Cognitive-Based Integrative (CBI) Programs
A model to mitigate risk-taking behaviors among adolescents
Cognitive-Based Integrative (CBI) Programs have been developed by Dr. James DeCarli and applied to six different programs to empower individuals, parents, and teens with the skills to improve health and resiliency, behavioral choices, and success. One is an independent class for recently separated parents to learn healthy co-parenting skills in the best interest of their child while living separate lives. The others include four independent classroom/activity-based classes. Three different classes provide children, teens, and adults with the necessary skills to become empowered to practice healthy behaviors and make positive choices in life. An additional class is available to professionals in their job capacity. Classes are generally over a weekend at an off-site retreat. In addition, the class can include the two-day, off-site retreat with a 1.5-hour weekly session for 6-weeks. Class topics can also be adapted to meet the objectives of the individual, parents, school, workplace, or other organizations.
The CBI Program models incorporate Neuroscience-based models promote behavior change and promotes healthy brain development. These are developed into initiatives and programs aimed at reducing injury and violence exposure while promoting mental health and wellness in communities. Public Health Behavior Solutions collaborates with public health agencies, schools, and hospitals at local, state, and federal levels, as well as global partners, to address issues such as injury and violence prevention, maternal and child health, adolescent health, child brain development, and disease prevention.
The CBI Programs contribute to healthier families, workplace environments, and communities, by meeting 16 health objectives in six topic areas (Adolescent Health, Family Planning, Injury, and Violence Prevention, Mental Health and Mental Disorders, Sleep Health, and Substance Abuse), of Healthy People 2030 comprehensive national goals and objectives. In addition, the CBI Program Neuroscience Models have also been applied to the Cognitive-based Integrative Model to Increase Vaccine Uptake, a behavior change approach to maximize vaccination rates in the United States and globally during a pandemic.
The CBI programs:
- Decreases risky behavior in adolescence at the primary and secondary levels of prevention, including early sexual behavior, drugs/alcohol use (including fentanyl exposure), and thrill-seeking such as street takeovers/drifting, speeding, riding unrestrained, distracted driving, gang affiliation, DUI, etc.
- Benefits those who have been exposed to family dysfunction, abuse, and trauma, including parents, teens, and professionals of authority.
- Reaches at-risk youth (juvenile probation/prevention and early intervention), ages 17 and younger who have violated state penal codes, including truancy, tobacco, graffiti, drugs, trespassing, daytime and nighttime curfew, riding a bicycle without a helmet, etc.
- Provides a benefit to adolescents, aged 18-24, who are interested in learning how to make choices, that they will not regret later. This is helpful to college students and those of this age group who are in the workforce.
- Provides expectant and new parents with lifestyle intervention for those who are interested in promoting healthier role modeling and parenting.
Questions email [email protected] or call Dr. James DeCarli at 323-491-6197 (PST)
Background
Early research in the development of the Neuroscience-Based Models applied to the CBI Programs established a strong neurodevelopmental association between exposure to child abuse and neglect and lifetime exposure to abuse, and illness. These traumas result in chronic activation that results in negative impacts on the amygdala and hippocampus, due to elevated Glucocorticoids (GCs). This results in adult manifestations that affect health and behavior. Our research in this area continues to study how exposure to traumatic experiences from in utero, early childhood, and teen years, affect psychopathology and cognitive functioning beginning in early adulthood. This is studied to learn how early exposure to trauma affects the developing brain, so we can more effectively establish neuroscience models to develop primary prevention programs in our CBI programs. The neuroscience models, incorporated within the CBI programs, improve individual behavioral control by managing Corticosteroid Receptors-CR (controlling hypothalamic-pituitary-adrenocortical-HPA) and Mineralocorticoid Receptors-MR (an intracellular steroid hormone receptor that mediates a physiological response, significant for maintaining homeostasis) within the hippocampus and amygdala, which are stimulated during an acute stress event.
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Dr. DeCarli developed these models under the direction of Richard. F. Thompson, faculty research advisor and mentor at the University of Southern California, Neuroscience Program. "I owe a debt of gratitude for his encouragement and validation of my interests in applied neuroscience", J. DeCarli. It began with the identifying biomarkers that associated atrophy of the hippocampus among Alzheimer's Disease patients to early childhood and lifetime exposure to traumas (as presented at the Psychoneuroimmunology Research Society Conference (PNIRS), Denver, Colorado (2005) and at the BIT Annual Tetra-Congress of MolMed-2010 Conference, Shanghai, China). Further associated research validated elevated glucocorticoids among victims of intimate partner violence as a biomarker for Alzheimer's disease. This supported later findings from case studies where victims of intimate partner violence give up control to the dominant partner, resulting in depression and loss of self, as the dominant partner uses this to obtain further control taking on duties as a caregiver of the victimized partner. While these findings made this link in gerontology, they also provided a foundation to study how both short- and long-term stress affects the developing brain. For example, when a child is raised in a specific environment the brain adapts accordingly to survive in what it is exposed to. Early childhood traumas and exposure to family dysfunction can contribute to risky behavior during adolescence, as identified in the Neuroscience-Based Models. The CBI Programs further help those who have been exposed to trauma by applying these Neuroscience-Based Models to help modify behavior to reduce risky behavior. The CBI Programs also help to address the next steps among victims identified in the Adverse Childhood Experiences (ACE) Study, by providing victims of abuse and early childhood trauma with appropriate behavioral tools to empower behavioral change. Additionally, early research of the CBI programs incorporated cognitive-based models and cognitive interviewing (CI) for the development of the USC Older Adult Conflict Scale (USC-OACS), a screening tool to assess elder maltreatment [Grant #5R21 AG030661, National Institute on Aging].
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While adult victims of child abuse and neglect (including child sexual abuse), often suffer from chronic and long-term acute illness throughout adulthood (DeCarli, 2009), the CBI programs provide psychological and behavioral tools for these victims. By applying cognitive neuroscience findings at the secondary and primary levels of prevention, CBI programs promote healthy lifestyles and reduce the risk of disease, disability, and early fatality, by empowering self-awareness and sustaining individual behavior change among victims. CBI programs are designed to benefit policies and prevention programs for individual clients and families, also for schools, community organizations, and local governments by establishing programs to promote behavior change and wellness. Specific CBI programs incorporate Neuroscience-Based Models applied to classes and programs for expecting parents, and parents with school-aged children, and adolescents, to reduce adolescent risk behavior, promoting brain health and wellness. Future research on developing a multidisciplinary pediatric emotional trauma therapeutic approach is in process to address the gap in the neurobiological developmental effects of children exposed to interpersonal trauma (DeCarli, J., 2012; DeCarli, J., 2020).
References
DeCarli, J. M., Aclan, M. D., Lindgren, N. A., & Diaz, C. (2024). In-Person and Telehealth behavioral skills Training to reduce child restraint system misuse. Journal of Organizational Behavior Management, 1–32. https://doi.org/10.1080/01608061.2024.2301936
DeCarli, J. (2020). The Pediatric Trauma Cry , Public Health Behavior Solutions, Los Angeles
DeCarli, J. (2012). Neurobiological Development Effects of Children Exposed to Interpersonal Trauma. Public Health Behavior Solutions, Los Angeles
DeCarli, J. (2009). Adult Manifestations of Childhood Sexual Abuse. The Public’s Health, 9(4), 1-3–6. publichealth.lacounty.gov/wwwfiles/ph/media/media/TPH-409.pdf
DeCarli, J. M., Aclan, M. D., Lindgren, N. A., & Diaz, C. (2024). In-Person and Telehealth behavioral skills Training to reduce child restraint system misuse. Journal of Organizational Behavior Management, 1–32. https://doi.org/10.1080/01608061.2024.2301936
DeCarli, J. (2020). The Pediatric Trauma Cry , Public Health Behavior Solutions, Los Angeles
DeCarli, J. (2012). Neurobiological Development Effects of Children Exposed to Interpersonal Trauma. Public Health Behavior Solutions, Los Angeles
DeCarli, J. (2009). Adult Manifestations of Childhood Sexual Abuse. The Public’s Health, 9(4), 1-3–6. publichealth.lacounty.gov/wwwfiles/ph/media/media/TPH-409.pdf
The CBI Program Neuroscience-based Models
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Neurodevelopmental Protective Pathway Model (NPPM): The NPPM describes the developmental factors that predispose teens to risky behavior and identifies the most critical time to implement behavioral interventions to reduce risky behavior (DeCarli, J, 2009).
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Self-Motivated Transformational Choice Model (SM-TCM): The SM-TCM includes a combination of the NPPM, Emotional Re-activity Change Model (ERCM) described below, Health Belief Model and the Transtheoretical Model to help provide the necessary skills to move an individual through each stage of behavior change so one can more effectively achieve their personal goals. The SM-TCM helps individuals to understand how their choices in life can be influenced and provides the necessary skills to help modify these behaviors (DeCarli, J, 2009)
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Emotional Re-activity Change Model (ERCM): The ERCM is a self-administered tool to help modify how the brain responds in situations, to help the individual maintain control and learn how to respond rather than to react. The ERCM is applied after the participant has obtained the skills from the Self-Motivated Transformational Choice Model (SM-TCM). The ERCM promotes sustainable behavior changes through neuroplasticity (DeCarli, J, 2008).
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CBI Program-Affiliated Classes
The CBI programs incorporate cognitive neuroscience, occupational therapy, and public health approaches to provide skills that empower individuals and families to reduce exposure to injury risk and promote healthy lifestyles. CBI programs are classes that can be hospital-based, judicial, school/community, college, and faith-based youth diversion programs. It has also been incorporated to assist professionals in their job performance (leadership capacity, law enforcement, teachers, childcare professionals, social workers, clergy, etc.). The application of the neuroscience-based models in the CBI programs has also incorporated equine-assisted therapy and other hands-on methods to help strengthen the learning of the parent and child or teen. The utilization of equine therapy is a vital contribution to the CBI Programs to improve personal growth and development. Why horses? Because a horse mirrors the behavior of the client through non-verbal communication. It helps to improve self-awareness, self-esteem, anxiety, relationships, career, leadership, and healing of grief. These programs are also included as part of our hospital and provider-based Community Benefit programs.
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1. Parent-Child Development Class
Developed for new parents and parents of elementary-aged children. It applies interactive methods of the NPPM that activate neurodevelopmental protective pathways demonstrated to reduce adolescent risk behavior at the primary level and promotes healthy lifestyles for both the parent and child. Class (parents only)
Select for Parenting For Success weekend retreat Healthy People 2030 Objectives |
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2. Parent and Teen Empowerment Class
Designed for parents of middle and high-school-aged children. Because these children are already in adolescence while it includes part of the NPPM model, its focus is on the SM-TCM and the ERCM, which is shown to build neurodevelopmental protective pathways that promote healthy risk-taking behavior, ability to make healthy personal choices, and healthy lifestyles in both the parent and the teen. The Parent-Teen Empowerment program can also be adapted to meet school needs or complement specific curricula. Class (parents & teens)
Select for Parenting For Success weekend retreat Healthy People 2030 Objectives |
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3. Empowered Youth Achievement Class
Developed as a prevention and early intervention program for parents and youth ages 17 and younger who are at the early stage of risk-taking behaviors and who have violated the California Vehicle Code and/or California Penal Code. It can be adapted to probation-related prevention programs. It applies part of the NPPM and the SM-TCM, as well as the ERCM, to help the child and parent identify healthy choices in their life that they desire and strengthen neurodevelopmental protective pathways to promote healthy lifestyles in both the parent and the teen. Class (parents & teens)
Healthy People 2030 Objectives |
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4. Making Choices as an Adolescent Adult (Class)
An interactive class, developed for young adults, and adolescents ages between the ages of 18-24. While those within this age group are classified as adults, the adolescent brain is not fully developed until the mid to late 20's. Whereas the choices and actions that these teens make are made with the Limbic system of the brain. These choices are made with elevated levels of dopamine based on feelings, instead of the prefrontal cortex of the brain, which is not fully developed. The prefrontal cortex helps to make long-term choices and decisions. As a result, choices made during this stage of development can often result in unintended life choices. This class provides a benefit to adolescent adults, who are interested in learning how to make choices, that they will not regret later. They will obtain self-guided tools to help them understand how the brain makes choices and how they can learn to be empowered to make the life choices that will get them in the direction they desire. This is helpful to college students and those of this age group who are in the workforce. This also provides a benefit to support Healthy Campus programs, by empowering students to make improved choices, promoting academic success and completion, and life-long learning. This class can be designed as a credit class, a class offered at the student health center, or for programs offered to student organizations and university housing. Class:
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5. Parental Child Empowerment Program:
Tools in the best interest of your child for recently separated parents. Healthy communication for the love and best interest of your child. Going through a separation can be difficult for adults and even more difficult when parents are separated and trying to co-parent. Often separation has unintended consequences making it difficult for the child to cope, increasing communication among the parents even more difficult. This program helps recently separated parents by providing each separate parent with the tools and skills to empower each other so they can better control their own emotions, so each parent can communicate with each other, in the best interest of their child, while respecting boundaries of each parent and child. While each parent goes through this program, these are done interdependently so each parent is not in the same class or session, in the best interest of the child. Program:
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6. Strategic Leadership For Professionals
Developed for professionals that provides them with the necessary skills to identify and overcome neurodevelopmental barriers to help them become a more effective leader in their career and improve relationships in their life. It applies an interactive approach of the SM-TCM, as well as the ERCM which will provide practical skills to help regulate emotions, overcome challenges and increase abilities to achieve goals. Beneficial to improve productivity, healthy working relationships and moral. Programs Available:
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CBI Programs incorporating Equine-Assisted Activities (Equine Empowerment Center)
We incorporate equine assisted interactions into our CBI programs at various equestrian guest ranches that host this form of the program. Plans are in the process of securing property to host these programs as the permanent home of our Equine Empowerment Center (EEC). The EEC will have two components. First, conservation land will host rescued horses where horses can be rehabilitated. Secondly, the provision of youth programs to provide shadowing of equine rehabilitation and veterinary medicine. And third, being the home of the CBI programs.
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Cognitive-Based Integrative (CBI) Programs
Applying neuroscience to public health interventions and bringing brain science to real life experience |
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Questions email [email protected] or call Dr. James DeCarli at 323-491-6197 (PST)
