child & Family Psychology Review 11(3): 75-113. Basic understanding of kernels Embry, D. D. (2004). "Community-Based Prevention Using Simple, Low-Cost, Evidence-Based Kernels and Behavior Vaccines." Journal of Community Psychology 32(5): 575. Using kernels for population change 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. Behavioral vaccines for disease control Sunday, October 30, 11
  130. 130. 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. What is a kernel? Sunday, October 30, 11
  131. 131. Four Types of Kernels Antecedent Kernel Reinforcement Kernel Relational Frame Kernel Physiological Kernel Happens BEFORE the behavior Happens AFTER the behavior Creates verbal relations for the behavior Changes biochemistry of behavior Embry, D. D., & Biglan, A. (2008). Evidence-Based Kernels: Fundamental Units of Behavioral Influence. Clinical Child & Family Psychology Review, 39. Sunday, October 30, 11
  132. 132. What 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. Sunday, October 30, 11
  133. 133. How come we are just hearing about this now… Sunday, October 30, 11
  134. 134. How come we are just hearing about this now… Sunday, October 30, 11
  135. 135. My perspective Full disclosure as a prevention scientist and advocate Descendent of a freed slaves Born premature, exposed to alcohol & tobacco and diagnosed educably mentally retarded Parents hospitalized for mental illness and die of addictions Gay man in 20-year relationship Sunday, October 30, 11
  136. 136. Mental, emotional, behavioral and health disorders are preventable by our own hands—right here in Vermont. Sunday, October 30, 11
  137. 137. Thank you, Dennis D. Embry, Ph.D. dde@paxis.org ph: 520-299-6770 www.paxis.org www.slideshare.net/drdennisembry Sunday, October 30, 11

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