This is the major paper about evidence-based kernels by Dennis D. Embry and Anthony Biglan published in 2008..
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 specific behavior and that is indivisible in the sense that removing any of its components would render it inert. Existing evidence shows that a variety of kernels can influence behavior in context, and some evidence suggests that frequent use or sufficient use of some kernels may produce longer lasting behavioral shifts. The analysis of kernels could contribute to an empirically based theory of behavioral influence, augment existing prevention or treatment efforts, facilitate the dissemination of effective prevention and treatment practices, clarify the active ingredients in existing interventions, and contribute to efficiently developing interventions that are more effective. Kernels involve one or more of the following mechanisms of behavior influence: reinforcement, altering antecedents, changing verbal relational responding, or changing physi- ological states directly. The paper describes 52 of these kernels, and details practical, theoretical, and research implications, including calling for a national database of kernels that influence human behavior.
Hawe dh vic november 2011 school hp (pp tminimizer)sarahportphillip
Critically important whole school health promotion work has to be sustained: Shifting from program thinking to system thinking
Penny Hawe
Population Health Intervention Research Centre
University of Calgary , Canada
www.ucalgary.ca/PHIRC phawe@ucalgary.ca
Joseph E. Donnelly - "Physical Activity and Academic Achievement in Elementar...youth_nex
The Youth-Nex Conference on Physical Health and Well-Being for Youth, Oct 10 & 11, 2013, University of Virginia
Joseph E. Donnelly, EdD, FACSM - "Physical Activity and Academic Achievement in Elementary School Children"
Panel 2 - How can we increase physical activity in children and adolescents? The presentations in this panel will describe programs that have successfully increased physical activity at preschool, in the home, at school, in communities, and in the private sector.
Website: http://bit.ly/YNCONF13
Hawe dh vic november 2011 school hp (pp tminimizer)sarahportphillip
Critically important whole school health promotion work has to be sustained: Shifting from program thinking to system thinking
Penny Hawe
Population Health Intervention Research Centre
University of Calgary , Canada
www.ucalgary.ca/PHIRC phawe@ucalgary.ca
Joseph E. Donnelly - "Physical Activity and Academic Achievement in Elementar...youth_nex
The Youth-Nex Conference on Physical Health and Well-Being for Youth, Oct 10 & 11, 2013, University of Virginia
Joseph E. Donnelly, EdD, FACSM - "Physical Activity and Academic Achievement in Elementary School Children"
Panel 2 - How can we increase physical activity in children and adolescents? The presentations in this panel will describe programs that have successfully increased physical activity at preschool, in the home, at school, in communities, and in the private sector.
Website: http://bit.ly/YNCONF13
Correlation between Theoretical Classroom Instruction and Related Learning Ex...Ryan Michael Oducado
To determine the relationship between performance in theoretical classroom instruction and related learning experience (RLE) of nursing students of WVSU.
Intervention research in schools :Mixed-method realist trials of complex preventive interventions in schools
Présentation de Laurence Moore au colloque "Recherche interventionnelle contre le cancer : Réunir chercheurs, décideurs et acteurs de terrain » - 17 et 18 novembre 2014, BnF, Paris
The leader of the TIHR Trauma Stream of work, Dr Milena Stateva recently presented an argument on the potential of action research to bring together evidence-based and value-based approaches to practice enhancement and policy making.
She was one of the key speakers at the Qualitative Research for Policy Making 2012 Conference, organised by ISCTE-IUL (Portugal) and Merlien Institute in May 2012. This highly interactive, cross-disciplinary conference brought together top policy researchers and practitioners to discuss best practices for delivering and interpreting qualitative research for policy making.
Milena’s presentation explores the tensions and possible links between value-based and evidence-based research and evaluation approaches, discusses the relevance of action research to policy making and evaluates the ability of action research to bring together these two perspectives through the case study of the Nottinghamshire County Council Fostering Futures Therapeutic Fostering Service.
Interprofessional Simulation: An Effective Training Experience for Health Car...Dan Belford
Background
This descriptive study measured the effectiveness of and participants' satisfaction with an interprofessional simulation education workshop as a teaching strategy for health care professionals.
Method
Health care professionals completed a 1-day clinical simulation workshop on interprofessional collaboration, after which they had the opportunity to fill out 4 evaluative instruments
School Based Mindfulness Interventions Within a Response to Intervention Fram...Innovations2Solutions
Public education is continually evolving to best meet the academic and social-emotional needs of an increasingly diverse student population. A major driving force for this change is the No Child Left Behind Act (2001), which holds schools and teachers accountable for student performance on standardized tests in reading, math, and science. In order to academically prepare students for these high-stakes tests, 43 states have adopted
the Common Core Standards. These standards hold students to a high level of performance in language arts and math that is designed to prepare them for career and college readiness. While the Common Core Standards provide a universal framework for academic standards across the United States, there is
no comparable measure for social-emotional learning standards despite the fact that approximately one in five children and adolescents either currently experience or will experience mental health issues that warrant intervention. These types of issues include both internalizing conditions such as anxiety and depression and externalizing conditions such as Attention
Deficit Hyperactivity Disorder, Conduct Disorder, and Oppositional Defiant Disorder. These disorders present a wide variety of challenges and adverse side effects for individuals who suffer from them. Some
of these negative side effects include lower academic achievement higher school dropout rates and negative peer relationships.
"Research Highlights from the Alberti Center for Bullying Abuse Prevention"
Presented by: Heather Cosgrove, Graduate Assistant with the Alberti Center; Michelle Serwacki, Graduate Assistant with the Alberti Center; and Bryan Blumlein, Graduate Student in the UB Graduate School of Education.
April 5, 2012
Connecticut nurturing environments for rapid results rev2Dennis Embry
Can we make huge change to benefit children and families. This talk was before state, federal and private leaders on how we can reclaim our children's futures.
Correlation between Theoretical Classroom Instruction and Related Learning Ex...Ryan Michael Oducado
To determine the relationship between performance in theoretical classroom instruction and related learning experience (RLE) of nursing students of WVSU.
Intervention research in schools :Mixed-method realist trials of complex preventive interventions in schools
Présentation de Laurence Moore au colloque "Recherche interventionnelle contre le cancer : Réunir chercheurs, décideurs et acteurs de terrain » - 17 et 18 novembre 2014, BnF, Paris
The leader of the TIHR Trauma Stream of work, Dr Milena Stateva recently presented an argument on the potential of action research to bring together evidence-based and value-based approaches to practice enhancement and policy making.
She was one of the key speakers at the Qualitative Research for Policy Making 2012 Conference, organised by ISCTE-IUL (Portugal) and Merlien Institute in May 2012. This highly interactive, cross-disciplinary conference brought together top policy researchers and practitioners to discuss best practices for delivering and interpreting qualitative research for policy making.
Milena’s presentation explores the tensions and possible links between value-based and evidence-based research and evaluation approaches, discusses the relevance of action research to policy making and evaluates the ability of action research to bring together these two perspectives through the case study of the Nottinghamshire County Council Fostering Futures Therapeutic Fostering Service.
Interprofessional Simulation: An Effective Training Experience for Health Car...Dan Belford
Background
This descriptive study measured the effectiveness of and participants' satisfaction with an interprofessional simulation education workshop as a teaching strategy for health care professionals.
Method
Health care professionals completed a 1-day clinical simulation workshop on interprofessional collaboration, after which they had the opportunity to fill out 4 evaluative instruments
School Based Mindfulness Interventions Within a Response to Intervention Fram...Innovations2Solutions
Public education is continually evolving to best meet the academic and social-emotional needs of an increasingly diverse student population. A major driving force for this change is the No Child Left Behind Act (2001), which holds schools and teachers accountable for student performance on standardized tests in reading, math, and science. In order to academically prepare students for these high-stakes tests, 43 states have adopted
the Common Core Standards. These standards hold students to a high level of performance in language arts and math that is designed to prepare them for career and college readiness. While the Common Core Standards provide a universal framework for academic standards across the United States, there is
no comparable measure for social-emotional learning standards despite the fact that approximately one in five children and adolescents either currently experience or will experience mental health issues that warrant intervention. These types of issues include both internalizing conditions such as anxiety and depression and externalizing conditions such as Attention
Deficit Hyperactivity Disorder, Conduct Disorder, and Oppositional Defiant Disorder. These disorders present a wide variety of challenges and adverse side effects for individuals who suffer from them. Some
of these negative side effects include lower academic achievement higher school dropout rates and negative peer relationships.
"Research Highlights from the Alberti Center for Bullying Abuse Prevention"
Presented by: Heather Cosgrove, Graduate Assistant with the Alberti Center; Michelle Serwacki, Graduate Assistant with the Alberti Center; and Bryan Blumlein, Graduate Student in the UB Graduate School of Education.
April 5, 2012
Connecticut nurturing environments for rapid results rev2Dennis Embry
Can we make huge change to benefit children and families. This talk was before state, federal and private leaders on how we can reclaim our children's futures.
New prevention for everyone washington state aug 2011 copyDennis Embry
Washington State Educational Service District #113 had an exciting event in which virtually every level of community and government was present to learn how to apply evidence-based kernels and behavioral vaccines across the board to achieve large benefits in reducing or preventing mental, emotional, behavioral, and related physical health problems. This even was the first to engage in helping Dr. Embry write a new book for chaining
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012 Dennis Embry
Troubles impact the future of our children in the modern world, many of which are traceable to what evolutionary thinkers call—evolutionary mismatch. I am a participant with the Evolution Institute, which says this about mismatch:
Natural selection adapts organisms to their past environments and has no ability to foresee the future. When the environment changes, adaptations to past environments can misfire in the current environment, producing a mismatch that can only be solved by subsequent evolution or by modifying the current environment. Mismatches are an inevitable consequence of evolution in changing environments.
Today, we examples of potential mismatch lurking in a whole range of mental, emotional, behavioral, and related disorders affecting maternal and child health. It this talk, I plan to explore how five simple policies might address mismatch that has created epidemics of autism, fetal alcohol effects, schizophrenia, depression, and other ills. These three policy categories emerge from robust science that challenges our conventional theories about the causes of troubling things like the rise of autism, serious mental illness, or aggressive and violent behavior.
In my experience as a prevention scientist, Manitoba is perhaps the only place in the Western Hemisphere capable of implementing policies and practices that might reverse adverse trends affecting the wellbeing of mothers and children for the future. So let us have a roundtable about three easy pieces for our futures:
1. Policy Goal 1: Reduce multiple sources of neuro-inflammation before pregnancy, during pregnancy and during childhood—using low-cost, scientifically proven evidence-based kernels [1].
2. Policy Goal 2: Recognize, reinforce and reward non-use of tobacco, alcohol & other drugs among women of childbearing age —using low-cost, scientifically proven evidence-based kernels [1].
3. Policy Goal 3: Create public-private partnerships to promote specific nurturing environments actionable strategies for children and their caregivers [2, 3]
References Utilized and Cited
1. Embry DD, Biglan A: Evidence-Based Kernels: Fundamental Units of Behavioral Influence. Clinical Child & Family Psychology Review 2008, 11(3):75-113.
2. Biglan A, Flay BR, Embry DD, Sandler IN: The critical role of nurturing environments for promoting human well-being. American Psychologist 2012, 67(4):257-271.
3. Embry DD: Behavioral Vaccines and Evidence-Based Kernels: Nonpharmaceutical Approaches for the Prevention of Mental, Emotional, and Behavioral Disorders. Psychiatric Clinics of North America 2011, 34(March):1-34.
Embry Nov 2010 colloquium for uni manitoba faculty of medicineDennis Embry
The Community Medicine Department of the University of Manitoba sponsored a colloquium by Dr. Embry. This talk emphasizes scientific approaches to non-pharacuettical methods to prevent mental, emotional and behavioral disorders
This bundle of articles covers all of Dr. Embry's bold and original studies related to the largest youth violence prevention study in the US during the 1990s.
WEEE Management Model: a Challenge / a Reality (ITU Green Standards Week)Ecopilas
José Pérez García CEO @Recyclia & President #tragamovil opens discussion on #Ewaste challenge #GSWMadrid 16 Sept. We need to make it easy for the consumer" = Recyclia offers 26.000 drop-off sites in Spain #GSWMadrid
Il giornale del blog www.ufficiarredati.info voce del portale italiano dell'ufficio a noleggio www.ufficiarredati.it
Tra l'altro all'interno:
- twitter il profilo di uffici arredati
- cultura al Ready Center Larciano
- umorismo a Carpi al business center O&A
- IX workshop dei centri uffici del network a Brescia
25 List Building Tricks: Ideas, Examples and Resources to Improve Your Email ROIAWeber
Learn how to dramatically grow your email marketing lists with these 25 ideas and resources. Compiled with input and real examples from a variety of marketing all-stars, you're sure to find new tricks to increase your subscriber base and keep them more engaged with your content.
Presented by Hunter Boyle at Affiliate Summit East NYC, #ASE12, Aug. 2012.
For more tricks, visit: http://www.aweber.com/blog
Welcome to the January Edition of Crisis Management’s RecallRegister, Aon’s monthly recall and product safety newsletter. This publication provides a review of the month’s recalls asreported by the U.S. Consumer Product Safety Commission (CPSC), the U.S Food and Drug
Administration (FDA), the U.S. Department of Agriculture (USDA), National Highway Traffic Safety Administration (NHTSA) and the Canadian Food Inspection Agency (CFIA). In addition to recall announcements, RecallRegister provides an update on the product recall and contamination insurance marketplace and environment. Each month, we highlight issues of importance including new markets and capacity, significant recall events and changes in legislation affecting the consumer products industry.
Apples & Pears Entertainment Pty Limited - The Event Entertainment Agencyapplesandpears
One of the best event entertainment company that operates in Melbourne and Sydney. We are proficient in arranging any sort of live entertainment and party entertainment. We can make available keynote speakers, wedding bands, magicians, celebrity speakers, vocalists to you anytime. We offer both private entertainment as well as corporate entertainment to you.
Как данные помогают рекламодателю? Рецепт целевого трафика., Сергей Спивак, S...Soloway
Как влияют данные на эволюцию медийных технологий?
Где рекламодателю купить данные для целевого трафика?
Как померить выгоду от покупки данных?
Примеры эффективности.
1
4
Discrete Trial Training (DTT) effect on children with ASD
Introduction
Autism Spectrum Disorder (ASD) is a condition that affects the development of an individual affecting their behaviour and the ability to communicate (Autism Spectrum Disorder, 2021). In most cases, this disorder exhibits its symptoms within the initial two years of an individual, despite its diagnosis being plausible for individuals of all ages. Persons diagnosed with this disorder often have repetitive behaviours and restricted interests, find it difficult to partake in social interactions and communication with others, and show other symptoms that may impede the individual's ability to perform well in school, work and several other aspects of life ("Autism Spectrum Disorder, 2021). The individuals diagnosed with the disorder will, in some cases, be reliant on their families and individuals close to them for help and support. Despite the disorder's potency as a life-long condition, some services and treatments are provided, helping an individual diagnosed with the condition improve the quality of their life. It is also important to note that the disorder has several different variations; hence, the spectrum of different characteristics, unique to every diagnosed individual.
According to studies conducted, one in fifty-four children is diagnosed with the disorder in the United States, occurring in children of all racial backgrounds and socioeconomic groups ("Data and Statistics on Autism Spectrum Disorder | CDC," 2021). According to the same report, the disease is four times more likely to occur in boys than in girls. Between 2009 to 2017, the number of children aged between 3-17 years diagnosed with development disorders, inclusive of ASD, increased from 16.2% to 17.8%. (Ünlü et al., 2018). In the use of discrete trial training (DTT), children are taught a plethora of skills, which include academic, language, and social skills, necessary to facilitate their development. In the treatment of ASD, options are limited. However, early diagnosis, coupled with behaviour interventions, is considered to have the best outcomes in managing the disorder's symptoms (Masi et al., 2017).
The prevalence of ASD in children has been noted to rise significantly in the population (Masi et al., 2017; "Data and Statistics on Autism Spectrum Disorder | CDC," 2021), affecting a larger portion of the population. This number of affected individuals is projected to rise even higher in the coming years, a problem in society that needs to be addressed. In the treatment of the disorder, drug interventions, while widely used, have failed to prove their efficiency in improving or managing symptoms in most cases (Masi et al., 2017). The treatment options for the disorder are also very limited. The use of drug interventions, early diagnosis, and early behavioural interventions is very expensive and inaccessible to many individuals affected by the condition. Identifying the disorder i ...
EFFICACY OF AND PREFERENCE FOR REINFORCEMENT ANDRESPONSE COSEvonCanales257
EFFICACY OF AND PREFERENCE FOR REINFORCEMENT AND
RESPONSE COST IN TOKEN ECONOMIES
ERICA S. JOWETT HIRST
SOUTHERN ILLINOIS UNIVERSITY
CLAUDIA L. DOZIER
UNIVERSITY OF KANSAS
AND
STEVEN W. PAYNE
STATE UNIVERSITY OF NEW YORK
Researchers have shown that both differential reinforcement and response cost within token
economies are similarly effective for changing the behavior of individuals in a group context
(e.g., Donaldson, DeLeon, Fisher, & Kahng, 2014; Iwata & Bailey, 1974). In addition, these
researchers have empirically evaluated preference for these procedures. However, few previous
studies have evaluated the individual effects of these procedures both in group contexts and in
the absence of peers. Therefore, we replicated and extended previous research by determining
the individual effects and preferences of differential reinforcement and response cost under both
group and individualized conditions. Results demonstrated that the procedures were equally
effective for increasing on-task behavior during group and individual instruction for most chil-
dren, and preference varied across participants. In addition, results were consistent across partici-
pants who experienced the procedures in group and individualized settings.
Key words: differential reinforcement, independent group contingency, preference, response
cost, token economy
The token economy is a common behavioral
intervention that has been demonstrated to be
effective for increasing appropriate behavior
and decreasing inappropriate behavior for many
populations across different settings (Doll,
McLaughlin, & Barretto, 2013; Hackenberg,
2009; Kazdin, 1977). Token economies involve
delivery, removal, or both delivery and removal
of conditioned reinforcers (e.g., tokens and
points) that can be exchanged for back-up rein-
forcers (e.g., prizes, treats, and leisure activ-
ities). When tokens are delivered contingent on
appropriate behavior or for the absence of inap-
propriate behavior, these procedures are termed
differential reinforcement of alternative behavior
(DRA) or differential reinforcement of other
behavior (DRO), respectively. When tokens are
removed contingent on inappropriate behavior
or for the absence of appropriate behavior, this
procedure is termed response cost (RC).
An advantage of token economies is that
they can be implemented with a group of indi-
viduals as a general behavior-management strat-
egy during small-group instruction or as a
classwide intervention. Classwide behavior-
management strategies such as token economies
should be considered to address minor disrup-
tive behavior, to increase motivation for learn-
ing, or as a complement to an individualized
intervention. However, general behavior-
management strategies may not be effective in
isolation for some individuals who engage in
severe problem behavior or have more intense
Correspondence concerning this article should be
addressed to Claudia L. Dozier, Department of Applied
Behavioral Science, U ...
Pick one of the following terms for your research Morals, prin.docxkarlhennesey
Pick one of the following terms for your research: Morals, principles, values, corporate social responsibility, or ethical culture.
Journal Article Analysis
Each student will select one of the key terms presented in the module and conduct a search of Campbellsville University’s online Library resources to find 1 recent peer-reviewed academic journal article (within the past 3 years) that closely relate to the concept. Your submission must include the following information in the following format:
DEFINITION: a brief definition of the key term followed by the APA reference for the term; this does not count in the word requirement.
SUMMARY: Summarize the article in your own words- this should be in the 150-200 word range. Be sure to note the article's author, note their credentials and why we should put any weight behind his/her opinions, research or findings regarding the key term.
DISCUSSION: Using 300-350 words, write a brief discussion, in your own words of how the article relates to the selected chapter Key Term. A discussion is not rehashing what was already stated in the article, but the opportunity for you to add value by sharing your experiences, thoughts and opinions. This is the most important part of the assignment.
REFERENCES: All references must be listed at the bottom of the submission--in APA format.
Be sure to use the headers in your submission to ensure that all aspects of the assignment are completed as required.
Any form of plagiarism, including cutting and pasting, will result in zero points for the entire assignment.
Social Science & Medicine 58 (2004) 1367–1384
Effective/efficient mental health programs for school-age
children: a synthesis of reviews
Gina Browne
a,b,
*, Amiram Gafni
a,b,c
, Jacqueline Roberts
a,b
, Carolyn Byrne
a
,
Basanti Majumdar
a,d
a
System-Linked Research Unit (SLRU), School of Nursing, McMaster University, Hamilton, Ont., Canada
b
Department of Clinical Epidemiology and Biostatistics (CE&B), McMaster University, Hamilton, Ont., Canada
c
Centre for Health Economics & Policy Analysis, McMaster University, Hamilton, Ont., Canada
d
Primary Health Care for Women of KwaZulu-Natal, South Africa
Abstract
The prevalence of mental health problems, some of which seem to be occurring among younger cohorts, leads
researchers and policy-makers to search for practical solutions to reduce the burden of suffering on children and their
families, and the costs to society both immediate and long term. Numerous programs are in place to reduce or alleviate
problem behaviour or disorders and/or assist positive youth development. Evaluated results are dispersed throughout
the literature. To assess findings and determine common elements of effective children’s services, a literature search was
undertaken for evidence-based evaluations of non-clinical programs for school-age children. Prescriptive comments aim
to inform service-providers, policy-makers and families about best pra ...
Unit2 SPPHS5006 Due 10.18.2022ReadingsUse your .docxjolleybendicty
Unit2 SPPHS5006 Due 10.18.2022
Readings
Use your
Social Policy and Social Programs text to complete the following:
· Read Chapter 2, "An Overview of Social Policy Analysis: A Critical Value Approach," pages 29–39.
Use the Capella Library to complete the following:
· Contandriopoulos, D., & Brousselle, A. (2012).
Evaluation models and evaluation use [PDF].
Evaluation, 18(1), 61–77.
Multimedia
Listen to this audio presentation:
·
Ethics, Values, and Policy Analysis.
UNIT2ASSIGN: Assignment Description
This assignment involves the application of Chambers and Bonk's (2013) contention that all social programs and policies are created to meet three criteria: adequacy, equity, and efficiency (p. 2). As a social worker, you will spend a great deal of time working within the social program or policy context. In other words, you will work in the agencies created by policies, implement the programs offered by the agencies, and have direct contact with those who are served by the programs and policies. Social workers must be concerned about these policies and programs, both their weaknesses and strengths, if social workers are to uphold our professional ethical standards.Assignment Instructions
For the first assignment for this course, compose a written document that contains the following:
· A description and assessment of your past experiences with policy and program planning, either your experience making policy or experience with a policy that someone else made.
· Reflect on your past professional involvement with policy or program planning and evaluation either in the human services field or elsewhere. If you do have some knowledge and experience in this regard, please describe it. What kind of policy or program were you concerned with? What was the degree of your involvement and the level of knowledge you had at that time regarding social policy and program planning?
· The selection and explanation of a program or policy that oppresses, alienates, or discriminates, informed by personal experience or information found via the Internet or the Capella Library.
· Strategies for policy or program changes that aim to empower or create privilege.Reference
Chambers, D. E., & Bonk, J. F. (2013).
Social policy and social programs: A method for the practical public policy analyst (6th ed.). Pearson.
Submission Requirements
The assignment you submit is expected to meet the following requirements:
· Written communication: Written communication is free of errors that detract from the overall message.
· APA formatting: Resources and citations are formatted according to current APA style and formatting standards.
· Length of paper: 2–3 double-spaced pages.
· Font and font size: Times New Roman, 12 point.
View the scoring guide for this assignment to ensure you fulfill all grading criteria. SEE BELOW
Unit2Disc1: Divers.
Discussion WK 9The Role of the RNAPRN in Policy EvaluationIn .docxJeniceStuckeyoo
Discussion WK 9
The Role of the RN/APRN in Policy Evaluation
In the Module 4 Discussion, you considered how professional nurses can become involved in policy-making. A critical component of any policy design is evaluation of the results. How comfortable are you with the thought of becoming involved with such matters?
Some nurses may be hesitant to get involved with policy evaluation. The preference may be to focus on the care and well-being of their patients; some nurses may feel ill-equipped to enter the realm of policy and political activities. However, as you have examined previously, who better to advocate for patients and effective programs and polices than nurses? Already patient advocates in interactions with doctors and leadership, why not with government and regulatory agencies?
In this Discussion, you will reflect on the role of professional nurses in policy evaluation.
To Prepare:
· In the Module 4 Discussion, you considered how professional nurses can become involved in policy-making.
· Review the Resources and reflect on the role of professional nurses in policy evaluation.
By Day 3 of Week 9
Select an existing healthcare program or policy evaluation or choose one of interest to you.
Review community, state, or federal policy evaluation and reflect on the criteria used to measure the effectiveness of the program or policy described.
Post an evaluation topic and a brief description of the evaluation. Discuss how social determinants impact this issue.
RESOURCES:
Milstead, J. A., & Short, N. M. (2019).
Health policy and politics: A nurse's guide (6th ed.). Jones & Bartlett Learning.
· Chapter 7, “Health Policy and Social Program Evaluation” (pp. 116–124 only)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5409875/
https://www.sciencedirect.com/user/identity/landing?code=Di7po9j9EMcw3P8H7oOBTNkBnjVKGuf9x44QkC1I&state=retryCounter%3D0%26csrfToken%3D9f776cf2-08bc-4f09-a8f6-072222840d99%26idpPolicy%3Durn%253Acom%253Aelsevier%253Aidp%253Apolicy%253Aproduct%253Ainst_assoc%26returnUrl%3Dhttps%253A%252F%252Fwww.sciencedirect.com%252Fscience%252Farticle%252Fpii%252FS0029655418300617%26prompt%3Dlogin%26cid%3Datp-40f879d1-8ae6-4b6d-b906-4c41401a9ea7
i J LUUU^S
Why Don't We See More Translation
of Health Promotion Research to Practice?
Rethinking the Efficacy-to-Effectiveness Transition
I Russell E. Glasgow, PhD, Edward Lichtenstein, PhD, and Alfred C, Marcus, PhD
The gap between research and practice is well documented. We address one of the
underlying reasons for this gap: the assumption that effectiveness research naturally
and logically follows from successful efficacy research. These 2 research traditions
have evolved different methods and values; consequently, there are inherent differ-
ences between the characteristics of a successful efficacy intervention versus those of
an effectiveness one. Moderating factors that limit robustness across settings, popu-
lations, and intervention staff need to .
Contextual Influences on the Implementation of a Schoolwide .docxmelvinjrobinson2199
Contextual Influences on the
Implementation of a Schoolwide Intervention
to Promote Students’ Social, Emotional,
and Academic Learning
Yolanda Anyon, Nicole Nicotera, and Christopher A. Veeh
Schoolwide interventions are among the most effective approaches for improving students’
behavioral and academic outcomes. However, researchers have documented consistent chal-
lenges with implementation fidelity and have argued that school social workers should be
engaged in efforts to improve treatment integrity. This study examines contextual influences
on the implementation of a whole-school intervention called Responsive Classroom (RC)
in one urban K–8 public school serving a diverse student body. RC improves social, emo-
tional, literacy, and math outcomes for disadvantaged students with behavior problems by
building on the assets of teachers to intervene with misbehaving students in the classroom
setting or school environment. Yet little is understood regarding the factors that constrain or
enable implementation of RC in noncontrolled research conditions. Results from a mixed-
methods convergent analysis of focus group, observation, and survey data indicate the influ-
ence of the following three contextual factors on implementation fidelity: (1) intervention
characteristics such as compatibility with staff members’ beliefs about behavior change and
management, (2) organizational capacity such as principal and teacher buy-in, and (3) the
intervention support system such as training and technical assistance. Implications for future
school social work research and practice with respect to the implementation of schoolwide
programs are discussed.
KEY WORDS: context; fidelity; implementation; school social work; schoolwide interventions
School social workers are often called on to deliver interventions to improve the behavior of disruptive and off-task students, as these
young people are at greater risk than their peers for
academic and psychosocial problems extending
across the life span ( O’Shaughnessy, Lane, Gresham,
& Beebe-Frankenberger, 2003; Sprague & Hill,
2000). For example, behavior problems in elemen-
tary school are among the strongest predictors of
underachievement, delinquency, and violence later
in life ( Sprague & Hill, 2000). Moreover, low-
income children and adolescents of color are more
likely to be identified by school staff as having be-
havior problems but are less likely to have access to
supports they need to make improvements ( Reyes,
Elias, Parker, & Rosenblatt, 2013). In the larger con-
text of persistent racial and class disparities in aca-
demic achievement, the need for early interventions
among disadvantaged young people is clear ( Reyes
et al., 2013).
Emerging evidence suggests that schoolwide and
teacher-focused interventions are among the most
effective approaches for improving student behav-
ioral outcomes ( Durlak, Weissberg, Dymnicki,
Taylor, & Schellinger, 2011). How.
Journal Article Critque: An overview of prevention and intervention programs ...LaKeisha Weber
Greenwood, P. & Turner, S. (2009). An overview of prevention and intervention programs for juvenile offenders. Victims and Offenders, 4, 365-374. Retrieved from Academic Search Complete database.
1
JOURNAL SUMMARY 2
Journal Summary
[Insert Name]
Lamar University
Journal Summary
Van der Donk, Hiernstra-Beernink, Tjeenk-Kalff, van der Leij and Lindaur (2013) conducted a study to determine the effects of executive functioning and working memory interventions on academic achievement and classroom behavior in students diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). This study consisted of two randomly selected groups of 175 students each between the ages of 8 and 12 that had a single, prior diagnosis of ADHD. The students were either assigned to a computer-based or a teacher instructed intervention. Students were selected from various elementary schools from two Dutch regions. The interventions were implemented by developmental psychologists that underwent a three-hour training course for their respective intervention. Group monitoring by a licensed clinical staff, recording observations of implementation, and reviewing student work samples were methods used to authenticate intervention fidelity. The computer-based intervention consisted of working memory tasks that adapted to the students’ skill level in a game format. The teacher instructed intervention consisted of several visual and verbal tasks that addressed five executive functions that are critical for success within a classroom setting. Both interventions were implemented 5 times a week for 45 minutes for a duration of 5 weeks. Various assessment methods including standardized tests and checklists were administered at baseline, at the conclusion of the intervention period, and six months after the intervention period to measure academic performance and classroom behavior. Results of the study showed a notable increase in academic performance and a statistically significant improvement in student behavior in the classroom.
Strengths and Weaknesses
This study had several strengths and limitations. One strength of the study was the randomization of the test groups. Randomly assigning subjects is the best practice to ensure efficacy. Each group was comprised of 175 students which is an adequate sample size to determine valid results. Measures were taken to verify the fidelity of intervention implementation. One limitation of this study was the content and applicability of the test groups differed greatly making it difficult to compare the efficacy of the interventions. Single tasks were used to assess the effects of working memory training which made results ambiguous as to whether academic and behavior improvement was due to the changes in ability or due to assessed tasks resembling practiced tasks.
Instructional Implications
The Centers for Disease Control and Prevention (CDC) reported that in 2016, 9.4% of children ages 4-17 were diagnosed with ADHD in the United States. 62% of children diagnosed with ADHD are taking some sort of medication. These medications help alleviate behavior sympt.
Creating an Evidence-Based Approach to Lifespan Suicide PreventionDennis Embry
Keynote: Address:
Humans appear to be the only species on the planet that kill themselves, which is the apparent result of the unique properties of language and the fact that other humans are the principal predator and the principal source of safety in our lives. Last year, three times as many America’s died from suicide as died at the height of the polio epidemic in the 1950s: 36,000 deaths from suicide, versus 3,000 from polio.
A public-health approach across the lifespan is required to reduce this terrible suffering and injury. A public-health campaign is less about the warning signs of suicide than specific actions that disable the “pump handle” to the wells of despair that result in suicidality.
This talk lays out four key principles from a lead article in a special issue of the American Psychologist on prevention, by the presenter and colleagues [1]. These principles arise from the consilience of evolutionary, medical, and behavioral sciences. The principles are not limited to the prevention of suicide; indeed, they principles address prevention of multiple mental, emotional, behavioral, and related physical disorders as outlined by the Institute of Medicine [2].
This talk integrates these principles with low-cost evidence-based kernels [3] and behavioral vaccines [4, 5] that can operate as an integrated public-health model to prevent multiple mental, emotional, behavioral, and related disorders [6]. This talk specifically shows how several apparently simple strategies can be promoted to prevent suicide across the lifespan, illustrated by data and practical mechanisms with rapid results and cost savings for multiple-silos of government and the private sector. The net result is happier, healthier, and productive citizens of all ages.
Breakout #1: Preventing Future Suicide from Pregnancy through Childhood Evidence-based Kernels and Behavioral Vaccines
This breakout expands on the keynote with specific evidence-based kernels and behavioral vaccines, organization and implementation details for low-cost strategies that can avert suicidality 10 to 20 years later cost effectively. One specific strategy that will be covered in greater detail is the Good Behavior Game (which is being widely promoted by in the US and Canada), as the only early elementary school strategy with lifetime scientific data on reducing sucidality [7]. Presently, the Substance Abuse and Mental Health Services Administration (SAMSHA) is funding 30 sties to do the Good Behavior Game, with 28 of those being supervised by Dr. Embry and his colleagues.
Breakout #2: Preventing Suicide from Adulthood through Senior Years
This breakout explores what science we have that shows pathways for preventing suicide among adults of all ages, beyond signs of suicide. This breakout links the principles from the keynote with evidence-based kernels and behavioral vaccines that can be used in multiple contexts and initiatives. Policies and practices can be scale
Something has been happening in America. More and more young people are showing up with various mental, emotional, and behavioral disorders—based on the 2009 Institute of Medicine Report on the Prevention of Mental, Emotional, and Behavioral Disorders Among Young People. These disorders—from alcohol addiction to other serious mental and behavioral problems—are not just happening in K-12 education: they are fully present in larger numbers on college and university campuses. And, even more importantly, they are now epidemic in our broader society, causing untold damage to the fiscal stability of America, its national security, and global economic competitiveness.
Oddly, it is American institutions of higher learning that have pioneered the world’s best science why and how this epidemic is happening and what can be done to avert the problems. Still more oddly, it is not American institutions of higher learning leading the charge on applying that science—something at odds with the unique heritage of America applying science to better the world. Other rich democracies now lead in applying prevention science for the protection of their future generations.
American Colleges and Universities can become one of the drivers of great carbon revolution, not just a revolution in silicon technology. By a carbon revolution, this means resolving the problems of human behavior that are the largest burdens of social and economic pain and suffering.
In my presentations, I intend to outline how the youthful energies of our young people might be combined with prevention science for population-level prevention and protection against mental, emotional, behavioral and related physical disorders plaguing our futures.
• First, the presentation is aimed at evoking understanding of how these problems have arisen from fundamental evolutionary mismatch—something that my colleagues in the evolutionary sciences have started to map well.
• Second, the presentation gives concrete examples of how prevention science can be scaled to a public-health model to protect our young people and our broader society.
• Third, the presentation outlines how colleges and universities—students, faculty and staff—might have a leadership role in changing the trajectory of these problems rapidly.
• Fourth, the presentation maps how all this can be funded in a politically powerful way, which will in turn strengthen colleges and universities by reducing the huge rise in tuition and other costs that have well outpaced inflation. Indeed, the cost of higher education is now significantly higher in the US proportionately than that of other rich democracies.
I realize that this not a standard presentation about addictions among our college-age youth, decrying the alcohol industry or arguing over the age of drinking or the legalization of marijuana. I believe we must have a much bigger solution, not just for the sake of the young people on our campuses—but for all o
Rapid results for usa jobs and child family wellbeingDennis Embry
Imagine US Corporations repatriated and invested their $1.5 trillion overseas profits back into the use to increase employment in the nation's 4.6 million small businesses, reduce and prevent the nation's epidemic of mental, emotional, and behavioral disorders among our young people, and improved the health of the country and radically reduced the burden of our prisons on the taxpayers while improving public safety. Impossible? Hardly. The US tax code enables this to happen, and the US companies will only pay interest on their investments in the US—not the repatriated funds. This can happen through the vehicle of Social Impact Bonds, and the world-class prevention science of the United States. Please read and help us make this idea happen.
Connecticut Presentation for Major ChangeDennis Embry
The state of Connecticut recently held a major meeting with Congressional members, cabinet members, and funders to outline a plan to create major, population-level impact on improving the wellbeing of Connecticut's children and families. This presentation opened the discussion
Creating a culture of prevention and recoveryDennis Embry
Texas is the land of professed public bootstraps, and very private suffering. There is not a family in Texas that has not been touched by the rising prevalence of mental, emotional, behavioral and related physical illnesses. In fact there is not a family in America that has not been so touched, based on the elegant epidemiological monitoring in the US.
So in the land of big hats, why cannot Texas take the lead in a very big idea that will save billions of dollars, improve health, increase the global economic competitiveness of the US, and improve our national security? All that sounds, well, frankly very patriotic and American. What is the really big idea?
First, virtually every mental, emotional, and behavioral disorder (including addictions) is preventable. How solid is that statement? Stamp on the ground ten times as hard as you can. Did you feel it? Well that is how solid the science is. You don’t hear it on your TV; you don’t hear that science in your newspaper or Time magazine; you don’t hear it from your health care provider; and people are not learning this at university. And absolutely nobody is lobbying the Texas Legislature or Governor about this science and possibility. I’ll wager you might not believe me, even though I am a pretty dang good scientist. So if you don’t believe me that the science exists, you can go to www.pubmed.gov and look every study or fact I site. After my talk, you will jabbering away at just about anybody who will listen.
Second, recovery from mental, emotional, and behavioral disorders—including very serious ones like schizophrenia and bipolar disorder—can go into remission. This remission and recovery is not dependent on medications. Now that is not a fact that you will hear on TV, or hear from the pharmaceutical detail people in your doctor’s office. Now I read almost everything I can on these problems, and I missed hearing about this science—until recently. That shows you how buried it is. At my plenary, you will hear about the practical science of recovery.
Third, there are ways to pay for all this using something called, “Social Impact Bonds.” So instead of Texas selling bonds for building another prison, bonds can be sold preventing or reducing the problems in the first place. Now there’s an idea. And, yes other countries are doing this.
The really big idea—a Texas big idea? Well, Texas could be the first place in America to do all this. That would change America, and all our futures.
Biglan et al the critical role of nurturing environments for promoting human ...Dennis Embry
The recent Institute of Medicine report on prevention (National Research Council & Institute of Medicine, 2009) noted the substantial interrelationship among mental, emotional, and behavioral disorders and pointed out that, to a great extent, these problems stem from a set of common conditions. However, despite the evidence, current research and practice continue to deal with the prevention of mental, emotional, and behavioral disorders as if they are unrelated and each stems from different conditions. This article proposes a framework that could accelerate progress in preventing these problems. Environments that foster successful development and prevent the development of psychological and behavioral problems are usefully characterized as nurturing environments. First, these environments minimize biologically and psychologically toxic events. Second, they teach, promote, and richly reinforce prosocial behavior, including self-regulatory behaviors and all of the skills needed to become productive adult members of society. Third, they monitor and limit opportunities for problem behavior. Fourth, they foster psychological flexibility—the ability to be mindful of one's thoughts and feelings and to act in the service of one's values even when one's thoughts and feelings discourage taking valued action. We review evidence to support this synthesis and describe the kind of public health movement that could increase the prevalence of nurturing environments and thereby contribute to the prevention of most mental, emotional, and behavioral disorders. This article is one of three in a special section (see also Muñoz Beardslee, & Leykin, 2012; Yoshikawa, Aber, & Beardslee, 2012) representing an elaboration on a theme for prevention science developed by the 2009 report of the National Research Council and Institute of Medicine. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
CAPE MAY: A Different Scientific Perspective About the Causes and Cures of Bu...Dennis Embry
The story of the bully is very old. You can read descriptions of bullies in the Old Testament. Bullying seems to be increasing. Why is that? Why is it that aggressive, disturbing and disruptive behaviors have steadily increased in America—much more than other rich countries? We see bullying at preschool, at elementary school, in secondary school. We see bullying in the workplace, in the media, in every walk of life imaginable. Why is this so? What has happened that this behavior is more prevalent? The causes of being a bully and being bully victim have increasingly intriguing scientific findings. This presentation outlines what might underlying causes of the increase and the implications for larger action in society. We will look a biology, the brain, behavior and even evolutionary findings to get a deeper understanding for action. Some of the causes of being a bully and being a bully victim will surprise you, and will lay the foundation for a culture freer of bullying.
Cape May New Jersey Presentation on PreventionDennis Embry
The story of the bully is very old. You can read descriptions of bullies in the Old Testament. Bullying seems to be increasing. Why is that? Why is it that aggressive, disturbing and disruptive behaviors have steadily increased in America—much more than other rich countries? We see bullying at preschool, at elementary school, in secondary school. We see bullying in the workplace, in the media, in every walk of life imaginable. Why is this so? What has happened that this behavior is more prevalent? The causes of being a bully and being bully victim have increasingly intriguing scientific findings. This presentation outlines what might underlying causes of the increase and the implications for larger action in society. We will look a biology, the brain, behavior and even evolutionary findings to get a deeper understanding for action. Some of the causes of being a bully and being a bully victim will surprise you, and will lay the foundation for a culture freer of bullying.
In this 1 hour presentation, a deeper unstinting of why crime prevention must incorporate evolutionary theory. Humans are the principle predator of humans, and the principle source of safety. This talk outlines several clear strategies with large preventive effects.
New Hampshire Keynote on Prevention for Whole County 11 10-11Dennis Embry
Cheshire County, NH, seeks to be the healthiest county in America by 2020. The County is off to a roaring start: it has statistical snapshots and research briefs. Now the summit is about moving into high-gear to influence the behavior of 77,000 people from birth to 100 to meet the challenge.
How will the organizers and advocates do this with due hast and cost-efficiency in terms of people power, money and time?
How will the organizers and advocates make increased wellness and reduced morbidity and mortality happen across all the categories —from healthy weights, to mental illness, to cancer, to unintentional or intentional injuries, to addictions, to self harm, and heart disease?
This talk lays out real answers from somebody who has done large scale prevention trials with success, with diverse problems.
First, people will learn to tackle the problems not so much by topic (i.e., each separate issue), but by tackling the underlying common threads that hold and cause multiple problems. When you cut the common thread, you have impact across many domains. This is called a multi-problem or syndemic approach, and participates will learn from examples how to apply this to real-world issues from the Research Briefs.
Second, people need to use powerful yet low cost tools to influence those 77,000 to make changes in their behavior—with enough people to tip the balance of change. We cannot do therapy with every citizen to achieve the change; we need a public health model that empowers each citizen—young or old—to act not just for themselves but also in ways that help the health and wellbeing futures of many others. Again, the talk and related activities will illustrate how such behavior change and mobilization can be done using the same basic toolkit over and over, with examples.
Third, the whole community needs a way to be invested in ALL OUR FUTURES, not just self. Why? Because, the aggregate success actually reduces the “behavioral contagion” causing many of these problems. And, health equals wealth, both an individual and community level. This part of the presentation gives examples and illustrations that can help create the healthiest county not just for 2020—but also for decades to come
Keynote talk: Vermont Assn. for Mental Health and Friends of Recovery Annual...Dennis Embry
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
Women In Medicine University of KansasDennis Embry
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.
Nurturing the genius of genes the new frontier of education, therapy, and un...Dennis Embry
Not every child seems equally susceptible to the same parental, educational, or environmental influences even if cognitive level is similar. This study is the first ran- domized controlled trial to apply the differential susceptibility paradigm to education in relation to children’s genotype and early literacy skills. A randomized pretest–posttest control group design was used to examine the effects of the Intelligent Tutoring System Living Letters. Two intervention groups were created, 1 receiving feedback and 1 completing the program without feedback, and 1 control group. Carriers of the long variant of the dopamine D4 receptor gene (DRD4 7-repeat) profited most from the computer program with positive feed- back, whereas they performed at the lowest level of early literacy skills in the absence of such feedback. Our findings suggest that behind modest overall educational intervention effects a strong effect on a subgroup of susceptible children may be hidden.
Harvard University Brief on Causes and Cures of Bullying and Harassment Dennis Embry
Bullying and harassment in the 21st century in the United States is one of the symptoms of a broader epidemic of mental, emotional, behavioral and related physical illnesses—collectively the result of evolutionary mismatches and selection by consequences within the broader culture. Focusing on bullying and harassment per se may paradoxically serve to maintain multiple toxic conditions causing victimization that all here assembled find reprehensible.
Harvard Presentation on the Science of Bullying PrevetionDennis Embry
Dr. Dennis Embry presented a guest lecture at a one day event sponsored by Harvard University. Dr. Embry's comments focused on how broad scale evolutionary mismatch is causing vulnerability to multiple forms of mental, emotional, and behavioral disorders that are linked to bullying and harassment for both perpetration and victimization.
Our Futures Meeting in Central FloridaDennis Embry
Central Florida Behavioral Health Network met on June 8-9 at the Manatee County Chamber of Conference and United Way conference center. The aim of this two days is to implement a collection of evidence-based based kernels to achieve population level changes for protection against multiple mental, emotional, behavioral and related disorders. Dr. Dennis Embry from PAXIS presented and consulted with the coalitions
Creating Evidence-Based Practices When None ExistDennis Embry
On April 28, 2011, the Assistant Secretary of Health and Human Services for Research and Evaluation asked Dr. Dennis Embry to speak at the Pew Trust in Washington, DC. He was asked to answer a key question regarding evidence-informed strategies: “When evidence-based programs are not available to meet the needs of a particular population, then how should/can we use evidence to inform innovation?” Here is the powerpoint for this well-received presentation.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Novas diretrizes da OMS para os cuidados perinatais de mais qualidade
Embry & Biglan "Evidence Based Kernels" Review paper 2008
1. Clin Child Fam Psychol Rev
DOI 10.1007/s10567-008-0036-x
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, This paper presents an analysis of fundamental units of
fundamental units of behavioral influence that appear to behavioral influence that underlie effective prevention and
underlie effective prevention and treatment for children, treatment. We call these units kernels. They have two
adults, 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
specific behavior and that is indivisible in the sense that one or more specific behaviors. Second, they are funda-
removing any of its components would render it inert. mental units of behavior influence in the sense that deleting
Existing evidence shows that a variety of kernels can any component of a kernel would render it inert. Under-
influence behavior in context, and some evidence suggests standing kernels could contribute to an empirically based
that frequent use or sufficient use of some kernels may theory of behavioral influence, facilitate dissemination of
produce longer lasting behavioral shifts. The analysis of effective prevention and treatment practices, clarify the
kernels could contribute to an empirically based theory of active ingredients in existing interventions, and contribute
behavioral influence, augment existing prevention or to developing interventions that are more efficient and
treatment efforts, facilitate the dissemination of effective effective. Subsequent sections of this paper expand on the
prevention and treatment practices, clarify the active two essential features of evidence-based kernels, as well as
ingredients in existing interventions, and contribute to the origins of the idea and terminology.
efficiently developing interventions that are more effective. The ultimate goals of treatment and prevention research
Kernels involve one or more of the following mechanisms are a reduction of the prevalence of the most common and
of behavior influence: reinforcement, altering antecedents, costly problems of behavior and an increase in the preva-
changing verbal relational responding, or changing physi- lence of wellbeing. Current thinking about how to
ological states directly. The paper describes 52 of these accomplish this assumes that we will identify empirically
kernels, and details practical, theoretical, and research supported programs and, to a lesser extent, policies, and
implications, including calling for a national database of will disseminate them widely and effectively. Although
kernels that influence human behavior. substantial progress is occurring through this strategy, there
are at least four limitations to it that point to the value of
Keywords Evidence-based kernels Á kernels as a complementary strategy.
Public-health benefits Á Prevention Á Treatment First, it is difficult to implement a program’s efficacy
widely with fidelity or effectiveness. Ringwalt et al. (2003)
surveyed a sample of 1,795 school staff members who were
D. D. Embry (&) in charge of teaching substance-use prevention programs.
PAXIS Institute, P.O. 31205, Tucson, AZ 85751, USA Nearly two-thirds reported teaching content that meta-
e-mail: dde@paxis.org analyses showed was effective. However, only 17% used
effective delivery and only 14% used both effective
A. Biglan
Oregon Research Institute, Eugene, OR, USA delivery and content. In a second study, Ringwalt et al.
e-mail: tony@ori.org (2003) found that about one-fifth of teachers of substance-
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2. Clin Child Fam Psychol Rev
use prevention curricula did not use a curriculum guide at Existing formal programs address only a small range of
all and only 15% reported following one closely. Hallfors situations and behaviors they seek to influence. For
and Godette (2002) studied 104 school districts in 12 states. example, parents may complain to a teacher, principal,
They found that many districts selected evidence-based nurse, or doctor how hard it is to get their young child
programs, but only 19% of district coordinators indicated moving in the morning. Alone, such a complaint does not
their schools implemented those programs with fidelity. merit implementing parenting skills training. However, a
They concluded there was inadequate funding and infra- simple behavior change strategy, such as the Beat the
structural support for implementation. More recently, Timer game (Adams and Drabman 1995), in which the
prevention programs with long-standing efficacy data from child receives a reward for completing a behavior before
more controlled conditions and settings, such as Project the timer goes off, could solve the problem, and prevent
Alert or Reconnecting Youth (e.g., Bell et al. 1993; parent–child conflict. Even in situations where an effective
Ellickson et al. 1993), were tested for effectiveness in real- program exists, the program dissemination strategy will fail
world contexts and conditions. Most often, the obtained to affect any practices of those who choose not to adopt the
effectiveness results do not replicate the efficacy trials program. A related issue is that that many problems have
(e.g., Hallfors et al. 2006; Sanchez et al. 2007; St. Pierre no evidence-based programs on published approved lists.
et al. 2005). Research on how to get programs widely For example, bipolar disorder is increasingly common
adopted, effectively implemented, and appropriately among younger children, yet there are no listed programs
adapted to different conditions is still in its infancy. for teachers with such children. Thus, given current evi-
However, initial evidence suggests that sole reliance on dence, it is likely that for now most daily practices that
program dissemination to affect population outcomes will influence human development will fall outside the scope of
have a limited impact, even with restrictive policies (e.g., existing programs. Failing to improve those practices is a
Hallfors et al. 2007). missed opportunity.
Second, many problems—or behaviors—that affect Cost is a fourth limitation of depending solely on pro-
wellbeing do not require lengthy or complex interventions gram dissemination to affect public health. The National
involving consultations, workshops, training, or support. Registry of Effective Programs and Practices provides
Consider a few examples. A teacher might improve cost information (see http://modelprograms.samhsa.gov/
classroom behavior just by using some non-verbal cues template.cfm?page=nrepbutton). Direct costs for program
during transitions (Abbott et al. 1998; Krantz and Risley developers include material production, training, licensing,
1977; Rosenkoetter and Fowler 1986) or reduce aggression ongoing consultation of adopters, results monitoring, and
and bullying on the playground by cooperative games program improvement. There are also hidden costs, such as
(Murphy et al. 1983). A parent might easily improve a venues, staff training, temporary staff replacement to cover
teenager’s cooperation with a mystery motivator (Madaus duties, and administrative costs. For example, a model
et al. 2003). A principal might reduce disturbing or dis- universal program that reduced observed aggression on the
ruptive behaviors and increase engaged learning with the playground by about 10% (Grossman et al. 1997) requires
principal’s lottery (Thorpe et al. 1978). A college professor 17.5 h of direct instruction per pupil, plus indirect costs for
might increase participation of students with response material and training of teachers. Thus, a school with 25
cards instead of the expensive clicker systems (Shabani and teachers may spend $12,000–15,000 for materials, training,
Carr 2004). In other words, a simple method of behavior staff timing, and (possibly) substitute teachers. A cost of
influence might well solve a specific problem, and that was $500 per teacher per universal program is unexceptional
all that was required. The simple solution might actually for listed programs. Therapeutic model programs (e.g.,
avoid larger, more unpleasant difficulties or have greater Ogden and Halliday-Boykins 2004; Szapocznik and Wil-
good over time. For example, the response cards used in a liams 2000) can cost between $80,000 and 200,000
classroom increase academic achievement (Gardner et al. depending on the nature of licensing needs, training,
1994) or the use of organized recess might not only reduce materials, supervision, monitoring, and staffing. If multiple
aggression on the playground, but also improve the aca- evidence-based programs are required, costs per problem
demic performance of children in the classroom with (e.g., tobacco, alcohol, violence, bullying, or mental ill-
ADHD (Jarrett et al. 1998). Thus, simple solutions might ness) can bring the total to hundreds of thousands of dollars
just be sufficient in many cases. in direct and indirect costs per setting. These funds are not
Third, program dissemination is unlikely to affect typically available to schools, human service agencies,
practices or problems that fall outside the scope of a pro- groups, and others charged with prevention and treatment.
gram. Teachers, clinicians, parents, healthcare providers, There is no reason to expect a surge in such funds at a
coworkers, supervisors, and many others are constantly local, state, or federal level anytime soon. Clearly, if pro-
trying to have a beneficial influence on others’ behavior. gram adoption is the only avenue to large population
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3. Clin Child Fam Psychol Rev
effects, progress will be slow and costly. It would be very prevention or treatment behavior-change programs, distinct
useful from a public health and safety perspective if there from the earlier nebulous concepts of ‘‘principles of
were low-cost prevention, intervention, and treatment effectiveness.’’ The perceived need for a taxonomy and
strategies to deploy easily—reducing the need for more nomenclature for these active ingredients emerged from a
expensive strategies that might not be possible to field yearlong series of meetings organized by the second
where money and resources are scarce. author, involving some 20 leading prevention, scientific,
A fifth concern is that existing programs have limited and policy leaders. Some of the scientists at the meetings
effectiveness, modest effect sizes, scalability concerns, were Richard Catalano, Harold Holder, Brian Flay, and the
weak generalization, difficulty with maintenance or sus- authors of this paper. These scientists had created and
tainability, and even iatrogenic effects (e.g., Hallfors et al. tested many prevention and treatment programs and had
2006; St. Pierre et al. 2005; Sanchez et al. 2007). This is used some common ingredients to make those programs
not to diminish the enormous progress of prevention sci- work. The scientists, however, had never denominated
ence in the past 30 years (Biglan 2004). However, those ingredients or active components in ways that each
inspection of recent meta-analyses of interventions (e.g., other understood or that others might easily perceive for
Bledsoe 2003; Derzon et al. 2005, 2006; Ennett et al. 2003; new invention or systematic replications.
L}sel and Beelmann 2003; Lipsey et al. 2006; Scheckner
o Other disciplines do have such taxonomies and
et al. 2004; Tobler et al. 2000) finds plenty of room for nomenclature. For example, medications contain lists of
improving the effectiveness of our programs. known ‘‘active ingredients,’’ which have proven effec-
A sixth concern is that current evidence-based programs tiveness separate from effects of the compounded product.
do not easily meet the diffusion criteria (Rogers 1995). For For example, aspirin is clearly effective in its own right,
instance, individuals who might be early adopters of pro- and so are enteric coatings. Joined, they result in a product
ven and tested prevention strategies can often gain access such as ‘‘buffered aspirin,’’ composed of two separate
to these strategies only through institutions such as schools active ingredients. One can look up medications’ active
or state agencies. If a school or agency lags, thousands of ingredients in publications like the Physician’s Desk Ref-
individuals or families in geographic areas cannot avail erence and look up how to use them in the Merck Manual.
themselves of strategies that might prevent school failure, Nothing similar exists in applied behavioral science.
substance abuse, mental illness, delinquency, or other ills. We chose the term ‘‘evidence-based kernel’’ for several
Individual teachers also cannot adopt science-based strat- reasons. First, it had the metaphorical resonance of some-
egies, as almost all evidence-based prevention programs thing organic that influenced life or behavior. Second, the
require school or district adoptions. For example, it is metaphor was about something very compact, although
easier for a parent or teacher to gain access to a prescrip- obviously in quantity or through blending, it could become
tion drug to treat ADHD or depression than to obtain something bigger or more productive. Third, the term was
evidence-based strategies that might similarly affect novel, which would confer the ability to track its use and
behavior (e.g., Ridgway et al. 2003; Schilling et al. 2003; make its meaning clear and crisp compared to words or
Larun et al. 2006). phrases in past use such as ‘‘principles of effectiveness.’’
Each limitation points to the value of identifying and The unit of a kernel is indivisible in the sense that it
making available kernels of behavior influence. We do not would be ineffective if one eliminated any of its compo-
suggest that kernels replace tested, proven programs; we nents. Experimental evaluations of kernels may involve
propose that kernels supplement or strengthen programs, randomized controlled trials (RCTs) or interrupted time-
help to create new programs more efficiently, or make series experiments (Flay et al. 2004). Examples of kernels
effective behavior–influence techniques available in situa- include timeout, written praise notes, self-monitoring,
tions where programs are unavailable, impractical, or just framing relations among stimuli to affect the value of a
unnecessary based on the simplicity of the problem given stimulus, and physiological strategies such as nasal
addressed. breathing when upset or increasing omega-3 fatty acids in
the diet in order to influence behavior. The description of a
kernel as an indivisible procedure merits discussion by
Kernel Definition, Derivation, and Examples metaphor and example.
First, a kernel is like a seed that contains central infor-
We designate as evidence-based kernels any indivisible mation for growth or change. Second, a kernel also evokes
procedure shown through experimental evaluation to pro- the idea of an implicit human technology to effect change
duce reliable effects on behavior (Embry 2004). The from the earliest use of agriculture to the use of core rou-
derivation of the term ‘‘kernels’’ arose in Embry’s (2004) tines in modern computers. A broken seed will not grow,
paper describing the active ingredients in evidenced-based and a broken core computer routine (‘‘kernel panic’’) will
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4. Clin Child Fam Psychol Rev
cause the machine to be inoperative. One of the oldest journals; they can be found, too, in old culturally selected
prepared foods by humans, dating to the Neolithic era— practices. For example, choral responding is a scienti-
bread, further illustrates the point of indivisibility. Bread fically proven practice described herein (e.g., Godfrey
consists of flour and water. Bread may be leavened or et al. 2003), yet it can be found as a cultural practice from
unleavened. Even unleavened, bread can be quite varied: cultures as environmentally diverse as Polynesians to
lavashes, tortilla, chapatis, rotis, naans, etc. Bread is simple Arctic peoples; scientists funded by the National
and irreductable: remove the flour or liquid, there is no Institute of Health have recently experimentally demon-
bread. The example of bread also illustrates the nearly strated the efficacy of the omega-3 fatty acid on
infinite ways additions to it can make it sweet, spicy, bitter, influencing many types of human behavior (e.g., Freeman
fattening, medicinal, or celebratory. Of course other prep- et al. 2006a, b), while grandmothers several hundred years
arations of meat, legumes, fruits, or vegetables can be ago made sure that everybody had their daily dose of cod
served with bread to form daily meals or diet—a culinary liver oil; and while legions of behavioral scientists since
equivalent of a program. the 1960s may have demonstrated the effects of praise
Second, an evidence-based kernel has core components (e.g., Leblanc et al. 2005), the Yup’ik peoples of Alaska
that cannot be removed and be effective. Consider some apparently applied the principle a long time before Euro-
examples: (1) Timeout must be a brief removal from pean contact.
whatever is reinforcing the undesirable behavior, followed Humans—be they parents, teachers, leaders, business
by intensive reinforcement for engaging in the desired people, or even scientists—attempt to influence behavior,
behavior upon return; (2) a Home-Note from school must which begs the question of what influence might mean.
cue high rates of positive reinforcement from home adults, Thus, a kernel may increase the frequency or duration of a
not emphasize the bad behavior at school; (3) beat the behavior or may make a behavior less likely. The change in
timer requires some kind of mechanical device to keep frequency or duration of behavior is observable in real
track of time, set for a brief time, and with a signal that time. The mechanism of influence might be a function of
cues reinforcement for the target behavior when the time an antecedent to channel behavior, a consequence follow-
elapses; and (4) nasal breathing must involve breathing ing the behavior, a set of words about the behavior, or
through the nose and not the through the mouth, when direct manipulation of physiology. These possible mecha-
upset, for the physiological and behavior benefits to nisms or pathways of how kernels can influence the
happen. acquisition, rate, or duration of behavior will be discussed
Programs, however, are rarely irreductable. Programs subsequently. Some examples of kernels now merit
contain many components or kernels, and the loss of a attention.
single one enables the program still to have some effect in
most cases. For example, evidence-based reading programs
The Example of Timeout
like Direct Instruction or Success for All have kernels such
as choral responding or peer-assisted learning among many
Timeout was one of the first kernels of behavior–influence
other active ingredients. The loss or omission of a single
technology (Wolf et al. 1964). Dicky was a 3-year-old boy
program component may reduce results but will not oblit-
with autism who had undergone surgery for cataracts. He
erate results typically.
lived in a psychiatric hospital and had frequent tantrums
Naturally, some may ask about the cultural competence
resulting in self-injury. In tribute to the late Montrose
of evidence-based kernels. Anthropologists or evolutionary
Wolf, Risley described this landmark study (Risley 2005):
theorists (e.g., Wilson and Wilson 2007) posit human
evolution and advancement are significantly based on our After having just discovered the power of adult
ability to influence each other for group benefit. We sug- attention for young children, and realizing that the
gest that the idea of evidence-based kernels has deep roots staff could not simply ignore temper tantrums, espe-
in anthropology. Humans have a long history of creating cially violent ones with mild self-abuse, Wolf
ways to influence each other, and noticing the effects of decided to prescribe a response to tantrums that
their inventions to do so. While we hold fast to the notion would minimize any social reinforcing effect of the
that an evidence-based kernel must have peer-reviewed necessary attention and counterbalance that rein-
publication showing experimentally proven results, we are forcement with a period of social isolation. The
not blind to the fact that many kernels listed in this pub- prescription for tantrums was to place Dicky, calmly
lication have more than chance analogue in the wisdom and without comment, in his room until the tantrum
traditions of cultures to influence the behavior of relatives, ceased and at least 10 minutes had passed. When
mates, and neighbors. Many of the kernels herein are not tantrums were under control and after wearing glasses
just found in evidence-based programs or scientific had been hand shaped, Dicky began to throw his
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5. Clin Child Fam Psychol Rev
glasses occasionally. When the social isolation pre- Theoretical Taxonomy of Kernels
scription was applied, glasses throwing decreased
from about twice per day to zero. But the hospital Although simple enumeration of kernels may support
staff doubted that it was due to the procedure, effective practice, their contribution may be more sub-
because Dicky didn’t seem to mind being taken to his stantial if we organize them within a theoretical framework
room; he just rocked in his rocking chair and hum- to delineate the key influences on behavior. Such a frame-
med to himself. Because throwing glasses was both work would facilitate generating new kernels and could
less serious and more reliably measured than tan- point to overlooked procedures for influencing behavior.
trums, Wolf agreed to discontinue the procedure— Kernels are understandable in terms of the operant
and glasses throwing soon increased to the previous behavior of biological organisms, viewed within a
level. The social isolation procedure was reinstated, developmental and evolutionary perspective. Human
and glasses throwing decreased again to zero. behavior—including verbal, cognitive, and emotional
(pp. 281–282) functioning—has developed over time as a function of the
biological capacities of the organism and the consequences
Thus was born timeout, shown since in hundreds of
to behavior. Human behavioral tendencies are adaptive
studies to reduce the frequency of a vast range of behav-
functions of current situations and a history of consequences
iors. It is a staple of nearly every evidence-based
for behaving in similar situations (e.g., Biglan 1995).
prevention program for parenting (e.g., Incredible Years
Kernels involve one of four primary processes. Many
[Webster-Stratton and Reid 2007]; Triple P [Sanders and
involve consequation of behavior—the presentation or
Markie-Dadds 1996]; Parent Management Training
removal of reinforcing or aversive consequences (Biglan
[Forgatch et al. 2005a, b]). It is also part of popular culture.
1995, Chap. 3). Others involve an antecedent stimulus
Shows like Nanny 911 display its use; websites with advice
affecting motivation to behave due to a history of conse-
to parents describe it (e.g., http://www.thelaboroflove.com/
quences for responding to that stimulus (e.g., teachers’ use of
forum/quality/timeout.html). Although there is no popula-
standard signals to prompt students to sit down; Jason, Neal,
tion-based data on the prevalence of families and schools
and Marinakis 1985; Wasserman 1977). A third type pri-
using timeout, it seems that in many areas, timeout is the
marily involves altering the relations that people derive
normative replacement for harsh methods of discipline.
among verbal stimuli in ways that affect motivation. For
example, to elicit a public commitment to engage in a
The Example of Nasal Breathing or ‘‘Doing Turtle’’ behavior (Chassin et al. 1990), a person feels prompted to
associate a network of consequences (such as others’
Humans are amazing at noticing the effects of small approval) with engaging in the behavior and other conse-
physiological interventions that influence human behavior. quences with not engaging in the behavior (e.g.,
Grandmothers and experienced teachers, for example, disapproval). Each of these three types of kernels involves
often tell children who are emotionally overwrought and ways in which a person’s social environment affects his or
hyperventilating to close their mouths and breathe through her behavior. In a sense, kernels provide prescriptions for
the nose while exhaling through the mouth. This strategy how the social environment can show more support of human
is taught formally in such evidence-based prevention development.
programs as the Incredible Years and PATHS (Positive A fourth type of kernel alters a biological function of the
Alternative Thinking Skills), and even has a child-friendly organisms in ways that affect behavior. An example is sup-
name and story of ‘‘doing turtle’’ (Robin et al. 1976). The plementation of diets with omega-3 fatty acid (Haag 2003).
strategy is based in empirical observations of the rela- Indeed, any pharmacological agent that affects behavior
tionship among breathing patterns, physiological would fall into this category, although we stress the impor-
measures, behavior, and children’s emotional states tance of distinguishing prescription medications from non-
(McDonnell and Bowden 1989; Naveen et al. 1997; Perna prescription, scientifically proven kernels that individuals or
et al. 2002; Pine et al. 1998; Telles et al. 1997; Zaich- organizations might choose to use without a prescription.
kowsky et al. 1986). This kernel also illustrates how a Table 1 presents a list of kernels organized according to
simple strategy might be independently discovered and this theoretical framework. We categorize each kernel in
tested from very different theoretical perspectives (e.g., terms of the primary mechanism by which it affects
pediatric medical practice, basic research, child psychol- behavior, although clearly many kernels involve more than
ogy, prevention, parenting, and even alternative bodywork one process. Space precludes a complete review of the
such as yoga). Like most kernels, it can be used and empirical evidence for each kernel, but we cite all exper-
proven on its own, or incorporated in programmatic imental evaluations done for each kernel along with the
efforts. types of experimental evaluations that have occurred. In
123
6. Table 1 Example taxonomy of potential kernels
Kernel example Description Behaviors affected Evidence and experimental designs
123
Kernels altering consequences for behavior
Kernels increasing frequency of behavior
Verbal praise Person or group receives spoken (or signed) Cooperation, social competence, academic Leblanc et al. (2005), Lowe and McLaughlin (1974), Marchant
recognition for engagement in target acts, engagement/achievement, positive parent–child and Young (2001), Marchant et al. (2004), Martens et al.
which may be descriptive or simple interactions or marital relations, better sales; (1997), Matheson and Shriver (2005), Robinson and
acknowledgements reduced disruptive or aggressive behavior; Robinson (1979), Scott et al. (2001) (All TS)
reduced DSM-IV symptoms
Peer-to-peer written A pad or display of decorative notes is posted Social competence, academic achievement, work Cabello and Terrell (1994), Embry et al. (1996), Farber and
praise: ‘‘Tootle’’ on a wall, read aloud, or placed in a photo performance, violence, aggression, physical Mayer (1972), Heap and Emerson (1989), Mayer et al.
notes, compliments album where peers praise behaviors health, vandalism (1983, 1993), Skinner et al. (2000) (TS plus 1 RCT with
books/praise notes other kernels)
Beat the timer or Reduced time set to complete a task, with Parent–child interactions, compliance, physical Adams and Drabman (1995), Ball and Irwin (1976), Drabman
beat the buzzer access to reward or recognition if task abuse, child aggression, ADHD, work and Creedon (1979), Hudson et al. (1985), Luiselli and
successfully completed before time completion, academic accuracy Greenidge (1982), McGrath et al. (1987), Wolfe et al.
interval (1981), Wurtele and Drabman (1984) (TS)
Mystery motivators/ Person draws variable prize of higher and Conduct disorders, oppositional defiance, ADHD, DeMartini-Scully et al. (2000), Madaus et al. (2003), Moore
grab bag/prize bowl/ lower values for engaging in targeted substance abuse, work performance et al. (1994), Petry et al. (2000, 2001a, b, c, 2004, 2005),
game of life behavior Petry and Simcic (2002), Robinson and Sheridan (2000) (TS
with children; RCTs with adults)
Public posting Results, products of activity posted for all, Speeding, academic achievement, conservation, Parsons (1982, 1992), Jackson and Mathews (1995), Whyte
(graphing) of may be scores of individuals, teams, or donations, community participation, injury et al. (1983), Ragnarsson and Bjorgvinsson (1991),
feedback of a targeted display of work product for all to see control Nordstrom et al. (1990), Van Houten and Nau (1981), Nicol
behavior and Hantula (2001) (TS)
Principal lottery Tokens or symbolic rewards for positive Academic achievement, disruptive behavior, Thorpe et al. (1978, 1979) (All TS)
behavior result in random rewards from aggression
status person (e.g., principal, authority
figures) such as positive phone calls home
Safety or Tokens or reward tickets given for observed Safety behaviors, accident reduction, improved Geller et al. (1982), Putnam et al. (2003), Roberts and Fanurik
performance lottery safety or performance behavior, then sales or work performance (1986), Saari and Latham (1982) (All TS)
entered into lottery
Team competition Groups compete on some task, performance, Improved academic engagement/achievement, Beersma et al. (2003); Hoigaard et al. (2006), Kivlighan and
or game reduced disruptive behavior, increased sales, Granger (2006), Koffman et al. (1998), Neave and Wolfson
fund raising, and safety; reduced smoking; (2003) (All TS, and one naturalistic study)
changed brain chemistry favoring attention
and endurance
Clin Child Fam Psychol Rev
7. Table 1 continued
Kernel example Description Behaviors affected Evidence and experimental designs
Contingent music Music played or stopped in real time, based Increased weight gain of babies, improved baby Allen and Bryant (1985), Barmann and Croyle-Barmann
on observed behavior of the individual or development possibly, work performance, (1980), Barmann et al. (1980), Bellamy and Sontag (1973),
group academic achievement, attention and focus Blumenfeld and Eisenfeld (2006), Cevasco and Grant
(ADHD symptoms down); reduced aggression (2005), Cook and Freethy (1973), Cotter (1971), Davis et al.
(1980), Dellatan (2003), Deutsch et al. (1976), Eisenstein
(1974), Harding and Ballard (1982), Hill et al. (1989),
Clin Child Fam Psychol Rev
Holloway (1980), Hume and Crossman (1992), Jorgenson
(1974), Larson and Ayllon (1990), Madsen (1982), McCarty
et al. (1978), McLaughlin and Helm (1993), Standley (1996,
1999), Wilson (1976), Wolfe (1982) (All TS)
Special play Adult (caregiver or teacher) plays with the Improved stress physiology, compliance, and Bratton et al. (2005) (Meta analysis)
child, but lets the child lead in determining social competence; reduced trauma or
what games will be played and how depressive symptoms
Choral responding Person(s) chant or sign answer to oral or Compared to hand raising, improved academic Godfrey et al. (2003), Kamps et al. (1994), Taubman et al.
visual prompt in unison; praise/correction achievement, disruptive symptoms, retention; (2001), Wolery et al. (1992) (All TS)
follows reduced behavior problems
Mystery shopper Unknown individuals make ‘‘purchase’’ or Reduced tobacco sales; improved customer Bennett et al. (2003), Borfitz (2001), Krevor et al. (2003),
‘‘help request’’, and target receives praise, relations; better sales, better compliance by Lowndes and Dawes (2001), Moore (1984), Norris (2002),
reinforcement or corrective feedback pharmacists, better service from medical Saunders (2005), Steiner (1986), Sykes and O’Sullivan
personnel or prevention personnel (2006) (All TS)
Peer-to-peer tutoring Dyad or triad take turns asking questions, Improved academics, reduced ADHD/conduct Allsopp (1997), Delquadri et al. (1983), DuPaul et al. (1998),
give praise or points and corrective problems, and long-term effects on school Fantuzzo and Ginsburg-Block (1998), Greenwood (1991a,
feedback engagement decreased special education needs b), Maheady et al. (1988a, b), Sideridis et al. (1997) (Both
TS and RCT)
Computer action Motor response to hit target or get right Increased attention and reduced ADHD like Aase and Sagvolden (2006), Ford et al. (1993), Green and
game answer; visual/auditory feedback for symptoms, which is associated with release of Bavelier (2003), Koepp et al. (1998), Silva (1999) (TS, and
correct response, with scoreboard dopamine in the brain TS mixed with randomized conditions)
Correspondence Symbolic or live models typically Increased rates of targeted behaviors such as Anderson and Merrett (1997), Luciano et al. (2001), Luciano-
training, ‘‘Say-Do’’ represented with a language frame; others academic engagement, disturbing behavior or Soriano et al. (2000) (TS)
elicit what individual says will do and self-care behaviors
reinforcement follows
Correspondence Symbolic or live models typically presented. Increased rates of targeted behaviors such as Merrett and Merrett (1997), Morrison et al. (2002), Roca and
training, ‘‘Do-Say’’ Cues for behavior and reports by academics, self-care or other developmental/ Gross (1996) (TS)
individual to others followed by praise/ life skill tasks
reinforcement
Kernels decreasing frequency of behavior
Time out Using timer, remove from natural Decreases non-compliance, argumentative Fabiano et al. (2004), Kazdin (1980), Wolf et al. (1967) (TS)
reinforcement for 1 min ? 1 min for each behavior and mood outbursts
year of age
Sit and watch, Very brief removal from reinforcement Reduces disruptions in classroom, aggression on Embry (1982, 1984), Murphy et al. (1983), Porterfield et al.
contingent (2 min or less), with high-density playground or during physical education, (1976), White and Bailey (1990) (TS)
observation or reinforcement upon reentry for desired reduces dangerous behavior
response lock out behavior
123
8. Table 1 continued
Kernel example Description Behaviors affected Evidence and experimental designs
123
Taxes on Percent of purchase price of goods Increasing taxation on liquor or tobacco reduces Biglan et al. (2004) (TS)
consumptive (cigarettes, alcohol, luxury consumption
behaviors
Positive note home Adult sends home positive note for inhibition Reduces disruptive and aggressive behavior and Gupta et al. (1990), Hutton (1983), Kelley et al. (1988),
for inhibition that results in home reward problems at home; increases engagement at McCain and Kelley (1993), Taylor et al. (1984) (TS)
school
Timed rewards for Using fixed or variable interval, person Reduces ADHD symptoms, conduct problems, Conyers et al. (2003), Conyers et al. (2004), Hegel and
inhibition (DRO) receives praise and reward for not accidental attention to negative; increases Ferguson (2000) (TS)
engaging in a behavior engagement in prosocial activities
Premack principle The opportunity to engage in a high- Decreases ADHD like behavior, inattention, Agathon and Granjus (1976), Andrews (1970), Browder et al.
probability behavior is made contingent disruptive behavior, non-compliance (1984), Ghosh and Chattopadhyay (1993), Gonzalez and
engaging in a targeted behavior or on the Ribes (1975), Harrison and Schaeffer (1975), Homme et al.
inhibition of problematic behavior (1963), Hosie et al. (1974), Knapp (1976), Leclerc and
Thurston (2003), Mazur (1975), McMorrow et al. (1978),
Van Hevel and Hawkins (1974), Welsh et al. (1992),
Williamson (1984) (TS)
Response-cost Small symbolic reward removed or debited, Decreases inattention and disruption; decreases Conyers et al. (2004), Filcheck et al. (2004), Furr-Holden et al.
(point loss) non-emotionally, quickly following ADHD like behaviors; may if used as a part of (2004), Jason et al. (2005), Jorgensen and Pedersen (2005),
targeted behavior teams in first grade decrease substance abuse Kellam and Anthony (1998), Kelley and McCain (1995),
over lifetime McGoey and DuPaul (2000), Storr et al. (2002) (TS and
RCT with other embedded kernels)
Low emotion or Corrective feedback given without biological Reduces inattention, disruptions, aggression; Abramowitz et al. (1987, 1988), Acker and O’Leary (1987),
‘‘private’’ cues of threat or intense emotion; short reduces emotional responding by adults, Harris et al. (2003), Houghton et al. (1990), Maglieri et al.
reprimands rather than long reprimands are typically of including attention to negative behavior (2000), Merrett and Tang (1994), Ostrower and Ziv (1982),
more effective ones Pfiffner et al. (1985), Piazza et al. (1999), Rolider and Van
Houten (1984), Scholer et al. (2006), Van Houten et al.
(1982) (All TS)
Stop clock Clock triggered when students misbehave. Increased academic engagement and reduced Cowen et al. (1979) (TS)
Lower times on the clock result in access disruptions
to rewards
Law enforcement Fine or ticket given for relatively minor non- Reduces tobacco possession, illegal water use, Agras et al. (1980), de Waard and Rooijers (1994), Fletcher
fine or citation compliant behavior parking in handicap spots (1995), Jason et al. (2000, 2005), Jorgensen and Pedersen
(2005), Liberman et al. (1975) (TS and RCT)
Over-correction or Person repeats restorative or correct behavior Reduces symptoms of developmental delay; Carey and Bucher (1986), Foxx and Jones (1978), Lennox
positive practice many times reduces aggression or noncompliance; may et al. (1988), Maag et al. (1986), Singh (1987), Singh and
reduce accidental attention to negative behavior Singh (1988), Sisson et al. (1993), Sumner et al. (1974),
Watson (1993) (All TS)
Buzzer/noise A buzzer or noxious noise happens upon Reduces non seatbelt use, bedwetting, walking Ankjaer-Jensen and Sejr (1994), Collins (1973), Crisp et al.
training some undesired behavior through unauthorized door or driving on (1984), Hirasing and Reus (1991), Meadow (1977),
shoulder of road Robertson (1975), Robertson and Haddon (1974) (All TS)
Clin Child Fam Psychol Rev
9. Table 1 continued
Kernel example Description Behaviors affected Evidence and experimental designs
Kernels affecting behaviors primarily via antecedents
Non-verbal transition Visual, kinesthetic and/or auditory cues to Reduces dawdling, increases time on task or Abbott et al. (1998), Embry et al. (1996), Krantz and Risley
cues single shift attention or task in patterned engaged learning; gives more time for (1977), Rosenkoetter and Fowler (1986), (TS plus RCT with
way, with praise or occasional rewards instruction other embedded kernels)
Stop lights in school Traffic light signals when behavior is Decreases noise, off task behavior, or increases Cox et al. (2000), Jason and Liotta (1982), Jason et al. (1985),
settings or traffic appropriate/desirable or inappropriate/ stopping in dangerous intersections Lawshe (1940), Medland and Stachnik (1972), Van Houten
Clin Child Fam Psychol Rev
settings undesirable in real time, and connected to a and Malenfant (1992), Van Houten and Retting (2001),
kind of occasional reinforcement Wasserman (1977) (All TS)
Boundary cues and These may be lines or other cues such as Decreases dangerous behavior; decreases pushing Carlsson and Lundkvist (1992), Erkal and Safak (2006),
railings ropes or rails that signal where behavior is and shoving; increases waiting behavior in a Marshall et al. (2005), Nedas et al. (1982), Sorock (1988)
safe, acceptable or desired queue; reduces falls (All TS)
Cooperative, structured Planned activities during children playtime Decreases aggression/increases social Bay-Hinitz et al. (1994), Leff et al. (2004), Mikami et al.
peer play and involve rules, turn taking, social competence; affects BMI, reduces ADHD (2005), Murphy et al. (1983), Ridgway et al. (2003) (TS and
competencies, and cooperation with/ symptoms and increases academics after; RCT)
without ‘‘soft competition’’ reduces social rejection in M.S.
Self-modeling Drawn, photographic, or video model viewer/ Increases academic engagement; increases Barker and Jones (2006), Ben Shalom (2000), Bray and Kehle
listener engaging targeted behavior, attention; increases recall and long term (2001), Buggey (2005), Clare et al. (2000), Clark et al. (1992,
receiving rewards or recognition memory; improves behavior; reduces 1993), Clement (1986), Davis (1979), Dowrick (1999),
dangerous behavior; increases social Dowrick et al. (2006), Elegbeleye (1994), Hartley et al.
competence; improved sports performance; (1998, 2002), Hitchcock et al. (2004), Houlihan et al. (1995),
reduced health problems Kahn et al. (1990), Kehle et al. (2002), Law and Ste-Marie
(2005), Lonnecker et al. (1994), Meharg and Lipsker (1991),
Meharg and Woltersdorf (1990), Owusu-Bempah and Howitt
(1983, 1985), Possell et al. (1999), Ram and McCullagh
(2003), Reamer et al. (1998), Rickards-Schlichting et al.
(2004), Rickel and Fields (1983), Schunk and Hanson (1989),
Schwartz et al. (1997), Walker and Clement (1992), Wedel
and Fowler (1984), Woltersdorf (1992) (All TS)
Self-monitoring Coding target behavior with a relational Reductions in alcohol, tobacco use; reductions in Agran et al. (2005), Blick and Test (1987), Boyle and Hughes
frame, which is often charted or graphed illness symptoms from diabetes; increased (1994), Brown and Frank (1990), Buggey (1995, 1999),
for public or semi-public display, school achievement; changes in other social Burch et al. (1987), Carr and Punzo (1993), Cavalier et al.
occasioning verbal praise from others competencies or health behaviors; reductions in (1997), Clare et al. (2000), Clarke et al. (2001), Dalton et al.
ADHD, Tourettes and other DSM-IV disorder; (1999), de Haas-Warner (1991), Foxx and Axelroth (1983),
improvement in brain injured persons Glasgow et al. (1983a, b), Gray and Shelton (1992), Hall
and Zentall (2000), Harris et al. (2005), Hertz and
McLaughlin (1990), Hitchcock et al. (2004), Hughes et al.
(2002), Kern et al. (1994), Martella et al. (1993), Mathes
and Bender (1997), McCarl et al. (1991), McDougall and
Brady (1995), McLaughlin et al. (1985), Nakano (1990),
O’Reilly et al. (2002), Petscher and Bailey (2006), Possell
et al. (1999), Rock (2005), Selznick and Savage (2000),
Shabani et al. (2001), Shimabukuro et al. (1999), Stecker
et al. (1996), Thomas et al. (1971), Todd et al. (1999),
Trammel et al. (1994), Winn et al. (2004), Wood et al.
123
(1998, 2002) (TS & RCT, latter most from medical studies)
10. Table 1 continued
Kernel example Description Behaviors affected Evidence and experimental designs
123
Paragraph shrinking After hearing or seeing some content, person Improved reading responses and retention Bean and Steenwyk (1984), Mathes et al. (1994), Spencer
learns to ‘‘shrink’’ meaning to eight to ten et al. (2003) (TS)
words, full sentence; praise typically
happens for good summaries
Errorless discrimination Stimuli are faded or shaped in such a way Improved reading, letter recognition and life-task Akhtar et al. (2006), Egeland and Winer (1974), Etzel and
training that errors are nearly non-existent discriminations; reductions in symptoms of LeBlanc (1979), Fillingham et al. (2003), Hunkin et al.
mental retardation or brain injury (1998), Keel and Gast (1992), Lambert (1979), Melchiori
et al. (1992), Plummer et al. (1977), Schilmoeller et al.
(1979), Stawar (1978), Terrace (1969), Walsh and Lamberts
(1979) (TS)
Kernels affecting behaviors primarily via relational frames
Adjectival noun for Verbal phrase ‘‘I am/we _____’’ is paired Increased rule governed behavior; increases Choenarom et al. (2005), Embry et al. (1996), Gaskell and
belonging to status with status, belonging, protection or safety behavior associated with the named group; Smith (1986), Juarez (2002), Mishima (2003) (RCT)
group decreases aggression within group; may affect
physical health
Public commitment Individuals sign or pledge self to collective Voting, contributing money, recycling Burgess et al. (2000), Chen and Komorita (1994), Wang and
behavior Katzev (1990)
‘‘US’’ and ‘‘THEM’’ Individuals or groups divided into two Increase aggression and violence by each group Roos (2005), Sherif (1958, 1968, 1970), Sherif, Hogg and
role framing groups, with differences framed by toward each other Abrams (2001), Sherif et al. (1955) (RCT)
clothing, adornment, language, social
position, etc.
Graphic/node maps A graphic organizer for goal-based behavior, Increased sobriety and goal completion; increased Collier et al. (2001), Czuchry and Dansereau (1996, 1999,
guided by other status individuals treatment compliance 2003), Czuchry et al. (1995), Dansereau et al. (1993, 1995),
Dees et al. (1994), Joe et al. (1994, 1997), Melville et al.
(2004), Newbern et al. (1999, 2005), Pitre et al. (1996,
1997, 1998) (RCT)
MI Oral or written questions by status individual Reduced substance abuse, increased social Cohen et al. (2006), Bernstein et al. (2005), Burke et al.
(or on paper) around major goals of target competence & related goals; reduced injuries or (2003), Monti et al. (1999), Resnicow et al. (2001), Rusch
person with clarifying questions about antisocial behavior; increase in healthy and Corrigan (2002), Smith (2004), Sobell et al. (2003),
interfering behavior behaviors, increase achievement Stein et al. (2006) (RCT)
Media associating Media (TV, video, radio) showing behavior Reduces sexually transmitted diseases; reduces Beyth-Marom et al. (1993), Downs et al. (2004), Pechmann
behavior with results in social rejection or escape from alcohol, tobacco and other drug use (2001), Pechmann and Ratneshwar (1994), Pechmann et al.
immediate negative social rejection (2003) (RCT)
social outcomes
Kernels affecting behaviors primarily via physiology
Pleasant greeting with Friendly physical and verbal gestures, on a Affects donations; social status an perceptions of Edwards and Johnston (1977), Ferguson (1976), Field (1999),
or without positive frequent basis safety or harm; affects behavior streams of Fry (1987), Howard (1990), La Greca and Santogrossi
physical touch aggression, hostility or politeness (1980), Schloss et al. (1984) (TS)
Massage, brushing or Any method of rubbing, stroking and Reduces aggression, arousal, cortisol, depressive Diego et al. (2002), Field et al. (1996a, b, c, d), Field (1998),
stroking therapeutic touch applied to the body symptoms, PTSD symptoms, and pain Jones et al. (1998), Scafidi and Field (1996) (RCT)
Clin Child Fam Psychol Rev
11. Table 1 continued
Kernel example Description Behaviors affected Evidence and experimental designs
Turtle technique Using a turtle metaphor, child holds self, Reduces arousal and aggression against peers or Heffner et al. (2003), Robin et al. (1976) (TS plus embedded in
verbal frame, breaths through nose, and adults RCT with other kernels)
engage in sub-verbal or verbal self-
coaching, with peer or adult reinforcement
Omega-3 fatty acid 1–3 g taken orally per day; or fish Reduces aggression, violence, depression, bipolar Fava (2001), Freeman et al. (2006), Gesch et al. (2002),
supplementation or consumption several times per week high disorder, post-partum depression and borderline Hibbeln et al. (2006), Jarvinen et al. (2006), Mickleborough
Clin Child Fam Psychol Rev
increased fish in omega-3 personality disorder; early evidence for et al. (2006), Richardson (2006), Stoll et al. (2000), Vaddadi
consumption reducing symptoms of developmental (2006), Zanarini and Frankenburg (2003) (RCT)
disorders; and for reducing CVD and asthma
Zinc supplementation or 15 mg/day eaten or supplemented Evolving evidence finds the addition of zinc to the Akhondzadeh et al. (2004), Arnold et al. (2005), Arnold and
dietary consumption diet or by supplementation to increase the DiSilvestro (2005), Bilici et al. (2004), McGee et al. (1990),
effectiveness of drug treatment and/or may Sandyk (1990) (RCT)
prevent ADHD symptoms
‘‘Rough and tumble’’ Several times per week child or adolescent Reduces aggression, teaches self-control, may Boulton and Smith (1989), Gordon et al. (2002), Hines and
free play with higher engages in rough and tumble play, causing improve status among same-sex peers; changes Kaufman (1994), Jacklin et al. (1984), Paquette (2004),
status conspecific increased arousal and self-control c-fos gene expression in lab animals; the Pellegrini and Smith (1998), Reed and Brown (2001), Scott
mediated by status adult or peer behavior may be especially important to the and Panksepp (2003) (RCT, TS and ethology studies)
development of positive behavior among boys
and unique contribution of fathering
Aerobic play or Daily or many times per week child or adult Reduces ADHD symptoms, reduces depression; Antunes et al. (2005), Atlantis et al. (2004), Berlin et al.
behavior engage running or similar aerobic solitary reduces stress hormones; may increase (2006), Blue (1979), Blumenthal et al. (2005), Crews et al.
activities, game, or food gathering cognitive function; decreases PTSD (2004), Doyne et al. (1983), Dunn et al. (2001, 2005),
behavior Dustman et al. (1984), Khatri et al. (2001), Kubesch et al.
(2003), Manger and Motta (2005), Marin and Menza (2005),
Phillips et al. (2003), Stein (2005), Stella et al. (2005) (TS
and RCT)
Nasal breathing When aroused, person breaths through nose, Reduces panic, anxiety and hostility; may Backon (1990), Block et al. (1989) (RCT)
not mouth improve cognitive function; changes core temp
of limbic area
Progressive muscle Person tenses and relaxes sequence of Reduces panic, fear, anxiety; decreases negative Larsson et al. (2005), Norlander et al. (2005), Pawlow and
relaxation muscles combined with anxiety evoking attributions; decreases phobic responses with Jones (2005), Wencai et al. (2005) (RCT)
stimulus paired with evoking stimuli
TS, time-series; RCT, randomized control trial
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12. Clin Child Fam Psychol Rev
each of the following, we describe the empirical evidence feedback about the rate of a targeted behavior. Each delivers
in detail for one kernel. positive consequences contingent on a behavior. In the case
of public posting of feedback, it is necessary that the recip-
Designating Example Kernels for This Paper ients of the post in some sense want to increase the behavior
recorded in the postings. An example of a powerful yet
The 52 kernels presented in Table 1 are not exhaustive; they simple reinforcement kernel involves writing positive notes
are simply examples that meet the definition of a kernel to increase behavior. Written praise notes from a supervisor
from the four types. That is, the kernel has one or more peer- increase work performance (Nordstrom et al. 1988), notes
reviewed experimental studies showing behavior change. written by a teacher to students increase academic success
We are aware of many more kernels; the more kernels we (Hickey et al. 1979), and notes from students to each other
identified, the more we found others. Because of the year- increase social competence (Skinner et al. 2000).
long process that gave rise to the need for and idea We also put special play with parents in this category. It
denominating the active ingredients of evidence-based involves adults letting the child lead in free play activities
prevention and a book about the science of preventing (Webster-Stratton and Reid 2007). Its purpose is to facili-
problems of adolescence (Biglan et al. 2004), many of the tate interactions in which parents do not command,
52 kernels were evident to us at first blush because of our criticize, or unduly restrict activities of the child and allow
own published studies and that of our colleagues on par- the child to engage in fantasy play with the parent. Such
enting, violence prevention, substance abuse prevention, interactions presumably are reinforcing for parent and
etc.; others we chose deliberately to illustrate the potential child; the child receives the undivided attention of the
theoretical diversity of kernels—an interesting point in parent contingent on cooperative play, and the parent
itself, exemplified by reactions to early drafts of the paper. experiences cooperative and pleasant interactions with the
Some early readers were delighted to see the inclusion of child contingent on listening to the child and following the
examples from behavior analysis, yet chaffed at the physi- child’s lead.
ological kernels such as omega-3 and massage—despite the
scientific evidence available for each. Others objected to Decrease Behavior by Altering Consequences
behavioral procedures, arguing that behavioral procedures
were proven to be ineffective—despite studies showing Other procedures alter consequences in order to decrease
otherwise. We are aware that any given professional com- the frequency or probability of a behavior. Some involve
munity might disagree with the theoretical approach of ensuring an undesirable behavior does not elicit rein-
another professional group, yet a taxonomy of kernels forcement. Timeout is one such procedure. Rewarding
begins to elucidate how, where, when, for whom, and for behavior incompatible with the undesirable behavior is
what scientifically proven strategies might be more or less another.
beneficial in influencing human behavior. We imagine that A third set (ostensibly designed to decelerate behavior
a database of kernels will emerge, much like the human rates) involves delivering aversive consequences for a
genome project (i.e., http://genomics.energy.gov/) wherein certain behavior—traditionally termed punishment. How-
the breadth, depth, magnitude, and replications of the ever, many so-called punishments (e.g., lengthy grounding,
effects of any given kernel might be reported by the inter- mandatory minimum sentences) have no beneficial effect
national research community in order to build an open- and, in fact, cause harm (Sampson and Laub 1994). Indeed,
source molecular technology of behavioral influence. The a major challenge for many parenting programs is getting
arbitrary selection of the 52 kernels in this paper illustrates parents to be less punitive. Thus, in developing procedures
the possibility of a rich ‘‘behaviornome’’ type project for to make aversive consequences contingent upon behavior,
fundamental units of behavioral influence. Subsequent we must evaluate them carefully to ensure they are effec-
paragraphs detail examples of four types of kernels for tive and have few side effects.
influencing behavior from Table 1, as a proof of concept Fining is an example of a negative consequence
from 52 experimentally demonstrated kernels. affecting behavior. Agras et al. (1980) found that receiving
a fine reduced individual, but not business, water wastage.
Kernels Altering Consequences for Behavior Fletcher (1995) found that fines for parking in disabled-
reserved spaces notably decreased the behavior.
Increasing Rate or Probability of Behavior
Kernels Altering Behavior Through Antecedents
Many kernels increase behavior by mobilizing reinforce-
ment for the targeted behavior. These include vocal praise, Many kernels work by establishing the functions of ante-
written praise notes, prize bowls, and public posting of cedents to behavior. A common example in schools is
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13. Clin Child Fam Psychol Rev
teachers establishing signals to guide transitions (Marion an object. After multiple experiences of this sort, however,
and Muza 1998; Rosenkoetter and Fowler 1986; West et al. a child also learns that if an object has a name, the name
1995). For example, many teachers turn lights off and on to also goes with the object. In other words, they become able
signal students to return to their seats and become quiet and to derive the mutual entailment of name to object and
attentive. Of course, positive consequences (e.g., praise) object to name. Further experiences like this enable chil-
are involved in establishing effectiveness of the stimulus, dren to derive relations that are more complex. For
but once established, the salient feature is the influence of example, learning that a puppy is a kind of dog and that
the light on the behavior. Buddy is a puppy, a child is able to derive that Buddy is a
Assigning students meaningful roles (Rutter 1981), dog. We call this ability to derive relations between two
such as setting up equipment for an assembly, taking roll, stimuli based on their relations with a third stimulus
or taking photographs for communicating desirable school combinatorial entailment.
functions, are activities that organize useful behavior. The third defining feature of relational responding is the
Antecedents may also include organized playground transformation of function. Humans’ derivation of relations
activities to reduce aggressive behavior and occasion among stimuli can transform the functions of stimuli that
various social competencies (Murphy et al. 1983). Rein- participate in the relation. For example, discovering that
forcement follows naturally from the enactment of the one coin is worth more than another makes the coin more
role. reinforcing. Learning that water has bacilli in it may have
It would be arbitrary to classify antecedent interventions no impact on a child, but upon learning that bacilli are
based upon whether they increase or decrease behavior. germs, and that germs can you make you sick, a child’s
This is because antecedents that prompt a desired behavior reaction to the water changes.
simultaneously make troublesome behavior less likely. A fourth defining feature of relational responding is
arbitrary applicability. Many of the relations we learn arise
Kernels Altering Behavior by Influencing Relational from physical relations among stimuli. For example,
Responding smaller than and larger than are terms based on the relative
size of objects. However, humans become able to relate
Tradition within psychology suggests it is unfeasible to stimuli in these terms even though the stimuli do not have
deal with cognitive and emotional influences on behavior physical features involving relative size. If you hear that
within a basic behavioral framework of antecedents and one person has a bigger heart than another person does, you
consequences. However, recent work on relational frame may expect that person to be kinder, even though you
theory (Hayes et al. 2001) has shown that human cognitive understand that his heart is not literally larger.
and verbal behavior can be understood in terms of basic For theorists accustomed to the panoply of existing
operant processes, while honoring that humans do appear cognitive constructs, which admittedly do a good job of
to have unique evolutionarily selected brain structures predicting much human behavior, the value of this analysis
supporting language. To the extent this is true, it provides a may be obscure. Its value lies in providing a direct analysis
parsimonious account of complex human functioning of the specific procedures that influence relational
within a contextualist framework focusing on manipulable responding and thereby transform the functions of stimuli.
influences on behavior (Biglan and Hayes 1996).
Increasing Behavior by Altering Relational Responding
Research on Relational Responding
Perhaps the simplest and most important procedures of this
There is growing evidence that a fundamental feature of type are those that augment the value of stimuli by influ-
human cognitive or verbal processes is the relating of encing people to relate them to stimuli they already value.
stimuli (Barnes et al. 2000). Because this analysis is a If we tell children they can stay up a half hour more if they
recent development and likely to be unfamiliar to most get five stickers, we change their valuing of the stickers. In
readers, we will elaborate on it here. Barnes et al. (2000) essence, any procedures influencing people to relate a
present a theoretical analysis of relational responding. stimulus with stimuli they already value make that stimulus
According to them, relating stimuli is the core feature of more reinforcing. Prevention and treatment scientists,
verbal behavior. Perhaps the most rudimentary relational unlike marketing professionals, are often unfamiliar with
responding involves naming. At the beginning of learning relational responding.
language, young children learn to say names for objects One example of relational responding involves branding
and separately learn to orient to objects when they hear to influence behavior (Fischer et al. 1991). A recent study
their names. Each response is operant behavior reinforced shows that children preferred foods ‘‘branded’’ as
by consequences such as attention, praise, and gaining of McDonald’s (logos, wrapping papers, etc.), even for
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carrots, which McDonald’s does not sell (Robinson et al. Decreasing Behavior by Altering Relational Responding
2007). Another example of branding is the introduction to
the PeaceBuilders program (Embry et al. 1996). It used Some behavior–influence procedures discourage behavior
kernels like peer-to-peer praise/tootle notes and positive by prompting a person to relate the behavior to aversive
notes home to establish the word PeaceBuilder as a valued stimuli. In general, any procedure that prompts a person to
concept and to make being a PeaceBuilder—and all relate undesirable behavior to negatively valenced stimuli
behaviors later related to this concept—more reinforcing. would qualify as such a procedure—provided there was
The program improved social competence and reduced experimental evidence of its effect. For example, media
aggression and injuries due to violence (Flannery et al. associating drug use with negative outcomes have some-
2003; Krug et al. 1997). Biglan and colleagues recently times been shown to reduce drug use (Palmgreen et al.
completed a study showing that pairing fun social activities 1995). Messages suggesting that youth’s peers will reject
for middle-schoolers with a non-smoking brand (f2b—for them for smoking affects their motivation to use tobacco
Freedom to Breathe) reduced smoking among students (Pechmann and Knight 2002; Pechmann et al. 2003).
even when the program had little overt antitobacco content
(Gordon et al. 2008). Kernels Altering Behavior Through Physiological
Another example of a kernel using relational responding Interventions
involves public commitment. When people publicly com-
mit to engage in a behavior, they are more likely to follow Finally, some procedures primarily affect physiological
through on the behavior (e.g., Burn and Oskamp 1986). behavior. For centuries, humans have altered their health
The public oath makes behavior inconsistent with that and mood by manipulating physiological states. Anthro-
pledge aversive due to expected disapproval for failing to pological and archeological literatures are replete with
follow through with the promise. examples (Lalramnghinglova 1999; Rajan et al. 2002;
In self-modeling, the professional helps to create a story Rodrigues 2006; Spindler 1995). Hunters and gatherers
about a person’s behavior (Hosford 1980); the person typi- often consume plants with stimulant properties, apparently
cally participates in the process. The story embeds a person’s since they confer an advantage during tasks such as hunt-
self in a set of relations with desired behaviors and attributes ing, which requires sustained effort and attention. Modern
(e.g., depicting a child as a hero at school or home for helping humans have similar reasons for using caffeine.
bring about peaceful behaviors; Embry et al. 1996). A child The impact of omega-3 fatty acid is a particularly
might learn a series of self-help skills through photographs or important example of a physiological kernel (Olafsdottir
video (Hartley et al. 1998), making the child more apt to et al. 2005). We use this example because of its exemplary
relate engaging in the behavior with valued ideas, such as laboratory, epidemiological, and randomized control stud-
being a ‘‘PeaceBuilder’’ (Embry et al. 1996). ies across many domains of prevention, intervention, and
Motivational interviewing (MI) is a powerful example of treatment. Aside from epidemiological research on the
relational responding. MI may seem complex, yet we believe relationships of omega-3 fatty acid (n-3) to a wide variety
that subdividing it would destroy its effects. In MI, the of causes of morbidity and mortality (Hibbeln 2001),
interviewer prompts a person to discuss a topic he or she experimental and quasi-experimental studies find supple-
generally avoids (e.g., one’s drinking patterns and difficul- mentation of omega-3 reduces violent aggression among
ties associated with them; Bernstein et al. 2005; men (Gesch et al. 2002). Its use also reduces depression or
McCambridge and Strang 2004; Miller et al. 1988). The bipolar disorder (Mischoulon and Fava 2000; Stoll et al.
interviewer is warm and accepting as the person talks but 1999; Sund et al. 2003) and other health or public health
asks questions designed to put the person in psychological concerns, such as low birth weight and offspring IQ
contact with negative consequences of his/her behavior and (Helland et al. 2003). Although not yet proven, omega-3
the possible benefits of changing the behavior. It is clear this may even alleviate some of the problems associated with
process has reinforcing and antecedent features, but the most poverty, since poorer people have diets lower in omega-3
salient aspect of the process seems to be that it alters the way (Egeland et al. 2001; Liu et al. 2004).
people relate their problematic behavior to negative conse- Another intervention affecting behavior through direct
quences and the possible alternatives to more reinforcing impact on physiology is deep breathing, shown to reduce
consequences. In other words, MI changes people’s net- anxiety, arousal, and aggression among all ages (Appels
works of relations in ways that make some behaviors more, et al. 1997; DiFilippo and Overholser 1999; Peck et al.
and others less, desirable. Although most treatment profes- 2005; Sharma et al. 2005; Suzuki et al. 2000). Zinc sup-
sionals are familiar with complex forms of MI, very brief, plementation may reduce or moderate ADHD symptoms
scientifically validated forms do exist (McCambridge and (Arnold et al. 2005; Bilici et al. 2004). We include a
Strang 2004)—including just 15 min (Cohen et al. 2006). variety of strategies that enhance self-regulation in aroused
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states such as ‘‘rough and tumble’’ play and related martial conducted clinical studies using interrupted time series
arts training for children, as studies have shown it to reduce (Henderson et al. 1986; Leibowitz 1975; Libb et al. 1973;
children’s aggressive behavior (Bjorklund and Brown Madaus et al. 2003; Moore et al. 1994; Robinson and
1998; Paquette 2004; Pellegrini 1992; Shannon et al. 2002) Sheridan 2000; Snell and Cole 1976) and formal RCTs
and the mechanism appears to involve alteration of brain (Petry et al. 2004, 2005).
chemistry (Panksepp et al. 2003; Siviy et al. 1996; Taylor Physiological kernels have a similar scientific trajectory.
et al. 1986). The martial arts studies with children show For example, the understanding of omega-3 (n-3) has roots
improved self-regulation, less aggression, and positive in early epidemiological or forensic inquiries showing
mood along with decreased impulsiveness (Lakes and Hoyt differences among individuals with diseases or disorders
2004; Palermo et al. 2006; Twemlow and Sacco 1998; (Anderson and Connor 1989; Gudbjarnason et al. 1991;
Zivin et al. 2001), though student self-report may show less Lieber et al. 1969; Rudin 1981). Initial epidemiological
change than classroom teacher reports (McDiarmid 2008). findings (Hibbeln 1998, 2001, 2002) prompted precision-
The distinction between biological and environmental oriented laboratory studies (Hibbeln et al. 1998; Hibbeln
interventions is not certain. Of course, any environmental and Salem 1995) and larger epidemiological inquiries. All
manipulation may influence biological functioning. Below this work led to clinical trials evaluating omega-3 supple-
we discuss interventions that directly manipulate biological mentation (Nemets et al. 2002; Sund et al. 2003; Zanarini
processes instead of changing psychological or behavioral and Frankenburg 2003).
functioning. The frequent use of interrupted time-series designs in
Although many pharmacological agents alter behavior developing kernels deserves further comment. It reflects not
and meet our definition of a kernel, the substantial litera- simply an arbitrary methodological preference but an
ture on these influences is beyond the scope of this paper. incremental, inductive, bottom-up strategy to build effective
Moreover, unlike nutritional supplements and nasal behavior–influence practices. Kernels are of necessity sim-
breathing, FDA-approved pharmacological agents require ple steps targeting a behavior one can easily measure
prescriptions; thus, they would not be available to most repeatedly; it is thus easy to implement interrupted time-
prevention practitioners or consumers directly. series designs. Single-subject studies are quite robust in
Prevention scientists, oriented toward the implementa- terms of reducing threats to validity (Sidman 1960) and in
tion of programs, may overlook physiological interventions. answering questions of whether a particular medication,
Publications about these kernels are not in journals devoted procedure, or process is efficacious in changing the behavior
to behavioral science but more likely to appear in medical, of a person or small group of persons (e.g., families, class-
public health, or specialty journals. However, the evidence rooms, and organizations; Dadds et al. 1984; Greenwood
for them suggests that treatment and prevention scientists and Matyas 1990; Mayer et al. 1983; McGrath et al. 1987;
should pay greater attention to the reciprocal relationships Reagles and O’Neill 1977). Such interrupted time-series
between physiology and behaviors. designs are not limited to evaluating individuals but are often
the choice for evaluating policy impact on large, important
Types of Experimental Evidence Supporting Kernels social issues (Briscoe et al. 1975; Hayes and Cone 1977;
Wagenaar et al. 1988). One may summarize interrupted
We define kernels as procedures shown empirically to time-series designs effectively via effect sizes and meta-
affect a behavior. In keeping with the Society for Preven- analyses (Campbell 2004; Stage and Quiroz 1997).
tion Research Standards of Evidence (Flay et al. 2004), our An important limitation on current understanding of
criteria for empirical support include RCTs and interrupted kernels is that we have relatively little information about
time-series designs in which a procedure’s impact is situations in which they will be effective and those in
evaluated on a repeated measure of target behavior. Most which they will not be effective. Further research should
evaluations of kernels have been via interrupted time-series explore the range of situations in which given kernels work
designs, while some, such as omega-3 impact, have been in and seek to develop a theory of the relationship between
randomized trials. Some have undergone evaluation both situations and the efficacy of kernels.
ways. Some studies measured generalizability of results
across time, behaviors, people, or places; others measured
only proximal or immediate effects. The Utility of Kernels
Many kernels result from interplay between basic and
applied research. Variable interval or ratio contingency Disseminating Effective Behavior–influence Practices
management kernels (e.g., Mystery Motivator, Prize Bowl)
have roots in animal (Ferster and Skinner 1957) then human If our ultimate public health goal is to minimize the
(Majovski and Clement 1977) research. Researchers next prevalence of behavioral and psychological problems and
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