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

1. CHS Colloquium for University of Manitoba Faculty of Medicine • November 18, 2010
Behavioral Vaccines and Evidence
Based Kernels:
Non-Pharmaceutical Approaches
for the Prevention of Mental,
Emotional and Behavioral Disorders
Dennis D. Embry, Ph.D., Senior Scientist, PAXIS Institute;
Co-Investigator, Johns Hopkins Center for Prevention and Intervention;
Co-Investigator, Promise Neighborhood Research Consortium, Eugene, OR
www.slideshare.net/drdennisembry

2. Purpose today
Define scientific alternative strategies for
behavioral influence that can be used for the
prevention of mental, emotional and behavioral
disorders:
Behavioral vaccines
Evidence-based kernels
Review a bold scientific opportunity and agenda
that is possible in Manitoba
My dislaimers

3. FREE DOWNLOAD
Embry, D. D., & Biglan, A. (2008).
Evidence-Based Kernels: Fundamental
Units of Behavioral Influence. Clinical
Child & Family Psychology Review, 39.
Download at:
www.pubmed.gov
Described in the 2009 IOM Report, p. 210

4. A R T I C L E
C linical C hild and Family P sychology R eview, Vol. 5, N o. 4, D ecember 2002 ( C 2002)
COMMUNITY-BASED
PREVENTION USING SIMPLE,
LOW-COST, EVIDENCE-BASED
KERNELS AND BEHAVIOR T he G ood B ehavior G ame: A B est P ractice C andidate
VACCINES as a U niversal B ehavioral V accine
Dennis D. Embry
PAXIS Institute
D ennis D . E mbry1
A paradox exists in community prevention of violence and drugs. Good
research now exists on evidence-based programs, yet extensive expenditures
on prevention have not produced community-level results. Various
multiproblems are quite prevalent in the United States, such as violence,
Attention Deficit Hyperactivity Disorder (ADHD), conduct problems, A “ behavioral vaccine” provides an inoculation against morbidity or mortality, impactingphys-
learning disabilities, depression, and other mood problems. Various studies ical, mental, or behavior disorders. A n historical example of a behavioral vaccine is antiseptic
have observed that intuitively appealing community-based coalitions and hand washing to reduce childbed fever. I n current society, issues with high levels of morbidity,
LY
best practice requirements have not produced prevention gains as hoped such as substance abuse, delinquency, youth violence, and other behavioral disorders ( multi-
for by many. Calls for more money, fidelity, or dose seem unlikely to problems) , cry out for a low-cost, widespread strategy as simple as antiseptic hand washing.
succeed. Other alternatives may be possible. Most of the best practices C ongruent research findings from longitudinal studies, twin studies, and other investigations
N
aimed at preventing these community problems are composed of suggest that a possibility might exist for a behavioral vaccine for multiproblem behavior. A
evidence-based kernels, which act on core principles of prevention (risk
O
simple behavioral strategy called the G ood B ehavior G ame ( G B G ) , which reinforces inhibi-
and protective factors). What is not widely known is that the
evidence-based kernels are powerful in their own right. Evidence-based
tion in a group context of elementary school, has substantial previous research to consider
kernels are irreducible units of behavior-change technology, and they can its use as a behavioral vaccine. T he G B G is not a curriculum but rather a simple behavioral
be put together into behavioral vaccines (daily practices) with powerful procedure from applied behavior analysis. A pproximately 20 independent replications of the
longitudinal prevention results. Kernels and behavioral vaccines are G B G across different grade levels, different types of students, different settings, and some
simple, and they are not programs or curriculum in the conventional with long-term follow-up show strong, consistent impact on impulsive, disruptive behaviors
sense. This article presents examples of evidence-based kernels and of children and teens as well as reductions in substance use or serious antisocial behaviors.
behavioral vaccines that can be promoted easily across whole communities T he G B G , named as a “ best practice” for the prevention of substance abuse or violent be-
or states using social marketing principles. Widespread propagation of havior by a number of federal agencies, is unique because it is the only practice implemented
evidence-based kernels and behavioral vaccines could have a significant
by individual teachers that is documented to have long-term effects. Presently, the G B G is
impact on communities and their prevention norms, providing low-cost
alternatives and practical models for community psychology, public health, only used in a small number of settings. H owever, near universal use of the G B G , in major
and policy makers. Behavioral kernels and vaccines can add needed political jurisdictions during the elementary years, could substantially reduce the incidence of
precision to prevention science and community psychology. © 2004 Wiley substance use, antisocial behavior, and other adverse developmental or social consequences
Periodicals, Inc. at a very modest cost, with very positive cost-effectiveness ratios.
K E Y W O R D S: substance abuse prevention; violence prevention; public policy; best practice.
Correspondence to: Dennis D. Embry, Ph.D., PAXIS Institute, P.O. Box 68494, Tucson, AZ 85737. E-mail:
dde@paxis.org
INT R OD U CT ION I n the late 1840s, D r I gnaz Semmelweis worked in
JOURNAL OF COMMUNITY PSYCHOLOGY, Vol. 32, No. 5, 575–591 (2004) © 2004 Wiley Periodicals, Inc. the maternity wards of a V ienna hospital. B y metic-
Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/jcop.20020
A behavioral vaccine is a simple, scientifically ulous observation, he discovered that the mortality
proven routine or practice put into widespread daily rate in a delivery room staffed by medical students
use that reduces morbidity and mortality. A powerful was up to three times higher than in a second deliv-
example comes from an epidemic that occurred 150 ery room staffed by midwives. Semmelweis postulated
years ago. that the students might be carrying the infection from
D uring the nineteenth century, women died in their dissections to mothers giving birth. H e tested the
childbirth at alarming rates in E urope and the U nited hypothesis by having doctors and medical students
States. U p to 25% of women who delivered their ba- wash their hands with a chlorinated solution before
bies in hospitals died from childbed fever ( puerperal examining women in labor. T he mortality rate in his
sepsis) , discovered later to be caused by Streptococcus maternity wards eventually dropped to less than 1% .
pyogenes bacteria. Washing of hands with antiseptic solution—a behav-
ioral vaccine—now saves millions of lives every year.
1 PA
X I S I nstitute, PO B ox 68494, Tucson, A rizona 85737; e-mail: Today, the C enters of D isease C ontrol and Prevention
dde@paxis.org. ( C D C ) web site states, “ [A ntiseptic] hand washing is
273
1096-4037/02/1200-0273/0 C 2002 Plenum Publishing C orporation

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6. 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
Four Types of Kernels
Kernels: Fundamental Units of
Behavioral Influence. Clinical
Child & Family Psychology
Review, 39.

7. 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 often the active ingredients of evidence-based
programs
• Can be spread by word-of-mouth, by modeling, by
non professionals.
• Can address historic disparities without stigma, in
part because they are also found in cultural wisdom.

8. Rapid

9. 52 Examples of Kernels
Antecedents
Reinforcements
Physiological
Relational frames

10. = Public Posting Kernel
Antecedent
Kernel
Happens
BEFORE the
behavior
= radar

11. Kernel Description Behaviors Affected References
Combinations of visual, kinesthetic and/or auditory
Non-verbal cues that single shifting attention or task in Reduces dawdling, increases time on task or Rosenkoetter, & Fowler, 1986; Krantz, & Risley, 1977; Abbott et al., 1998;
transition cues patterned way, coupled with praise or occasional engaged learning; gives more time for instruction Embry et al., 1996
rewards.
Antecedent Stop lights in Traffic light signals when behavior is appropriate/
(Cox, Cox, & Cox, 2000; Jason & Liotta, 1982; Jason, Neal, & Marinakis,
desirable or inappropriate/undesirable in real time, Decreases noise, off task behavior, or increases
Kernel school settings or
traffic settings
and connected to some kind of occasional stopping in dangerous intersections
1985; Lawshe, 1940; Medland & Stachnik, 1972; Van Houten & Malenfant,
1992; Van Houten & Retting, 2001; Wasserman, 1977)
reinforcement.
These may be lines or other cues such as ropes or Decreases dangerous behavior; decreases
Boundary cues and (Carlsson & Lundkvist, 1992; Erkal & Safak, 2006; Marshall, et al., 2005;
rails that signal where behavior is safe, acceptable pushing and shoving; increases waiting behavior
railings or desired in a queue; reduces falls
Nedas, Balcar, & Macy, 1982; Sorock, 1988)
Happens Cooperative, Planned activities happen during children play time
Decreases aggression and increases social
competence; also affects body mass index, and (Bay-Hinitz, Peterson, & Quilitch, 1994; Leff, Costigan, & Power, 2004;
BEFORE the Structured peer
play
that involve rules, turn taking, social competencies,
and cooperation with or without “soft competition.”
appears to reduce ADHD symptoms, and increase
academics afterwards; reduces social rejection in
Mikami, Boucher, & Humphreys, 2005; Murphy, et al., 1983; Ridgway,
Northup, Pellegrin, LaRue, & Hightsoe, 2003)
behavior middle school
(Barker & Jones, 2006; Ben Shalom, 2000; Bray & Kehle, 2001; Buggey, 2005; Clare,
Drawn, photographic or video model viewer/listener Increases academic engagement; increases attention; Jenson, Kehle, & Bray, 2000; Clark, Beck, Sloane, Goldsmith, & et al., 1993; Clark, Kehle,
increases recall and long term memory; improves behavior; Jenson, & Beck, 1992; Clement, 1986; R. A. Davis, 1979; Dowrick, 1999; Dowrick, Kim-
Self-modeling engaging targeted behavior, receiving rewards or reduces dangerous behavior; increases social competence; Rupnow, & Power, 2006; Elegbeleye, 1994; Hartley, Bray, & Kehle, 1998; Hartley, Kehle, &
recognition. improved sports performance; reduced health problems Bray, 2002; Hitchcock, Prater, & Dowrick, 2004; Houlihan, Miltenberger, Trench, Larson, & et
al., 1995; Kahn, Kehle, Jenson, & Clark, 1990; Kehle, Bray, Margiano, Theodore, & Zhou,
2002; Law & Ste-Marie, 2005; Lonnecker, Brady, McPherson, & Hawkins, 1994; Meharg &
(Agran, et al., 2005; Blick & & Woltersdorf, 1990; Owusu-Bempah& Frank, 1990; Buggey, 1995;
Lipsker, 1991; Meharg Test, 1987; Boyle & Hughes, 1994; Brown & Howitt, 1985; Owusu-
Reductions in alcohol, tobacco use; reductions in illness Buggey, Toombs, Gardener, & Cervetti, 1999; Burch, Clegg, & Bailey, 1987; Carr & Punzo, 1993; Cavalier,
Coding target behavior with a relational frame, which symptoms from diabetes; increased school achievement; changes Bempah & Hodges, 1983;Clare, et al., 2000;McLoughlin,Kehle, & Truscott, 2001; Dalton, Martella, &
Ferretti, &
Howitt, 1997; Possell, Kehle, Clarke, Bray, & Bray, 1999; Ram & McCullagh, 2003;
Reamer, Brady, & Hawkins, 1998; Rickards-Schlichting, Kehle, & Bray, 2004; Rickel & Fields,
Self-monitoring is often charted or graphed for public or semi-public in other social competencies or health behaviors; reductions in Marchand-Martella, 1999; de Haas-Warner, 1991; R. M. Foxx & Axelroth, 1983; Glasgow, Klesges,
Godding, & Gegelman, 1983; Glasgow, Klesges, & Vasey, 1983; Gray & & Simon, 1997; Walker &
1983; Schunk & Hanson, 1989; Schwartz, Houlihan, Krueger, Shelton, 1992; Hall & Zentall,
display, occasioning verbal praise from others ADHD, Tourettes and other DSM-IV disorder; improvement in 2000; K. R. Harris, Friedlander, 1992; Wedel & Fowler, 1984; Woltersdorf, 1992) 1990; Hitchcock,
Clement, Saddler, Frizzelle, & Graham, 2005; Hertz & McLaughlin,
brain injured persons et al., 2004; Hughes, et al., 2002; Kern, Dunlap, Childs, & Clarke, 1994; Martella, Leonard, Marchand-
Martella, & Agran, 1993; M. Y. Mathes & Bender, 1997; McCarl, Svobodny, & Beare, 1991; McDougall &
Brady, 1995; McLaughlin, Krappman, & Welsh, 1985; Nakano, 1990; O'Reilly, et al., 2002; Petscher &
Bailey, 2006; Possell, et al., 1999; Rock, 2005; Selznick & Savage, 2000; Shabani, Wilder, & Flood, 2001;
After hearing or seeing some content, person is told Shimabukuro, Prater, Jenkins, & Edelen-Smith, 1999; Stecker, Whinnery, & Fuchs, 1996; Thomas,
Paragraph Abrams, & Johnson, 1971; Todd, Horner, &G. Mathes, Fuchs, Fuchs, Henley,Winn, Skinner,
(Bean & Steenwyk, 1984; P. Sugai, 1999; Trammel, Schloss, & Alper, 1994; & et al.,
to “shrink” meaning to 8-10 words, full sentence; Improved reading responses and retention Allin, & Hawkins, 2004; Wood, Murdock, & Cronin, 2002; Wood, Murdock, Cronin, Dawson, & Kirby, 1998)
Shrinking praise typically happens for good summaries.
1994; Spencer, Scruggs, & Mastropieri, 2003)

12. Prize Bowl/Mystery
Motivator Kernel
Reinforcement
Kernel
Happens AFTER
the behavior

13. Kernel Description Behaviors Affected References
Person or group receives spoken (or Examples: Cooperation, social competence, academic (Leblanc, Ricciardi, & Luiselli, 2005; Lowe & McLaughlin, 1974; Marchant
engagement, academic achievement, positive-parent child
signed) recognition for engagement in & Young, 2001; Marchant, Young, & West, 2004; Martens, Hiralall, &
Verbal Praise target acts, which may be descriptive or
interactions, positive marital relations, better sales Bradley, 1997; Matheson & Shriver, 2005; C. M. Robinson & Robinson,
performance; reduced disruptive or aggressive behavior; 1979; S. Scott, Spender, Doolan, Jacobs, & Aspland, 2001)
simple acknowledgements reduced DSM-IV symptoms
Reinforcement Peer-to-peer written A pad or display of decorative notes are
Examples: social competence, academic (Cabello & Terrell, 1994; Embry, Flannery, Vazsonyi, Powell, & Atha, 1996;
praise--“Tootle” Notes, posted on a wall, read aloud, or placed in a
Kernel compliments books/ photo type album in which behaviors
achievement, work performance, violence,
Farber & Mayer, 1972; Heap & Emerson, 1989; Mayer, Butterworth,
Nafpaktitis, & Sulzer-Azaroff, 1983; Mayer, Mitchell, Clementi, Clement-
aggression, physical health, vandalism Robertson, & et al., 1993; Skinner, Cashwell, & Skinner, 2000)
praise notes receive written praise from peers
Tokens or symbolic rewards for positive
behavior result in random rewards from Academic achievement, disruptive behavior, (Thorpe, Darch, & Drecktrah, 1978; Thorpe,
Principal Lottery status person (e.g., principal, authority aggression Drecktrah, & Darch, 1979)
figures) such as positive phone calls home
Happens AFTER Safety or Tokens or reward tickets given out for
Safety behaviors, accident reduction,
(Geller, Johnson, & Pelton, 1982; Putnam, Handler, Ramirez-
Performance observed safety or performance behavior, Platt, & Luiselli, 2003; Roberts & Fanurik, 1986; Saari &
the behavior Lottery which are entered into lottery
improved sales or work performance Latham, 1982)
Music is played or stopped in real time, Increased weight gain of babies, improved baby (Allen & Bryant, 1985; Barmann & Croyle-Barmann, 1980; Barmann, Croyle-Barmann, & McLain, 1980;
Bellamy & Sontag, 1973; Blumenfeld & Eisenfeld, 2006; Cevasco & Grant, 2005; Cook & Freethy, 1973;
development possibly, work performance, academic
Contingent music Cotter, 1971; W. B. Davis, Wieseler, & Hanzel, 1980; Dellatan, 2003; Deutsch, Parks, & Aylesworth, 1976;
based on observed behavior of the achievement, attention and focus (ADHD symptoms Eisenstein, 1974; Harding & Ballard, 1982; Hill, Brantner, & Spreat, 1989; Holloway, 1980; Hume &
Crossman, 1992; Jorgenson, 1974; Larson & Ayllon, 1990; Madsen, 1982; McCarty, McElfresh, Rice, &
individual or group. down); reduced aggression Wilson, 1978; McLaughlin & Helm, 1993; Standley, 1996, 1999; Wilson, 1976; D. E. Wolfe, 1982)
Improved academic engagement and achievement, (Beersma, et al., 2003; Hoigaard, S?fvenbom, &
Soft Team Groups compete on some task, reduced disruptive behavior, increased sales,
increased funding raising, increased safety; reduced
Tonnessen, 2006; Kivlighan & Granger, 2006; Koffman,
competition performance, or game. smoking; changed brain chemistry favoring attention Lee, Hopp, & Emont, 1998; Neave & Wolfson, 2003;
and endurance Tingstrom, Sterling-Turner, & Wilczynski, 2006)
Peer-to-peer Increased academic achievement; reduced (Allsopp, 1997; Delquadri, Greenwood, Stretton, & Hall, 1983;
Dyad or triad take turns asking questions,
ADHD and conduct problems; long-term DuPaul, Ervin, Hook, & McGoey, 1998; Fantuzzo & Ginsburg-Block,
tutoring give praise or points and corrective
effects on school engagement; decreased 1998; Greenwood, 1991a, 1991b; Maheady, Harper, & Sacca,
feedback 1988; Maheady, Sacca, & Harper, 1988; Sideridis, et al., 1997)
special education needs.

14. Omega 3 kernel
30%
Physiological
Percentage with Psychosis at 12 months
Kernel 27.5%
24%
18%
Changes 12%
biochemistry of
behavior 6%
4.9%
0%
Omega-3 Placeo
Psychosis
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.

15. Reduced Felony Violent Offences Among Prisoners
with recommended daily amounts of vitamins, minerals and essen=al fa>y acids
Ratio of Disciplinary Incidents Supplementation/Baseline
1.00
Ac=ve ‐37.0% Placebo ‐10.1%
0.75 p ‹ 0.005 p = ns
0.50
Active
0.25 Placebo
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

16. Consilience Issues (pardon a digression)
Parsimony or Occams’ Razor:
"Pluralitas non est ponenda sine neccesitate" or
"plurality should not be posited without necessity."
The words are those of the medieval English
philosopher and Franciscan monk William of
Ockham (ca. 1285-1349).
Links to meta theories versus depending on
mezzo-theories—e.g., “selection by consequences
that embraces evolution, neural plasticity, and
principles of reinforcement.”

17. Apparent consumption o inoleic acid (% of dietary energy) among
Australia, Canada, UK and USA for the years 1961–2000
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Evolution Neonates Breast Milk
& Mismatch
In the Rife Valley, the Successful human American infants have
human brain evolution neonates born with been getting steadily less Theory
the result of eating fish 60-day supply of omega-3 (n3) and more Almost all adolescent
pro-inflammatory risky behaviors have now
high in omega-3 not omega-3 in
omega-6 (n6) in breast been documented to be
savannah animals subcutaneous fat from milk related to low n3 and
mother’s diet high n6 in US diet
See Broadhurst, Cunnane, & See HIbbeln et al. (2007).Maternal seafood
change in last 50 years
Crawford (1998). Rift Valley lake fish See Ailhaud et al. (2006).Temporal changes
consumption in pregnancy and
in dietary fats: Role of n6
and shellfish provided brain-specific neurodevelopmental outcomes in childhood Hibbeln et al. (2006). Healthy intakes of n-3
polyunsaturated fatty acids in excessive
nutrition for (ALSPAC study): an observational cohort
adipose tissue and n-6 fatty acids: estimations considering
early Homo study worldwide diversity.
development and relationship to obesity

18. Text Text Text Text
Text Text Text Text

19. Kernel Description Behaviors Affected References
Pleasant greeting with Affects donations; social status an
Friendly physical and verbal perceptions of safety or harm; affects (Edwards & Johnston, 1977; Ferguson, 1976; T. Field, 1999; Fry,
or without positive 1987; Howard, 1990; la Greca & Santogrossi, 1980; Schloss,
gestures, on a frequent basis. behavior streams of aggression, hostility or Schloss, & Harris, 1984)
physical touch politeness
Physiological (Diego, et al., 2002; T. Field, N. Grizzle, et al., 1996; T. Field, Kilmer,
Massage, Any method of rubbing, stroking Reduces aggression, arousal, cortisol,
Kernel brushing or and therapeutic touch applied to depressive symptoms, PTSD
Hernandez-Reif, & Burman, 1996; T. Field, Seligman, Scafidi, &
Schanberg, 1996; T. M. Field, 1998; T. M. Field, Grizzle, Scafidi, &
Schanberg, 1996; Jones, Field, & Davalos, 1998; Scafidi & Field,
stroking the body symptoms, and pain 1996)
Using a turtle metaphor, child holds self,
Turtle verbal frame, breaths through nose, and Reduces arousal and aggression (Heffner, Greco, & Eifert, 2003; Robin,
engage in sub-verbal or verbal self- against peers or adults Schneider, & Dolnick, 1976)
Technique coaching, with peer or adult reinforcement
Changes “Rough and Tumble” Several times per week child or adolescent Reduces aggression, teaches self-control, may improve status
among same-sex peers; changes c-fos gene expression in
(Boulton & Smith, 1989; Gordon, Kollack-Walker, Akil, &
engages in rough and tumble play, causing Panksepp, 2002; Hines & Kaufman, 1994; Jacklin, DiPietro, &
biochemistry of Free Play with higher
status conspecific
increased arousal and self-control mediated
laboratory animals; the behavior may be especially important to
the development of positive behavior among boys and unique Maccoby, 1984; Paquette, 2004; Pellegrini & Smith, 1998;
by status adult or peer contribution of fathering Reed & Brown, 2001; E. Scott & Panksepp, 2003)
behavior (Antunes, Stella, Santos, Bueno, & de Mello, 2005; Atlantis, Chow, Kirby, & Singh, 2004;
Aerobic play Daily or many times per week child or adult Reduces ADHD symptoms, reduces depression;
engage running or similar aerobic solitary reduces stress hormones; may increase cognitive
Berlin, Kop, & Deuster, 2006; Blue, 1979; Blumenthal, et al., 2005; Crews, Lochbaum, &
Landers, 2004; Doyne, Chambless, & Beutler, 1983; Dunn, Trivedi, Kampert, Clark, &
Chambliss, 2005; Dunn, Trivedi, & O'Neal, 2001; Dustman & et al., 1984; Khatri, et al., 2001;
or behavior activities, game, or food gathering behavior function; decreases PTSD Kubesch, et al., 2003; Manger & Motta, 2005; Marin & Menza, 2005; Phillips, Kiernan, &
King, 2003; M. B. Stein, 2005; Stella, et al., 2005)
Progressive Person tenses and relaxes sequence of Reduces panic, fear, anxiety; decreases negative (Larsson, Carlsson, Fichtel, & Melin, 2005; Norlander, Mo?s,
muscles in combination with anxiety attributions; decreases phobic responses with & Archer, 2005; Pawlow & Jones, 2005; Wencai, Xinhu, Kele,
muscle relaxation evoking stimulus paired with evoking stimuli & Yiyuan, 2005)
Zinc Evolving evidence shows that the addition of zinc (Akhondzadeh, Mohammadi, & Khademi, 2004; Arnold, et al.,
15 mg per day eaten or to the diet or by supplementation increases the 2005; Arnold & DiSilvestro, 2005; Bilici, et al., 2004; McGee,
supplementation or effectiveness of drug treatment and/or may Williams, Anderson, McKenzie-Parnell, & Silva, 1990;
dietary consumption supplemented prevent ADHD symptoms. Sandyk, 1990)

20. Motivational (values expression) kernel
A Simple Gift Example: My Values1
Relational Please provide responses to questions about your ideas, your beliefs, and your life. Please bear in mind that,
Frame there are no right or wrong answers. There are just answers important to you.
Please circle the 1st, 2nd and 3rd most important value from this list
Kernel Athletic ability 1 2 3
Being good at art 1 2 3
Being smart or getting good grades 1 2 3
Creativity 1 2 3
Independence 1 2 3
Living in the moment 1 2 3
Membership in a social group (such as your community, racial group or club) 1 2 3
Music 1 2 3
Creates verbal Politics
Relationships with friends or family
1
1
2
2
3
3
relations for the Religious values
Sense of humor
1
1
2
2
3
3
behavior Please look at the values you picked as most important to you, and to think about times when these values were important to you. Please describe
in a few sentences why the selected values are important to you. Focus on your thoughts and feelings, and don’t worry about spelling, grammar,
or how well written it is. Please list the top two reasons why the values you selected are important to you:
Reason #1:
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.

21. Motivational (values expression) kernel
A Simple Gift Example: My Values1
Relational Please provide responses to questions about your ideas, your beliefs, and your life. Please bear in mind that,
Frame there are no right or wrong answers. There are just answers important to you.
Please circle the 1st, 2nd and 3rd most important value from this list
Kernel Athletic ability 1 2 3
Being good at art 1 2 3
Being smart or getting good grades 1 2 3
Creativity 1 2 3
Independence 1 2 3
Living in the moment 1 2 3
Membership in a social group (such as your community, racial group or club) 1 2 3
Music 1 2 3
Creates verbal Politics
Relationships with friends or family
1
1
2
2
3
3
relations for the Religious values
Sense of humor
1
1
2
2
3
3
behavior Please look at the values you picked as most important to you, and to think about times when these values were important to you. Please describe
in a few sentences why the selected values are important to you. Focus on your thoughts and feelings, and don’t worry about spelling, grammar,
or how well written it is. Please list the top two reasons why the values you selected are important to you:
Reason #1:
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.

22. Motivational (values expression) kernel
A Simple Gift Example: My Values1
Relational Please provide responses to questions about your ideas, your beliefs, and your life. Please bear in mind that,
Frame there are no right or wrong answers. There are just answers important to you.
Please circle the 1st, 2nd and 3rd most important value from this list
Kernel Athletic ability 1 2 3
Being good at art 1 2 3
Being smart or getting good grades 1 2 3
Creativity 1 2 3
Independence 1 2 3
Living in the moment 1 2 3
Membership in a social group (such as your community, racial group or club) 1 2 3
Music 1 2 3
Creates verbal Politics
Relationships with friends or family
1
1
2
2
3
3
relations for the Religious values
Sense of humor
1
1
2
2
3
3
behavior Please look at the values you picked as most important to you, and to think about times when these values were important to you. Please describe
in a few sentences why the selected values are important to you. Focus on your thoughts and feelings, and don’t worry about spelling, grammar,
or how well written it is. Please list the top two reasons why the values you selected are important to you:
Reason #1:
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.

23. Motivational (values expression) kernel
A Simple Gift Example: My Values1
Relational Please provide responses to questions about your ideas, your beliefs, and your life. Please bear in mind that,
Frame there are no right or wrong answers. There are just answers important to you.
Please circle the 1st, 2nd and 3rd most important value from this list
Kernel Athletic ability 1 2 3
Being good at art 1 2 3
Being smart or getting good grades 1 2 3
Creativity 1 2 3
Independence 1 2 3
Living in the moment 1 2 3
Membership in a social group (such as your community, racial group or club) 1 2 3
Music 1 2 3
Creates verbal Politics
Relationships with friends or family
1
1
2
2
3
3
relations for the Religious values
Sense of humor
1
1
2
2
3
3
behavior Please look at the values you picked as most important to you, and to think about times when these values were important to you. Please describe
in a few sentences why the selected values are important to you. Focus on your thoughts and feelings, and don’t worry about spelling, grammar,
or how well written it is. Please list the top two reasons why the values you selected are important to you:
Reason #1:
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.

24. Kernel Description Behaviors Affected References
Increased rule governed behavior; (Choenarom, Williams, & Hagerty, 2005;
Adjectival Noun for Verbal phrase “I am/we _____” is paired
increases behavior associated with the
Relational Belonging to Status with status, belonging, protection or
named group; decreases aggression Embry, et al., 1996; Gaskell & Smith,
Group safety
Frame within group; may affect physical health 1986; Ju?rez, 2002; Mishima, 2003)
Kernel
Public Individuals sign or pledge self to Voting, contributing money,
collective behavior (Burns & Oskamp, 1986)
Commitment recycling,
Individuals or groups are divided into Increase aggression and (Roos, 2005; Sherif, 1958, 1968, 1970;
“US” and “THEM” two groups, with differences highlighted
Creates verbal framed around clothing, adornment, violence by each group toward Sherif, Hogg, & Abrams, 2001; Sherif,
Role Framing
language, social position, etc. each other White, & Harvey, 1955)
relations for the
(Collier, Czuchry, Dansereau, & Pitre, 2001; Czuchry & Dansereau, 1996, 1999, 2003;
behavior Graphic/ node A graphic organizer for goal-based Increased sobriety and goal Czuchry, Dansereau, Dees, & Simpson, 1995; Dansereau, Dees, Greener, & Simpson, 1995;
Dansereau, Joe, & Simpson, 1993; Dees, Dansereau, & Simpson, 1994; Joe, Dansereau,
maps behavior, guided by other status completion; increased treatment Pitre, & Simpson, 1997; Joe, Dansereau, & Simpson, 1994; Melville, Davis, Matzenbacher, &
Clayborne, 2004; Newbern, Dansereau, Czuchry, & Simpson, 2005; Newbern, Dansereau, &
individuals compliance Pitre, 1999; Pitre, Dansereau, & Joe, 1996; Pitre, Dansereau, Newbern, & Simpson, 1998;
Pitre, Dansereau, & Simpson, 1997)
Verbal questioning by status individual Reduction in substance abuse, increase in social (Bernstein, et al., 2005; Burke, Arkowitz, &
Motivational around major goals of target person, competences and related goals; reduction in Menchola, 2003; Resnicow, et al., 2001; Rusch &
Interviewing with clarifying questions about injuries or antisocial behaviors; increase in Corrigan, 2002; D. K. Smith, 2004; Sobell, et al.,
interferring behaviors. healthy behaviors (Monti, et al., 1999) 2003; L. A. R. Stein, et al., 2006)
Media associating Reduces sexually transmitted (Beyth-Marom, Austin, Fischhoff, Palmgren, & et
Media (TV, video, radio) showing
behavior with al., 1993; Downs, et al., 2004; Pechmann, 2001;
“immediate” negative behavior results in social rejection or diseases; reduces alcohol, Pechmann & Ratneshwar, 1994; Pechmann,
escape from social rejection
social outcomes tobacco and other drug use Zhao, Goldberg, & Reibling, 2003)

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27. 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.

28. “Behavioral health could learn from public
health in endorsing a population health
perspective”—(IOM, page 19).
“Families and children have ready access to
the best available evidence-based prevention
interventions, delivered in their own
communities…in a respectful non-stigmatizing
The story of the Broad
Street water pump during
way”—(IOM, page 387).
the cholera epidemic in
London.

29. What is a public-health
approach?
Potential harm is universal,
Personal or Group Risk is Common,
Stigmatizing Persons or Groups At Risk Reduces
Prevention Results, and/or
More Cost Efficient to Reach All Above “Case
Finding.”

30. Community reinforcement case study

31. PeaceBuilders School-Community Reinforcement Study
Positive Peer-to-Peer Social
Home Notes Notes Competence Violence

32. Injury Prevention Study Using Positive Reinforcement
Change in Nurses’
Office Visits from
Year to Year
Control/Wait List Intervention
Krug, E. G., N. D. Brener, et al. (1997). "The impact of an elementary school-based violence prevention program on visits to
the school nurse." American Journal of Preventive Medicine 13(6): 459-463.

33. Injury Prevention Study Using Positive Reinforcement
60%
50%
Change in Nurses’
40% Office Visits from
30% Year to Year
20%
10%
0%
-10%
-20%
All Visits Injury Viists Non-Injuries Fighting Injuries Non-Fighting Injuries
Control/Wait List Intervention
Krug, E. G., N. D. Brener, et al. (1997). "The impact of an elementary school-based violence prevention program on visits to
the school nurse." American Journal of Preventive Medicine 13(6): 459-463.

34. Injury Prevention Study Using Positive Reinforcement
60%
50%
Change in Nurses’
40% Office Visits from
30% Year to Year
20%
10%
0%
-10%
-20%
All Visits Injury Viists Non-Injuries Fighting Injuries Non-Fighting Injuries
Control/Wait List Intervention
Krug, E. G., N. D. Brener, et al. (1997). "The impact of an elementary school-based violence prevention program on visits to
the school nurse." American Journal of Preventive Medicine 13(6): 459-463.

35. Injury Prevention Study Using Positive Reinforcement
60%
50%
Change in Nurses’
40% Office Visits from
30% Year to Year
20%
10%
0%
-10%
-20%
All Visits Injury Viists Non-Injuries Fighting Injuries Non-Fighting Injuries
Control/Wait List Intervention
Krug, E. G., N. D. Brener, et al. (1997). "The impact of an elementary school-based violence prevention program on visits to
the school nurse." American Journal of Preventive Medicine 13(6): 459-463.

36. Reward & Reminder case study on tobacco

39. Reward &
Reminder:
Logic
model

40. Baseline After Reward and Reminder
60%
Wyoming
Percentage of Illegal or Non-Compliant Tobacco Sales to Minors
50%
40%
Reward &
30%
20%
Reminder Impact 10%
on Access 0%
60%
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Wisconsin
50%
40%
30%
20%
10%
0%
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Data Source: Synar Report, SAMSA

41. Reward &
Reminder:
Impact on
prevalence
Source: Youth Risk Behavior Survey (YRBS), Centers for Disease Control

42. Reward &
Reminder:
Impact on
prevalence
Source: Youth Risk Behavior Survey (YRBS), Centers for Disease Control

43. Good Behavior Game Case Study

44. Why not turn about the lives of high risk primary
grade children using a teacher invented procedure?
Muriel Saunders,
the teacher

45. Her invention immediately increases time to learn

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

48. Safe Playing Case Study

49. A environmental policy case
study in reducing early
rebelliousness, risk taking
and sensation seeking
This risk factor can be easily measured in early-childhood, and it
predicts lifetime injuries, delinquency, alcohol/drug abuse
abuse, and school difficulties.

50. Contextual example of such risk

51. Oh,prior prevention efforts in Sweden had resulted
in more fatalities…

52. Safe Playing Self-Modeling Books

55. Safe Playing Boundary Lines

56. Safe Playing Beat the Timer

57. Safe Playing Verbal Praise/Stickers

58. Safe Playing Sit and Watch
Sit and Watch

59. Conduct small single subject
studies first to test tools
Use the first
studies to
identify sources
of variation

61. Prevention Store
Prevention Science Meets
Retail Consumers

63. From Kernels to Public Health
Ecological assessments in high, medium and Randomized or interrupted time-series studies
low settings at population level
Early interrupted time series designs to identify Opportunity for many studies here in Manitoba.
potential active ingredients.
Middle combined interrupted time series that
look for adverse effects
Testing mechanisms that increase participation
Small randomized or cross over studies, run as
“mini-effectiveness” trials

64. Calculating RE-AIM for population-level change
(PC)
RE-AIM MATH REACH = Total population being targeted (see IMPLEMENTATION = The percent of persons/
Reach, Efficacy, census data) entities who actually adopted kernel who
Adoption, actually use it (needs to be at least 40% to
Implementation, & EFFICACY = The effect size difference produced 60%).
Maintenance by the kernel or collection of kernels.
MAINTENANCE = This is the percent of people
ADOPTION = The percent of reach actually or settings who keep doing the kernel over
choose to use the kernel or collection of time.
kernels (must be above 20%-25% to achieve
population-level change.
Change = R * E * A * I * M
for more info, visit www.re-aim.org

65. Reach
Reach is the absolute number, proportion Representativeness refers to whether participants
(percent), and representativeness of individuals have characteristics that reflect the target
who participate in a given strategy. population's characteristics.
If the intent is to increase physical activity in sedentary people between
the ages of 35 and 70, you wouldn't test your program on triathletes or
toddlers.

66. Reach
Reach is the absolute number, proportion Representativeness refers to whether participants
(percent), and representativeness of individuals have characteristics that reflect the target
who participate in a given strategy. population's characteristics.
0% to 100%—higher number, leverages more result
If the intent is to increase physical activity in sedentary people between
the ages of 35 and 70, you wouldn't test your program on triathletes or
toddlers.

67. Efficacy
Efficacy/Effectiveness is the impact of a strategy on produce the change if used—from none to hig
important outcomes. This includes potential negative potent.
effects, quality of life, and costs or increase in positive
outcomes. Think of this of this measured ability to
Be mindful that all strategies have negative effects that subtract
from the good effects.

68. Efficacy
Efficacy/Effectiveness is the impact of a strategy on produce the change if used—from none to hig
important outcomes. This includes potential negative potent.
effects, quality of life, and costs or increase in positive
outcomes. Think of this of this measured ability to
Higher efficacy X more reach = more leverage
Be mindful that all strategies have negative effects that subtract
from the good effects.

69. Adoption
Adoption is the absolute number, proportion, and settings who must adopt the strategy to achie
representativeness of people, settings and/or staff results.
who are willing to offer a strategy.
Notice there can be multiple levels of people or

70. Adoption
Adoption is the absolute number, proportion, and settings who must adopt the strategy to achie
representativeness of people, settings and/or staff results.
who are willing to offer a strategy.
Notice there can be multiple levels of people or
Hi efficacy X large reach X many adoptions = more leverage

71. Implementation
Implementation, at a setting level (home, clinic, consistency of delivery as intended and the time
office, business, etc), refers to how closely the user and cost of the program.
or agents (e.g., staff members) follow the strategy
that is recommended or proven. This includes

72. Implementation
Implementation, at a setting level (home, clinic, consistency of delivery as intended and the time
office, business, etc), refers to how closely the user and cost of the program.
or agents (e.g., staff members) follow the strategy
that is recommended or proven. This includes
(efficacy X reach X adoptions) X robust implementation = Hi leverage

73. Maintenance
Maintenance is the extent to which a strategy, At the individual level, maintenance is the long-
program or policy becomes routine or stable term effects on outcomes after 6 or more months
organizationally. after adoption and implementation.

75. Dennis Embry
dde@paxis.org
www.slideshare.net/drdennisembry