Trying to make LA schools less toxic is hit-and-miss; relatively few students receive care they need

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The Peacemakers of Harmony Elementary School in Los Angeles, CA.

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For millions of troubled children across the country, schools have been toxic places. That’s not just because many schools don’t control bullying by students or teachers, but because they enforce arbitrary and discriminatory zero tolerance school discipline policies, such as suspensions for “willful defiance”. Many also ignore the kids who sit in the back of the room and don’t engage – the ones called “lazy” or “unmotivated” – and who are likely to drop out of school.

In the Los Angeles Unified School District (LAUSD), which banned suspensions for willful defiance last May, the CBITS program (pronounced SEE-bits), aims to find and help troubled students before their reactions to their own trauma trigger a punitive response from their school environment, including a teacher or principal.

Gabriella Garcia’s son attended Harmony Elementary School during the 2012-2013 school year. The school has 730 children in kindergarten through fifth grade. She says without CBITS, she would have lost custody of him and her other two children. “But for some reason,” she says, “I let him (her son) take that test.”

“That test” is a questionnaire given to some of the fifth-grade students at the school, which is located in a mostly Hispanic neighborhood south of downtown Los Angeles.

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Every semester, Lauren Maher, a psychiatric social worker, gives all the children in Harmony’s fifth grade a brightly colored flyer to take home. It asks the parent to give permission for her or his child to fill out a questionnaire about events the child may have experienced in, or away from, school. “Has anyone close to you died?” “Have you yourself been slapped, punched, or hit by someone?” “Have you had trouble concentrating (for example, losing track of a story on television, forgetting what you read, not paying attention in class)?” are three of the 45 questions.

Garcia’s son was one of a small group of students whose answers on the questionnaire, as well as his grades and behavior, were showing signs that he was suffering trauma. He joined one of the two groups, each with eight students that met once a week for 10 weeks at the school. In the group, the students don’t

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In mental illness, let’s go beyond nature v. nurture to look at what interferes with the brain’s function

AmindbodyBased on her ethnographic study of psychiatric residency programs, anthropologist T.M. Luhrmann concluded psychiatry is “of two minds”: one “mind” emphasizes the role of neurochemistry, while the other “mind” places more importance on the context of our suffering, including relationships past and present.

Identifying the origins of mental illness likely depends on both interpretations. There is an undeniable organic component to mental illness, just as psychological and social conditions are inexorably linked to mental well-being. But like the Democrats and Republicans, these two approaches are often pitted against one another, often leading to that old, tiresome nature versus nurture debate.

Unfortunately, in a world of limited resources, including limited time, the implicit guiding question — Where should we place our focus? — naturally divides our attention. Is it helpful to explore genes and neurobiology in our efforts to reach best outcomes? Or is it better to explore the social conditions that contribute to mental disorders? Unfortunately, much like U.S. politics, the treatment of mental illness often is derailed when such questions become fodder for polarizing arguments that serves allegiances and professional agendas more than persons in the throes of mental suffering.

Instead of worrying if nature is more influential than nurture, perhaps it would be more helpful to identify what counts as optimal functioning for the brain. Perhaps we could then focus on the value of combining information, thus leading to better outcomes rather than increased competition (and often, market share). I think the significance of function often gets overlooked because we aren’t adept at looking at any issues from multiple levels. Although the term biopsychosocial was coined to address the issue of scale and focus in the treatment of mental illness, it often feels piecemeal in approach.

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Arresting our way out of drug crisis is yesterday’s theory, says VT Gov. Shumlin; urges public health approach

AshumlinState of the state addresses—like the State of the Union—tend to cover a wide range of topics from the economy to health care to education.  Vermont Governor Peter Shumlin broke the mold when he devoted his entire 2014 State of the State address to the state’s drug addiction crisis.  The rising tide of drug addiction and drug-related crime spreading across Vermont is “more complicated, controversial, and difficult to talk about” than any other crisis the state confronts, he said.

“We have lost the war on drugs,” he said. ” The notion that we can arrest our way out of this problem is yesterday’s theory.”  Even though Vermont is the second smallest state in the union (pop. 626,600), more than $2 million of heroin and other opiates are being trafficked into the state every week. Shumlin expressed alarm over the increase in the deaths from heroin overdose that doubled in 2013 from the year before and the 770 percent increase in treatment for opiates.

Shumlin told emotional stories of young Vermonters becoming addicted to prescription opiates and heroin — one recovered, one died from an overdose. While stories of young and promising individuals dying from heroin overdoses may grab headlines, data from the Centers for Disease Control and Prevention (CDC) show that deaths from prescription opioid pain relievers — such as codeine, methadone, and oxycodone — between 1999-2008 now exceed deaths involving heroin and cocaine combined.

CDC reports that in 2008, 36,450 deaths were attributed to drug overdoses in the U.S.  Opioid pain relievers were involved in 14,800 deaths (73.8%) of the 20,044 prescription overdose deaths.  The drug overdose death rate of 11.9 per 100,000 (Vermont’s rate was 10.9 per 100,000) was roughly three times the rate in 1991. Prescription drugs accounted for most the increase.  An April 12, 2012 statement from the Office of National Drug Control Policy reported that death from unintentional drug overdoses is greater than car accidents, the leading cause of injury in the U.S.

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Dr. Jeffrey Brenner: “I believe ACE scores should become a vital sign, as important as height, weight, and blood pressure.”

This video looks at the relationship between ACEs and hospital emergency rooms.

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Dr. Jeffrey Brenner is founder and executive director of the Camden Coalition of Healthcare Providers, and a 2013 MacArthur Foundation genius award winner. He did groundbreaking work in Camden, N.J., by using data to identify people who were hospital emergency room “frequent fliers”. He found that between their trips to the ER, little or nothing was done to help them improve their health. So, he began putting basic services in place to help these people. His work was written up in a New Yorker article — The Hot Spotters, by Dr. Atul Gawande — in  2011.

That article sent a shock of electricity through me — not only because it was so well written, but because Brenner was on to a solution for markedly reducing health care costs. However, it seemed to me that there was a piece missing —  if Brenner knew about the CDC’s Adverse Childhood Experiences Study, he (and other physicians) might be able to identify the people who suffer most in our society more quickly.

Today, an essay Brenner wrote about how the medical community has neglected the ACE Study, even though its findings were published in 1998, appeared on Philly.com’s The Field Clinic blog. It’s well worth a read. Here’s part of it:  

For nearly 15 years we’ve had the secret to delivering better care at lower cost in America.  The information has sat, hidden away in the medical literature, and barely mentioned among physicians.  It’s a remarkable story of bias. The neglect of this information by the medical community tells you a lot about our failings as a profession and the poor training we receive.  It’s also a powerful commentary on the values of our society and the biases built into our society’s view of health and healthcare.

In the 1990’s, a physician at Kaiser Permanente in California, Dr. Vincent Felitti, conducted a mail survey with 17,000 middle class patients.  He asked them questions about traumatic events that might have happened to them as children.  Incredibly, over 70% of people receiving the survey responded, and they gave permission to connect their survey answers to their medical records.

….In the work that I do in the City of Camden building interventions for high-cost complex

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San Francisco’s El Dorado Elementary uses trauma-informed & restorative practices; suspensions drop 89%

El Dorado Elementary School Principal Silvia Cordero announces one of the winners of the weekly student-of-the-week award.

El Dorado Elementary School Principal Silvia Cordero announces one of the winners of the weekly student-of-the-week award.

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For one young student – let’s call him Martin — the 2012-2013 school year at El Dorado Elementary in the Visitacion Valley neighborhood of San Francisco was a tough one, recalls Joyce Dorado, director of UCSF HEARTS — Healthy Environments and Response to Trauma in Schools.

“He was hurting himself in the classroom, kicking the teacher, just blowing out of class many times a week.” There was good reason. The five-year-old was exposed to chronic violence and suffered traumatic losses. His explosions were normal reactions to events that overwhelmed him.

This year, Martin’s doing better. That’s because he spent months working with a HEARTS therapist, and that therapist worked with his teachers and other school staff to create a more safe and supportive learning environment. Still, on days when he feels extremely anxious, Martin sometimes asks to visit the school’s Wellness Center, a small, bright room stocked with comforting places to sit, headphones to listen to music, and soft and squishy toys.

“If a student starts to lose it, the teacher can give the kid a pass to go to the Wellness Center,” says Dorado. “The kid signs in, circles emotions on a ‘feelings’ chart (to help the person who staffs the center understand how to help the child). The staff member starts a timer. The kid gets five to 10 minutes. The kid can sit on the couch with a blanket, listen to music, squeeze rubber balls to relieve tension and anger, or talk to the staff member. Kids who use the room calm down so that they can go back to class. It’s not a punishment room. It’s not a time-out room. It’s not an in-school suspension room. It’s a room where you feel better going out than when you went in.”

One day this year, as school staff members are meeting in the Wellness Center, Martin bursts in. “I need to borrow something,” he tells them. “Somebody needs my help.”

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Georgia juvenile court judge galvanizes statewide child trauma initiatives

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Douglas County (GA) Juvenile Court Judge Peggy Walker and “Dalton”

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Douglas County Juvenile Court Judge Peggy Walker is an activist judge for the children of Georgia – the children she loves who do not get what they need for healthy, successful lives.  She’s seen how the children are failed when they come back to court again and again. Now she’s doing something about it.  When she takes over later this year as the president of the National Council of Juvenile and Family Court Judges, she’ll have a national platform to promote changes in polices and practices to prevent and treat childhood trauma.  For now, she is spreading the word around the state of Georgia through conferences in four different regions, with the first one held January 10 at the Carter Center in Atlanta.

Woven into Judge Walker’s Georgia Summit on Complex Trauma keynote address to more than 400 participants —  including judges, their staffs, child and family services professionals, and advocates — was a description of a painful case from her work as a judge.  She began her presentation on what science tells us to do for children who have experienced complex trauma with a photo of herself (shown above) holding “Dalton.” He was the first drug-free child in the court’s family drug treatment program; his mother “Tonya” was a participant (both names are pseudonyms).

During the 10 years that “Tonya” had been in and out of her court, Judge Walker did not know her story. When she found out, she learned that  “Tonya’s” mother was alcoholic, emotionally abusive, and manipulative.  At age seven, “Tonya” was raped by a 50-year-old neighbor who was later incarcerated but freed after three years.  She tried drug treatment in

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At Reedley (CA) High School, suspensions drop 40%, expulsions 80% in two years with PBIS, restorative justice; but going the distance might require more tools

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In 2009, when the Kings Canyon Unified School District in California’s rural Central Valley offered its 19 schools the opportunity to adopt a system that would reduce school suspensions and expulsions, Reedley High School jumped at the chance.

Today, Reedley is in its fourth year of changing a zero-tolerance policy that has failed this school and community miserably, just as every zero-tolerance policy across the country has. The school, which has 1,900 students, is feeling its way out of those draconian days by integrating PBIS — Positive Behavioral Interventions and Support — and entering into a unique partnership with the West Coast Mennonite Central Committee and the local police department to implement a successful restorative justice program.

This approach is already having remarkable effect. The school saw a 40% drop in suspensions from the 2010-2011 to the 2012-2013 school year — from 401 to 249 suspensions involving 198 and 80 students, respectively. Expulsions went from 94 in 2010-2011 to 20 last year. But this year’s trends indicate that impressive decline may have stalled out.

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New federal guidance should help slow the flow in “school-to-prison pipeline”, but much work remains

AzeroAdvocates for fair and effective school discipline practices received a boost from the federal government with new guidance issued by the Departments of Education and Justice on January 8.  The guidance instructs schools on how to administer school discipline without discriminating on the basis of race, color, or national origin.  In addition to the guidance, the Administration issued a package of resources to assist in the improvement of school climates and discipline, including key principles and action steps based on best practices and emerging research.

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Suspensions plummet with peer mediation, but at this school, it’s just another program that’s going away

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Mt. Diablo High School peer mediators Cheyna Reed, Dajon (Broddy) Mathis, Ashley Holmes and Kristen Burns.

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In May 2011, Mt. Diablo High School in Concord, CA, hired social worker Deonne Wesley to coordinate a grant from the U.S. Department of Education Safe and Supportive Schools program. The program was set up to “create and support safe and drug-free learning environments and to increase academic success for students in these high-risk schools”.

It took a year for California to lay the foundation for the program, and another year for each of the 58 participating school districts to hire staff. At Mt. Diablo, which has 1,340 students, the program was up and running during the 2012-2013 school year.

Wesley trained 18 students to be peer mediators to work with students who were suspended for fighting, and to help prevent fights.

Those mediators worked with 46 students who had racked up 51 days of suspension for fighting in school. The peer mediators, with Wesley supervising, helped the students talk out the dispute and come to an agreement on how to avoid further conflict. Afterwards, the number of suspensions for those 46 students dropped to 19 for the rest of the school year.

The grant also funded a part-time drug and alcohol counselor. She led four eight-week workshops and two ongoing harm-reduction groups. Prior to attending the workshops, 80 students who attended at least two workshops had accumulated 242 days of suspensions. After they attended the workshops, the suspensions in that group dropped to six.

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In Vallejo, CA, schools — where referrals, suspensions, expulsions outnumbered students 5 to 1– there’s no place to go but up

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Dr. Ramona Bishop in her office in a building that was once part of the Mare Island Naval Shipyard in Vallejo, CA.

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When Dr. Ramona Bishop walked into her office on April Fool’s Day in 2011, the Vallejo schools had hit rock-bottom: The system had been in receivership since 2004. Its 14,000 students were racking up nearly 80,000 referrals, suspensions, and expulsions that school year, making it one of the top ten suspending schools in the state. Academic scores had tanked. Only half the students were making it to graduation. And morale? What morale?

The City of Vallejo had just dragged itself out of a 2008 bankruptcy resulting from the double whammy of the housing bubble and the 1996 closing of the Mare Island Naval Shipyard. It emerged emaciated, with all services cut to the bone.

Bishop couldn’t have asked for a more challenging job.

But this woman likes doing turn-arounds. She did one on a smaller scale when she was principal

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