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…
MEB’s are
preventable.
Break-even for
MEB
prevention is
1-2 years.

Key messages…
MEB’s are
preventable.
Break-even for
MEB
prevention is
1-2 years.
MEB
prevention
balances gov’t
budgets.

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.

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.

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.

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.

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.

January 8, 2011
The 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
independent
s 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 living
longer though get
progressively sicker…

5-Year
Olds
65-Year
Olds
Who are living
longer though get
Requiring more wealth transfer

5-Year
Olds
65-Year
Olds
Who are less
and less able…
Who are living
longer though get

5-Year
Olds
65-Year
Olds
Who are less
and less able…
Who are living
longer though get
But elders voting to stop funds to kids

Our Own Children’s or Loved-ones’ Futures

depression
bipolar
drugs tobacco
alcohol
ADHD
aggression
learning disabilities
stealing
suicide
depression
crime
violence
dangerous acts
asthma
obesity 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

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

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

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
Mood

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
Substance
Behavior
Mood

Youth MEB Prevalence Rate Comparison
USA United Kingdom OECD
4x
2x

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

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




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

Mood
Stability
Attention
Reward
Delay
Executive
Function
Behavioral
Competencies
Motor
Skills
Immune-
Healing
FunctionsMulti-Inﬂammatory Brain & Body Response

Mood
Stability
Attention
Reward
Delay
Executive
Function
Behavioral
Competencies
Motor
Skills
Immune-
Healing
FunctionsMulti-Inﬂammatory Brain & Body Response
Mental Illness
Substance
Abuse
Violence
Work
Problems
Obesity,
etc
CancerEarly
Sex
School
Failure
STD’s Special
Ed

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…

Essential
Brain Nutrient
Deficiencies
Essential
Movement
Deficiencies
Essential
Reinforcement
Deficiencies
Essential
Behavioral
Deficiencies
Impacted By…

Essential
Brain Nutrient
Deficiencies
Essential
Movement
Deficiencies
Essential
Reinforcement
Deficiencies
Essential
Behavioral
Deficiencies
Impacted By…
Cultural
Toxins

Essential
Brain Nutrient
Deficiencies
Essential
Movement
Deficiencies
Essential
Reinforcement
Deficiencies
Essential
Behavioral
Deficiencies
Physical
Toxins
Impacted By…
Cultural
Toxins

Essential
Brain Nutrient
Deficiencies
Essential
Movement
Deficiencies
Essential
Reinforcement
Deficiencies
Essential
Behavioral
Deficiencies
Physical
Toxins
Policy
Toxins
Impacted By…
Cultural
Toxins

Essential
Brain Nutrient
Deficiencies
Essential
Movement
Deficiencies
Essential
Reinforcement
Deficiencies
Essential
Behavioral
Deficiencies
Physical
Toxins
Policy
Toxins
Biological
Toxins
Impacted By…
Cultural
Toxins

Essential
Brain Nutrient
Deficiencies
Essential
Movement
Deficiencies
Essential
Reinforcement
Deficiencies
Essential
Behavioral
Deficiencies
Based on Fundamental Evolutionary “Mis-Match” of Mechanisms of Human Evolution
Physical
Toxins
Policy
Toxins
Biological
Toxins
Impacted By…
Cultural
Toxins

Evolutionary Mismatch
Changes in modern human ecology for
which were were evolved and adapted
now affecting…
Sleep
Eating
Mental health
Problem behaviors
Physical Health
Sexual 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
RatioofDisciplinaryIncidentsSupplementation/Baseline
Active
Placebo
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)
Inpatient
Discharge
Suble>e,
Hibbeln
et
al
Am
J
Psychiatry
2006;163:
1100-‐1102


Omega-3 Status and US Military Suicide Deaths
Suicide Deaths of Active-Duty US Military and
Omega-3 Fatty-Acid Status: A Case-Control Comparison
Michael D. Lewis, MD; Joseph R. Hibbeln, MD; Jeremiah E. Johnson, RD;
Yu Hong Lin, PhD; Duk Y. Hyun, BS; and James D. Loewke, BS
ABSTRACT
Background: 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).
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

Why not help our high-risk
children & youth with
omega-3?
0%
6%
12%
18%
24%
30%
Psychosis
Omega-3 Placeo
27.5%
4.9%
PercentagewithPsychosisat12months
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
)%(mumitpobusnerdlihc
n=4260 n=1583
15
0
15
20
25
30
n=875
None 0–340 g
per week
>340 g
per week
tnempolevedlaicoS
n=4919 n=1798
35
0
15
20
25
30
n=584
QIlabreV
n=3493 n=1330
35A
B
0
15
20
25
30
n=875
rotomeniF
n=4923 n=1798
35
Prosocial Suboptimal
Social Development Suboptimal
Verbal Suboptimal
Fine Motor Skills Suboptimal
Maternal seafood consumption in pregnancy
None 0–340 g
per week
>340 g
per 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/

REVIEW Open Access
Clearance of fear memory from the hippocampus
through neurogenesis by omega-3 fatty acids:
a novel preventive strategy for posttraumatic
stress disorder?
Yutaka Matsuoka1,2
Abstract
Not only has accidental injury been shown to account for a significant health burden on all populations, regardless
of age, sex and geographic region, but patients with accidental injury frequently present with the psychiatric
condition of posttraumatic stress disorder (PTSD). Prevention of accident-related PTSD thus represents a potentially
important goal. Physicians in the field of psychosomatic medicine and critical care medicine have the opportunity
to see injured patients in the immediate aftermath of an accident. This article first briefly reviews the prevalence
and associated factors of accident-related PTSD, then focuses on a conceptual model of fear memory and
proposes a new, rationally hypothesized translational preventive intervention for PTSD through promoting
hippocampal neurogenesis by omega-3 fatty acid supplementation. The results of an open-label pilot trial of
injured patients admitted to the intensive care unit suggest that omega-3 fatty acid supplementation immediately
after accidental injury can reduce subsequent PTSD symptoms.
Matsuoka BioPsychoSocial Medicine 2011, 5:3
http://www.bpsmedicine.com/content/5/1/3
Clearance of fear memory from the hippocampus
through neurogenesis by omega-3 fatty acids: a novel
preventive strategy for posttraumatic stress disorder?
Matsuoka
Matsuoka BioPsychoSocial Medicine 2011, 5:3
http://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

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
Ratesper1,000Children(0-8Years)
Substantiated Child Maltreatment
Pre Post
Prinz et al., 2009, Prevention Science
Two Years Later

10
12
13
15
16
Control Counties
Pre Post
Two Years Later

10
12
13
15
16
Control Counties
Triple P Counties
Pre Post
Two Years Later

Child Abuse Hospital Injuries
1.30
1.43
1.55
1.68
1.80
Pre
Post
Two Years Later

1.30
1.43
1.55
1.68
1.80
Control Counties
Pre
Post
Two Years Later

1.30
1.43
1.55
1.68
1.80
Control Counties
Triple P Counties
Pre
Post
Two Years Later

Child Out-of-Home Placements
3.00
3.38
3.75
4.13
4.50
Pre
Post
Two Years Later

3.00
3.38
3.75
4.13
4.50
Control Counties
Pre
Post
Two Years Later

3.00
3.38
3.75
4.13
4.50
Control Counties
Triple P Counties
Pre
Post
Two Years Later

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…

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

PAX
Introduced
The
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

PAX
Introduced
The
distracOons
per
hour
decreased

by
56%
with
the
introducOon
of
the

PAX
environment
of
PAX
language

and
several
PAX
kernels.
PAX
GBG
Played
DisrupOons
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

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

Timeline of benefits from PAX GBG
Age 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

results in Vermont of the Good
Behavior Game for EVERY ﬁrst
grader, since break-even is in
one year?

Reinforcement
for “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?
Reinforcement
for “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
Law
Example
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%
PercentageChange
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%
PercentageChange
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 Days
Baseline Reward and Reminder
Why not publicize and reward clerks and stores
for not selling tobacco or alcohol to minors if…
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%
Source:YRBS,USCentersforDiseaseControl
UnitedStates
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
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
UnitedStates
Source:YRBS,USCentersforDiseaseControl
=Trend =Wyoming =Wisconsin =UnitedStates
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
communicate to
cost-efficiency
and benefits.
Show short-
term benefits

Use
personalized
business
models to
communicate to
cost-efficiency
and benefits.
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

O
N
LY
Clinical Child and Family Psychology R eview, Vol. 5, No. 4, D ecember 2002 ( C 2002)
T he G ood B ehavior G ame: A B est Practice Candidate
as a U niversal B ehavioral Vaccine
D ennis D. E mbry1
A “behavioral vaccine” providesaninoculationagainstmorbidity or mortality, impactingphys-
ical, mental, or behavior disorders. A n historical example of a behavioral vaccine is antiseptic
hand 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.
Congruent research findings from longitudinal studies, twin studies, and other investigations
suggest that a possibility might exist for a behavioral vaccine for multiproblem behavior. A
simple 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 consider
its use as a behavioral vaccine. The G B G is not a curriculum but rather a simple behavioral
Evidence-based Kernels: Fundamental Units of Behavioral
Influence
Dennis D. Embry Æ Anthony Biglan
Ó The Author(s) 2008. This article is published with open access at Springerlink.com
Abstract This paper describes evidence-based kernels,
fundamental units of behavioral influence that appear to
underlie effective prevention and treatment for children,
adults, and families. A kernel is a behavior–influence
procedure shown through experimental analysis to affect a
This paper presents an analysis of fundamental units of
behavioral 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-BASED
PREVENTION USING SIMPLE,
LOW-COST, EVIDENCE-BASED
KERNELS AND BEHAVIOR
VACCINES
Dennis D. Embry
PAXIS Institute
Ⅲ
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
Antecedent
Kernel
Reinforcement
Kernel
Relational
Frame
Kernel
Physiological
Kernel
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 perspective
Full 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 in
20-year relationship

Mental, emotional, behavioral and health
disorders are preventable by our own
hands—right here in Vermont.

Thank you,
Dennis D. Embry, Ph.D.
dde@paxis.org
ph: 520-299-6770
www.paxis.org
www.slideshare.net/drdennisembry

Keynote talk: Vermont Assn. for Mental Health and Friends of Recovery Annual Conference

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Keynote talk: Vermont Assn. for Mental Health and Friends of Recovery Annual Conference