• Patrick Kennedy builds connections among diverse sectors to change healthcare

    (l to r) Patrick Kennedy, Bill Emmet, Kennedy Forum executive director, and Mike Thompson

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    Former U.S. Congressman Patrick Kennedy is building a “Community of Mental Health,” by making connections that are needed for mental health to be fully integrated into our understanding of overall health. To achieve this goal, the son of U.S. Senator Edward M. Kennedy has created the Kennedy Forum—so named to evoke the memory of President John F. Kennedy and employ the family name to inspire, motivate, and unite advocates and policymakers around a shared vision of what healthcare should be. The Kennedy Forum is focused on the development, implementation, and dissemination of mental health and addiction policy and standards—with the first order of business being the implementation of the new mental health and addiction parity law.

    The Kennedy Forum is providing this leadership by convening people with diverse interests and perspectives in a variety of formats including one-on-one meetings, national summits, locally focused seminars and forums being held venues as diverse as Chicago and Cape Cod. The goal of the Forum is to help shape the service delivery and payment system of the future—one that encourages prevention, early intervention, and coordinated care for all who need it.

    Patrick Kennedy (center) addresses gathering at the Kennedy compound in Hyannis Port, MA

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    The premier meeting of the Kennedy Forum was held at the Kennedy Library in Boston in the fall of 2013 (the second such meeting will be held in June 2015). Earlier this summer, a series of small gatherings took place at the Kennedy compound in Hyannis Port, on Cape Cod in Massachusetts. A meeting is scheduled for November 13 in Chicago to address local issues. Part of that meeting will address prevention and early intervention in mental health, including the traumatic impact of community violence on the city’s children.

    Arthur Evans

    Arthur Evans at Philadelphia “I Will Listen” event

    The gatherings at the the family home on Cape Cod brought together leaders from a variety of fields to share experiences and expertise and learn from each other, often for the first time. Here are several examples of participants who illustrate different perspectives on improving health in the broadest sense of the word:

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  • Massachusetts “Safe and Supportive Schools” provisions signed into law, boosts trauma-informed school movement

    Massachusetts Gov. Deval Patrick

    Massachusetts Gov. Deval Patrick

    Massachusetts Governor Deval Patrick today signed into law provisions to create conditions for “safe and supportive schools” intended to improve education outcomes for children statewide, and giving momentum to the state’s trauma-informed schools movement. They were included in The Reduction of Gun Violence bill (No. 4376). This groundbreaking advance was achieved when advocates seized the opportunity to add behavioral health in the schools to the options under consideration as state officials searched for ways to strengthen one of the nation’s more restrictive gun laws in the aftermath of the tragic shooting of schoolchildren in Newtown, CT.

    House Speaker Robert DeLeo saw the connection between reducing gun violence and school achievement and was instrumental in the bill’s passage. When the original sponsor of a Safe and Support Schools Act, Katherine Clark, left the state legislature for the U.S. House of Representatives, some advocates were concerned the void would not be filled. Their fears were assuaged when Rep. Ruth Balser of Newton and Sen. Sal DiDomenico of Boston became lead sponsors.

    The schools act supporters were jubilant that the legislation they labored on for years was incorporated in the gun violence bill now signed into law, and expressed deep relief and excitement about the achievement. They also said the hard work of statewide implementation now begins.

    The law requires the state education department to develop a framework for safe and supportive schools, first developed by a task force established by the legislature in 2008, that provides a foundation to help schools create a learning environment in which all students can flourish. The framework is based on a public health approach that includes fostering the emotional wellbeing of all students, preventive services and supports, and intensive services for those with significant needs.

    Within the framework, schools are encouraged, but not mandated, to develop action plans that will be incorporated into the already required School Improvement Plans. The law also provides a self-assessment tool to help in the creation of the plans.

    Under the leadership of the Trauma and Learning Policy Initiative (TLPI), a coalition of the Massachusetts Advocates for Children and Harvard Law School, the “Safe and Supportive Schools Coalition” was formed to move the legislation

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  • To prevent childhood trauma, pediatricians screen children and their parents…and sometimes, just parents…for childhood trauma

    TabithaLawson

    Tabitha Lawson and her two happy children

    When parents bring their four-month-olds to a well-baby checkup at the Children’s Clinic in Portland, OR, Drs. Teri Petersen, R.J. Gillespie and their 15 other partners ask the parents about their adverse childhood experiences (ACEs).

    When parents bring a child who’s bouncing off the walls and having nightmares to the Bayview Child Health Center in San Francisco, Dr. Nadine Burke Harris doesn’t ask: “What’s wrong with this child?” Instead, she asks, “What happened to this child?” and calculates the child’s ACE score.

    In rural northern Michigan, a teacher tells a parent that her “problem” child has ADHD and needs drugs. The parent brings the child to see Dr. Tina Marie Hahn, who experienced more childhood trauma than most people. Instead of writing a prescription, Hahn has a heart-to-heart conversation with the parent and the child about what’s happening in their lives that might be leading to the behavior, and figures out the child’s ACE score.

    What’s an ACE score? Think of it as a cholesterol score for childhood trauma.

    Why is it important? Because childhood trauma can cause the adult onset of chronic disease (including cancer, heart disease and diabetes), mental illness, violence, becoming a victim of violence, divorce, broken bones, obesity, teen and unwanted pregnancies, and work absences.

    The CDC’s Adverse Childhood Experiences Study (ACE Study) measured 10 types of childhood adversity: sexual, physical and verbal abuse, and

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  • Failing schools or failing paradigm?

    Roberto is an eight-year-old, former student in my second-grade class.  (All names are pseudonyms.)  In his short life, he’s experienced at least five major life traumas. One: his mother abandoned him when he was a baby. Two: he was placed in foster care with strangers. Three: he joined his father, but shortly after, Daddy was sent to prison. Four: Roberto moved again to live with Grandpop. Grandpop was ill and on house arrest, unable to leave his home, so Roberto was essentially under “house arrest” too, except for school. Roberto came to school, walked the perimeter of the classroom staring out windows, distracting other children. Sometimes, he just walked out of the classroom. His father was eventually released from prison and came to live with Grandpop, but Grandpop soon evicted Daddy after a fight with him. Five: Grandpop died.

    Ashley, a bright and engaging nine-year-old, witnessed her stepfather break her stepbrother’s leg with a baseball bat last night. The police were called, invaded her home about 1 a.m., and took her stepfather away. This morning, she came to school as usual, but in a trance, unable to focus.

    Jasmine responds much more aggressively. When she is off her medications, and her traumas are re-triggered, her tiny, wiry 45-pound frame can muscle a chair over her head. She screams and curses in guttural tones while heaving the chair at a classmate. She’s being raised by a hesitant uncle in place of her deceased parents.  Jasmine goes home to a darkened row-house, with ”illegal smoke” wafting out the front door that hangs wide open to the street.

    Jamar’s been absent from school. After several suicide attempts, he’s at the Crisis Center. Jamar suffered brutal beatings from Mom’s boyfriend, who stuffed a sock in his mouth to muffle his screams. He will come back directly to my classroom from the Crisis Center, without the dedicated adult support he is due.

    Ashley, Roberto, Jasmine and Jamar had at least eight other classmates with similar stories in our one classroom at the same time. These four real vignettes are hard to read. They’re tragic. Yet these kids are only a small portion of my class.  For the last 13 years, one-half to two-thirds of the students in my urban, public school classrooms have experienced similar lives.  These children are only four of the thousands across only one city: Philadelphia.

    Theirs is not a deficit issue. They’re not “sick” or “bad” children; they’re injured.

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  • What’s missing in climate change discussion? The certainty of trauma…and building resilience

    Aclimate

    This spring, a group of more than 160 mental health professionals, resilience-building specialists and mindfulness teachers officially launched the International Transformational Resilience Coalition. Their goal is a challenging one: to raise awareness of how climate change traumatizes communities around the world. The group’s mission is to not only educate the mental health field about this threat, but to also provide preventive solutions before disaster strikes.

    The initiative was first envisioned by Bob Doppelt, executive director of The Resource Innovation Group, an BobDoppelt2Oregon-based nonprofit that works across the U.S. to develop new approaches to social-ecological problems, including climate change. Doppelt said that efforts to mitigate climate change have focused on external aspects like fixing and improving infrastructure and developing new forecasting models.

    “And throughout all of that work,” he said, “it dawned on me that we were missing what is likely to be the most important issue facing us, and that is the human response to climate change.”

    Doppelt said he’d seen this firsthand after Hurricane Sandy devastated communities in southeast Florida, a region where The Resource Innovation Group played a key role in helping the government address climate change readiness. Trained as a counseling psychologist, Doppelt decided that it was essential to develop programs for teaching people how to become resilient as they faced the acute trauma and chronic stress brought on by climate change.

    A year-and-a-half ago, The Resource Innovation Group launched its own program to teach mindfulness skills to individuals, organizations and community leaders across the country. The premise is that everyone will need coping techniques as climate change disrupts communities in both profound and subtle ways.

    Yet, resiliency is a word that Doppelt uses carefully. “We came up with the term transformational resilience because in many cases the impacts of climate change mean there is no going back to pre-crisis conditions,” he said.

    Doppelt also realized that this approach needed an entire network of dedicated mental health and mindfulness professionals – not just one organization like his championing the cause. That’s when he helped organize nearly two dozen founding members, including Dr. Sandra Bloom, co-creator of the Sanctuary Model, and Elaine Miller-Karas, executive director and co-founder, Trauma Resource Institute.

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