The Institute of Medicine Report: The State of Prevention Three Years Later

1. The Institute of Medicine Report: The State of Prevention Three Years Later Anthony Biglan, Senior Scientist Oregon Research Institute Eugene, Oregon

2. “The scientific foundation has been created for the nation to begin to create a society in which young people arrive at adulthood with the skills, interests, assets, and health habits needed to live healthy, happy, and productive lives in caring relationships with others.”

4. Explosion of randomized trials

6. Two critical insights • Psychological and behavioral problems occur in the context of other problems • All of these problems stem from a common set of environmental conditions

7. Relative Risk of Problem Behaviors --Representative Sample of 8th Graders Boles, S., Biglan, A., Smolkowski, K. (2006) Relationships among negative and positive behaviors in adolescence. Journal of Adolescence, 29, 33-52.

8. These problems are a function of common stressful conditions • Genetic, epigenetic, neuroscience, and behavior analysis are converging to show that in a stressful and threatening environment the cluster of problem behaviors have survival value31 • Threat • Heightens aggressiveness • Fosters deviant peer formation • Contributes to early childrearing32 • Increases depression33

10. Fostering Nurturing Environments34 • Minimize toxic social and biological conditions • Promote and richly reinforce diverse forms of prosocial behavior • Limit opportunities for problem behavior • Promote psychological flexibility—a mindful approach to pursuing one’s values

11. Evidence-based family interventions through the lifespan

12. Positive Parenting Program —Triple P* • A community-wide system of parenting supports that includes • Brief media communications • Brief advice for specific problems • More extensive interventions when needed • Multiple randomized trials showing benefit • Including an RCT in 18 counties in South Carolina14 * Funded in part by NIDA

13. Substantiated child maltreatment Effect size = 1.09, p <.03. Triple P stopped a rising trend of substantiated child-maltreatment in counties using Triple P, compared to counties not receiving Triple P. Before Triple P After Triple P

14. Evidence-based school interventions affecting social, behavioral, and academic outcomes • e-Circle Professional Development for Preschool Providers15 • Providing Alternative Thinking Strategies/PATHS16 • Positive Behavior Intervention and Support17-18 • Positive Action19 • Seattle Social Development Program20

15. The Good Behavior Game21 • Classroom teams in elementary school earn small rewards for being on-task and cooperative

16. No tobacco ADHD averted Less illness Happier families Less vandalism Less alcohol Less depression Fewer referrals Less stress for staff and students Timeline of benefits First Month More time for teaching and learning First Year Fewer service needs Better academics Better attendance Two-three years Special education averted Oppositional Defiance averted 5-15 years years Fewer conduct disorders Less crime, violence, suicide High school graduation & university

17. First graders exposed to GBG for one year had these benefits at age 21. Read this and other GBG studies at www.pubmed.gov

18. How much might GBG save for America’s future?22 Cost Savings • GBG will cost about $150 per child. • GBG pays back $4,637 to individuals, taxpayers, and others per student exposed in first grade over 15 years. • Assuming 4,000,000 first graders each year in the US, that saves $18 billion every first grade cohort by age 21, after an investment of $600 million (less after first five years).

19. Evidence-based kernels • Simple empirically supported behavior-influence techniques • More than 50 have been identified23 • Examples • Prize Bowl, to reduce serious addictions and complete recovery goals • Beat the Timer • My Values activity, to increase high school graduation rates • Omega 3 supplementation • Praise notes

20. Effective alcohol policies24 See: http://promiseneighborhoods.org/policies/

21. Poverty rates by age: 1959 to 2009

22. A Strategic Plan for Oregon

23. A System for Monitoring Successful Development • Monitor critical aspects of development at key endpoints: (a) birth; (b) second birthday; (c) kindergarten entry; (d) fifth grade; (e) 8th grade; (f) high school graduation. • Assess: (a) cognitive, verbal, and academic development; (b) physical health, (c) social competence; and (d) the absence of psychological and behavioral problems.

24. A System of Effective Family Supports • Successful development depends on young people living in nurturing families (Biglan, Flay, Embry, & Sandler, 2012). • Oregon needs to build a system of prevention that makes evidence-based family programs available to every family that wants and would benefit from these programs.

25. Positive Behavior Support in Every School, Preschool, and Childcare Setting • A system for monitoring the extent to which schools, preschools, and childcare settings are nurturing positive social and behavioral development of students. • Develop and implement a plan to increase the availability of training and programs that nurture students’ prosocial development. • Expand the availability and evaluate the impact of evidence-based programs and practices to minimize harassment and bullying and maximize the support of positive behavior in preschools, childcare settings, and schools.

26. Policies that Support Development and Prevent Problems • Public policy is vital to creating an environment that nurtures successful development and prevents the most common and costly psychological and behavioral problems. • Preventing tobacco use through tested and effective policies. • Preventing alcohol use through tested and effective policies. • Preventing obesity and diabetes and enhancing cognitive and social development through policies.

27. Ongoing Public Education • Policymakers, civic leaders, teachers, and parents are often not aware of what is possible. • An ongoing public education campaign would generate support for evidence-based interventions and would encourage people to be more nurturing in their relations with others.

28. Summary • Build a surveillance system. • Build an effective system of family supports. • Ensure that every school is providing positive behavioral supports. • Implement tested and effective preventive policies. • Provide ongoing public education about prevention.