Community Monitoring to Foster Population Level Prevention

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Community Monitoring to Foster Population Level Prevention

National Prevention Network • August, 2006

Community Monitoring

to Foster Population

Level Prevention

Dennis D. Embry, Ph.D., PAXIS Institute

Co-Investigator, Early Adolescence Center, Oregon

Research Institute

Co-Investigator, Center for Early Prevention and

Intervention, Johns Hopkins University

The workshop is a

result of collaboration

between the Society for

Prevention Research

and the National

Prevention Network

1


Today’s workshop aims…

Re-package or re-purpose commonly

collected data in communities to show

politically and socially significant outcomes.

Develop or adopt simple measures that

show prevention effects.

Use powerful, practical, and simple

experimental designs to prove that

prevention is happening in communities.

Present data and information that

persuade policy makers to support

prevention.

2


Are you an everyday scientist

3


Are you an everyday scientist

3


Are you an everyday scientist

Human beings are the only organism

on this planet that can consciously

create a future environment for

themselves.

3


Are you an everyday scientist

Human beings are the only organism

on this planet that can consciously

create a future environment for

themselves.

Other animals accidentally affect

their environment.

3


Are you an everyday scientist

Human beings are the only organism

on this planet that can consciously

create a future environment for

themselves.

Other animals accidentally affect

their environment.

What makes an everyday scientist

3


Are you an everyday scientist

Human beings are the only organism

on this planet that can consciously

create a future environment for

themselves.

Other animals accidentally affect

their environment.

What makes an everyday scientist

What is it that you want to increase

AND decrease in the future

3


A Counting of Ability

Are we there yet

Have we achieved our goals of

preventing substance abuse

Have we reached our goals of

preventing violence

Have we accomplished our our task

of preventing mental illness

Have we attained the goal of

preventing educational failure

Have we completed our goal of

preventing crime

Prevention

Goals

4


State Success

50%

30-day smokers

40%

30%

20%

10%

0%

1993 1997 1999 2003 2005

5


State Success

What do

you

predict

in 2005

50%

30-day smokers

40%

30%

20%

10%

0%

1993 1997 1999 2003 2005

5


State Success

What do

you

predict

in 2005

50%

30-day smokers

40%

30%

20%

10%

0%

1993 1997 1999 2003 2005

5


State Success

60%

30-day alcohol use

50%

40%

30%

20%

10%

0%

1993 1997 1999 2003 2005

6


State Success

What do

you

predict

in 2005

60%

30-day alcohol use

50%

40%

30%

20%

10%

0%

1993 1997 1999 2003 2005

6


State Success

What do

you

predict

in 2005

60%

30-day alcohol use

50%

40%

30%

20%

10%

0%

1993 1997 1999 2003 2005

6


State Success

40%

30-day binge drinking

30%

20%

10%

0%

1993 1997 1999 2003 2005

7


State Success

What do

you

predict

in 2005

40%

30-day binge drinking

30%

20%

10%

0%

1993 1997 1999 2003 2005

7


State Success

What do

you

predict

in 2005

40%

30-day binge drinking

30%

20%

10%

0%

1993 1997 1999 2003 2005

7


State Success

40%

Rode with someone drinking

30%

20%

10%

0%

1993 1997 1999 2003 2005

8


State Success

What do

you

predict

in 2005

40%

Rode with someone drinking

30%

20%

10%

0%

1993 1997 1999 2003 2005

8


State Success

What do

you

predict

in 2005

40%

Rode with someone drinking

30%

20%

10%

0%

1993 1997 1999 2003 2005

8


State Success

Drug exchange on campus this year

35%

30%

25%

20%

15%

10%

5%

0%

1993 1997 1999 2003 2005

9


State Success

What do

you

predict

in 2005

Drug exchange on campus this year

35%

30%

25%

20%

15%

10%

5%

0%

1993 1997 1999 2003 2005

9


State Success

What do

you

predict

in 2005

Drug exchange on campus this year

35%

30%

25%

20%

15%

10%

5%

0%

1993 1997 1999 2003 2005

9


State Success

30%

30-Day Marijuana use

25%

20%

15%

10%

5%

0%

1993 1997 1999 2003 2005

10


State Success

What do

you

predict

in 2005

30%

30-Day Marijuana use

25%

20%

15%

10%

5%

0%

1993 1997 1999 2003 2005

10


State Success

What do

you

predict

in 2005

30%

30-Day Marijuana use

25%

20%

15%

10%

5%

0%

1993 1997 1999 2003 2005

10


State Success

4%

30-day cocaine use

3%

2%

1%

0%

1993 1997 1999 2003 2005

11


State Success

What do

you

predict

in 2005

4%

30-day cocaine use

3%

2%

1%

0%

1993 1997 1999 2003 2005

11


State Success

What do

you

predict

in 2005

4%

30-day cocaine use

3%

2%

1%

0%

1993 1997 1999 2003 2005

11


State Success

50%

Currently sexually active

40%

30%

20%

10%

0%

1993 1997 1999 2003 2005

12


State Success

What do

you

predict

in 2005

50%

Currently sexually active

40%

30%

20%

10%

0%

1993 1997 1999 2003 2005

12


State Success

What do

you

predict

in 2005

50%

Currently sexually active

40%

30%

20%

10%

0%

1993 1997 1999 2003 2005

12


State Success

Threatened or injured on school property w/weapon

10%

8%

6%

4%

2%

0%

1993 1997 1999 2003 2005

13


State Success

What do

you

predict

in 2005

Threatened or injured on school property w/weapon

10%

8%

6%

4%

2%

0%

1993 1997 1999 2003 2005

13


State Success

What do

you

predict

in 2005

Threatened or injured on school property w/weapon

10%

8%

6%

4%

2%

0%

1993 1997 1999 2003 2005

13


State Success

Attempted suicide

14%

12%

10%

8%

6%

4%

2%

0%

1993 1997 1999 2003 2005

14


State Success

What do

you

predict

in 2005

Attempted suicide

14%

12%

10%

8%

6%

4%

2%

0%

1993 1997 1999 2003 2005

14


State Success

What do

you

predict

in 2005

Attempted suicide

14%

12%

10%

8%

6%

4%

2%

0%

1993 1997 1999 2003 2005

14


Why is the

journey’s end so

far away

Perhaps we need more money

to buy a better car

15


Why is the

journey’s end so

far away

Perhaps we need more money

to buy a better car

Try spending $300+ per capita for prevention for 3 years

15


So make your case for

more prevention

Try these on for size:

We didn’t have enough money or staff

People implemented prevention badly (poor dose

and fidelity)

We got a late start

We were confused by the Legislature

The coalitions didn’t have enough training

Contracting was at fault

18


What would

you notice if

these things

were changing

19


What is the vision of

community level prevention

More

Less

20


Time Series Data Example

60%

30-Day Alcohol Use

40%

20%

0%

October

November

December

January

February

March

April

May

Group 1 9th Graders

21


Time Series Data Example

60%

30-Day Alcohol Use

40%

20%

0%

October

November

December

January

February

March

April

May

Group 1 9th Graders

21


Time Series Data Example

60%

30-Day Alcohol Use

40%

20%

0%

October

November

December

January

February

March

April

May

Group 1 9th Graders

21


Time Series Data Example

60%

30-Day Alcohol Use

40%

20%

0%

October

November

December

January

February

March

April

May

Group 1 9th Graders

21


Time Series Data Example

60%

30-Day Alcohol Use

40%

20%

0%

October

November

December

January

February

March

April

May

Group 1 9th Graders

21


Time Series Data Example

60%

30-Day Alcohol Use

40%

20%

0%

October

November

December

January

February

March

April

May

Group 1 9th Graders

21


Time Series Data Example

60%

30-Day Alcohol Use

40%

20%

0%

October

November

December

January

February

March

April

May

Group 1 9th Graders

21


Time Series Data Example

60%

30-Day Alcohol Use

40%

20%

0%

October

November

December

January

February

March

April

May

Group 1 9th Graders

21


Time Series Data Example

60%

30-Day Alcohol Use

40%

20%

0%

October

November

December

January

February

March

April

May

Group 1 9th Graders

21


Time Series Data Example

0.5

30-Day Alcohol Use

0.3

0.1

-0.1

October

November

December

January

February

March

April

May

Group 2 9th Graders

22


Time Series Data Example

0.5

30-Day Alcohol Use

0.3

0.1

-0.1

October

November

December

January

February

March

April

May

Group 2 9th Graders

22


Time Series Data Example

0.5

30-Day Alcohol Use

0.3

0.1

-0.1

October

November

December

January

February

March

April

May

Group 2 9th Graders

22


Time Series Data Example

0.5

30-Day Alcohol Use

0.3

0.1

-0.1

October

November

December

January

February

March

April

May

Group 2 9th Graders

22


Time Series Data Example

0.5

30-Day Alcohol Use

0.3

0.1

-0.1

October

November

December

January

February

March

April

May

Group 2 9th Graders

22


Time Series Data Example

0.5

30-Day Alcohol Use

0.3

0.1

-0.1

October

November

December

January

February

March

April

May

Group 2 9th Graders

22


Time Series Data Example

0.5

30-Day Alcohol Use

0.3

0.1

-0.1

October

November

December

January

February

March

April

May

Group 2 9th Graders

22


Time Series Data Example

0.5

30-Day Alcohol Use

0.3

0.1

-0.1

October

November

December

January

February

March

April

May

Group 2 9th Graders

22


Time Series Data Example

0.5

30-Day Alcohol Use

0.3

0.1

-0.1

October

November

December

January

February

March

April

May

Group 2 9th Graders

22


Time Series Data Example

60%

30-Day Alcohol Use

40%

20%

0%

October

November

December

January

February

March

April

May

Group 1 9th Graders

Group 2 9th Graders

23


Time Series Data Example

60%

30-Day Alcohol Use

40%

20%

0%

October

November

December

January

February

March

April

May

Group 1 9th Graders

Group 2 9th Graders

23


Time Series Data Example

60%

30-Day Alcohol Use

40%

20%

0%

October

November

December

January

February

March

April

May

Group 1 9th Graders

Group 2 9th Graders

23


Lessons learned

24


Lessons learned

Why are repeated measures important to

prevention practice

Write a 10-word answer in the next minute

24


Lessons learned

Why are repeated measures important to

prevention practice

Write a 10-word answer in the next minute

Why are repeated measures important to

prevention policy

Discuss this for 1 minute with neighbor here.

24


Lessons learned

Why are repeated measures important to

prevention practice

Write a 10-word answer in the next minute

Why are repeated measures important to

prevention policy

Discuss this for 1 minute with neighbor here.

How would repeated measures improve

prevention in your community or state

Interview your neighbor for 1 minute each (two

minutes total)

24


Syndemic

approach to

prevention data

SYNDEMIC |syn·dem·ic|

(noun): two or more afflictions

interacting synergistically, contributing

to excess burden of disease in a

population.

Related concepts include: linked

epidemics, interacting epidemics,

connected epidemics, co-occurring

epidemics, comorbidities, and clusters

of health-related crises.

25


Thinking about relationships

"You think that if you

understand one, you

understand two

because

one and one are two.

But you must also

understand 'and'.”

—Sufi Saying

26


Thinking about relationships

Substance abuse and violence are

related.

Write down what the “and” is, in 10 words

or less in the next minute.

"You think that if you

understand one, you

understand two

because

one and one are two.

But you must also

understand 'and'.”

—Sufi Saying

26


Thinking about relationships

Substance abuse and violence are

related.

Write down what the “and” is, in 10 words

or less in the next minute.

Substance abuse and educational

problems are related.

Tell your neighbor what you think the

“and” is, in the next two minutes.

"You think that if you

understand one, you

understand two

because

one and one are two.

But you must also

understand 'and'.”

—Sufi Saying

26


Thinking about relationships

Substance abuse and violence are

related.

Write down what the “and” is, in 10 words

or less in the next minute.

Substance abuse and educational

problems are related.

Tell your neighbor what you think the

“and” is, in the next two minutes.

Substance abuse and mental illness

are related.

Interview your neighbor about what an

“and” is, in the next two minutes.

"You think that if you

understand one, you

understand two

because

one and one are two.

But you must also

understand 'and'.”

—Sufi Saying

26


Syndemic Case Example of Billy

27


Money

Time

• Classroom disruptions 77,760

• Physical hits on others 6,480

• Acts of vandalism 325

• Hours of instruction disruptive 360 hrs

• Items stolen from others 1,350

• Administrative hours lost 144 hrs

• Teacher hours lost in meetings 90 hrs

• Janitor, secretary and aide hours 180 hrs

• Threats of lawsuits 2

• Complaints to superintendent 5

• Nurses office visits for meds,

illnesses, injuries, etc. 1,200

Billy’s Costs

28


Syndemic

indicators of

prevention

Write down as many data

currently being collected that

might indicate of Billy’s in your

community or state are going

up or down in rate in the next

minute.

29


Develop or adopt simple measures

that show prevention effects.

“Simplicity is

the ultimate

sophistication.”

– Leonardo da Vinci

30


Prevention syndemic measures

“To prevent a syndemic, one

must prevent or control not

only each affliction, but also

the forces that tie those

afflictions together.”

What is a countable 3rd factor

3rd

Factor

Substance

Abuse

Violence

What are measurable ties

31


Potential syndemic prevention

measures

Current data being collected across

silos

Consider different developmental

ages and stages that predict

Consider sources you have not

spoken to

New things that might be collected

frequently

Can you count it

Can you measure it

32


Consider some interesting

measures of child-youth syndemics

Disruptive behavior in by high-risk child AND peers

in classroom.

What syndemics might be predicted

What are the connections between the two

Aggressive behavior on the playground AND adult

attention to behavior

What syndemics might be predicted

What are the connections between the two

Square footage of student work on walls of high school

AND delinquency/vandalism

What are the ties between

33


Syndemic Developmental Pathways and Ties

What might be measures in the community to show

prevention results and effects

34


Re-package or re-purpose

commonly collected data in

communities to show politically

and socially significant outcomes.

“If you torture data long enough, it will tell you anything you want !”

– Anonymous

“You can't just sit around and do nothing while you're waiting - you

have to kind of piggyback on some experiments so you can generate

data. But when you get it, there is no feeling like it in the world.”

– Caroline Whitacre

35


In the public hearing…

“What effect are your prevention

programs for tobacco, drugs and

violence having”

36


State Level

Percent of Illegal Sales to Minors of Tobacco

Baseline

Reward & Reminder

Baseline

Reward & Reminder

37


State Level

Percent of Illegal Sales to Minors of Tobacco

60%

50%

40%

30%

20%

10%

0%

Baseline

Reward & Reminder

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Baseline

Reward & Reminder

37


State Level

Percent of Illegal Sales to Minors of Tobacco

60%

50%

40%

30%

20%

10%

0%

Baseline

Reward & Reminder

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Baseline

Reward & Reminder

37


State Level

Percent of Illegal Sales to Minors of Tobacco

60%

50%

40%

30%

20%

10%

0%

Baseline

Reward & Reminder

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Baseline

Reward & Reminder

37


State Level

Percent of Illegal Sales to Minors of Tobacco

60%

50%

40%

30%

20%

10%

0%

Baseline

Reward & Reminder

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

60%

50%

40%

30%

20%

10%

0%

Baseline

Reward & Reminder

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

37


State Level

Percent of Illegal Sales to Minors of Tobacco

60%

50%

40%

30%

20%

10%

0%

Baseline

Reward & Reminder

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

60%

50%

40%

30%

20%

10%

0%

Baseline

Reward & Reminder

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

37


State Level

Percent of Illegal Sales to Minors of Tobacco

60%

50%

40%

30%

20%

10%

0%

Baseline

Reward & Reminder

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

60%

50%

40%

30%

20%

10%

0%

Baseline

Reward & Reminder

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

37


Examples of other data

Study: Meth use down in local workers

By Alexis Huicochea

ARIZONA DAILY STAR

Tucson, Arizona | Published: 08.29.2006

A study of workplace drug-test results reveal a decrease

in methamphetamine use by more than 25 percent in

Tucson, officials said Monday.

The study is based on data from Quest Diagnostics, the

nation's largest provider of diagnostic testing services,

according to a news release. The drug-test results are

from pre-employment screenings and random on-the-job

testing…

38


Violence Prevention Study

Change in

Nurses’

Office

Visits from

Year to

Year

Control/Wait List

PeaceBuilders

39


Violence Prevention Study

Change in

Nurses’

Office

Visits from

Year to

Year

60%

50%

40%

30%

20%

10%

All Visits

Injury Viists

Non-Injuries

0%

-10%

Control/Wait List

PeaceBuilders

Fighting Injuries

Non-Fighting Injuries

-20%

39


Violence Prevention Study

Change in

Nurses’

Office

Visits from

Year to

Year

60%

50%

40%

30%

20%

10%

All Visits

Injury Viists

Non-Injuries

0%

-10%

Control/Wait List

PeaceBuilders

Fighting Injuries

Non-Fighting Injuries

-20%

39


Violence Prevention Study

Change in

Nurses’

Office

Visits from

Year to

Year

60%

50%

40%

30%

20%

10%

All Visits

Injury Viists

Non-Injuries

0%

-10%

Control/Wait List

PeaceBuilders

Fighting Injuries

Non-Fighting Injuries

-20%

39


Use powerful, practical, and simple

experimental designs to prove

that prevention is happening in

communities.

“If your result needs a statistician, then you

should design a better experiment”

Ernest Rutherford quotes (Baron Rutherford of Nelson. New

Zealander born British Chemist who laid the groundwork for

the development of nuclear physics by investigating

radioactivity. Nobel Prize in 1908. 1871-1937)

40


Multi-School Prevention

Disruptive Behaviors Per 15 Minutes

First Point = Baseline; Second = 1 month after; Third = 2 month after

Successive Months and Years

41


Multi-School Prevention

Disruptive Behaviors Per 15 Minutes

60

50

40

30

20

10

0

First Point = Baseline; Second = 1 month after; Third = 2 month after

9/00 10/00 11/00 12/00 1/01 2/01 3/01 4/01 5/01 9/01 10/01 11/01 12/01

Successive Months and Years

41


Reducing disruptive acts and

increasing time for learning

# of disruptions

# of disruptions

# of disruptions

40

30

20

10

0

40

30

20

10

0

40

30

20

10

0

Rate of Disruptions/Student/Hour

Baseline

Implement Good Behavior Game

4/1/05 4/8/05 4/13/05 4/29/05 5/16/05 5/24/05

Date

Series1

Rate of Disruptions/Student/Hour

Baseline

Implement Good Behavior Game

1-Apr 4/8/05 4/13/05 4/29/05 5/16/05 5/24/05

Date

Series1

Rate of Disruptions/Student/Hour

Baseline

Implement Good Behavior Game

31-Mar 1-Apr 8-Apr 4/13/05 4/29/05 5/15/05 5/24/05

Date

Series1

How might these data have

furthered a prevention agenda

in a community

What kinds of impact might

you see as a result of doing this

for children on syndemics

In near term (same academic

year)

Over a few years

Is this a scientific experimental

design

42


Reducing

vandalism

How might these data have furthered a

prevention agenda in a community

What kinds of impact might you see as

a result of doing this for children on

syndemics

In near term (same academic year)

Over a few years

Is this a scientific experimental design

Dollars Spent Per Student for Vandalism

43


Multiple-Baseline

Is this a valid experimental

design

How could this design be

used in your community

What might you want to go

up or down

Talk with partner for 1

minute about what kinds of

syndemic prevention issues

that could be measured in

this way

45


Reversal design example

46


Reversal Design Example

47


Good resources for

practical data and

evaluation thinking

Behavior Analysis for Lasting Change

by Beth Sulzer-Azaroff, Roy G. Mayer

(See Amazon.com)

48


Present data and information that

persuade policy makers to

support prevention.

49


Policy makers’ perspectives

Elected Officials

State elected officials

City or county

elected officials

Appointed officials

state officials

local officials

Non-elected leaders

Business people

Non-profit boards

Top civic movers and

shakers

Civil service

State

Local

50


Presentation issues

How does your work further the recipients

agenda or goals

Who has goals or agendas competing for their

attention

How will or can your results or efforts enhance

personal reinforcers of the key audience

How can you link your results to policymakers’

actions in a positive light

How can your success reflect well on other

stakeholders who help you

Do you have testimonials AND data (Why is

this important)

51


Presentation framing

What is your metaphor

Never use US versus THEM

What compels people to feel emotionally

engaged (not avoiding) your presentation

How is your presentation a fractal of your

prevention efforts

How does your message and approach appeal to

both logic, common sense, AND science

What are the costs of not doing your approach

AND doing it AND using alternative

52


Everyday scientist revisited

Summarize a key principle you have

learned today in 10 words or less

In the next 1 minute, list as many Text

things you will do MORE after you

return to community from the

lessons learned today.

In the next 1 minute, list as many

things you will do LESS after you

return to community.

53


Everyday scientist revisited

Summarize a key principle you have

learned today in 10 words or less

In the next 1 minute, list as many Text

things you will do MORE after you

return to community from the

lessons learned today.

In the next 1 minute, list as many

things you will do LESS after you

return to community.

Remember, we are creating a future, whether we think so or not.

53


Thank you…

Dennis D. Embry, Ph.D.

President/CEO

PAXIS Institute

PO 68494

Tucson, AZ 85737

Ph: 520-299-6770

dde@paxis.org

54

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