Creating Evidence-Based Practices When None Exist

To Boldly Go where no scientist has gone…
Creating new solutions for new situations or problems using
evidence-based kernels and applied designs
April 28, 2011
By
Dennis D. Embry, Ph.D.
Forum on Emphasizing Evidence-Based Programs for Children and Youth
President/Senior Scientist
Sponsored by the Office of the Assistant Secretary for Planning and
PAXIS Institute • Tucson, AZ Evaluation (ASPE), U.S. Department of Health and Human Services (HHS)

We should use evidence-
based programs, right?
But what if it is a new situation…
like an epidemic of meth use among first-time new mothers
eligible for home-visiting, and no home visiting programs
were ever tested for meth?

But what if it is a rising new problem…
like foster children with multiple psychiatric disorders and
medications for which there are no randomized trials?

But a new setting with no evidence base…
like problem behaviors in after-school programs?

But an old problem with only descriptive studies…
like violent felony youth offenders re-entering community?

A major threat to validity in Cook & Campbell…

…Time of History

35%

Born 1946-1955
30%
Born 1966-1975 Born 1936-1945

Cumulative Probability
25%
Born 1956-1965

20%

15%

10%

5%

0%
0 5 10 15 20 25 30 35 40 45 50
Age of Onset of Depression

3 out-of-4 41 million out What American’s Sleep
17-24 year of 75 million eat today deprivation
children predicts rise
olds unfit for violence,
is epidemic,
prescribed
US military psychotropic depression, and predicts
service drugs in 2009 bipolar & suicide. rise in MEBs.
What does this
mean for home What if this is not What does this mean What do parenting
visiting programs? over-diagnosis? for HHS programs? programs do with this?

No evidence-based programs have been tested in these current contexts

“Madame Secretary…there is a big, unexpected
bug in the problem you want us to solve…”

What are the options?
Punt…do nothing?

Punt…do nothing?
Argue that there is no problem? The data are wrong?

Punt…do nothing?
Insist on choosing a program from the National Registry of
Effect Programs or Practices (but there are none that are
proven to work)?

Punt…do nothing?
Insist on choosing a program from the National Registry of
Effect Programs or Practices (but there are none that are
proven to work)?
Use eco-behavioral assessments, evidence-based kernels
and applied behavior analysis designs to evolve a solution?

What is an eco-behavioral assessment?
Rates of Bio-
Consequence Relational
Target Antecedents Behaviors Physiological-
s Frames
Behaviors Epigenic

Low Rate
Examples Settings

Medium
Rate
Settings

High Rate
Settings

Rates of Bio-
s Frames
Behaviors Epigenic

Low Rate
Examples Settings Physical
Medium cues or
Rate events
Settings before
behaviors
High Rate
Settings

Rates of Bio-
s Frames
Behaviors Epigenic

Low Rate Increase
Examples Settings Physical or
Medium cues or decrease
Rate events in rate,
Settings before duration
behaviors or
High Rate intensity
Settings

Rates of Bio-
s Frames
Behaviors Epigenic

Low Rate Increase After a
Examples Settings Physical behavior,
or
Medium cues or decrease increase or
decrease
Rate events in rate,
future rate,
Settings before duration
duration or
behaviors or
intensity of
High Rate intensity that behavior
Settings

Rates of Bio-
s Frames
Behaviors Epigenic

Low Rate Increase After a Words
Examples Settings Physical behavior, altering
or rate,
cues or decrease increase or
Medium decrease duration,
Rate events in rate, intensity
future rate,
Settings before duration or
duration or general-
behaviors or
intensity of
High Rate intensity that behavior ization of
Settings behavior

Rates of Bio-
s Frames
Behaviors Epigenic

Low Rate Increase After a Words
Examples Settings Physical behavior, altering Extrinsic or
or rate, internal bio-
cues or decrease increase or
Medium decrease duration, physical events
Rate events in rate, intensity that change
future rate,
Settings before duration or rate, duration
duration or general- or intensity of
behaviors or
intensity of
High Rate intensity that behavior ization of behavior
Settings behavior

Antecedents in eco-behavioral assessment
Rates of Bio-
s Frames
Behaviors Epigenic

Low Rate
Examples Settings Using ATM machine increases drug relapse
Physical
cues or Spanking a child with ADHD or oppositional
Medium
objects deﬁance disorder increases child’s
Rate
dangerous behaviors
Settings BEFORE
behaviors Verbal praise by teacher or foster parent
High Rate ﬂips out children with sexual abuse
Settings

Behaviors in an eco-behavioral assessment
Rates of Bio-
s Frames
Behaviors Epigenic

Low Rate Teachers send negative home
Examples Settings notes to foster parents about foster
child at school.
Medium
Home visitors make “cold” rather
Rate
Settings than “warm” referrals for ATOD
treatment
High Rate Children with behavior problems
Settings have low rates of physical activity

Behaviors in an eco-behavioral assessment
Rates of Bio-
s Frames
Behaviors Epigenic

Low Rate Teachers send negative home
Increase
Examples Settings notes to foster parents about foster
or child at school.
Medium decrease
Home visitors make “cold” rather
Rate in rate,
Settings than “warm” referrals for ATOD
duration
treatment
or
High Rate intensity Children with behavior problems
Settings have low rates of physical activity

Consequences in an eco-behavioral assessment
Rates of Bio-
s Frames
Behaviors Epigenic

Low Rate Foster kid acts up in
Examples Settings math, gets sent to
principals ofﬁce—
Medium escaping math
Rate
Settings Traumatized foster
kid freezes when
High Rate adult blows speaks
Settings loudly at school

Consequences in an eco-behavioral assessment
Rates of Bio-
s Frames
Behaviors Epigenic

Low Rate After a Foster kid acts up in
Examples Settings behavior, math, gets sent to
increase or principals ofﬁce—
Medium decrease escaping math
Rate
future rate, Traumatized foster
Settings
duration or kid freezes when
intensity of adult blows speaks
High Rate
Settings
that behavior loudly at school

Relation frames in an eco-behavioral assessment
Rates of Bio-
Relational
Target Antecedents Behaviors Consequences Physiological-
Frames
Behaviors Epigenic

Low Rate
Examples Settings

Medium
Rate
Settings

High Rate
Settings

Rates of Bio-
Relational
Frames
Behaviors Epigenic

Low Rate Words
Examples Settings altering
rate,
Medium duration,
Rate intensity
Settings or
general-
High Rate ization of
Settings behavior

Rates of Bio-
Relational
Frames
Behaviors Epigenic

Low Rate Words Problematic
Examples Settings altering settings
rate, focus on
Medium duration, DSM
Rate intensity Successful
Settings or settings
general- focus on
High Rate ization of behavior
behavior change
Settings

Physiology in an eco-behavioral assessment
Rates of Bio-
s Frames
Behaviors Epigenic

Low Rate
Examples Settings

Medium
Rate
Settings

High Rate
Settings

Rates of Bio-
s Frames
Behaviors Epigenic

Low Rate
Examples Settings Extrinsic or
internal bio-
Medium physical events
Rate that change
Settings rate, duration
or intensity of
High Rate behavior
Settings

Rates of Bio-
s Frames
Behaviors Epigenic

Low Rate Too much
Examples Settings omega-6 & too Extrinsic or
little omega-3 in internal bio-
Medium diet of mom’s in physical events
Rate home visiting that change
program
Settings rate, duration
Foster child or intensity of
High Rate chronically behavior
sleep deprived
Settings

Clin Child Fam Psychol Rev
DOI 10.1007/s10567-008-0036-x

Evidence-based Kernels: Fundamental Units of Behavioral
Influence
Basic understanding of kernels
Dennis D. Embry Æ Anthony Biglan
Embry, D. D. and A. Biglan (2008). "Evidence-Based Kernels:
Fundamental Units of Behavioral Influence." Clinical Child & Family
Ó The Author(s) 2008. This article is published with open access at Springerlink.com

Abstract This paper describes evidence-based kernels, This paper presents an analysis of fundamental units of
Psychology Review 11(3): 75-113.
fundamental units of behavioral influence that appear to behavioral influence that underlie effective prevention and
underlie effective prevention and treatment for children, treatment. We call these units kernels. They have two
adults, and families. A kernel is a behavior–influence defining features. First, in experimental analysis,
procedure shown through experimental analysis to affect a researchers have found them to have a reliable effect on

A R T I C L E

COMMUNITY-BASED
Using kernels for population change
PREVENTION USING SIMPLE, Embry, D. D. (2004). "Community-Based Prevention Using Simple,
LOW-COST, EVIDENCE-BASED
KERNELS AND BEHAVIOR Low-Cost, Evidence-Based Kernels and Behavior Vaccines."
VACCINES
Dennis D. Embry
PAXIS Institute
Journal of Community Psychology 32(5): 575.
A paradox exists in community prevention of violence and drugs. Good

C linical C hild and Family P sychology R eview, Vol. 5, N o. 4, D ecember 2002 ( C 2002)

T he G ood B ehavior G ame: A B est P ractice C andidate
as a U niversal B ehavioral V accine
Behavioral vaccines for disease control
D ennis D . E mbry1
Embry, D. D. (2002). "The Good Behavior Game: A Best Practice
A “ behavioral vaccine” provides an inoculation against morbidity or mortality, impactingphys-
Candidate as a Universal Behavioral Vaccine." Clinical Child &
Family Psychology Review 5(4): 273-297.
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,
LY

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.
C ongruent research findings from longitudinal studies, twin studies, and other investigations
N

suggest that a possibility might exist for a behavioral vaccine for multiproblem behavior. A
O

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 T he G B G is not a curriculum but rather a simple behavioral

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

• 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.

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
Four Types of Kernels Behavioral Influence. Clinical
Child & Family Psychology
Review, 39.

Kernels are building
blocks of behavior change
Humans survive individually and collectively by
influencing the behavior or other humans
The 2008 paper by Embry and Biglan identifies
52 evidence based kernels that can be used to
design or or improve programs.

Using kernels to build
population-level change…
Problem
Kernel
#1 Observed
Proximal
Observed Effect
Kernel
Proximal Kernel
#2
Effect

Kernel Big
Kernel
#3 Change
Effect
Observed
Proximal
Effect
t

Public-health kernel case study

30.0% 12.0%

25.0% 10.0%
20.0% 8.0%
15.0% 6.0%
10.0% 4.0%
5.0% 2.0%
0.0%
18.0%
United States United States
40.0% 16.0%

35.0% 14.0%

30.0% 12.0%

25.0% 10.0%

20.0% 8.0%

15.0% 6.0%

10.0% 4.0%

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

= Trend = Wyoming = Wisconsin =United States

Population level example of use of kernels
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.

30.0% 12.0%

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

30.0% 12.0%
0.0%
25.0% 10.0%
18.0%
20.0% 8.0%
United States United States
40.0%
15.0% 16.0%
6.0%

10.0% 4.0%
35.0%
5.0% 14.0%
2.0%

0.0%
30.0% 12.0%
18.0%
Wisconsin Wisconsin
40.0% 16.0%
25.0% 10.0%
35.0% 14.0%

20.0%
30.0% 8.0%
12.0%

25.0% 10.0%
15.0% 6.0%
20.0% 8.0%

10.0%
15.0% 4.0%
6.0%
10.0% 4.0%
5.0%
5.0% 2.0%
2.0%
0.0%
0.0% 0.0%
1995 1997 1999 2001 2003 2005 2007 1995 1997 1999 2001 2003 2005 2007



30.0% 12.0%

25.0% 10.0%
20.0% 8.0%
15.0% Youth Who Smoked During the Last 30 Days
6.0% Youth Who Smoked Every Day the Last 30 Days
Youth Who Smoked During the Last 30 Days
Baseline Youth Who Smoked Every Day the Last 30 Days
Baseline
Reward and Reminder Reward and Reminder
45.0% Baseline Reward and Reminder 18.0% Baseline Reward and Reminder
10.0%
45.0% Wyoming 4.0%
18.0% Wyoming
40.0% Wyoming 16.0% Wyoming
40.0% 16.0%
5.0%
35.0% 2.0%
14.0%
35.0% 14.0%
30.0% 12.0%
0.0%
30.0% 12.0%
25.0% 10.0%
25.0% 18.0%
10.0%
20.0% 8.0%
20.0% United States 8.0% United States
40.0%
15.0%
15.0% 16.0%
6.0%
6.0%
10.0% 4.0%
10.0% 4.0%
35.0%
5.0% 14.0%
2.0%
5.0% 2.0%
0.0%
30.0%0.0% 12.0%
18.0%
18.0%
Wisconsin Wisconsin
Wisconsin
40.0% Wisconsin 16.0%
25.0%
40.0% 10.0%
16.0%
35.0%
35.0% 14.0%
14.0%
20.0%
30.0%
30.0% 8.0%
12.0%
12.0%
25.0%
25.0% 10.0%
10.0%
15.0% 6.0%
20.0%
20.0% 8.0%
8.0%

10.0%
15.0%
15.0% 4.0%
6.0%
6.0%
10.0%
10.0% 4.0%
4.0%
5.0%5.0%
5.0% 2.0%
2.0%
2.0%
0.0%
0.0%
0.0% 0.0%
1995 1997 1999 2001 2003 2005 2007 1995 1997 1999 2001 2003 2005 2007



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Kernels lower cost of training, support & change…
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Tactics
of
Scientiﬁc
Evaluating

MURRAY

Understanding fundamental issues of scientific
design and testing of behavioral influence

Muir KA, Milan MA J Appl Behav Anal. 1982 Fall;15(3):
455-60.Parent reinforcement for child achievement: the
use of a lottery to maximize parent training effects.
.

Lifespan example of one kernel
for prevention, intervention and
treatment

Lessons for the
day and future

for more info, check out;
www.slideshare.net/drdennisembry

Creating Evidence-Based Practices When None Exist

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