Our Futures Meeting in Central Florida

Creating Our Futures:
How we can better our world and ourselves
A doable plan authored by everyone in this room
With Dennis D. Embry, Ph.D. • June 8 and 9, 2011

Thursday, June 9, 2011 1

Our Vision & Values

Goal 1: Create local, regional and Value 1: Increase
national teams to link their wisdom, nurturance of prosociality
skills, connections, and knowledge. for persons of all ages.
Goal 2: Reduce major indicator of Value 2: Reduce toxic
common mental, emotional, inﬂuences affecting all ages.
behavioral and related health
disorders 20% or more in 3 years. Value 3: Increase
psychological ﬂexibility
Goal 3: Increase every major among people of all ages.
indicator of child and youth
wellbeing by 20% more in 3 years.


Interviewing each
other about our
futures


Your child’s,
grandchild’s or child of
choice’s suitcase for life


Your child’s, Their friends’ suitcases
grandchild’s or child of for life
choice’s suitcase for life


What bricks—heavy objects of pain, injury, illness,
or problem—do you NOT want in those suitcases?


Reporting out


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 65-Year
Olds Olds



5-Year 65-Year
Olds Olds

Who are living
longer though get
progressively sicker…


Requiring more wealth transfer

5-Year 65-Year
Olds Olds

Who are living
longer though get



5-Year 65-Year
Olds Olds

Who are living
Who are less
longer though get
and less able…



5-Year 65-Year
Olds But elders voting to stop funds to kids Olds

Who are living
Who are less
longer though get
and less able…


Our Own Children’s Future


Our Own Children’s Future

ADHD

stealing aggression

asthma depression
learning disabilities
obesity cancer
bipolar
depression
hi-blood pressure heart-disease
violence tobacco
suicide diabetes alcohol
crime drugs
dangerous acts


How many of you know a regular
American family with a child with…
a mental, emotional or behavioral disorder?


How many of you know a regular
American family with a child with…
a mental, emotional or behavioral disorder?

Like a more
Like ADHD or Like learning or serious mental Like a serious
behavior developmental illness like addictions
problems? disorder? bipolar or problem?
suicidal actions?


Key messages about mental, emotional & behavioral disorders…



MEB’s are
preventable.



MEB’s are Break-even for
preventable. MEB prevention
is one year.



MEB’s are Break-even for MEB prevention
preventable. MEB prevention balances
is one year. budgets.



MEB’s are Break-even for MEB prevention MEB prevention
preventable. MEB prevention balances improves US
is one year. budgets. business.




Effective MEB
prevention helps
national security.




Effective MEB MEB prevention
prevention helps helps US global
national security. success.




MEB prevention
Effective MEB MEB prevention saves Social
prevention helps helps US global Security &
national security. success. Medicare.




MEB prevention
Effective MEB MEB prevention saves Social MEB prevention
prevention helps helps US global Security & heals past
national security. success. Medicare. inequities.


TUV"2003"4-/(560,"2(7-"W0&'"#(56)=&"X&*7('0,""
Estimates Possible Benefits of Universal GBG Implementation in First Grade by State

Select State:
North Carolina
9,222,414 Estimated Total Population 2006
If every cohort of
first-graders
36
138,336 Estimated No. of 1st Graders in 2006
Adjust for Percent of 1st Graders Protected by Good
100 100% 138,336 Estimated 1st Graders Reached
Behavior Game in the State
Adust to reflect average cost per student for education
compared to national average
20 100% $8,701
Average Cost Per Student Per Year receives the Good
Behavior Game just
!"#$%&#!"#$%&'()*(+",-&-(,./"&/01&"'/('"'/-"2003"4-/(560,"2(7-"82429":-3$.-&"'/-";,-5(+-).-"0<"'/-"<0++016)=";,0%+-7&"%>"?@"'0"@ABC"D6&,$;*0)&"(,-"'>6.(++>",-3$.-3"%>"
@AB"'0"E@B"0<"'/-"%(&-+6)-"0,"%-<0,-"242"1(&"&'(,'-3C"F/6&"-&*7('0,".07;$'-&"%-)-G'&"$&6)="242"H$&'"6)"I6,&'"2,(3-J"+6K-"'/-"+0)=L'-,7"&'$36-&"
'(&)"*+,-(&!"F/-"G,&'"&'-;&"6)50+56)="(3H$&*)=">0$,"(&&$7;*0)&C"
M9"#-+-.'"'/-"&'('-">0$"(,-"<0.$&-3"0)"6)"'/-";$++"301)N"?9"#-+-.'"'/-";-,.-)'(=-"0<"M&'"=,(3-,&">0$"6)'-)3"'0",-(./"6)">0$,"&'('-N"O9"'/-)"(3H$&'"'/-"&+63-,&"<0,"'/-";-,.-)'(=-&"
0<"67;(.'">0$"/0;-"'0"(./6-5-P,-7-7%-,6)="242",-3$.-&";,0%+-7&"%>"('"+-(&'"?@BN"Q9"'/-)"(3H$&'"'/-".0&'"0<"'/-";,0%+-7&">0$"(,-"',>6)="'0";,-5-)'"6)">0$"(,-(C""F/-"
+01-&'"+-5-+"6&"("3-<($+'".0&'"0<"'/-";,0%+-7C"":-7-7%-,J"'/-".0&'"0<"RSF"306)="()>"'/6)="6&"($'07(*.(++>".07;$'-3C" in first grade, the
Estimated Adjust for
Current Impact of Prevalence
Population the Good After
Adjust for
Average
Cost of
Adjusted Average Annual
Average
Annual
Total Cost of
the Problem
Estimated Per
Year Costs
good people of
North Carolina will
Prevalence Behavior Universal Problem Cost of Behavior With SAVINGS for
of Problem Game on 1st Grade Per Child Problem NOT DOING Percent of 1st
or Behavior Problem Delivery Per Year Per Child GBG Graders Reached
Move slider (or per each

save$250 million for
Move slider 100%
left if think right if think disruption)
Child, Adolescent & Adult will less be problem costs
effective more
Problems

each group of kids
Total daily disruptions in state $1.0
4,565,095 70000.00% 1,369,528 $0.01 $8,217,171 $5,752,020
before GBG
ADHD 3rd Grade
2 7.00% 3000.00% 3.00% $750 $7,262,651 $4,150,086

when they are
Oppositional Defiance 3rd Grade 3 5.00% 2700.00% 2.30% $900 $6,225,129 $3,361,570

Adolescent Conduct Disorder
4 14.00% 5600.00% 8.40% $1,400 $27,113,897 $10,845,559
Special Education 1st-Grade 12
5 7.00% 2200.00% 4.80% 500.00% $435 $4,212,822 $1,324,030
Adult Criminal Behavior
Serious Adult Drug Addictions
6

7
12.00%
20.00%
1200.00%
800.00%
10.80%
12.00%
45000.00%
4900.00%
$4,500
$490
$74,701,553
$13,556,949
$7,470,155
$5,422,779 young adults.
Teen/Adult Suicidal Ideations
8 14.00% 7000% 7.00% $992 $7,684,853 $3,842,427

Total Minimum Estimated Child, Adolescent and Adult Morbibity Costs for Each First Grade
Cohort if Nothing is Done New Each Year: $148,975,025

Esimtated Cost of the Good Behavior Game Per First Grader as Behavioral Vaccine (this
includes local staff, materials, incentives, training, technical support, and overhead)
$62.00 This is less than cost of most
childhood disease vaccines.
Over the next 10
years, that’s $2.5
Esimtated Cost of Implementing the Good Behavior Game Per Classroom $1,550

Cost per 1st Grade Cohort Based on Percentage of Students Reached: $8,576,845

billion.
Return on
Investment

Net Profit at Start of 2nd Grade Per 1st Grade Cohort: $931,003 11%

Net Profit at 6th Grade Per 1st Grade Cohort: $32,517,918 379%

The cost? $62 per
Net Profit at 12th Grade Per 1st Grade Cohort: $110,701,906 1291%

Net Profit at the 29th Year of Life Per 1st Grade Cohort: $247,316,107 2884%

first grader.
Note: Over a Decade of 1st Grade Cohorts Getting GBG, these numbers would be x10:

References:
1 Tingstrom DH, Sterling-Turner HE, Wilczynski SM. The Good Behavior Game: 1969-2002. Behavior Modification
2006;30:225-53.
2
van Lier PAC, Muthen BO, van der Sar RM, Crijnen AAM. Preventing Disruptive Behavior in Elementary Schoolchildren:
Impact of a Universal Classroom-Based Intervention. Journal of Consulting & Clinical Psychology 2004;72(3):467-78.
3 Ibid.

4 Ialongo N, Poduska J, Werthamer L, Kellam S. The distal impact of two first-grade preventive interventions on conduct
problems and disorder in early adolescence. Journal of Emotional & Behavioral Disorders 2001;9(3):146-60.
Thursday, June 9, 2011 5 Bradshaw CP, Zmuda JH, Kellam S, Ialongo N. Longitudinal Impact of Two Universal Preventive Interventions in First 18

Major Ecologic Causes of the Dual Inﬂammatory Threats to Children & Youth

Physiological Antecedents Reinforcement Verbal Relations


Multi-Inﬂammatory Threat Reaction




Mood Reward Executive Behavioral
Attention
Stability Delay Function Competencies

Immune-
Motor Healing
Skills Multi-Inﬂammatory Threat Reaction Functions




Substance Work Obesity,
Early Mental Illness Violence Cancer School
Abuse Problems etc
Sex Failure

Mood Reward Executive Behavioral
Attention
Stability Delay Function Competencies

Immune-
STD’s Motor Healing Special
Skills Multi-Inﬂammatory Threat Reaction Functions Ed




Obesity
Conduct
Disorders

Homicide &
Suicide

Depression

Oppositional/
Addictions ADHD

Aggression

Self
harm

ANXIETY

R PATH = Risky behaviors or health

What are we here?


What is a Preventionist?
What is the deﬁnition?

What is a Preventrepreneur?
What is the deﬁnition?


How to save…
…OUR futures


To change our futures, we must put practical tools
in many hands…


Increase nurturance of prosociality for
persons of all ages
This can be individual, family, school and/or community action

Reduce toxic inﬂuences of all ages
This can be at an individual, family, school and/or community level

Increase psychological ﬂexibility among
people of all ages
This can be achieved across settings, as the above.

From Biglan, Flay and Embry. Nurturing Environments and the Next Generation of Prevention Research and Practice for the American Psychologist


The “Bible” of Prevention
Virtually every mental, emotional, behavioral
and related physical illness is preventable—
not just manageable by rather simple things
everyone can do.
Imagine that as many people knew what
these simple things were as people who
know who Lady Gaga is.


What is nurturing?
At home?
At school?
At work?
At church or temple?
In the community or politics?
In the media?


What is prosociality?
At home?
At school?
At work?
At church or temple?
In the community or politics?
In the media?


Now, the learning game or fast facts


Your wisdom: How do we teach/grow prosocialty?


Reinforcement Reinforcement Adult Behavior &
for “Good” for “Bad” coercion the Matching
In one hour of school, In one hour of school, Law
how often do peers how often do peers How often might adults
reinforce the “good” in reinforce the “bad” in The probability of human
in authority exert
behavioral choice
school? school? perceived threats of
“matches” this saturation
How often by adults How often by adults coercion in school, at
formula in the classroom,
at school? at school? home, or in the
home and community,
How often at home or How often at home or community in a single
and Matching Law works
day?
community in a day? community in a day? for all vertebrate
creatures


Oodles of Tootles


PeaceBuilders School-Community Reinforcement Study

Positive Peer-to-Peer Social
Home Notes Notes Competence Violence


What if these SAME notes were everywhere?


FREE DOWNLOAD

Embry, D. D., & Biglan, A. (2008).
Evidence-Based Kernels: Fundamental
Units of Behavioral Inﬂuence. Clinical
Child & Family Psychology Review, 39.

Free download at www.paxis.org

What is a kernel?
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.


Relational
Antecedent Reinforcement Physiological
Frame
Kernel Kernel Kernel
Kernel

Changes Creates verbal
Happens BEFORE Happens AFTER the
biochemistry of relations for the
the behavior behavior
behavior behavior

Embry, D. D., & Biglan, A. (2008).
Evidence-Based Kernels:
Fundamental Units of Behavioral
Four Types of Kernels Inﬂuence. Clinical Child & Family
Psychology Review, 39.


Beat the Timer

Antecedent
Kernel

Happens
BEFORE the
behavior


Powerful economics of scale inherent in this approach
Multi-Level Model for Public Health Prevention Outcomes

B Developme
ntal sta
Birth Childhood ges
Adolescence Ad
ulthood
Low Intensity
Multiple Hi reach
Fa
m

Sc
ilie

h

els
Settings O ools
s

lev
rg
an
A Co
iat
io

ach
m ns
mu
nit
ies

/re
/re
gio
ns
C
sity
en
Int

High Intensity
Low reach


Why not invite disadvantaged teens to select their
most life values?

Cohen, G. L., J. Garcia, et al. (2009). "Recursive Processes in Self-Afﬁrmation: Intervening to Close the
Minority Achievement Gap." Science 324(5925): 400-403.

15.0% 6.0%

10.0% 4.0%

5.0% 2.0%

0.0%
18.0%
Wisconsin Wisconsin
40.0% 16.0%

35.0% Youth Who Smoked During the Last 30 Days 14.0% Youth Who Smoked Every Day the Last 30 Days
Baseline Reward and Reminder Baseline Reward and Reminder
30.0%
45.0% 12.0%
18.0%
Wyoming Wyoming
25.0%
40.0% 16.0%
10.0%
35.0% 14.0%
20.0% 8.0%
30.0% 12.0%
15.0% 6.0%
25.0% 10.0%
10.0% 4.0%
20.0% 8.0%
5.0%
15.0% 2.0%
6.0%

0.0%
10.0% 4.0%

5.0% 18.0%
2.0%
United States United States
0.0%
40.0% 16.0%
18.0%
35.0% Wisconsin 14.0% Wisconsin
40.0% 16.0%

30.0%
35.0% 12.0%
14.0%

30.0%
25.0% 12.0%
10.0%
25.0% 10.0%
20.0% 8.0%
20.0% 8.0%
15.0% 6.0%
15.0% 6.0%
10.0%
10.0% 4.0%
4.0%

5.0%
5.0% 2.0%
2.0%
Source: YRBS, US Centers for Disease Control Source: YRBS, US Centers for Disease Control
0.0%
0.0% 0.0%
1995 1997 1999 2001 2003 2005 2007 1995 1997 1999 2001 2003 2005 2007

= Trend = Wyoming = Wisconsin =United States

Why not publicize and reward clerks and stores for not selling
tobacco or alcohol to minors if…
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.

What is a behavioural 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.

Such behavioural vaccines can become
cultural practices.

Embry, D. D. (2004). "Community-Based Prevention Using Simple,
Low-Cost, Evidence-Based Kernels and Behavior Vaccines."
Journal of Community Psychology 32(5): 575.


Key message by showing clear visual results
30%

Why not help

Percentage with Psychosis at 12 months
27.5%

our serious 24%

at-risk 18%
This cost
$12 to

children with 12%
achieve

omega-3 to
prevent 6%

4.9%
psychosis? 0%
Amminger, G. P., M. R. Schafer, et al. (2010).
Omega-3 Placeo "Long-Chain {omega}-3 Fatty Acids for

See p.214, IOM Report Psychosis Indicated Prevention of Psychotic Disorders: A
Randomized, Placebo-Controlled Trial." Arch
Gen Psychiatry 67(2): 146-154.


Reduced
Felony
Violent
Offences
Among
Prisoners

with
recommended
daily
amounts
of
vitamins,
minerals
and
essen=al
fa>y

acids

1.00
Ratio of Disciplinary Incidents Supplementation/Baseline

Placebo
-‐10.1%
Ac=ve
-‐37.0%
p
=
ns
0.75
p
‹
0.005

Active
0.50 Placebo

Error bars drawn at 2
standard errors to indicate
0.25 95% confidence interval

0
Before supplementation During supplementation

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


Cardiovascular
mortality
risk
and
LC
n-‐3
in
=ssues

200

150

100
rdiovascular
mortality
/100,000

50

0
15 25 35 45 55 65 85
75

%
n-‐3
HUFA-‐PL


Cardiovascular
mortality
risk
and
LC
n-‐3
in
=ssues

200
US
Military

150

100
rdiovascular
mortality
/100,000

50

0
15 17
25 35 45 55 65 85
75

%
n-‐3
HUFA-‐PL


Cardiovascular
mortality
risk
and
LC
n-‐3
in
=ssues

200
US
Military

150

100
2
gm/
d
LC
n-‐3
rdiovascular
mortality
/100,000

50

0
15 17
25 35 45 45 55 65 85
75

%
n-‐3
HUFA-‐PL


Low
Plasma
DHA
at
Baseline
Predicts
Greater
Risk
of
Future
Suicide
A>empts
Cox
propor=onal
hazard
ra=o=0.29,

p<0.002

1.0
Inpatient
Discharge
0.8

Survival
Probability
0.6

0.4
High
DHA

(n=16)
Low

DHA

(n=17)
0.2
(median
split
of
plasma
phospholipid
%
fa1y
acids)

0
0 200 400 600 800

Time
to
First
Suicide
A1empt
(days)

Suble>e,
Hibbeln
et
al
Am
J
Psychiatry
2006;163:
1100-‐1102


Low maternal omega-3 consumption from seafood and
suboptimal verbal IQ among their children
34

32

30

28
- UK , 8y

26
III

r = 0.97
Percentage of children with

24 r2 = 0.95
F=27.2
p<0.02.
low verbal IQ, WISC

22

20

18

16

14

0 0.05 0.10 0.15 0.20 0.25 0.30 0.35 0.40 0.45 0.50 0.55 0.60

-
Estimated omega 3 fatty acids from seafood (en %)
Mother at 32 wk gestation
Hibbeln et al, Lancet 2007: 369: 578-585

More
ﬁsh
meals
in
Swedish
15
year
olds
and
be>er

school
grades

(n
=
9,448)
50

45

40

35
Increase in child grade score (95% CI)

30

25

20

15

10

5
REF
0
< = >
one one one

Fish meals per week

Kim et al Acta Paediatr. 2010; 99 (1) :72-7.

More
ﬁsh
meals
in
Swedish
15
year
olds
and
be>er

school
grades

(n
=
9,448)
50

45

40

35

30

25

20

15

10

5
REF REF
0
< = >
one one one ES HS COL

Fish meals per week Parent Education


More
ﬁsh
meals
in
Swedish
15
year
olds
and
be>er

school
grades

(n
=
9,448)
50

45

40

35

30

25

20

15

10

5
REF REF REF
0
< = >
one one ES HS COL M F
one

Fish meals per week Parent Education


Be>er
Standard
Test
Score
in
Children

When
Moms
ate
Fish
in
Pregnancy
dropped out n=2,454 remained n=7,081
12

Standardized Assessment Test Score 11
10
9
8
Children- age 7

7
6 Mean
(SD)
p<0.0009
5
ANOVA-‐intake

4 and
reten=on

3
2
1
0

None 1-340g/w >340g/w None 1-340g/w >340g/w
Maternal seafood consumption in pregnancy

ALSPAC cohort Hibbeln et al, The Lancet 17 Feb 2007

Teacher-‐rated
ADHD
symptoms
Reduction in ADHD-related Symptoms
DSM Combined-type
DSM Hyperactivity
DSM Inattention
Conners Global Index
CG Emotional Lability
CG Restless-Impulsive
Conners Index
Social Problems
Perfectionism
Anxiety
Hyperactivity Placebo (N=52)
Active (N=50)
Cognitive Problems
Opposition

-0.15 0 0.15 0.30 0.45 0.60
Treatment Effect Size
(Mean change 0-3m / Pooled Baseline SD)

Richardson
and
Montgomery
2005

Homicide mortality and availability of linoleic acid (en%)
Combined Australia, United Kingdom, Canada
Argentina and USA data from 1961-2000

r = 0.93 1985
10 r2 = 0.86
F = 583
USA
p<1 X10 -40
8
Homicide mortality /100,000

6 1988 1999

1961

4 1961 Argentina

2000 2000
1961
UK
2 Canada
2000
1961

1961
Australia
0
0 2 4 6 8 10
Linoleic acid (en%)
[from 12 seed oils as en% of all commodities available for food consumption]
f=y0+a*exp(b*x) y0 = -1.98207a = 2.14258 b = 0.203595 Hibbeln et al, Lipids 2004; 23: 1207-1213

Essential Fats: Metabolism and Dietary
Sources


Sources
Omega-3

20:5n-3, eicosapentaenoic acid,
EPA Seafood
Breast milk
(DHA)

22:6n-3, docosahexaenoic acid,
DHA
(brain, retina, testis)


Sources
Omega-3

18:3n-3 alfa-linolenic acid,
ALA
Flax
~ Canola
Leaf plants
FADS 1-2

20:5n-3, eicosapentaenoic acid,
EPA Seafood
Breast milk
(DHA)

DHA


Sources
Omega-6 Omega-3

18:2n-6 linoleic acid, 18:3n-3 alfa-linolenic acid,
LA - Competition - ALA
Flax
~ Canola
Leaf plants
FADS 1-2

20:4n-6, arachidonic acid 20:5n-3, eicosapentaenoic acid,
AA EPA Seafood
Breast milk
(DHA)

22:5n-6 DPA n-6 DHA


DHA dietary deficiency impairs synapse development

Adequate Deficient

Hippocampal DHA 6.6 ± 0.7% 0.5 ± 0.1%
Fatty Acids DPAn-6 0.4 ± 0.1% 4.7 ± 0.1%

Cao et al. J. Neurochem. 2009

DHA dietary deficiency impairs synapse development

Adequate Deficient

Hippocampal DHA 6.6 ± 0.7% 0.5 ± 0.1%
Fatty Acids DPAn-6 0.4 ± 0.1% 4.7 ± 0.1%

Synapes in
Hippocampal
Neurons

30 µm

Mother mice fed adequate of deficient diets, embryo neurons harvested day 18
Cao et al. J. Neurochem. 2009

Explore the Vision
Plant Seeds for Change

Prepare to Move Change

Act for Behavior Change

Maintain and Grow Change


Explore thethe Vision of Families United
Explore Vision


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