Keynote talk: Vermont Assn. for Mental Health and Friends of Recovery Annual Conference
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Transcript of Keynote talk: Vermont Assn. for Mental Health and Friends of Recovery Annual Conference
Preventing Mental, Emotional and Behavioral Disorders
Vermont Association for Mental Health and Friends of Recovery Vermont 73rd Annual Conference • Montpelier, Vermont • October 27, 2011
by Dennis D. Embry, Ph.D.
Sunday, October 30, 11
Sunday, October 30, 11
Key messages…
Sunday, October 30, 11
Key messages…
MEB’s are preventable.
Sunday, October 30, 11
Key messages…
MEB’s are preventable.
Break-even for MEB
prevention is 1-2 years.
Sunday, October 30, 11
Key messages…
MEB’s are preventable.
Break-even for MEB
prevention is 1-2 years.
MEB prevention
balances gov’t budgets.
Sunday, October 30, 11
Key messages…
MEB’s are preventable.
Break-even for MEB
prevention is 1-2 years.
MEB prevention
improves US business.
MEB prevention
balances gov’t budgets.
Sunday, October 30, 11
Key messages…
MEB’s are preventable.
Break-even for MEB
prevention is 1-2 years.
MEB prevention
improves US business.
Effective MEB prevention
helps national security.
MEB prevention
balances gov’t budgets.
Sunday, October 30, 11
Key messages…
MEB’s are preventable.
Break-even for MEB
prevention is 1-2 years.
MEB prevention
improves US business.
Effective MEB prevention
helps national security.
MEB prevention
helps US global success.
MEB prevention
balances gov’t budgets.
Sunday, October 30, 11
Key messages…
MEB’s are preventable.
Break-even for MEB
prevention is 1-2 years.
MEB prevention
improves US business.
Effective MEB prevention
helps national security.
MEB prevention
helps US global success.
MEB prevention
balances gov’t budgets.
MEB prevention saves Social Security & Medicare.
Sunday, October 30, 11
Key messages…
MEB’s are preventable.
Break-even for MEB
prevention is 1-2 years.
MEB prevention
improves US business.
Effective MEB prevention
helps national security.
MEB prevention
helps US global success.
MEB prevention
balances gov’t budgets.
MEB prevention saves Social Security & Medicare.
MEB prevention heals past inequities.
Sunday, October 30, 11
January 8, 2011The Shootings in Tucson
Sunday, October 30, 11
Sunday, October 30, 11
Sunday, October 30, 11
What will we pack in our Vermont’s young people’s suitcases for
their whole lives?
Sunday, October 30, 11
What bricks—heavy objects of pain, injury, illness, or problems—do you NOT want in young people’s suitcases for life?
Sunday, October 30, 11
Ask the suitcase questions of 30 people: some republicans, some democrats, some independents and some who are apolitical.
Sunday, October 30, 11
What do you want to happen and not happen for our elders?
Sunday, October 30, 11
Bi-directional Wealth and Wellbeing Transfer
5-Year Olds
65-Year Olds
Sunday, October 30, 11
Bi-directional Wealth and Wellbeing Transfer
5-Year Olds
65-Year Olds
Who are livinglonger though get
progressively sicker…
Sunday, October 30, 11
Bi-directional Wealth and Wellbeing Transfer
5-Year Olds
65-Year Olds
Who are livinglonger though get
progressively sicker…
Requiring more wealth transfer
Sunday, October 30, 11
Bi-directional Wealth and Wellbeing Transfer
5-Year Olds
65-Year Olds
Who are lessand less able…
Who are livinglonger though get
progressively sicker…
Requiring more wealth transfer
Sunday, October 30, 11
Bi-directional Wealth and Wellbeing Transfer
5-Year Olds
65-Year Olds
Who are lessand less able…
Who are livinglonger though get
progressively sicker…
Requiring more wealth transfer
But elders voting to stop funds to kids
Sunday, October 30, 11
Sunday, October 30, 11
Our Own Children’s or Loved-ones’ Futures
Sunday, October 30, 11
depression
bipolar
drugs tobaccoalcohol
ADHD
aggression
learning disabilities
stealing
suicide
depression
crime
violence
dangerous acts
asthmaobesity cancer
heart-disease
diabetes
hi-blood pressure
Our Own Children’s and Loved-ones’ Futures
Sunday, October 30, 11
Sunday, October 30, 11
Lifetime Prevalence of Disorders in US Adolescents (N=10,123) 40%
35%
30%
25%
20%
15%
10%
5%
0%4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Age in Years
Merikangas et al., 2010
Sunday, October 30, 11
Lifetime Prevalence of Disorders in US Adolescents (N=10,123) 40%
35%
30%
25%
20%
15%
10%
5%
0%4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Age in Years
Anxiety
Merikangas et al., 2010
Sunday, October 30, 11
Lifetime Prevalence of Disorders in US Adolescents (N=10,123) 40%
35%
30%
25%
20%
15%
10%
5%
0%4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Age in Years
Anxiety
Behavior
Merikangas et al., 2010
Sunday, October 30, 11
Lifetime Prevalence of Disorders in US Adolescents (N=10,123) 40%
35%
30%
25%
20%
15%
10%
5%
0%4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Age in Years
Anxiety
BehaviorMood
Merikangas et al., 2010
Sunday, October 30, 11
Lifetime Prevalence of Disorders in US Adolescents (N=10,123) 40%
35%
30%
25%
20%
15%
10%
5%
0%4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Age in Years
Anxiety
SubstanceBehaviorMood
Merikangas et al., 2010
Sunday, October 30, 11
Youth MEB Prevalence Rate Comparison
USA United Kingdom OECD
4x2x
Sunday, October 30, 11
Depression by Jobs
Sunday, October 30, 11
Nearly 3 out of 4 of the nation's 17- to 24-year-olds are ineligible for military service for based on national epidemiological data
• Medical/physical problems, 35 percent.
• Illegal drug use, 18 percent.
• Mental Category V (the lowest 10 percent of the population), 9 percent.
• Too many dependents under age 18, 6 percent.
• Criminal record, 5 percent.
Army Times, Nov 5, 2009 • www.missionreadiness.org/PAEE0609.pd
Sunday, October 30, 11
Cumulative prevalence of psychiatric disorders by young adulthood: a prospective cohort analysis from the Great Smoky Mountains Study.By 21 years of age, 61.1% of participants had met criteria for a well-specified psychiatric disorder. An additional 21.4% had met criteria for a not otherwise specified disorder only, increasing the total cumulative prevalence for any disorder to 82.5%.
Sunday, October 30, 11
The US has 75 million children and teens.
40.4 million are on psychotropic medications
Wall Street Journal,
12-28-2010
Sunday, October 30, 11
CEPR An International Comparison of Small Business Employment 8
FIGURE 3 Manufacturing, Employment in Enterprises with fewer than 500 Employees, 2001
Source: Authors’ analysis of OECD data.
Key message about global competition
Many of these other rich democracies have nearly universal
access to prevention for MEBs, compared to the rationing model in
the US.
Having “fitter” employees allows these countries to have higher paying manufacturing jobs and
compete globally.
Sunday, October 30, 11
PhysiologicalReinforcement Antecedents Verbal Relations
Major Ecologic Causes of the Trends to Children, Youth and Adults
Sunday, October 30, 11
Multi-Inflammatory Brain & Body Response
PhysiologicalReinforcement Antecedents Verbal Relations
Major Ecologic Causes of the Trends to Children, Youth and Adults
Sunday, October 30, 11
MoodStability Attention Reward
DelayExecutiveFunction
BehavioralCompetencies
MotorSkills
Immune-Healing
FunctionsMulti-Inflammatory Brain & Body Response
PhysiologicalReinforcement Antecedents Verbal Relations
Major Ecologic Causes of the Trends to Children, Youth and Adults
Sunday, October 30, 11
MoodStability Attention Reward
DelayExecutiveFunction
BehavioralCompetencies
MotorSkills
Immune-Healing
FunctionsMulti-Inflammatory Brain & Body Response
PhysiologicalReinforcement Antecedents Verbal Relations
Major Ecologic Causes of the Trends to Children, Youth and Adults
Mental Illness SubstanceAbuse Violence Work
ProblemsObesity,
etc CancerEarlySex
SchoolFailure
STD’s SpecialEd
Sunday, October 30, 11
Essential Brain Nutrient Deficiencies
Essential Movement Deficiencies
Essential Reinforcement
Deficiencies
Essential Behavioral
Deficiencies
All Our Futures in Vermont’s Children, Youth, and Adults Being Affected by…
Sunday, October 30, 11
Essential Brain Nutrient Deficiencies
Essential Movement Deficiencies
Essential Reinforcement
Deficiencies
Essential Behavioral
Deficiencies
Impacted By…
All Our Futures in Vermont’s Children, Youth, and Adults Being Affected by…
Sunday, October 30, 11
Essential Brain Nutrient Deficiencies
Essential Movement Deficiencies
Essential Reinforcement
Deficiencies
Essential Behavioral
Deficiencies
Impacted By…
CulturalToxins
All Our Futures in Vermont’s Children, Youth, and Adults Being Affected by…
Sunday, October 30, 11
Essential Brain Nutrient Deficiencies
Essential Movement Deficiencies
Essential Reinforcement
Deficiencies
Essential Behavioral
Deficiencies
PhysicalToxins
Impacted By…
CulturalToxins
All Our Futures in Vermont’s Children, Youth, and Adults Being Affected by…
Sunday, October 30, 11
Essential Brain Nutrient Deficiencies
Essential Movement Deficiencies
Essential Reinforcement
Deficiencies
Essential Behavioral
Deficiencies
PhysicalToxins
PolicyToxins
Impacted By…
CulturalToxins
All Our Futures in Vermont’s Children, Youth, and Adults Being Affected by…
Sunday, October 30, 11
Essential Brain Nutrient Deficiencies
Essential Movement Deficiencies
Essential Reinforcement
Deficiencies
Essential Behavioral
Deficiencies
PhysicalToxins
PolicyToxins
BiologicalToxins
Impacted By…
CulturalToxins
All Our Futures in Vermont’s Children, Youth, and Adults Being Affected by…
Sunday, October 30, 11
Essential Brain Nutrient Deficiencies
Essential Movement Deficiencies
Essential Reinforcement
Deficiencies
Essential Behavioral
Deficiencies
Based on Fundamental Evolutionary “Mis-Match” of Mechanisms of Human Evolution
PhysicalToxins
PolicyToxins
BiologicalToxins
Impacted By…
CulturalToxins
All Our Futures in Vermont’s Children, Youth, and Adults Being Affected by…
Sunday, October 30, 11
Evolutionary MismatchChanges in modern human ecology for which were were evolved and adapted now affecting…
SleepEatingMental healthProblem behaviorsPhysical HealthSexual maturity
Sunday, October 30, 11
If we just hit the problem harder…
Sunday, October 30, 11
Sunday, October 30, 11
Sunday, October 30, 11
Sunday, October 30, 11
Sunday, October 30, 11
Reduce Omega 3 Brain Deficiency
Sunday, October 30, 11
0
0.25
0.50
0.75
1.00
Before supplementation During supplementation
Ratio
of D
isci
plin
ary
Inci
dent
s Su
pple
men
tatio
n/Ba
selin
e
ActivePlacebo
Reduced Felony Violent Offences Among Prisoners with recommended daily amounts of vitamins, minerals and essen=al fa>y acids
UK maximum security prison -‐ 338 offences among 172 prisoners over 9 months treatment in a compared to 9 months baseline.
Gesch et al. Br J Psychiatry 2002, 181:22-‐28
Ac=ve -‐37.0% p ‹ 0.005
Placebo -‐10.1% p = ns
Sunday, October 30, 11
Why not reproduce the rapid results in Vermont to get a 37% reduction in jail violence?
It cost the Brits 19¢ per day or $69.35 per year.
Sunday, October 30, 11
0
Time to First Suicide A1empt (days)
0
200 400 600 800
Survival Probability
0.2
0.4
0.6
0.8
1.0
High DHA (n=16)
Low DHA (n=17)
(median split of plasma phospholipid % fa1y acids)
InpatientDischarge
Suble>e, Hibbeln et al Am J Psychiatry 2006;163: 1100-‐1102
Sunday, October 30, 11
Omega-3 Status and US Military Suicide Deaths
e1J Clin Psychiatry
Suicide Deaths of Active-Duty US Military and Omega-3 Fatty-Acid Status: A Case-Control ComparisonMichael D. Lewis, MD; Joseph R. Hibbeln, MD; Jeremiah E. Johnson, RD; Yu Hong Lin, PhD; Duk Y. Hyun, BS; and James D. Loewke, BS
ABSTRACTBackground: The recent escalation of US military suicide deaths to record numbers has been a sentinel for impaired force efficacy and has accelerated the search for reversible risk factors.Objective: To determine whether deficiencies of neuroactive, highly unsaturated omega-3 essential fatty acids (n-3 HUFAs), in particular docosahexaenoic acid (DHA), are associated with increased risk of suicide death among a large random sample of active-duty US military.Method: In this retrospective case-control study, serum fatty acids were quantified as a percentage of total fatty acids among US military suicide deaths (n = 800) and controls (n = 800) matched for age, date of collection of sera, sex, rank, and year of incident. Participants were active-duty US military personnel (2002–2008). For cases, age at death ranged from 17–59 years (mean = 27.3 years, SD = 7.3 years). Outcome measures included death by suicide, postdeployment health assessment questionnaire (Department of Defense Form 2796), and ICD-9 mental health diagnosis data.Results: Risk of suicide death was 14% higher per SD of lower DHA percentage (OR = 1.14; 95% CI, 1.02–1.27; P < .03) in adjusted logistic regressions. Among men, risk of suicide death was 62% greater with low serum DHA status (adjusted OR = 1.62; 95% CI, 1.12–2.34; P < .01, comparing DHA below 1.75% [n = 1,389] to DHA of 1.75% and above [n = 141]). Risk of suicide death was 52% greater in those who reported having seen wounded, dead, or killed coalition personnel (OR = 1.52; 95% CI, 1.11–2.09; P < .01).Conclusion: This US military population had a very low and narrow range of n-3 HUFA status. Although these data suggest that low serum DHA may be a risk factor for suicide, well-designed intervention trials are needed to evaluate causality.J Clin Psychiatry© Copyright 2011 Physicians Postgraduate Press, Inc.
Submitted: January 24, 2011; accepted March 9, 2011.Online ahead of print: August 23, 2011 (doi:10.4088/JCP.11m06879).Corresponding author: Joseph R. Hibbeln, MD, USPHS, Section of Nutritional Neurosciences, Laboratory of Membrane Biochemistry and Biophysics, National Institute on Alcoholism and Alcohol Abuse, National Institutes of Health, 5625 Fishers Lane, Rm 3N-07, MSC 9410, Bethesda, MD 20892 ([email protected]).
Suicide rates among active-duty US military have increased to re-cord numbers, doubling since the inception of Operation Enduring
Freedom (Afghanistan) and Operation Iraqi Freedom and rivaling the battlefield in toll on the US military.1 Army Vice–Chief of Staff General Peter W. Chiarelli described the record suicide rate as “horrible” and voiced frustration that “the Army has not yet been able to identify any causal links among the suicide cases.”2(pA2)
Deficiencies of nutrients critical for brain function may be a signifi-cant contributing risk factor for psychiatric pathology, especially suicide and stress-related psychiatric symptoms.3 Highly unsaturated omega-3 essential fatty acids (n-3 HUFAs), in particular docosahexaenoic acid (DHA), are selectively concentrated in neural tissues and are required for optimal neural function.4 These fatty acids cannot be made de novo but are available only from dietary sources, with seafood being the richest source. Nutritional deficiencies in n-3 HUFAs may increase vulnerabil-ity to combat deployment stress, manifesting as psychiatric symptoms including adjustment disorders, major depression, impulsive violence, and suicide.5 In civilian populations, observational studies indicate that low fish consumption is associated with increased risk of completed sui-cides6,7 and greater suicidal ideation.8 Low DHA status was associated with increased risk of past suicide attempts9 and future suicide attempts.10 In comparison to placebo, 2 grams per day of n-3 HUFA reduced suicidal thinking and depressive symptoms and reduced the perception of stress among subjects (n = 49) with deliberate self-harm.11
These findings suggest that low DHA levels may be a contributing factor for adverse psychiatric symptoms. In this study, we posited that low DHA status would be associated with increased risk of suicide death among military personnel. Prospectively collected serum and supporting data were available from the Armed Forces Health Surveillance Center (AFHSC) for a large number of active-duty suicide deaths (n = 800) and matched controls (n = 800). To our knowledge, this is the largest study of biological factors among suicide deaths.
METHOD
Study DesignThis case-control study compared total serum fatty-acid composi-
tions from among 800 randomly selected active-duty US military suicide deaths to 800 matched controls (2002–2008). The AFHSC is a repository of more than 40 million serum samples with matched health data from US military personnel. Data from service members’ postdeployment health assessment (Department of Defense [DD] Form 2796, obtained within 6 months of completion of last deployment) closest to the date of serum sample provided information regarding time and theater of deployment (if applicable), exposure to stresses during deployment, self-report of mental health status, and indication for referral to mental health services; demographic data and frozen serum samples were provided by the AFHSC. Mental health and substance abuse–related ICD-9-CM diagnosis data reports were similarly obtained.
Sunday, October 30, 11
Why not help our high-risk children & youth with omega-3?
0%
6%
12%
18%
24%
30%
PsychosisOmega-3 Placeo
27.5%
4.9%
Perc
enta
ge w
ith P
sych
osis
at 1
2 m
onth
s
Amminger, G. P., M. R. Schafer, et al. (2010). "Long-Chain {omega}-3 Fatty Acids for Indicated Prevention of Psychotic Disorders: A Randomized, Placebo-Controlled Trial." Arch Gen Psychiatry 67(2): 146-154.
Sunday, October 30, 11
Sunday, October 30, 11
Reduce Omega 3 Brain Deficiency in baby’s brain
Sunday, October 30, 11
Sunday, October 30, 11
Reduce Omega 3 Brain Deficiency in baby’s brain
Sunday, October 30, 11
The benefits to the baby and society
Maternal seafood consumption in pregnancy
C
D
0
5
10
n=739
laicosorP)
%( mu
mitpobus nerdlihc
n=4260 n=1583
15
0
15
20
25
30
n=875
None 0–340 gper week
>340 gper week
tnempoleved laicoS
)%(
mumitpobus nerdlihc
n=4919 n=1798
35
0
15
20
25
30
n=584
QI labreV)
%( mu
mitpobus nerdlihc
n=3493 n=1330
35A
B
0
15
20
25
30
n=875
rotom eniF
)%(
mumitpobus nerdlihc
n=4923 n=1798
35
Prosocial Suboptimal
Social Development Suboptimal
Verbal Suboptimal
Fine Motor Skills Suboptimal
Maternal seafood consumption in pregnancy
None 0–340 gper week
>340 gper week
Sunday, October 30, 11
Omega-3 can improve school grades and success
-2
-1
0
1
2
3
4
5
6
7
Reading Spelling
Omega 3 Placebo
These were gains in academics after 3
months of exposure to fish oil.
Before Omega 3
After Omega 3
See www.durhamtrial.org/
Sunday, October 30, 11
REVIEW Open Access
Clearance of fear memory from the hippocampusthrough neurogenesis by omega-3 fatty acids:a novel preventive strategy for posttraumaticstress disorder?Yutaka Matsuoka1,2
AbstractNot only has accidental injury been shown to account for a significant health burden on all populations, regardlessof age, sex and geographic region, but patients with accidental injury frequently present with the psychiatriccondition of posttraumatic stress disorder (PTSD). Prevention of accident-related PTSD thus represents a potentiallyimportant goal. Physicians in the field of psychosomatic medicine and critical care medicine have the opportunityto see injured patients in the immediate aftermath of an accident. This article first briefly reviews the prevalenceand associated factors of accident-related PTSD, then focuses on a conceptual model of fear memory andproposes a new, rationally hypothesized translational preventive intervention for PTSD through promotinghippocampal neurogenesis by omega-3 fatty acid supplementation. The results of an open-label pilot trial ofinjured patients admitted to the intensive care unit suggest that omega-3 fatty acid supplementation immediatelyafter accidental injury can reduce subsequent PTSD symptoms.
Matsuoka BioPsychoSocial Medicine 2011, 5:3http://www.bpsmedicine.com/content/5/1/3
Clearance of fear memory from the hippocampusthrough neurogenesis by omega-3 fatty acids: a novelpreventive strategy for posttraumatic stress disorder?Matsuoka
Matsuoka BioPsychoSocial Medicine 2011, 5:3http://www.bpsmedicine.com/content/5/1/3 (8 February 2011)
Omega-3 for PTSD symptoms could be used for the patients evacuated from the State Hospital
Sunday, October 30, 11
Why not reproduce the rapid results in Vermont to get a significant reduction in psychosis, bipolar relapse, depression, and maybe even suicides plus increase the competences of future generations quickly.
Sunday, October 30, 11
Young children
Sunday, October 30, 11
Early stories and reading
Sunday, October 30, 11
Why not distribute specially constructed books for parents with young
Reduce dangerous, impulsive, disturbing behavior quickly?
Increase social-competence quickly?
Improve school readiness quickly?
Embry, D. D. and L. Peters (1985). A three-city evaluation of the diffusion of a pedestrian-safety injury control intervention. R. S. Division, New Zealand Ministry of Transport, Wellington, NZ.
Sunday, October 30, 11
Peer-to-Peer Notes
Positive Home Notes
Social Competence Violence
PeaceBuilders School-Community Reinforcement Study
Sunday, October 30, 11
Promote the Triple P (Positive Parenting Program)
Sunday, October 30, 11
10
12
13
15
16
Rate
s pe
r 1,0
00 C
hildr
en (0
-8 Y
ears
)
Substantiated Child Maltreatment
Pre Post
Prinz et al., 2009, Prevention Science
Two Years Later
Sunday, October 30, 11
10
12
13
15
16
Rate
s pe
r 1,0
00 C
hildr
en (0
-8 Y
ears
)
Substantiated Child Maltreatment
Control Counties
Pre Post
Prinz et al., 2009, Prevention Science
Two Years Later
Sunday, October 30, 11
10
12
13
15
16
Rate
s pe
r 1,0
00 C
hildr
en (0
-8 Y
ears
)
Substantiated Child Maltreatment
Control Counties
Triple P Counties
Pre Post
Prinz et al., 2009, Prevention Science
Two Years Later
Sunday, October 30, 11
Child Abuse Hospital Injuries
1.30
1.43
1.55
1.68
1.80
Rate
s pe
r 1,0
00 C
hildr
en (0
-8 Y
ears
)
Pre PostTwo Years Later
Prinz et al., 2009, Prevention Science
Sunday, October 30, 11
Child Abuse Hospital Injuries
1.30
1.43
1.55
1.68
1.80
Rate
s pe
r 1,0
00 C
hildr
en (0
-8 Y
ears
)
Control Counties
Pre PostTwo Years Later
Prinz et al., 2009, Prevention Science
Sunday, October 30, 11
Child Abuse Hospital Injuries
1.30
1.43
1.55
1.68
1.80
Rate
s pe
r 1,0
00 C
hildr
en (0
-8 Y
ears
)
Control Counties
Triple P Counties
Pre PostTwo Years Later
Prinz et al., 2009, Prevention Science
Sunday, October 30, 11
Child Out-of-Home Placements
3.00
3.38
3.75
4.13
4.50
Rate
s pe
r 1,0
00 C
hild
ren
(0-8
Yea
rs)
Pre PostTwo Years Later
Prinz et al., 2009, Prevention Science
Sunday, October 30, 11
Child Out-of-Home Placements
3.00
3.38
3.75
4.13
4.50
Rate
s pe
r 1,0
00 C
hild
ren
(0-8
Yea
rs) Control Counties
Pre PostTwo Years Later
Prinz et al., 2009, Prevention Science
Sunday, October 30, 11
Child Out-of-Home Placements
3.00
3.38
3.75
4.13
4.50
Rate
s pe
r 1,0
00 C
hild
ren
(0-8
Yea
rs) Control Counties
Triple P Counties
Pre PostTwo Years Later
Prinz et al., 2009, Prevention Science
Sunday, October 30, 11
Classrooms
Muriel Saunders
Sunday, October 30, 11
Instant change in disturbing or disruptive behaviours
Sunday, October 30, 11
PAX GBG decreased distracOon in classrooms by an average of 86% aPer only one month
2011 Replication in rural Tennessee by coaches trained just like you…
Sunday, October 30, 11
PAX GBG decreased distracOon in classrooms by an average of 86% aPer only one month
Baseline Disrup=ons Six 1st-‐grade classrooms averaged 136 per hour before coaching
2011 Replication in rural Tennessee by coaches trained just like you…
Sunday, October 30, 11
PAX IntroducedThe distracOons per hour decreased by 56% with the introducOon of the PAX environment of PAX language and several PAX kernels.
PAX GBG decreased distracOon in classrooms by an average of 86% aPer only one month
Baseline Disrup=ons Six 1st-‐grade classrooms averaged 136 per hour before coaching
2011 Replication in rural Tennessee by coaches trained just like you…
Sunday, October 30, 11
PAX IntroducedThe distracOons per hour decreased by 56% with the introducOon of the PAX environment of PAX language and several PAX kernels.
PAX GBG PlayedDisrupOons per hour decreased an addiOonal 30% aPer learning to play PAX GBG .
PAX GBG decreased distracOon in classrooms by an average of 86% aPer only one month
Baseline Disrup=ons Six 1st-‐grade classrooms averaged 136 per hour before coaching
2011 Replication in rural Tennessee by coaches trained just like you…
Sunday, October 30, 11
Why not turn about the lives of high risk primary grade children using a teacher invented procedure?
Sunday, October 30, 11
Timeline of benefits from PAX GBGAge of Child Benefits
1st Grade 75% reduction in disturbing, disruptive and destructive behavior; 25% increase academic achievement; less bullying and intimidation
3rd Grade 43% reduction in ADHD diagnoses; 33% reduction in Oppositional Defiant Disorder; 30%+ reduction special services needs;
6th grade 50%+ reduction in conduct disorders; 25% to 50% reduction tobacco use; reduction in bullying or harassment behaviors
8th Grade 75%r reduction in serious drug use and engagement in delinquent acts
12th Grade Major increase in high-school graduation; lower utilization of special services
Early 20’s Increase in college entry; Major reductions drug use; reductions in prison time
Age 29 Lifetime reduction in violent crime, suicide, psychiatric diagnoses, and lifetime addictions
Sunday, October 30, 11
Why not reproduce the rapid results in Vermont of the Good Behavior Game for EVERY first grader, since break-even is in one year?
Sunday, October 30, 11
Reinforcementfor “Bad”
In one hour of school, how often do peers
reinforce the “good” in school?
How often by adults at school?
How often at home or community in a day?
Reinforcementfor “Good”
How often might adults in authority exert
perceived threats of coercion in school, at
home, or in the community in a single
day?
Adult coercion
The probability of human behavioral choice
“matches” this saturation formula in the classroom,
home and community, and Matching Law works
for all vertebrate creatures
Behavior & the Matching
LawExample
Evolutionary Mismatch
In one hour of school, how often do peers
reinforce the “bad” in school?
How often by adults at school?
How often at home or community in a day?
Sunday, October 30, 11
-20%
-10%
0%
10%
20%
30%
40%
50%
60%
Percen
tag
e C
han
ge
All Visits Injury Viists Non-Injuries Fighting
Injuries
Non-Fighting
Injuries
CDC Nurses Office Study
Control/Wait List PeaceBuilders
What happens if you teach students to praise each other for “peaceability”
Sunday, October 30, 11
-20%
-10%
0%
10%
20%
30%
40%
50%
60%
Percen
tag
e C
han
ge
All Visits Injury Viists Non-Injuries Fighting
Injuries
Non-Fighting
Injuries
CDC Nurses Office Study
Control/Wait List PeaceBuilders
What happens if you teach students to praise each other for “peaceability”
Same Type of
“Kernel” as Camp
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What if these happened everywhere in Vermont?
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Why not use simple public written reinforcements that reduce violent injuries, early delinquency and improve social competence in school age children?
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Why not use the low-cost ($200 to $400) best practice from NIDA that dramatically reduces all addictions among virtually every group of people?
Barry, D., B. Sullivan, et al. (2009). "Comparable efficacy of contingency management for cocaine dependence among African American, Hispanic, and White methadone maintenance clients." Psychology of Addictive Behaviors 23(1): 168-174.
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Youth Who Smoked Every Day the Last 30 Days
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
18.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
18.0%
Baseline Reward and Reminder
Wyoming
Wisconsin
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
Wyoming
Wisconsin
Youth Who Smoked During the Last 30 DaysBaseline Reward and Reminder
Why not publicize and reward clerks and stores for not selling tobacco or alcohol to minors if…
Youth Who Smoked Every Day the Last 30 Days
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
18.0%
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
18.0%
1995 1997 1999 2001 2003 2005 2007
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
18.0%
Baseline Reward and Reminder
Source: YRBS, US Centers for Disease Control
Wyoming
Wisconsin
United States
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
1995 1997 1999 2001 2003 2005 2007
Wyoming
Wisconsin
United States
Youth Who Smoked During the Last 30 DaysBaseline Reward and Reminder
Source: YRBS, US Centers for Disease Control
= Trend = Wyoming = Wisconsin =United States
Embry, D. D. and A. Biglan (2009). Reward and Reminder: An Environmental Strategy for Population-Level Prevention. National Registry of Effective Programs and Practices, Substance Abuse and Mental Health Administration.
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Why not spread motivational goal map to reduce youth and young adult mental, emotional & behavioral problems?
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Acceptance & Commitment Therapy Kernels
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Make promotion & prevention universally accessible
Local Stores
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Do these preventive strategies make ¢ents?
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Key message by showing dollar benefits
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Use personalized
business models to
communicate to cost-efficiency and benefits.
Key message by showing dollar benefits
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Use personalized
business models to
communicate to cost-efficiency and benefits.
Key message by showing dollar benefits
Show short-term benefits
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Use personalized
business models to
communicate to cost-efficiency and benefits.
Allow decision makers and advocates to adjust cost
savings to their location.
Key message by showing dollar benefits
Show short-term benefits
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Show multiple outcomes to unite
stakeholders
Allow people to see benefits of universal access versus
rationing of prevention
Show costs of doing nothing
Show break-even point and ROI over short,
medium and long term
Key message by showing dollar benefits
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Social and physical environment expresses genes
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Policy Action and Lessons from Manitoba
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Manitoba is using new word prompt generalization of behaviors to support healthy children & adults…
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We need to spread health & wellbeing like dandelions
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This can be individual, family, school and/or community action
Increase nurturance of prosociality for persons of all ages
This can be at an individual, family, school and/or community level
Reduce toxic influences of all ages
This can be achieved across settings, as the above.
Increase psychological flexibility among people of all ages
From Biglan, Flay, Embry, and Sandler. Nurturing Environments and the Next Generation of Prevention Research and Practice
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ONLY
C linical C hild and Family P sychology R eview, Vol. 5, N o. 4, D ecember 2002 ( C� 2002)
T he G ood B ehavior G ame: A B est P ractice C andidateas a U niversal B ehavioral V accine
D ennis D . E mbry1
A “ behavioral vaccine” provides an inoculation against morbidity or mortality, impactingphys-ical, mental, or behavior disorders. A n historical example of a behavioral vaccine is antiseptichand washing to reduce childbed fever. I n current society, issues with high levels of morbidity,such as substance abuse, delinquency, youth violence, and other behavioral disorders (multi-problems) , cry out for a low-cost, widespread strategy as simple as antiseptic hand washing.C ongruent research findings from longitudinal studies, twin studies, and other investigationssuggest that a possibility might exist for a behavioral vaccine for multiproblem behavior. Asimple behavioral strategy called the G ood B ehavior G ame (G B G ) , which reinforces inhibi-tion in a group context of elementary school, has substantial previous research to considerits use as a behavioral vaccine. T he G B G is not a curriculum but rather a simple behavioral
Evidence-based Kernels: Fundamental Units of BehavioralInfluence
Dennis D. Embry Æ Anthony Biglan
! The Author(s) 2008. This article is published with open access at Springerlink.com
Abstract This paper describes evidence-based kernels,fundamental units of behavioral influence that appear to
underlie effective prevention and treatment for children,
adults, and families. A kernel is a behavior–influenceprocedure shown through experimental analysis to affect a
This paper presents an analysis of fundamental units ofbehavioral influence that underlie effective prevention and
treatment. We call these units kernels. They have two
defining features. First, in experimental analysis,researchers have found them to have a reliable effect on
Clin Child Fam Psychol Rev
DOI 10.1007/s10567-008-0036-x
COMMUNITY-BASEDPREVENTION USING SIMPLE,LOW-COST, EVIDENCE-BASEDKERNELS AND BEHAVIORVACCINESDennis D. EmbryPAXIS Institute
!A paradox exists in community prevention of violence and drugs. Good
A R T I C L E
Embry, D. D. and A. Biglan (2008). "Evidence-Based Kernels: Fundamental Units of Behavioral Influence." Clinical Child & Family Psychology Review 11(3): 75-113.
Basic understanding of kernels
Embry, D. D. (2004). "Community-Based Prevention Using Simple, Low-Cost, Evidence-Based Kernels and Behavior Vaccines." Journal of Community Psychology 32(5): 575.
Using kernels for population change
Embry, D. D. (2002). "The Good Behavior Game: A Best Practice Candidate as a Universal Behavioral Vaccine." Clinical Child & Family Psychology Review 5(4): 273-297.
Behavioral vaccines for disease control
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Is the smallest unit of scientifically proven behavioral influence.
• Is indivisible; that is, removing any part makes it inactive.
Produces quick easily measured change that can grow much bigger change over time.
Can be be used alone OR combined with other kernels to create new programs, strategies or policies.
• Are the active ingredients of evidence-based programs.
What is a kernel?
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Four Types of Kernels
AntecedentKernel
ReinforcementKernel
Relational FrameKernel
PhysiologicalKernel
Happens BEFORE the behavior
Happens AFTER the behavior
Creates verbal relations for the
behavior
Changes biochemistry of
behavior
Embry, D. D., & Biglan, A. (2008). Evidence-Based
Kernels: Fundamental Units of Behavioral Influence. Clinical Child & Family Psychology
Review, 39.
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What is a behavioral vaccine?It is a simple procedure (a kernel or a recipe of kernels) that, when used repeatedly, reduce morbidity and mortality and/or increase wellbeing or health.Behavioral vaccines can be used by individuals, families, schools, businesses, organizations to produce rapid population level change.
Embry, D. D. (2004). "Community-Based Prevention Using Simple, Low-Cost, Evidence-Based Kernels and Behavior Vaccines."
Journal of Community Psychology 32(5): 575.
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How come we are just hearing about this now…
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How come we are just hearing about this now…
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My perspectiveFull disclosure as a prevention scientist and advocate
Descendent of a freed slaves
Born premature, exposed to alcohol & tobacco and diagnosed
educably mentally retarded
Parents hospitalized for mental illness and die of addictions
Gay man in20-year relationship
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Mental, emotional, behavioral and health disorders are preventable by our own
hands—right here in Vermont.
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Thank you,Dennis D. Embry, [email protected]: 520-299-6770www.paxis.orgwww.slideshare.net/drdennisembry
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