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Wounded Warrior Project (WWP) will provide $45 million to Rush University Medical Center (Rush) to substantially grow its Road Home Program (RHP), allowing an expected 5,000 military veterans or their family members to receive mental health care services without cost to them over the next five years.

The grant, the largest single donation to Rush since its founding in 1837, will expand a WWP-funded program that provides three weeks of concentrated post-traumatic stress disorder (PTSD) treatment that has been proven to significantly reduce PTSD symptoms.

“This is a transformational commitment from Wounded Warrior Project that will expand assistance to many more veterans and their families who so badly need and richly deserve these services,” said Dr. Larry Goodman, CEO of Rush University Medical Center and the Rush System. “We are honored by this extraordinary commitment and the trust it shows in Rush and the Road Home Program.”

Intensive Outpatient Program found to relieve PTSD

The Road Home Program at Rush was launched in 2014 to help military veterans and their families make healthier transitions to civilian life by offering specialized mental health care, regardless of the ability to pay. In 2016, WWP, Rush, Emory Healthcare in Atlanta, Massachusetts General Hospital in Boston and UCLA Health in Los Angeles collaborated to create Warrior Care Network, a national care network that provides comprehensive mental health care to veterans living with PTSD, traumatic brain injury, and other related conditions.

As part of that effort, WWP provided a $15M grant for Rush to help support its treatment programs, including development of a three week long Intensive Outpatient Program (IOP). In the IOP, as it’s known for short, groups of eight to 12 veterans from across the country whose PTSD is not responding to standard treatment receive more than 100 hours of treatment, which includes cognitive processing therapy and wellness interventions such as mindfulness, yoga, art therapy and acupuncture.

More than 260 veterans have completed IOP therapy to date, and Rush researchers have documented rapid and clinically meaningful reductions in PTSD and depression symptoms for the great majority of them.

WWP grant also will support other services for veterans and their families

The new funding will make the IOP available to more than 1,500 veterans over the next five years. In addition to the IOP expansion, the new funding also will enable Road Home Program clinicians and therapists to provide outpatient therapy, counseling and other services to an additional 3,500 veterans and their family members from the Chicago area and elsewhere. Because spouses, children and other family members suffer as well when their loved one suffers from a trauma-based mental health issue, RHP provides free services to family members as well. 

“The Road Home Program at Rush has proven to be just that — a road home for thousands of men and women wounded while serving their country,” said retired Lt. Gen. Mike Linnington, Wounded Warrior Project’s CEO. “Wounded Warrior Project has increasingly focused on improving the mental health and wellness of our veterans. Invisible wounds are as debilitating as physical injuries, but with care like that provided at Road Home, they can be largely overcome.”

Expanded services will meet growing need

As many as one in three veterans who served in the conflicts in Iraq and Afghanistan have returned to the United States with what are called the “invisible wounds of war,” including PTSD, traumatic brain injury, and related mental health conditions associated with their military service.

“It is critical that the general health care system step up to do its share to care for our servicemen and women, and their families, who have given so much for our country. This support and generosity from Wounded Warrior Project is enabling us at Rush to provide the cutting-edge care and services that our warriors and their families so dearly earned,” said Dr. Mark Pollack, professor and chairperson of the Rush Department of Psychiatry and founding director of the Road Home Program.

The Road Home Program operates in a spirit of collaboration, connecting veterans to social services, education and vocational programming via local organizations. The center complements the many other important psychiatric and outreach services to veterans already offered by local Veterans Administration medical centers Edward Hines, Jr. VA Hospital; Jesse Brown VA Medical Center; and Captain James A. Lovell Federal Health Care Center.

The care, provided at no cost to the veteran and their family, helps fill in the gaps in mental health care currently not provided by VA or to those veterans who are not eligible or prefer to not receive care through the VA. Rush coordinates continuing care with the VA, working with a VA liaison so the veterans can continue to get treatment inside or outside of VA.

More than 1,000 people have received care from the Road Home Program since it was established to help military veterans and their families make healthier transitions to civilian life by offering specialized mental health care, peer-to-peer outreach, counseling and community resource navigation. This care includes evidence-based treatment for PTSD, traumatic brain injury and military sexual trauma; child and family counseling; service and resource navigation; peer-to-peer outreach; public awareness programming; and training for primary care physicians and others.

The WWP grant brings the total dollar amount of gifts made to Rush for the current fiscal year to nearly $86 million overall, making fiscal year 2018 the most successful year for fundraising in Rush’s history. The previous record for donations in a single year was $75.2 million in 2005. The past two largest gifts made to Rush were $20 million each.

Read more on Rush.edu.

For decades, addiction recovery was focused on helping people get clean and stay sober. There was lots of talk of willpower and surrendering, but not much discussion of mental health, past trauma and adverse childhood experiences. Today, that has changed dramatically, says Hanna LeBaron, the clinical director at Maple Mountain Recovery, a trauma-informed addiction treatment center outside Salt Lake City.

“We all agree there are underlying issues to substance abuse and addiction,” LeBaron says. “We’re actually looking into them now and starting to treat underlying issue.”

LeBaron says that in her 18 years of working in the treatment industry, providers have begun paying more attention to the root cause of addiction. For many people with substance use disorder, that is mental illness. In fact, the National Institute on Drug Abuse estimates that 60 percent of people with substance use disorder also have a diagnosable mental health disorder.

Understanding this can help practitioners treat substance use disorder more effectively, equip people with tools to stay in recovery long term, and help people without addiction empathize with those who are struggling.

“What we’re looking at is this [addictive] behavior as an adaptation,” LeBaron says. “It’s a strategy, a way to cope.”

Understanding the root cause of addiction can also help the person with substance use disorder understand their own actions, LeBaron says.

“A lot of time people who are using don’t understand why they are doing it,” she explains. “When you think about it logically, everybody knows it’s super dangerous to abuse drugs and alcohol. People die from using drugs, alcohol and tobacco even. So why do we put ourselves in danger? It’s because at that moment it gives us relief.”

Once the brain has experienced that feeling of self-medication it is hard to give up.

“The brain quickly learns this is an easy way to cope,” LeBaron says. “At that point, when we get that quick dopamine release, we’re not thinking about the longer term consequences.”

Viewing addiction as a maladaptive coping strategy has changed the way that substance use disorder is treated. Old methods — like tough love and confrontation — are now seen as dangerous, since they can further isolate or harm people who are already vulnerable.

“Those just don’t help because in the end they shame the client more,” LeBaron explains.

Still, many treatment centers don’t understand trauma, which requires a specialized and thorough approach, particularly when it is being treated alongside substance use disorder.

“At Maple Mountain Recovery, we have the understanding and the know-how,” LeBaron says. “We know it is important for our clients to do their trauma work while in treatment in order for them to have long-term recovery.”

At Maple Mountain, the program involves treatment professionals taking a more gentle approach. The first step, LeBaron says, is teaching clients healthy coping mechanisms that can replace their use of drugs or alcohol.

“Before we go and deal with the trauma they have to have some ways to cope,” she says. Exercise, meditation and therapy all provide healthy ways for clients to handle the discomfort that they’ll be facing during treatment.

It’s important that these new coping strategies be introduced before more in-depth trauma and mental health work starts, so that the client is able to process their feelings during their recovery.

“They have to have coping skills first and have to learn to relax,” LeBaron explains. “Often, clients have so much toxic stress that their brain isn’t even capable of relaxing: they’re always in fight, flight or freeze. We have to get them out of survival mode by helping them learn to relax.”

In addition, clients need to learn to be able to tolerate positive feelings. Many have spent years completely numbed by drugs and alcohol. Coming out of that, even positive feelings of joy, hope and contentment can be deeply uncomfortable, LeBaron explains. Here again, activities like yoga, time in the sauna or deep meditation can all be helpful.

“These activities may sound luxurious, but there is a reason behind all of them: We’re trying to reset the brain and get the brain to function in a more normal way,” LeBaron says.

Read more on TheFix.com.

A barbershop may not be the first place you would think to house a health care center, but Aaron Perry believes it’s the perfect place because it can bridge the deep-rooted gulf between the health care system and the black community.

Perry, a former University of Wisconsin (UW)–Madison police officer who is living with diabetes, has spent years unraveling the complex relationship between black men and the world-class health care system in Dane County. He founded the non-profit Rebalanced-Life Wellness Association in 2007 to help other black men with diabetes and reduce health disparities in his community.

His breakthrough came as he was getting a haircut at JP Hair Design in Madison and listening to the clientele and barbers talk about health. He realized that, instead of trying to draw black men into the health care system – a process which so far had proven largely unsuccessful – the health care system should be brought to meet black men in a place they trust and where they feel loved and respected.

“The men here were actually talking about their concerns, their health challenges. And I’m thinking, ‘This old myth that black men don’t talk about their health issues – they talk about it in the barbershop.’’’

The trouble was, he said, the men would talk about their health challenges – like having gout, feeling faint or having heart palpitations – but would leave the shop with these concerns unresolved.

Two years ago, with funding from SSM Health and support from barbershop owner Jeff “JP” Patterson, Perry knocked down the back wall of JP Hair Design and built the Men’s Health and Education Center.

Patterson liked the idea immediately when Perry pitched it to him over breakfast and says the reason it works comes down to the strong relationships between barbers and clientele.

“The clients trust us … they believe in us, have faith in what we say,” Patterson said. “We can easily persuade them. The good part is, as barbers, we are able to encourage them to go into the Men’s Health and Education Center, to get information, to get their blood pressure checked, to talk to one of the student nurses about issues.”

Although the 120 square foot room is small, the space is utilized to its full potential. One wall is lined with pamphlets on cancer, heart disease, high blood pressure, influenza, pneumonia, diabetes, and many other ailments. Above two computers preloaded with Harvard Medical School and the Mayo Clinic information is an eye test. Clientele can also have their body mass index calculated and their blood pressure checked. In April, 84 men had their blood pressure screened – 68 percent had high blood pressure.

The center also offers referrals for mental health concerns and substance abuse – although Perry hopes to one day be able to offer these services under the roof of the barbershop –  and brings in health care professionals, like a dental hygienist who does free oral screenings. They’ve learned that a large number of men struggle with mouth and tooth pain but grit through it.

Some live with pain for years. Dewayne Conklin came into the center in early May with high blood pressure and significant pain in the back of his jaw. Perry, using partnerships with Madison Public Health Dane County, got him an appointment at Access Community Health within four days. Doctors learned he had been enduring the pain from two decaying teeth for four and a half years. After the two teeth were removed, Perry said Conklin was practically doing backflips he was so happy and relieved.

“I’ll never forget what he said to me when he got out of the car,” Perry said. “He looked and me and said, ‘Man, who are you?’ And I said, ‘This is what we do at this men’s health center. This is what we do for this community.’”

“I wasn’t expecting anything more than a haircut,” Conklin said. “I’m very impressed.”

Perry was recently awarded a Community Collaboration grant from the Wisconsin Partnership Program at the UW School of Medicine and Public Health to expand his efforts reducing health disparities among black men and boys in Dane County. Perry will use the $300,000 in funding over a four-year period to start the Black Men’s Wellness Sustainable Initiative.

The grant, designed in response to feedback from nonprofit organizations across the state who sought more involvement from UW, also provides training and support from the university.

“What we heard loud and clear was that in addition to funding, organizations want to build their capacity to be more effective in their communities – and that the resources of the university can support that,” said Courtney Saxler, program officer for the Wisconsin Partnership Program.

The grants focus on health equity and are community-driven. Saxler said Perry fit the bill perfectly.  With the new funding, Perry said the center can now roll out what the men in the barbershop have been requesting.

He is most excited about the establishment of the Barbershop Health Advisory Committee, a collaboration between all eight black barbershops in Dane County. Of the 15,600 black men in Dane County, these barbershops have the potential of reaching upwards of 5,700 of them, he said. The committee will meet once a month to strategize on how to make their clientele healthier and develop a unified voice for healthy living across the county. If the advisory committee decides diabetes is the issue of the month, for instance, all the owners and barbers across Dane County will share a unified message about diabetes with their clientele.

Perry also plans to expand Black Men Run, a running group he started two and a half years ago, into a new group including black boys called Black Men Run, Brown Boys Read. The group will run for the first time next month and afterwards will sit in a park and read chapters from books written by black authors. A group of black men have also agreed to mentor the young boys.

“For these young men that don’t have fathers in their lives, we’re hoping that this has a great impact,” Perry said.

Perry said the barriers between the black community and the health care system are multi-faceted. Some people mistrust the medical community because of the experiences passed down by their elders. Many men have little awareness or interaction with the system, which can lead to frustration when they try to schedule an appointment and there are no available times that work.

Above all, some black people feel that this community doesn’t care about them and their well-being. The challenge is to change that narrative, Perry said, and many fathers have started to accomplish this by bringing their young sons into the center to teach them about their health and how to take care of their bodies.

By returning to the template of the early 1900s barbershops, which were social and cultural centers where men could see their doctor, fill prescriptions, and socialize, Perry believes he’s found a model for reducing disparities not just for the black community in Dane County, but for communities nationwide.

“I believe we can literally pick this 120 square foot room and put it in any barbershop nationwide and I think it would start to yield the same dividends and would have the same outcomes,” Perry said.

“We are reaching the men and that is real simple,” he added. “We’re doing the work that many have said could not be done.”

Read more on News.Wisc.edu.

The National Indian Health Board (NIHB) invites MSPI/DVPI grantees, Tribal behavioral health experts, public health professionals, advocates, researchers, community-based providers, and others to submit proposals to highlight the accomplishments of their programs at the American Indian and Alaska Native National Behavioral Health Conference, in Washington, DC from July 25-27, 2018. This year’s conference theme, “Promoting Connections Between Culture and Purpose” will provide evidenced-based, best, wise, or promising behavioral health practices developed in and for American Indian and Alaska Native (AI/AN) communities.

The Poster Session is a great way for success stories to be heard by a large audience of Tribal leaders, Tribal behavioral health professionals, health experts, public health professionals, federal employees, advocates, researchers and community-based providers as well as share program ideas with others.

Those interested should submit contact information and a brief description of the program within the application.

The deadline for proposals is Friday, June 15 at 11:59 p.m. EST.

Presenters will be notified within one week of their submission.

Poster Guidelines: Posters should contain information about your program and should be visually appealing. Presenters may choose to highlight specific program activities, programs, or data, based on the story they want to tell. All posters must be 36″ x 48″ (3ft by 4ft) to fit on the easels available at the conference. NIHB will provide additional guidelines upon selection.

Learn more and submit your poster proposal with NIHB!

Working-age Americans in 21 states faced a higher probability of premature death from 1990 to 2016, according to the most extensive state-by-state US health study ever conducted.

The likelihood of early death for men and women age 20 to 55 is highest in West Virginia, Mississippi, and Alabama. In contrast, same-age residents of Minnesota, California, New York, and several northeastern states have a lower probability of premature mortality.

“We are seeing dangerous disparities among states,” said Dr. Christopher Murray, director of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, whose organization coordinated the study. “Unless and until leaders of our health care system work together to mitigate risks, such as tobacco, alcohol, and diet, more Americans will die prematurely, and in many cases, unnecessarily.”

The study, published recently in JAMA, covers 1990 to 2016; it is part of the Global Burden of Disease (GBD) study, a comprehensive effort to quantify health internationally, covering 333 diseases and injuries and 84 risk factors. It is the most comprehensive state-by-state health assessment ever undertaken and includes estimates of prevalence, incidence, death, life expectancy, and several other summary health metrics for all 50 states, the District of Columbia, and the nation overall..

In 2016, key factors driving the increased likelihood of early death for those aged 20 to 55 included substance abuse, suicide, and alcohol-related conditions. For these diseases, the states with the “worst” and “best” age-standardized rates of years of life lost (YLLs) per 100,000 people were the following (with national rates shown for comparison):

• Drug use disorders: West Virginia (982), North Dakota (161), US (451)
• Alcohol-related conditions: New Mexico (328), Utah (110), US (156)
• Suicide: Utah (979), District of Columbia (306), US (564) 

Opioid use disorders rose from the 11th leading cause of disability-adjusted life years (DALYs) in 1990 to the seventh leading cause in 2016.

“The US has witnessed some improvements among youth under 20 and seniors over 55, but overall the nation and some of our states are falling behind other, less developed countries,” said Dr. Ali Mokdad, who, with Murray, wrote the study. “The strain on America’s health resources is getting worse, and the need for prevention services and greater access to and quality of medical care is increasing.”

In addition, the burden of mental health disorders is increasing in the United States with DALYs; major depression increased over 27% nationwide between 1990 and 2016. Similarly, the burden due to anxiety disorders increased by about 31% and totaled 1.76 million DALYs in 2016.

“These findings serve as compelling evidence of the need to increase mental health care and screening, as well as programs seeking to prevent mental disorders and to promote mental health,” Murray said.

Murray also noted that high body mass index (BMI), smoking, and high fasting plasma glucose (FPG) were the three largest health risks in 2016. Both high BMI and FPG are linked to diabetes. In addition, high BMI, commonly referred to as overweight or obesity, is associated with an increased risk of cardiovascular diseases, some types of cancer, and poor health generally.

“To an increasing degree, overweight, obesity, and sugary diets are driving up health care costs and are costing Americans years of healthy life,” Murray said. “They are undermining progress toward better health.”

Among the study’s findings:

• The three leading causes of years of life lost in the US in 2016 were: ischemic heart disease, lung cancer, and COPD, a change from 1990 when the third leading cause of YLLs was motor vehicle injuries.
• While smoking is declining, it remained the top risk factor for DALYs in 34 states in 2016.
• There also were increases between 1990 and 2016 nationally in Alzheimer’s disease, which moved from the seventh leading cause of YLLs to the fourth; diabetes rose from 12th to eighth.  

Mokdad said increasing access to primary care, such as general practitioners and physician assistants, would help identify patients’ early warning signs of poor health.  

“Primary care is our health system’s front line of defense, detection, and treatment,” he said. “Local, state, and federal dollars need to be targeted more effectively for primary care, especially for those millions of Americans not on Medicare.”

Top 10 Risk Factors in 2016 as a percentage of disability-adjusted life years:

• Tobacco
• Overweight/obesity (high BMI)
• Dietary risks
• Alcohol and drug use
• High fasting plasma glucose
• High systolic blood pressure
• High cholesterol
• Impaired kidney function
• Occupational risks
• Air pollution

“Top and Bottom” 10 States for Probability of Premature Death Among 20 to 55-Year-Olds Between 1990 and 2016:

• Ten states with lowest probability of premature death: Minnesota, California, New York, Connecticut, New Jersey, Washington, Massachusetts, Vermont, New Hampshire, and Hawaii
• Ten states with highest probability of premature death: West Virginia, Mississippi, Alabama, Oklahoma, Kentucky, Arkansas, New Mexico, Louisiana, Tennessee, and South Carolina

Read more on HealthData.org.

Once a week, every week, the health center at Stamford High School offers sophomore Roger Sanchez an oasis—someplace he can talk to a trusted adult about life’s pressures and problems, a place he feels free and unjudged.

School work, sports commitments, family and social obligations: life as a teenager can be stressful, he says. If it weren’t for the health center, conveniently located where he spends most of his days, he would have a much harder time accessing counseling sessions that help him cope with anxiety.

“The health center helps me out academically, emotionally and physically,” he said, and he recommends it to friends. “They get nervous, kind of, but I try my best to get them to come in. They never regret it.”

Sanchez, 16, is among a growing number of black and Hispanic teens receiving mental health services at school-based health centers — services, data show, they’d be much less likely to get or stick with if they pursued them elsewhere in their communities.

“For many students, this is the primary place where they get their care,” said Jesse White-Fresé, executive director of the Connecticut Association of School-Based Health Centers.

For the 2007-08 and 2008-09 school years, 1,130 black and Hispanic males in grades 7-12 received mental health services, data collected from 75 state-funded health centers show. Those youths registered 15,386 visits over the two-year period, the association’s issue brief reports.

White-Fresé suspects the number of males served is higher than reported since the data include only students whose parents agreed to disclose ethnicity during enrollment.

While students seek services for various reasons, research shows black and Hispanic students are more likely than their white peers to experience depression in particular.

In 2015, 36 percent of Hispanic high schools students and 27.3 percent of black students reported feeling so sad or hopeless every day for two or more weeks that they stopped doing some of their usual activities, according to the state Department of Public Health’s 2015 Connecticut Youth Risk Behavior Survey. By comparison, 22.6 percent of white students answered the same.

Against that backdrop, just 25.4 percent of all students said they receive the help they need when they feel sad, empty, hopeless, angry or anxious, the survey said.

Statewide there are more than 120 school-based health centers providing medical and mental health services to students, most of which have part of their operating expenses funded by the state.

Centers are often staffed with medical providers who can prescribe medication, and bill Medicaid, HUSKY A and HUSKY B for services. A school nurse can refer a student to a center, but a parent must sign a permission form for their child to receive care.

During the 2007-08 and 2008-09 school years, black and Hispanic students participated in an average of 13.6 therapy sessions, each session lasting 30 to 35 minutes. That same demographic typically stops seeing providers in their community after two or three sessions, according to the association.

“That is quite significant,” said Patricia Baker, president and CEO of the Connecticut Health Foundation, which funded the association’s study. “Schools are the most common setting in which kids can access mental health care.”

Various factors prevent youths from accessing care in their community, said White-Fresé. It often is difficult to get an appointment outside of school hours, for instance, and lack of transportation can be problematic.

“There are some real disparities that are happening but in this [school] setting those disparities are reduced,” she added.

If he couldn’t receive services in school, Sanchez says, it would be difficult to fit therapy sessions around school, sports and church obligations. He began accessing services in seventh grade at his middle school. At Stamford High School’s center, he has a standing weekly appointment with social worker Emily Segal and can often get a same-day appointment if an emergency arises. “It makes life easier for me,” he said.

Segal has been working at the center, run by nonprofit Family Centers, for 17 years and sees a growing number of students seeking help for anxiety. “There’s a lot of stress on these students,” she said. “It’s a tense, stressful time.”

Segal is a valuable resource “when you need someone to talk to,” said Berwens Desgazon, 15, a sophomore who receives mental health services. “If you have an emergency, you can just walk a couple of steps to get help.”

Desgazon has had weekly one-on-one sessions with Segal since last year. He says the center is a place he feels comfortable and safe discussing what’s happening in his life.

At Windham High School, which also has a health center, wellness center therapist Carolyn Franzen says being in the school helps her bond with students. “I’m part of their world,” she said. “They’re going to see me every day; they’re going to see me in the halls. I know their friends. It’s very different than leaving and driving to somebody’s office to get help.”

Windham High School’s student population is 70 percent Hispanic, she said, and roughly 90 percent of the school’s total population is enrolled in the center, which is affiliated with Windham Hospital.

In addition to the one-on-one counseling available at many centers, some offer group therapy as part of the Cognitive Behavioral Intervention for Trauma in Schools program. That national initiative launched in Connecticut in 2014 and most students who participate are black or Hispanic, according to Jason Lang, vice president for mental health initiatives at the Child Health and Development Institute, which trains mental health service providers.

About 50 Connecticut schools use the program, some of which offer the service at school-based health centers. Geared toward students who have experienced trauma, the program includes 10 group sessions. Statewide, 70 percent of participants are Hispanic, 20 percent are black and less than 10 percent are white, Lang said. Roughly half are males, he added.

“The group setting has benefits because children hear from their peers who have experienced similar things,” he said. “One of the challenges with trauma is that, because people tend not to talk about these things, people tend to think they’re alone and they’re the only ones who have experienced it.”

Leaving mental health issues untreated can have serious consequences, including truancy, involvement in the juvenile justice system, school suspensions, and aggressive incidents, a study by the Center for Children’s Advocacy at the UConn School of Law found.

Read more on Courant.com