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Evolving Statewide Comprehensive Preventive Practices. Anthony Biglan Oregon Research Institute tony@ori.org.

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evolving statewide comprehensive preventive practices

Evolving Statewide Comprehensive Preventive Practices

Anthony Biglan

Oregon Research Institute



A broad consensus has emerged about the conditions that are needed to prevent most problems of childhood and adolescence and to ensure that nearly every young person develops successfully.

research over the past 30 years shows what is possible
Research over the Past 30 Years Shows What Is Possible

Young people reach adulthood with all of the skills, interests, assets, and health habits needed to live happy and productive lives in caring relationships with other people

psychological and behavioral problems co occur
Psychological and Behavioral Problems Co-Occur
  • 8th grade behaviors such as:
      • substance use
      • antisocial behavior
      • sexual behavior
      • and depression

are 4.3 times more likely to occur together than to occur separately

in order to nurture successful development we need to
In Order to Nurture Successful Development We Need to:
  • Minimize toxic conditions
  • Promote and richly reinforce prosocial behavior
  • Limit opportunities for problem behavior
  • Promote psychological flexibility—the ability to hold your thoughts and feelings lightly and act in the service of your value
the importance of nurturing self regulation
The Importance of Nurturing Self-Regulation
  • Children who do not develop the capacity to inhibit impulsive behavior, to plan, and to regulate their emotions are at high risk for behavioral and emotional difficulties
moffitt et al 2011
Moffitt et al. (2011)
  • Examined self-control: ability to delay gratification, control impulses, and modulate emotional expression.
  • Followed a cohort of 1000 children from birth to age 32
  • Childhood self-control predicted physical health, substance dependence, personal finances, and criminal offending outcomes.
nurse family partnership
Nurse-Family Partnership*
  • Pregnancy through infancy
  • Focus on
    • Prenatal care
    • Maternal smoking
    • Mothering
    • Contraception
    • Work life

* Funded in part by NIDA

nurse family partnership1
Nurse-Family Partnership
  • Evaluated in three randomized trials for poor, teenager single mothers,
  • Significant effects on
    • Abuse and neglect
    • Children’s behavioral development
    • Mother’s economic wellbeing
    • Time to next baby
    • Children’s arrest as adolescent
positive parenting program triple p
Positive Parenting Program—Triple P*
  • A community-wide system of parenting supports that includes
    • brief media communications,
    • brief advice for specific problems, and
    • more extensive interventions when needed
  • Multiple randomized trials showing benefit
  • Including an RCT in 18 counties in South Carolina

* Funded in part by NIDA

substantiated child maltreatment
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

the family check up
The Family Check-Up*
  • Provides parenting support to families of adolescents via a family resource center in middle schools
  • Effects as much as five years later
      • Reduced substance use
      • Fewer arrests
      • Better school attendance & academic performance
  • Cost-effectiveness (Aos et al., 2004)
      • Savings of $5.02 per dollar invested
      • Total savings of $1,938 per youth

Probability of Arrest from Age 11-17 as a Function of Intervention Engagement






11 12 13 14 15 16 17

Age in Years

Connell, Dishion et al., 2008

the good behavior game
The Good Behavior Game*
  • Classroom teams in elementary school earn small rewards for being on-task and cooperative
  • Randomized trial in Baltimore Inner City Schools
      • Had preventive effects even into young adulthood
      • Substance abuse disorders
      • Antisocial personality
positive behavioral interventions supports pbis model
Positive Behavioral Interventions & Supports (PBIS) Model
  • Systematic approach to implementing and sustaining evidence-base practices for the social success of all youth within a facility.
  • Cohesive approach to thinking about how to achieve the ultimate goals of an organization by aligning all branches of an organization.
    • School-based improvements in academic and social behaviors (Horner et al, 2002; Sprague & Golly, 2004).
    • Improvements in organizational health (Bradshaw et al, 2005)
    • Randomized trials in Maryland (Bradshaw et al, 2007).
pbis model conceptual foundations
PBIS Model: Conceptual foundations
  • Applied behavior analysis,
  • Community health multi-tiered prevention model (Walker et al, 1996),
  • Universal screening and progress monitoring (Fuchs & Fuchs, 1986; Shin, Walker & Stone, 2002),
  • Merging of social and academic practices (Algozzine & Algozzine, 2009; McIntosh, Horner, Chard, Boland, & Good, 2006), and
  • Systems technology appropriate to implement effective practices on a large scale (Fixsen, Naoom, Blasé, Friedman, & Wallace, 2005).
pbis model four main components
PBIS Model: Four Main Components

Institute on Violence and Destructive Behavior Dr. Jeffrey R. Sprague jeffs@uoregon.edu

pbis model outcomes practices
PBIS Model: Outcomes & Practices
    • Valued social, behavioral, academic, outcomes your staff is trying to support for the youth within your facilities.
    • Proximal and distal
    • Day to day practices that support youth in achievement of these outcomes.
    • Evidence-based practices that meet the specific behavioral needs of your population- which will be varied.
    • Also includes practices like healthy menus, daily exercise time, etc.
pbis model systems and data
PBIS Model: Systems and Data
    • Day to day policies, protocols, trainings, resources that help staff support youth in attainment of the valued outcomes.
  • DATA:
    • Progress and outcome information that allows staff to know if those valued outcomes are being achieved. Basis of decision-making.
another way to think about it
Another way to think about it…

Supporting Social Competence &

Academic Achievement







Evidence-based, preventive.

Supporting Youth Behavior



Staff Behavior & Implementation Fidelity

pbis model tiers of support
PBIS Model: Tiers of Support
  • Alignment of outcomes, practices, systems, & data applied to all tiers of support:
    • Majority of youth
    • Small groups of youth
    • Individual youth
  • Model doesn’t change
pbis model
PBIS Model
  • Strengths:
    • Clarifies expectations
    • Provide structure
    • Data based decision making increases accountability and protects youth
  • Weaknesses:
    • Often mistaken for it’s parts and not as the whole model
    • May be viewed as competing with other models
    • The proactive / preventative nature may be perceived as incongruent with Juvenile Justice aims
positive action overview
Positive Action Overview
  • Positive Action teaches the positive actions for the whole self through six units that are contained in six program components.
    • Teacher/staff training
    • K-12 curriculum
    • Climate development
    • Counselors program
    • Family program
    • Community program
prevention of depression
Prevention of Depression
  • Clarke et al. (2001) found that a group program for adolescent offspring of depressed parents could reduce the incidence of depression to a level no higher than for adolescents whose parents were not depressed.
new beginnings program nbp
New Beginnings Program (NBP)
  • Small group program for divorcing families
  • Emphases on learning new skills and applying them in the family
effective reading instruction
Effective Reading Instruction
  • If children cannot read competently by the third grade, they are very unlikely to ever become competent readers
  • Reading skill is required for academic success in every other subject
  • A number of effective reading instruction programs has been validated in randomized trials
  • These evidence-based approaches are often not used
evidence based kernels
Evidence-based kernels
  • Simple techniques for affecting behaviors
  • Easy to learn and use
  • Often quick results
  • More than fifty have been identified (Embry & Biglan, 2008)
  • Prize Bowl to reduce serious addictions and complete recovery goals
  • Beat the Timer
  • My Values activity to increase high school graduation
  • Goal Node Interview to decrease alcohol, tobacco and marijuana use, and/or increase prosocial goals
  • Omega 3 Supplementation
  • Praise notes
effective policies in the u s
Effective Policies in the U.S.

For all policies, we have applied the Standards of Evidence as defined by Flay et al. in the Standards of Evidence document , Prevention Science, 2005.

effective policies in the u s1
Effective Policies in the U.S.

For all policies, we have applied the Standards of Evidence as defined by Flay et al. in the Standards of Evidence document , Prevention Science, 2005.

talk amongst yourselves
Talk Amongst Yourselves
  • What doubts, skepticism, and obstacles come to mind?
  • What might be a single specific step you might take to further prevention?
poverty the most important risk factor for problem development
Poverty: The Most Important Risk Factor for Problem Development
  • School failure and drop out
  • Crime
  • Substance abuse
  • Depression
  • Poor self-regulation
  • Heart disease
  • Cancer
among 25 developed countries
Among 25 Developed Countries,
  • The United States Has the Highest Proportion of Children Living in Poverty
  • And they are now higher than they have been since the 1960’s
so here s the deal
So here’s the deal:
  • You, your spouse and two children get $22,162 a year. ($1846/ month or about $10 an hour)
  • What is your house payment?
  • Food?
  • Clothes?
  • Entertainment?
poverty is associated with higher rates of
Poverty is associated with higher rates of
  • Mild mental retardation
  • School failure and drop out (Gutman et al., 2005)
  • Antisocial behavior (NICHD, 2005; Weatherburn & Lind, 2006)
  • Depression (Elder, Nguyen, & Caspi, 1985; Gutman et al., 2005)
  • Poor self-regulation (McLoyd, 1998)
parenting a key pathway from poverty to problem development
Parenting: A key pathway from poverty to problem development
  • Parents under financial strain
    • Less involved with their children
    • More likely to criticize and argue with them (Gutman et al., 2005)
  • Such disrupted parenting contributes to children's
    • Anxiety and depression (Elder et al., 1985; Gutman et al., 1994)
    • Failure in school (Gutman et al., 1994)
    • Aggressive behavior (NICHD, 2001)
    • Delinquency (Weatherburn & Lind, 2006)
health and social problems are closely related to inequality in rich countries
Health and Social Problems are Closely Related to Inequality in Rich Countries



Portugal *

Index of health and social problems

UK *

Greece *

* New Zealand

Ireland *

Austria *

France *

Australia *

Germany *

* Canada

Italy *

Denmark *



* Spain

Finland *



* Switzerland

Norway *

* Sweden

* Japan


Income Inequality



death rates of working age men in sweden vs england and wales
Death rates of working age men in Sweden vs. England and Wales

Death rates among working-age men are lower in Sweden than in England and Wales, in all occupational classes

rates of illness are lower at both high and low educational levels in england compared to the us
Rates of illness are lower at both high and low educational levels in England compared to the US

Note: Within each grouping of three, lowest educational level is on the left and highest educational level is on the right

policies poverty reduction
Policies: Poverty Reduction
  • Living wage ordinance
  • Uptake of benefits related to national and state assistance programs
  • Tenant-based rental assistance
  • Food assistance
  • Conditional cash transfers
  • Micro credit, micro finance
  • Enterprise zones
  • Health care access

ThePromiseNeighborhoods Initiative

“It's a moral outrage that, in the richest nation on earth, 37 million Americans are living in poverty.”

“I have called for the creation of a new program that replicates the success of the Harlem Children's Zone—an all-encompassing, all-hands-on-deck, anti-poverty effort that is literally saving a generation of children in a neighborhood where they were never supposed to have a chance.”

the promise neighborhoods research consortium pnrc
The Promise Neighborhoods Research Consortium (PNRC)
    • Develop the scientific infrastructure to support the Promise Neighborhoods Initiative and other high-poverty neighborhoods
    • Funded by NIDA from ARRA funds
    • Nationwide team of scientists
  • www.promiseneighborhoods.org
the key ingredients of effective prevention
The Key Ingredients of Effective Prevention
  • Measure developmental outcomes and their influences
  • Promote nurturing environments at every phase of development through evidence-based prevention programs, policies, and practices
  • Advocate for nurturing environments
  • Refine efforts in light of evidence
c omprehensive prevention is spreading
Comprehensive Prevention Is Spreading
  • Promise Neighborhoods Imitative
    • Funded
    • Unfunded but proceeding
      • Lane County Oregon
  • Choice Neighborhoods
  • Prevention Prepared Communities
  • I Have a Dream Foundation
  • Oregon’s Model Comprehensive Prevention Initiative
assessment of school readiness in almost every lane county school district
Assessment of School Readiness in Almost Every Lane County School District!
  • More than 50% of kindergarten students in our four Promise Neighborhood elementary schools were at risk to not be able to learn to read
  • By tracking readiness, we can evaluate our progress in preparing kids to succeed in school
components of the tobacco control movement
Components of the Tobacco Control Movement
  • Creative epidemiology
  • Pragmatic effort to find and disseminate whatever policies, media, or programs worked.
    • (Like Triple P, they found that not many wanted formal cessation programs.)
    • Media and policy were most important and went hand in hand.
  • Network of advocacy organizations
  • A surveillance system
making the case for comprehensive prevention
Making the Case for Comprehensive Prevention
  • Emphasize the inter-relationships among problems, their common origins, and the potential of evidence-based prevention to prevent the entire range of problems
  • Organize and creatively communicate the epidemiological and intervention evidence
  • Emphasize the role of these problems in physical health.
  • Emphasize the economic benefits of prevention.
effective prevention affects multiple problems
Effective Prevention Affects Multiple Problems
  • Crime
  • Drug Abuse
  • Depression
  • Health
  • Academic failure
  • Economic productivity




- Since 1879

Study Finds Children Do Better in Nurturing Families and Schools

A study of 2,000 elementary school students found that those in warm nurturing families and schools did significantly better than other children.

The study experimentally tested teaching adults and students to be warmer, kinder, more reinforcing of each other in the classroom and other school settings.

The study found important changes in important outcomes.

First, students were far more attentive during lessons and less disruptive.

Teachers reported more time to teach, and less absenteeism.

Second, there were significantly high test scores…

psychological and behavioral problems make a huge contribution to physical illness
Psychological and Behavioral Problems Make a Huge Contribution to Physical Illness
  • Causes of heart disease and cancer
    • Depression
    • Academic failure
    • Tobacco, alcohol, and other drug use and abuse
    • Delinquency
    • Premature or unsafe sex
    • Inadequate exercise
    • Poor dietary habits
psychosocial factors such as depression and stress account for 32 of heart attacks
Psychosocial factors such as depression and stress account for 32% of heart attacks
  • A little less than smoking
  • But more than for hypertension and obesity
education income correlation
Education Income Correlation

Source: Cortright, J. (2008). The city dividends: How cities gain by making small improvements in metropolitan performance. Chicago: CEOS for Cities.

poverty and its fiscal consequences
Poverty and Its Fiscal Consequences

Source: Cortright, J. (2008). The city dividends: How cities gain by making small improvements in metropolitan performance. Chicago: CEOS for Cities.

economic benefits of successful development cortright 2008
Economic Benefits of Successful Development (Cortright, 2008)
  • The Talent Dividend: Increasing the four-year college attainment rate in each of the nation’s 51 largest metropolitan areas by one percentage point would be associated with a $124 billion increase in aggregate annual personal income.
  • The Opportunity Dividend: Reducing poverty rates in metropolitan areas by one percentage point would decrease public sector outlays for family assistance, Medicaid and food stamps by about $13 billion annually.
yet we are lagging in educational attainment
Yet, we are lagging in educational attainment
  • Increase in the Share of Workers with Post-High School Education in Last 20 years:19%
  • Next 20 years: 4%
in the end it is a matter of our values
In the end, it is a matter of our values.
  • What do we want our communities to be like?
    • Virtually all children grow up to have the skills, interests, assets, and health habits needed to live happy and productive lives in caring relationships with other people?
    • Our work force is smart, hard working, cooperative, and innovative?
    • Crime is low?
    • Drug abuse and mental illness are a tiny fraction of what they are now?
    • People trust and care for each other.
making the case for comprehensive prevention1
Making the Case for Comprehensive Prevention
  • Don’t fight with those seeking funds for other problems. Join them in advocating for comprehensive prevention.
  • Create a website and use webinars, Facebook, and twitter to promote.
  • Train a cadre of presenters to do l5 to 30 minute presentations.
    • Focus on recruit opinion leaders.
    • Don’t train those in the choir unless you train them to present to others.
increasing the prevalence of nurturing environments
Increasing the Prevalence of Nurturing Environments
  • Evolve advocacy organizations focused on these values and goals
    • Rather than organizations focused on a single problem (e.g., Mothers Against Drunk Driving)
  • Develop the surveillance system to monitor the prevalence of nurturing environments as well as the problems
websites and email addresses
Websites and Email Addresses
  • www.promiseneighborhoods.org
  • www.nurturingenvironments.org
  • tony@ori.org