Ted talk: Testing a universal public-health approach to prevent psychiatric disorders… PAX IS Institute tm Dennis D. Embry, Ph.D. president/senior scientist passion into action science to practice promoting solutions
Conflict of Interest I own 100% PAXIS Institue, which designs, tests, and sells scientifically proven strategies to improve the wellbeing individuals, families, and communities—including PAX Good Behavior Game. We intend to to make money selling low-cost, powerful strategies to better the world. No apologies offered.
Text If the Polio Epidemic of the 1950s happened today There would be 6,000 deaths and 120,000 cases. How would America respond?
Remembering when America mobilized science for universal protection of children The ROI was 3-to-1 What if we could reduce mental, emotional & behavioral disorders like this? Use Hashtag: #SaveAllKids
pandemic epiphytotic endemic ecdemic epidemic pestiferous epizootic irruption (especially of medicine) of disease or anything outbreak resembling a disease; plaguey attacking or affecting many pestilential individuals in a community or eruption pestilent a population simultaneously "an epidemic outbreak of influenza"
Youthanasia Use Hashtag: #SaveAllKids
Cumulative Lifetime Prevalence of Disorders in US Adolescents (N=10,123) 1-out-2 USA 40% young adults will 35% Anxiety be a ffl icted with 30% one or more of 25% Substance these disorders Behavior 20% by age 18 Mood 15% 10% NOTE EARLY START 5% Merikangas et al., 2010 0% 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Age in Years Use Hashtag: #SaveAllKids
Cumulative Youngest Cohort prevalence of psychiatric Middle Cohort Cumulative Prevalence disorders by Oldest Cohort young adulthood: a NOTE prospective EARLIER START cohort analysis from the Great Smoky Mountains Study. 9 10 11 12 13 14 15 16 19 21 Use Hashtag: #SaveAllKids AGE
The US had 75 million children and teens 2009 40.4 million kids had one psychotropic med in 2009 Wall Street Journal, 12-28-2010 Use Hashtag: #SaveAllKids
Medicaid Expenditures for the Five Most Costly Conditions in Children $15 $13.80 Billion Billion FY $11.90 2011 Billion Medicaid Expendures (In US$, Billions) $12 FY Billion 2011 The cost of $8.90 Billion Mental Disorders is $9 $8.00 Billion FY Billion increasing $1 billion 2006 FY per year 2006 $6.10 $5.80 Billion Billion $6 FY Billion FY 2006 2011 $3.30 $3.20 $3.10 $2.90 Billion Billion Billion Billion $3 FY FY FY FY Billion 2011 2011 2006 2006 $0 Mental Asthma/ Trauma Acute Bronchitis Ottis Media Billion Disorders COPD & &URI bit.ly/TennTalkEmbryDay1 Fiscal Year Expenditures Source: Center for Financing, Access, and Cost Trends, Agency for HealhCare Research and Quality, 2006, 2011
The Next Big Thing? Universal Prevention of Psychiatric Disorders
PAX GBG scaffolds self-regulation in context of every classroom routine Increasing Reducing or Psychological Minimizing Self-Regulation Safety & Flexibility Toxic Influences PAX Vision PAX Quiet I’m a PAX Leader PAX Hands PAX OK/ PAX Breath Spleems Not OK Not OK Predict, Monitor onitor B e h a d v o i o & Reflect o r G G X Co-Regulation Group-Regulation a A m P e Tootles Notes es PAX Quiet P PAX IT notes s PAX Hands PA PAX Roles PA PAX Voices Granny’s Wacky acky PAX Roles Prizes Scaffolding with Nurturing Environment PAX Feet PAX Minutes Spleem Observations Framework & Evidence-Based Kernels ABCD Pinch Slates Richly Reinforcing Limiting Problematic Wilson et al., 2014; Brain & Behavioral Sciences Prosocial Behaviors Behaviors
Beyond Efficacy: Evidence of Scalability & Effectiveness Results
One-Semester Benefits of Province-Wide Mental-Health Benefits of PAX GBG v. Control High Problem Students Moderate Problems Students High Problem Students Moving to Moderate Risk Moving to Low Risk Moving to Low Risk 0% -5% PAX New Mexico Children’s Cabinet Policy (p<.01) -10% Control Testing rapid implementation in three diverse districts -15% N ≈ 5,000 PAX GBG -20% Changes In Observed Student Control Behaviors Within 90 Days -25% Improved Mental-Health = Control • Fewer conduct problems 40 • Fewer emotional problems -30% • Less hyperactivity PAX PAX 35 • Fewer peer problems Students = 3,329 • Better prosocial skills -35% 30 (p<.001) (p<.001) Disruptive, Jiang, D., Santos, R., Mayer, T., & Boyd, L. (2015, 7/14/2015) Program Evaluation with Multilevel and Multivariate Longitudinal Outcomes -40% Disturbing, 25 Manitoba Randomize Policy Trial Inattentive 20 Behaviors Province-wide policy evaluation with longitudinal follow up per Student 15 per Hour -35% -38% 10 -43% 5 0 District #1 District #2 District #3 Baseline Post-PAX Good Behavior Game
A National Public-Health Test to Prevent Childhood Psychiatric Disorders n = 100,000 • • All 50-states plus selected territories Standardized measures across sites, and interested Tribal Sites. plus relevant local measures or strategy measures. • Randomize-trial each site of 40-60 • classrooms per site, three conditions National research team (e.g. each site: members of the 2009 IOM report). • 1. PAX GBG Site investigators and site coordinators. 2. PAX GBG + Potential • Enhancements or Other Strategy National data repository for further analyses and follow up. 3. Preserved Control, classrooms as Cost? $20 million usual.
Further Reading • Search www.pubmed.gov (National Library of Medicine) for the following: • Good Behavior Game • “Behavioral Vaccines” • “Evidence-based kernels” • “Nurturing Environments” • www.researchgate.net/profile/Dennis_Embry/publications Thank you Dennis D. Embry dde@paxis.org
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