Reward

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Reward Reminder

• A Multi-State Experiment in Community
  Mobilization for Real Prevention Results

By Dennis D. Embry, Ph.D.
For more info, see www.paxtalk.com
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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

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The Original Scientist
Dr. Anthony Biglan, President, Society for
Prevention Research Senior Scientist, Oregon
Research Institute www.ori.org
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Reward Reminder in Action

• Reward and Reminder in action Video

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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?

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Wyoming case study

• History of Wyoming
• Use of science based practice at state level.
• Show sequence of data

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Wyoming case study

• The change created
• Policy
• Finances
• Community mobilization
• Legislation
• Other learnings, innovations and aspects (next
  slide)

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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.

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Wisconsin Replication

• State 10 times the size of Wyoming.
• Similar limitations
• 45-60 days start up
• No community input

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Wisconsin Replication

• State 10 times the size of Wyoming.
• Similar limitations
• 45-60 days start up
• No community input

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Kansas Replication

• 105 counties
• Only 10 counties receive RR
• No integrated media campaign

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The science behind this

• Effective mobilization is no accident

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Recipe for Success
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Building Blocks for Brain and Behavior Change
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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.
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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.
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Watching the brain work
Machines can now see the living brain work. This
technology is becoming more powerful every year.
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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.

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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.

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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

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RR Changing the Brain

• Creating collaboration, cooperation and common
  goals changes sense of belongingempowering
  creativity of RR coalitions
• Affecting brains of clerks
• Affecting the brains of youth teams

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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.
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RR Consequences

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

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Thank-You Cards to Clerks
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Scoreboard Consequence
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Formula for Consequences
The formula for the basic Matching Law.
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Common Cognitions

• I can do that.
• Everyone else is doing it.
• I am bored.
• No one likes me.
• Ill lose my friends.

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

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Cognitions in RR

• 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
  RR?

Consider the Relational Frame Network
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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. Develo
pment is the universal age related limitations on
behavior or cognitions.
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Adolescent Changing Personalities
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Adolescent Developmental Issues
Teens Adults
Teens seeing fear versus adults seeing fear.
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Developmental Interactions
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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

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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
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Ecology/Environment Example
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Depression Data
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RR Logic Model
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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
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RE-AIMing for Public Health
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Understanding Epidemiology

• Reward and Reminder Emerges from Careful
  Epidemiology

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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 dont smoke, drink or use.
• Early antisocial behavior

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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?

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RR Extensions

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

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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

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Thank you. We hope we helped you today.

• Dennis D. Embry, Ph.D.
• PAXIS Institute
• 520-299-6770 dde_at_paxis.org
• www.paxtalk.com