Dan Press traces how legal work for Native Americans led to advocacy to uproot trauma

In 1964, Dan Press was in his first year of law school and was not liking it; he wanted a way out. He applied for a volunteer spot with AmeriCorps VISTA, the domestic version of the Peace Corps, and was intrigued by a position on an Indian reservation.

Dan Press

“I knew nothing about Indians, but it sounded like a good opportunity,” says Press, who was raised in Flushing, in the Queens borough of New York City. “So, I signed up and the next thing I knew I was on a plane to Montana,” he says.

It was a move that changed the course of his life.

Press, an attorney and now 78 years old, has spent his entire working life fighting on behalf of Indian tribes. He helped found the Tribal Employment Rights Officein 1977, which now has 300 offices around the country. His first legal battles involved pushing for enforcement of laws passed a half a century earlier to give Native Americans preference in hiring for employment on Indian lands brought by outside agencies and firms, but until Press challenged practices and won, those laws were largely ignored.

During his long legal career from working for The Navajo-Hopi Legal Services Program for the Navajo Nation in Arizona to his work at Van Ness Feldman, a law firm in Washington, D.C., he’s also counseled Indian tribes in advancing legislation that’s resulted in hundreds of millions of dollars in land settlements and the procurement of new health facilities. He helped found the first intertribal bank in the nation. Press has also been a champion of promoting trauma-informed initiatives, which in 2018 earned him a Public Advocacy award from the International Society for Traumatic Stress Studies for “Outstanding and Fundamental Contributions to Advancing the Social Understanding of Trauma.” In addition, he is the author of “A How-To Handbook on Creating Comprehensive, Integrated Trauma-Informed Initiatives in Native American Communities.”

Press is the general and legislative counsel for the Campaign for Trauma-Informed Policy and Practice (CTIPP), which helps local, county and state initiatives advocate for legislation to expand trauma-informed practices across the country. He also served as general counsel for The Roundtable on Native American Trauma-informed Initiatives. Both organizations are pro bono clients of his law firm. He has taught classes on tribal government at Columbia University, including “The Holocaust and Genocide in America”, in which students looked at common themes that arose in the genocides of Native Americans and of Jews.

On his first foray into Indian land in Montana, Press tutored children and coached basketball on the Crow Indian Reservation in the southern part of the state. While there, he was approached by Joseph Medicine Crow, the last living war chief of the Crow tribe, an oral historian and writer, who chronicled the living stories of the Crow. Medicine Crow asked Press to translate Crow treaties with the federal government into everyday language. (Medicine Crow, who won a Presidential Medal of Freedom for his war time service during WW II and for his work chronicling Crow history, died in 2016). The project was a turning point for Press. “It made me interested in Indian law,” he recalls.

Gun violence expert says tackling underlying inequities key to prevention

Gun violence expert says tackling underlying inequities key to prevention

Through the news media, Americans are served an almost-daily dose of violence caused by guns. This year to date, more than 33,929 people in the United States have been killed and another 30,000+ have been injured by guns. The U.S. homicide rate for firearms is 22 times greater than that of the European Union, even though the European population is 35% larger.

But to Dr. Garen Wintemute, the statistics on injuries and deaths are only one part of the story. To reverse those appalling numbers, he says, the larger focus must be on changing the conditions that foster gun violence. These include the underlying inequities that are baked into the essence of American life.

“Violence has social determinants, such as disparities based on race/ethnicity, gender or sexual orientation, place of origin and other characteristics,” says Wintemute, director of the Violence Prevention Research Program at the University of California at Davis School of Medicine. He is an expert in the public health crisis of gun violence and a pioneer in injury epidemiology and prevention of firearm violence.

But to Dr. Garen Wintemute, the statistics on injuries and deaths are only one part of the story. To reverse those appalling numbers, he says, the larger focus must be on changing the conditions that foster gun violence. These include the underlying inequities that are baked into the essence of American life.

To really understand the root of gun violence, Wintemute says, you have to understand that the systemic forces that gave rise to it were intentional. “The structures that engender and perpetuate violence were built purposefully and must be taken down just as purposefully,” he says.

Wintemute has been leading by example. Since the 1980s, the emergency medicine doctor has been documenting and working to undo the grip that guns have on life and death in America, destroying lives and communities. Way ahead of the curve, Wintemute was among the first to call gun violence a public health crisis, in line with the former U.S. Surgeon General David Satcher, who wrote about it in 1995 while pushing for more funding to examine it.

Wintemute’s research, which includes undercover work at gun shows around the country, has helped to thwart the use of the widely popular handgun known as the Saturday Night Special. This cheap weapon, banned in West Hollywood, the city of Compton and 16 communities in the San Francisco Bay Area in the mid-1990s and other handguns have been linked to 90% of injuries and between 70 and 80% of murders over an 18-year period. His research and testimony also led to legislative debate attempting to restrict the sale of assault rifles, including the AK-47. And in 1997, Time magazine named Wintemute a Hero of Medicine for his gun violence prevention work.

California advocates press for expansion of visiting rights to incarcerated loved ones

California advocates press for expansion of visiting rights to incarcerated loved ones

In a recent nightmare, 8-year-old Jovina dreamt that her father got COVID-19. He was getting sicker, but she and her mother weren’t able to get there in time. “There,” in her father’s case, is a cell at the California Correctional Center (CCC) in Susanville, California, nearly 300 miles from where she lives in San Jose.

In Jovina’s mind are a swarm of worries about her father’s welfare, her mother Benee Vejar reports. If an earthquake shakes the Bay Area, Jovina says, “What if the building crushes in on him?” When she sees him on one of their infrequent, short video calls, her worries spike about his well-being. She “flips out” if he removes his mask, repeatedly asks him to wash his hands, and tells him how she longs for his embrace, declaring on a recent call, “Daddy, I want to squeeze you so bad!”

Recently Jovina refused to touch her food, telling her mother, “I don’t want to eat. I’m not feeling so good today. I miss my Dad. When are we going to be able to see him?”

A short while of waiting and torment later, and after 15 months of not being near him, a joyous visit with her father took place in June. However, like other children with incarcerated parents in California and around the country, Jovina has no clear sense of when she will be with her father again.

In the last year and a half, Jovina has had to cope with the added strain of living through a global pandemic, which, until recently, shut down family visits altogether. But she was already contending with the unpredictable and overwhelming stress of being separated from her father because he is incarcerated.

Jovina is among an estimated 5 million children in the United States who have had a parent incarcerated at some point in their childhood, according to Child Trends. Experiencing separation from a parent due to incarceration has long been identified as a childhood trauma in the landmark Centers for Disease Control and Prevention/Kaiser Permanente Adverse Childhood Experiences (ACE) Study. The study tied this and nine other types of childhood trauma to chronic health conditions in adulthood.

The separation is excruciating for parents as well. Philip Melendez of California, who was formerly incarcerated, echoed the feeling of despair.

“I did not see my family for a year and a half, and I felt myself slipping away,” he said earlier this year at a townhall meeting on family visitation led by California Attorney General and former Assembly member Rob Bonta. Melendez, who has been out of prison for 3 years after serving a 20-year sentence, said that family visitation was a lifeline for him: “[My family] kept me focused on what I needed to do to come home.”

Childcare providers use two-generational approach to help preschoolers from being expelled

It’s shocking: Preschoolers are three times more likely to be expelled than children in elementary, middle and high school, according to figures from the U.S. Department of Health & Human Services. Boys are four times more likely than girls to be kicked out, and African American children are twice as likely as Latinx and White children.

One organization with childcare centers and mental health providers in Kentucky and Ohio began a long journey 15 years ago, when they began hearing about young kids getting expelled. By integrating a whole family approach and the science of adverse childhood experiences, the Consortium for Resilient Young Children (CRYC) took a radically different approach to help little kids stay in school.

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Carolyn Brinkmann

“We came together 15 years ago to start addressing the growing need for social emotional supports for young children,” says Carolyn Brinkmann. “Our organizations were getting phone calls from their own programs about younger children being expelled from preschool and childcare, and we tried to figure out how to start responding to that.”

Brinkmann is the director for the Resilient Children and Families Program (RCFP), a coaching and training arm of the CRYC. The CRYC comprises five childcare or educational agencies and three mental health provider agencies in southwest Ohio and northern Kentucky. The RCFP provides coaching and training to around 50 community-based programs that serve around 1,541 children.

Brinkmann and her colleagues began by looking for programs that address stressors and promote resilience in the whole family.

“We’re not working with little ones in a vacuum,” says Whitney Cundiff, the team leader of early childhood services for Northkey Community Care in Covington, Kentucky, part of the consortium. Along with Brinkmann, Cundiff led the research and training for the Consortium and they decided to use something commonly known as a two-generational approach—little kids and their parents or caregivers.

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Whitney Cundiff

In 2008, Brinkmann trained childcare providers in the Strengthening Families Protective Factors approach, a framework developed by the Center for the Study of Social Policy. It includes building resilience in parents, strengthening families’ social connections in their communities, educating parents about child development, and helping parents link up with organizations that can help them when they’re struggling to feed and house their families or provide other basic needs. It does not, however, train people in PACEs science.

Then, in 2016, the RCFP joined a Cincinnati-based collaborative called Joining Forces for Children, a cross-sector collaborative that focuses on building resilience and preventing adversity in children and families. Among its founding members was Cincinnati Children’s Hospital pediatrician, Dr. Robert Shapiro, who was interested in their two-generational focus.

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Youth Detention Facility finds culture of kindness more effective than punishment

A corner of the Multi-Sensory-De-escalation Room. All photos of the MSDR courtesy of Valerie Clark

When a young person enters the de-escalation room in the Sacramento County Youth Detention Facility, they’ll find dimmed lights, bottles of lavender, orange and other essential oils, an audio menu featuring the rush of ocean waves and other calming sounds, along with squeeze balls, TheraPutty, jigsaw puzzles, and an exercise ball to bounce on.

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TheraPutty, squeeze balls and more

Sometimes, with a teen’s permission, “We’ll put a weighted blanket on them, just to give them that hug that feels good, since we can’t give them [real] hugs in our facility,” says Valerie Clark, the probation officer who oversees the room. Giving hugs violates the protocol requiring that staff maintain healthy boundaries with their young charges. But “especially if someone is highly upset and just really crying,” Clark explains, the blanket can be a comforting substitute.

Since it first opened to youth in November 2016, the de-escalation room has been a refuge for kids feeling overwhelming anger, grief, sadness, and anxiety, who are either referred by staff or can request a visit. They stay in it anywhere from 30 minutes up to two hours.

The room is one example of how the Sacramento County Probation Department is shifting its culture to be responsive to adolescent trauma. In 2016, the department sponsored a countywide summit on trauma and the adolescent brain. This February and March, 330 employees from the Youth Detention Facility, and 155 from Juvenile Field, Placement and Court divisions, were trained in the roots of trauma and how to respond to it. And five members of the probation leadership were certified as trainers in trauma-informed practices. The training includes learning about how trauma in childhood can trigger the brain into fight, flight and freeze; can cause depression and lead to disruptive behaviors, and how they can build strength and resilience in the youth they serve.

Prior to having the de-escalation room, says Clark, youth would be sent to their individual rooms when they were disruptive or upset. “This way they have the opportunity to regain control of their emotions and behavior so they can go back to their programs instead of [having to stay] in their room alone with their thoughts,” she explains.

An impetus for the room, known as the Multi-Sensory De-escalation Room, was legislation that was signed into law in California in 2016, says Shaunda Cruz, the deputy chief of field services at the Sacramento County Probation Department and one of the department’s trauma-informed champions.

“The legislation recognizes the impact that trauma, and obviously the impact of coming into a facility, has on young people,” she says. The law, which was sponsored by former California State Senator Mark Leno, limits the use of solitary confinement for minors in detention facilities to four hours, and allows it only when juveniles’ behavior is considered a safety threat and less restrictive options have been exhausted.

Around the same time that the legislation was being developed, members of the county probation department and juvenile court staff were working on a capstone project through a justice reform collaborative out of Georgetown University’s Center for Juvenile Justice Reform. That’s where the idea for an MSDR emerged, says Ruby Jones, assistant chief deputy of the Sacramento County Youth Detention Facility.

Lesson learned integrating ACEs science into health clinics: Staff first, THEN patients

Dr Omotoso
Dr. Omoniyi Omotoso

About two years ago, a team from LifeLong Medical Clinics jumped at the opportunity to integrate practices based on adverse childhood experiences   when it joined a two-year learning collaborative known as the Resilient Beginnings Collaborative (RBC). RBC began in 2018 and includes seven safety-net organizations in the San Francisco Bay Area. (Here’s a link to a report about the RBC.)

To join the RBC, LifeLong Clinics — which has  14 primary care clinics in Alameda, Contra Costa and Marin Counties — and the other collaborative teams had to agree to introduce all staff members to the science of childhood adversity and trauma-informed practices. LifeLong went full steam ahead with a 2.5-hour introductory training for more than 100 employees who work at its clinics that serve pediatric patients. Trauma Transformed, a program of the East Bay Agency for Children in Oakland, CA, did the training in October and November 2018.

LifeLong Clinics’ decision to move forward on integrating ACEs science and trauma-informed practices into its clinics is important particularly in California where a state policy has made childhood adversity a front and center issue. On Jan. 1, 2020, as an incentive to doctors who serve Californians in the state’s Medicaid program, the state began offering supplemental payments of $29 to doctors for screening the estimated 12 million pediatric and adult patients for adverse childhood experiences (ACEs).

ACEs comes from the groundbreaking Adverse Childhood Experience Study (ACE Study), first published in 1998 and comprising more than 70 research papers published over the following 15 years. The research is based on a survey of more than 17,000 adults and was led by Drs. Robert Anda and Vincent Felitti. The study linked 10 types of childhood adversity — such as living with a parent who is mentally ill, has abused alcohol or is emotionally abusive — to the adult onset of chronic disease, mental illness, violence and being a victim of violence. Many other types of ACEs — including racism, bullying, a father being abused, and community violence — have been added to subsequent ACE surveys. (ACEs Science 101Got Your ACE/Resilience Score?)

The ACE surveys — the epidemiology of childhood adversity — is one of five parts of ACEs science, which also includes how toxic stress from ACEs affects children’s brains, the short- and long-term health effects of toxic stress, the epigenetics of toxic stress (how it’s passed on from generation to generation), and research on resilience, which includes how individuals, organizations, systems and communities can integrate ACEs science to solve our most intractable problems.

After it trained employees in 2018, brainstorming around workflow was provided for staff at the LifeLong Howard Daniel Health Center in Oakland, CA, in February 2019, where LifeLong plans to pilot ACEs screening in newborns to five-year-olds, said Dr. Omoniyi Omotoso, the pediatric lead at LifeLong Clinics, who led the brainstorming about workflow and additional training.

Four months into that training, in June, Omotoso showed staff the ACEs questionnaire and asked them how they thought patients would feel about it.

And that’s when Omotoso realized that they had to put on the brakes. “A lot of the staff were uncomfortable because they themselves had similar instances that they personally were triggered by as they read the [ACE] questions themselves,” said Omotoso, who splits his clinical time between LifeLong Howard Daniel Health Center and LifeLong William Jenkins Health Center. He said that LifeLong will be using the de-identified PEARLS ACE screener for its pediatric population, which asks those surveyed to write on the form the number of ACEs that apply to them. (Here’s a link to ACEs Aware, where you’ll find out more information about PEARLS, the only pediatric ACEs screener for which California providers can be reimbursed.)

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San Mateo (CA) launches county initiative to tackle ACEs and build resilience

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Group ice-breaker exercise

When you’re working with people who’ve had a lot of childhood and adult adversity, it’s hard for you to believe that anyone else can have a bad day, says Laura van Dernoot Lipsky. “Your neighbor or your best friend says: ‘I’ve had a bad day.’ And you think, ‘Oh, I’m sorry you had a bad day; were you sex trafficked today? No, you were not!’”

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Laura van Dernoot Lipsky

Van Dernoot Lipsky, the author of Trauma Stewardship: An Everyday Guide to Caring for Yourself While Caring for Others, was driving home one of several points of how working in a job that serves severely traumatized people can harm people who help them, too.

CA announces robust perinatal depression prevention for Medi-Cal recipients

Melinda Coates experienced a tumultuous pregnancy. “I was really mentally upset literally from day one (of the pregnancy),” she says. (Melinda Coates is a pseudonym. To protect her and her children’s privacy and safety, we are not using her real name.)

Coates had hoped to get counseling last October, when she was seven months pregnant. That’s when she enrolled in the state’s Medi-Cal program, shortly after she and her abusive husband moved to California, “but nobody was able to get me in that quickly,” she says. “If I had gotten the help that I needed with my mental state, I may not have stayed in my abusive marriage as long,” she says.

Six weeks after her son’s birth she had one session with a counselor who prescribed an antidepressant. “I was supposed to go back, and I needed to reschedule, but I never heard from her again,” says Coates, who has been living in a domestic violence shelter since the end of June with her eight-month-old son and three-year-old daughter. She is currently separated and filing for a divorce from her husband.

A new policy in California that went into effect in July now makes it possible for pregnant women like Coates to get the counseling they need, according to a recently-released MediCal bulletin.

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Medical students’ ACE scores mirror general population, study finds

national survey published in 2014 revealed a disturbing finding. Compared to college graduates pursuing other professions, medical students, residents and early career physicians experienced a higher degree of burnout.

Citing that article, a group of researchers at University of California at Davis School of Medicine wondered whether medical students’ childhood adversity and resilience played a role in their burnout, said Dr. Andres Sciolla, an associate professor of psychiatry and behavioral sciences at the University of California at Davis Medical School. Sciolla is the lead author of a recent study in the journal Academic Psychiatry that investigated those questions.

Their query was based on the landmark CDC-Kaiser Permanente Adverse Childhood Experiences Studythat showed a remarkable link between 10 types of childhood trauma — such as witnessing a mother being hit, living with a family member who is addicted to alcohol or who is mentally ill, living with a parent who is emotionally abusive, experiencing divorce — and the adult onset of chronic disease, mental illness, being violent or a victim of violence, among many other consequences. The study found that two-thirds of the more than 17,000 participants had an ACE score of at least one, and 12 percent had an ACE score of four or more. (For more information, see ACEs Science 101.)

The ACE Study and subsequent research shows that people with an ACE score of 4 are twice as likely to be smokers and seven times more likely to be alcoholic than someone with an ACE score of 0. Having an ACE score of 4 increases the risk of emphysema or chronic bronchitis by nearly 400 percent, and attempted suicide by 1200 percent. An ACE score of 6 or higher is associated with a 20-year shorter lifespan than someone with an ACE score of 0. However, subsequent research has shown that social buffers, such as having just one caring adult in a child’s life, can mitigate the impact of ACEs.

For the UC Davis study, 86 third-year medical students completed an ACE survey. Of those, 49% had an ACE score of 0, 40 % had ACE scores between 1-3, and 12 % had ACE scores of 4 or more.

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Shifting the focus from trauma to compassion

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Dr. Arnd Herz

Dr. Arnd Herz, a self-described champion for ACEs science, would like nothing more than to witness a greater appreciation of how widespread adverse childhood experiences are. Herz, a pediatrician and director of Medi-Cal Strategy for the Greater Southern Alameda Area for Kaiser Permanente Northern California, would also like to encourage more people in health care to engage in a trauma-informed care approach, a change in practice that he says not only benefits patients, but also health care providers and their staff.

“It makes so much sense,” say Herz. “This is why I went into medicine. I don’t want to just click off diagnoses, but create relationships and help people by understanding them better, and trauma-informed care is just a way to bring compassion back into the care that we do.”

For the uninitiated, a trauma-informed approach includes an awareness that adverse childhood experiences (ACEs) are common, knowing how to recognize the signs and symptoms of trauma, creating a safe environment where the focus is on “What happened to you?” rather than “What’s wrong with you?”, engaging trauma survivors as equal decision-makers in their care, and offering patients referrals to supportive services as needed, according to a report by the Substance Abuse and Mental Health Services Administration and a primer by the Center for Health Care Strategies.

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