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

Key messages…


Key messages…

MEB’s are preventable.


Key messages…


Break-even for MEB

prevention is 1-2 years.


Key messages…


Break-even for MEB


MEB prevention

balances gov’t budgets.


Key messages…


Break-even for MEB


MEB prevention

improves US business.

MEB prevention



Key messages…


Break-even for MEB


MEB prevention


Effective MEB prevention

helps national security.

MEB prevention



Key messages…


Break-even for MEB


MEB prevention




MEB prevention

helps US global success.

MEB prevention



Key messages…


Break-even for MEB


MEB prevention




MEB prevention


MEB prevention


MEB prevention saves Social Security & Medicare.


Key messages…


Break-even for MEB


MEB prevention




MEB prevention


MEB prevention


MEB prevention saves Social Security & Medicare.

MEB prevention heals past inequities.


January 8, 2011The Shootings in Tucson


What will we pack in our Vermont’s young people’s suitcases for

their whole lives?


What bricks—heavy objects of pain, injury, illness, or problems—do you NOT want in young people’s suitcases for life?


Ask the suitcase questions of 30 people: some republicans, some democrats, some independents and some who are apolitical.


What do you want to happen and not happen for our elders?


Bi-directional Wealth and Wellbeing Transfer

5-Year Olds

65-Year Olds



5-Year Olds

65-Year Olds

Who are livinglonger though get

progressively sicker…



5-Year Olds

65-Year Olds



Requiring more wealth transfer



5-Year Olds

65-Year Olds

Who are lessand less able…






5-Year Olds

65-Year Olds

Who are lessand less able…




But elders voting to stop funds to kids


Our Own Children’s or Loved-ones’ Futures


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


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



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




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




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




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



Youth MEB Prevalence Rate Comparison

USA United Kingdom OECD

4x2x


Depression by Jobs


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


http://www.missionreadiness.org/PAEE0609.pd

http://www.missionreadiness.org/PAEE0609.pd

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%.


The US has 75 million children and teens.

40.4 million are on psychotropic medications

Wall Street Journal,

12-28-2010


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.


PhysiologicalReinforcement Antecedents Verbal Relations

Major Ecologic Causes of the Trends to Children, Youth and Adults


Multi-Inflammatory Brain & Body Response




MoodStability Attention Reward

DelayExecutiveFunction

BehavioralCompetencies

MotorSkills

Immune-Healing

FunctionsMulti-Inflammatory Brain & Body Response




MoodStability Attention Reward

DelayExecutiveFunction

BehavioralCompetencies

MotorSkills

Immune-Healing

FunctionsMulti-Inflammatory Brain & Body Response



Mental Illness SubstanceAbuse Violence Work

ProblemsObesity,

etc CancerEarlySex

SchoolFailure

STD’s SpecialEd


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…





Deficiencies


Deficiencies

Impacted By…






Deficiencies


Deficiencies

Impacted By…

CulturalToxins






Deficiencies


Deficiencies

PhysicalToxins

Impacted By…

CulturalToxins






Deficiencies


Deficiencies

PhysicalToxins

PolicyToxins

Impacted By…

CulturalToxins






Deficiencies


Deficiencies

PhysicalToxins

PolicyToxins

BiologicalToxins

Impacted By…

CulturalToxins






Deficiencies


Deficiencies

Based on Fundamental Evolutionary “Mis-Match” of Mechanisms of Human Evolution

PhysicalToxins

PolicyToxins

BiologicalToxins

Impacted By…

CulturalToxins



Evolutionary MismatchChanges in modern human ecology for which were were evolved and adapted now affecting…

SleepEatingMental healthProblem behaviorsPhysical HealthSexual maturity


If we just hit the problem harder…


Reduce Omega 3 Brain Deficiency


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


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.


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


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.


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.


Reduce Omega 3 Brain Deficiency in baby’s brain


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


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/


http://www.durhamtrial.org

http://www.durhamtrial.org

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


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.


Young children


Early stories and reading


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.


Peer-to-Peer Notes

Positive Home Notes

Social Competence Violence

PeaceBuilders School-Community Reinforcement Study


Promote the Triple P (Positive Parenting Program)


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


10

12

13

15

16

Rate

s pe

r 1,0

00 C

hildr

en (0

-8 Y

ears

)


Control Counties

Pre Post


Two Years Later


10

12

13

15

16

Rate

s pe

r 1,0

00 C

hildr

en (0

-8 Y

ears

)


Control Counties

Triple P Counties

Pre Post


Two Years Later


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




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





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




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)





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





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




Classrooms

Muriel Saunders


Instant change in disturbing or disruptive behaviours


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…



Baseline Disrup=ons Six 1st-‐grade classrooms averaged 136 per hour before coaching



PAX IntroducedThe distracOons per hour decreased by 56% with the introducOon of the PAX environment of PAX language and several PAX kernels.





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 .





Why not turn about the lives of high risk primary grade children using a teacher invented procedure?


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


Why not reproduce the rapid results in Vermont of the Good Behavior Game for EVERY first grader, since break-even is in one year?


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?


-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”


-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


What if these happened everywhere in Vermont?


Why not use simple public written reinforcements that reduce violent injuries, early delinquency and improve social competence in school age children?


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.


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.


Why not spread motivational goal map to reduce youth and young adult mental, emotional & behavioral problems?


Acceptance & Commitment Therapy Kernels


Make promotion & prevention universally accessible

Local Stores


Do these preventive strategies make ¢ents?


Key message by showing dollar benefits


Use personalized

business models to

communicate to cost-efficiency and benefits.



Use personalized

business models to



Show short-term benefits


Use personalized

business models to


Allow decision makers and advocates to adjust cost

savings to their location.


Show short-term benefits


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



Social and physical environment expresses genes


Policy Action and Lessons from Manitoba


Manitoba is using new word prompt generalization of behaviors to support healthy children & adults…


We need to spread health & wellbeing like dandelions


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


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


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?


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.


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.


How come we are just hearing about this now…


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


Mental, emotional, behavioral and health disorders are preventable by our own

hands—right here in Vermont.


Thank you,Dennis D. Embry, [email protected]: 520-299-6770www.paxis.orgwww.slideshare.net/drdennisembry


mailto:[email protected]

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http://www.paxis.org

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http://www.slideshare.net/drdennisembry

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keynote talk: vermont assn. for mental health and friends of recovery annual conference

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