Reward & Reminder A Multi-State Experiment in Community Mobilization for Real Prevention Results… For more info, see By Dennis D. Embry,

Reward & ReminderA Multi-State Experiment in Community

Mobilization for Real Prevention

Results…

For more info, see www.paxtalk.com

By Dennis D. Embry, Ph.D.

Objectives

• Learn how and why a low-cost evidence-based community mobilization strategy (behavioral kernel/vaccine) can have large measurable effects

• Learn some of key principles to apply in other projects to produce results

• Generalize from tobacco to alcohol and social sources

The Original Scientist

Dr. Anthony Biglan, President, Society for Prevention ResearchSenior Scientist, Oregon Research Institute; www.ori.org

Reward & Reminder in Action

• Reward and Reminder in action Video

Review of key ingredients

• What are the key behaviors by teams?• How is this the same or different from law

enforcement strategies?• How is this different from an educational

strategy?• How is this different from most community

efforts?

Wyoming case study

• History of Wyoming

• Use of science based practice at state level.

• Show sequence of data

Wyoming case study

• The change created– Policy– Finances– Community

mobilization– Legislation

• Other learnings, innovations and aspects (next slide)

Wyoming case study

• Wyoming TV commercial• Meaningful roles for kids• Peer-to-peer adaptation• Humor cards• Getting larger norms,

language shift, change Wyoming

• Communities and state need to be connected.

Wisconsin Replication

• State 10 times the size of Wyoming.

• Similar limitations:– 45-60 days

start up– No community

input

Wisconsin Replication

• State 10 times the size of Wyoming.

• Similar limitations:– 45-60 days

start up– No community

input

Kansas Replication

• 105 counties• Only 10 counties

receive R&R• No integrated

media campaign

The science behind this

Effective mobilization is no accident

Recipe for Success

Building Blocks for Brain and Behavior Change

Antecedents & Ancestors

Antecedents are the more immediate cues, prompts, language, people and structures in our social and physical environment that signal likely consequences from certain individual or group action.

Ancestral stories are the combination people whose customs, behaviors and practices in the past that constrain or amplify present behavior.

Brain and Behavior

Brain is the macro-structure, such as major functions, micro-structure (such as receptors) and neurochemistry that affects drive, mood, and every type of behavior.

Behavior is actions by a person that can be measured or counted.

Watching the brain work

Machines can now see the living brain work. This technology is becoming more powerful every year.

Serotonin

• When we feel safe or belong to a community or group with intact status, our serotonin rises.

• If our levels of serotonin go down because of chronic perceived stress, threats, perceived powerlessness or lack of any control, anger from others or humiliation or loss of status, our serotonin tends to decline.

• Serotonin changes as a result of the social environment and relationships we have with family, peers, and other adults.

Dopamine

• This is molecule of reward, goal setting, learning, movement and inhibition. Some might be surprised to know it controls both “Go” and “Stop” in the brain.

• Dopamine comes from rewarding activities, social reinforcement, sense of control, movement, eating, sex, fighting, and food. Most illegal drugs and many prescription drugs (e.g., stimulant drugs for ADHD) increase dopamine.

Changing the Brain

• Serotonin Drainers– Fighting & violence– Lowered status– High stress– Sex hormones– TV viewing?– Low physical activity– Some foods– Low sunlight

• Serotonin Makers– Touch– Affection– Increased status– Social connections– Perceived safety– Certain foods– Physical activity

R&R Changing the Brain

• Creating collaboration, cooperation and common goals changes sense of belonging—empowering creativity of R&R coalitions

• Affecting brains of clerks

• Affecting the brains of youth teams

Consequences & Cognitions

Consequences (Contingencies) are events or stimuli that follow some behavior that either increase, maintain or decrease the rate, duration or intensity of behaviors.

Cognitions are non-verbal or verbal events by a person that can measured by self-report or bio-mechanical means.

R&R Consequences

• What are the consequences used in R&R?– Clerks – Stores– Law enforcement– Coalitions and community– Young people– Communities/state– Elected Officials

“Thank-You Cards” to Clerks

Scoreboard Consequence

Formula for Consequences

The formula for the basic Matching Law.

Common Cognitions

• I can do that.• Everyone else is

doing it.• I am bored.• No one likes me.• I’ll lose my friends.

• She always…• He never…• She is (bad word)…• He is (good word)…• I am ________• We are ______

Cognitions in R&R

• What are cognitions about retailers and clerks?

• What are the cognitions about the program by its participants?

• What are the cognitions by the community about R&R?

Consider the Relational Frame Network

Disposition, Development and Drive

Disposition is temperament of an individual, which can involve such characteristics as irritability, extroversion, attention, general anxiety.

Drive is the state that an individual is in, such as hungry, fear or contentment.

Development is the universal age related limitations on behavior or cognitions.

Adolescent Changing Personalities

Adolescent Developmental Issues

Teens seeing fear versus adults seeing fear.

Teens Adults

Developmental Interactions

Drive & Disposition of Clerks

• Fearful of employment loss• Often harassed by customers• Stressed from low-pay, strange hours• Fearful of dangerous teens• Pressure to have high sales at store• Incentives provided by tobacco

companies

Environment & Ecology

Environment is the larger social and economic context that affects the ABCs.

Ecology is meta-environment context, such as the plains versus the Pacific Northwest

Ecology/Environment Example

Depression Data

R&R Logic Model

Seven Steps of Community Level Change

1. Clear vision and mission

2. Action planning

3. Leadership

4. Responsible community organizers

5. Documentation and feedback on intermediate outcomes

6. Technical assistance

7. Making outcome matter Source: Kansas Work Group/ Community Toolbox

RE-AIMing for Public Health

Understanding Epidemiology

Reward and Reminder Emerges from Careful Epidemiology

Epidemiology Underneath

• Analysis of key predictors of 30-day use in Wyoming by Drs. Kami London, Narina Nunez, & Embry:– Perceived access– Friends who urge you don’t smoke, drink or

use.– Early antisocial behavior

Reduce Perceived Availability

• How can we reduce perceived availability from retailers?

• How can we reduced perceived availability from social sources?

• How can we reduce overall perceived community availability?

R&R Extensions

• Stimulate phone trees• Distribute some visits every 1-2 months• Older youth patrol for R&R hotspots• Dribbled PR on stores that pass• Use the R&R Protocol for alcohol, too• Use R&R for social sources (e.g.,

shoulder taps)

Summary

• Good science underlying plan (e.g., Reward and Reminder behavioral vaccine)

• Good community coalition processes (e.g., adapted from the Kansas Community Tool Box

• Simple measures and data systems• Clear epidemiological model and logic model• Simple, simple, simple, and doable and

sensible

Thank you. We hope we helped you today.

Dennis D. Embry, Ph.D.

PAXIS Institute

520-299-6770 • [email protected]

www.paxtalk.com