NNED - National Network to Eliminate Disparities in Behavioral Health

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Call for Proposals for the NICWA National American Indian Conference on Child Abuse and Neglect

Presenters at NICWA’s 36th Annual Protecting Our Children National American Indian Conference on Child Abuse and Neglect, this year being held in Anchorage, Alaska, on April 15–18, 2017, are the heart and soul of this annual event, increasingly recognized as the premiere national gathering dedicated to tribal child welfare and well-being. Each year over 70 presenters are selected to lead vigorous dialogue about best practices, current research, advocacy efforts, policy implications, and other lessons learned with over 1,100 conference attendees.

NICWA provides meaningful programming to conference attendees, creating a space where participants can learn about the latest developments and best practices from experts in the field and from one another. Participants represent a cross-section of fields and interests including child welfare, mental health, and juvenile justice service providers; legal professionals; students; advocates for children; and tribal, state, and federal leaders.

About the Workshops

The highly competitive selection process aims to select presenters who represent an expertise and mastery of innovative and effective developments in these key areas:

  • Children’s Mental Health
  • Child Welfare, Foster Care, and Adoption Services
  • Judicial and Legal Affairs
  • Youth and Family Involvement

Workshop sessions will be 90 minutes in length. Participation varies depending on topic, but on average workshops will have between 20–70 participants. NICWA highly values interactive and participatory workshops. Please share in your submission how your workshop will help conference attendees learn through interactive learning. For more information on the workshops, click here.

Submission Process

All proposals must be submitted online here. NICWA has put together a tool to help you draft your proposal here. This year, NICWA will accept proposals until Thursday, November 16, 2017!

Submit a Proposal now!

Learn more at NICWA.org.

Disparities in Health Outcomes, Barriers to Care Are About More Than Just Access

Black men wait 32% longer to cross the street than white men, according to a study from Portland, Oregon. Males in their 20s, identically dressed, had very distinct experiences: While the white men waited only 7.4 seconds to cross, Black men waited an average of 9.79 seconds for a driver to yield after signaling their intention to cross. 

Such an anecdote, at first glance, seems to have little to do with health care. Yet—as Dr. David Williams of Harvard University, the keynote speaker at the opening plenary of the 2017 U.S. Conference on AIDS (USCA), illustrated with diverse statistics—the overlap between structural racism that people of color, particularly Black people, face every day and significantly lower health outcomes is impossible to ignore. Even Black people with a college degree have a shorter life expectancy than white people without a high school diploma. When it comes to health disparities, there are systemic problems that run even deeper than the already very real and widely acknowledged problem of lack of access to poor and working class people.

Access to health care alone is not the only cause of disparities in health outcomes, and increasing access will not eliminate the disparities in the absence of other interventions. If we truly hope to end the HIV epidemic in the U.S., we must address all the barriers to care—we must indeed make access to affordable, comprehensive health care available to all people, but we also must ensure that providers treat and support their patients in an affirming manner and spirit of cultural humility, that people living with and vulnerable to HIV see people who look like and can relate to them when they seek or are offered services, and we must make sure that interventions are appropriate to the populations they are hoping to reach.

A person living with HIV who has a sustained suppressed viral load cannot sexually transmit HIV to their partner. It is clear that engaging and retaining people living with HIV in care is our greatest—and only–hope of eliminating new transmissions, as well as in preventing AIDS-related deaths. Yet far too many health care providers still fail to inform their patients living with HIV that adherence to treatment and maintenance of an undetectable viral load will prevent HIV transmission to their loved ones.

“No provider since I was diagnosed in 2001 has ever told me that being undetectable prevented transmission,” said Shyronn Jones of Atlanta. “I learned about it last year, from Bruce Richman [founder of the Prevention Access Campaign]. I feel betrayed by my doctors, that they withheld this information from me.”

Jones’s example is echoed by numerous people living with HIV, especially women of color. Asked why they do not convey this critically important information to their patients, medical providers sometimes say that they don’t think their patients can “handle the information;” they worry patients won’t understand that continued viral suppression requires adherence to treatment; they worry that knowing will discourage condom use. Such excuses come off as patronizing, disrespectful of their patients’ intelligence. This is just one example of how providers undermine their patients’ trust in them—a powerful barrier to engagement and retention in care.

Journalist and activist George M. Johnson, a panelist in Wednesday’s session hosted by the Black AIDS Institute highlighting their new report, the State of Healthcare Access in Black America, reminded that the history of being left out of the health care system entirely or used as lab rats by the health care system has created an intergenerational mistrust in the Black community that is hard to break. Even when there is access, people may be reluctant to take advantage of that access.

Read more at BlackAIDS.org.

What Makes Families Resilient?

Family resilience has been defined as the family’s ability to “withstand and rebound from disruptive life challenges, strengthened and more resourceful” (Walsh, 2011, p 149). From decades of research and clinical experience, Dr. Froma Walsh, one of the leading authorities on family resilience, has identified nine processes around the beliefs, organization, and communication of families that can shape their response to adversity.

Family resilience, as Dr. Walsh points out, is not just about weathering a storm. Rather, it’s about turning adversity into a catalyst for the family’s growth. It’s about enriching relationships and making family members more skilled at coping with future stresses. We all strive for resilience. Who wouldn’t want the ability to meet life’s inevitable challenges with grace? But how are resources for resilience built within a unit of unique individuals, circumstances, and dynamics? With the magic of the small, everyday things, it appears. A conversation here, an activity there. Word by word, bond after bond, families fill their wells with strength and wisdom, hope and creativity. And the reassurance of this common well of reserves becomes a big part of their resilience.

Dr. Walsh in her own words:

What has surprised you from your research on resilient families?

I found that there was resilience not only in the “normal” families but also in the families that had gone through hard times. It was never about the “rugged individual” saying “I just did it on my own” and “I had all the ingredients inside of me.” Rather, resilience was more about relational support from others. Another surprise was how adversity itself can turn into an opportunity to become stronger, together. Resilience is something that can be built at any point in the lifecycle, even in the most vulnerable families.

Is there something that resilient families seem to share?

Most families put the nine processes of resilience together differently and creatively, like recipes. The beliefs or practices can be either skills or ways of thinking and being together that promote adaptation to the situation and enable families to have hope in really dark times. They can also enable family members to take action when they feel stuck or have a positive outlook. I like the saying Master the art of the possible: understand that there are certain things you can’t change the situation and focus your energy on the things that you can change.

How important is family resilience for the well-being of family members during challenging times?

A basic premise in family systems is: The whole is greater than the sum of its parts. It isn’t just that you have a strong mother or father who holds everything together. Rather, there has to be a sense of common purpose and mutual interdependency. We are here to support each other and care about each other. When one falls back or needs help, the others will step forward. This way, the resilience of the family unit will trickle down to each individual, because each family member is participating in the resilience.

What can families who relocate between cultures learn from your research to better prepare themselves for the stresses of international transitions?

For international adaptation, a lot has to do with openness. It’s easy and comforting to keep to yourself or the expat community. But immersion is important, and so is leaving your comfort zone. Start having conversations with people. Invite them to your home. Share a meal. In other words, go outwards and open your boundaries. It will enrich your experience while enlarging your heart and your mind. But don’t cut yourself from your past. If you were to cut off a plant from its roots and transplant it elsewhere, it will not survive. You have to bring some of its roots with it.

How does communication nurture the family’s resilience?

Communication helps family members feel more connected. What parents impart onto their children and the way they carry themselves is so important. In a way, they are conveying a set of attitudes and beliefs to their kids. Also, as part of communication, an important aspect in family resilience is to acknowledge the hardships. You have to sit with family members, comfort them, and acknowledge their feelings. It’s equally important to have joy together. It’s not just problem-solving. It is also finding things to celebrate, finding ways to have fun or to laugh at mistakes. In the end, it’s also about the outlook that we hold as individuals and as families. We can look at adversity and see all the ways that it can run us down. Or we can think of it as something that will transform and empower us.

Read more at PsychologyToday.com

Harris County Protective Services: Integrating a Fragmented System of Care

It is estimated that 40-60% of children in state care have behavioral health problems, which are often accompanied by physical health concerns as well.

In 2012, approximately 4,800 children in Harris County, TX were placed into protective custody programs. These children come from a variety of backgrounds and experiences, and are placed in the care of foster parents, kinship placements or other caretaking scenarios. Harris County Protective Services (HCPS) has provided children in state custody with physical health checks, full dental exams, x-rays and pharmaceutical services since the 1970s. However, 100 percent of mental health and behavioral health cases were referred out. The majority of children in kinship care in Harris County (56 percent) did not receive behavioral health treatment. “Kids weren’t being screened. They often went without assessment and treatment for mental health issues, and conditions worsened,” says Jacquelyn M. McMillon, Children’s Services Administrator at HCPS.

Since Medicaid became available to children in state custody, use of the HCPS medical clinics began dwindling. It was clear that their current model needed re-evaluating and they sought a better health care approach for children.

Laying the Groundwork for Success

HCPS received funding from the Hogg Foundation to implement an integrated health care program for children ages birth through 17 in state care. The program attempted to address gaps in services for children in foster care, who tend to have much higher rates of mental health concerns, physical health concerns, and developmental delays than children from similar socioeconomic circumstances.

The grant included a planning phase during which HCPS put together a steering committee to discuss the clinic and its services, and gather information from a broad stakeholder group including kinship caregivers, foster parents, alumni of the CPS system, parent partners, parent representatives, and organizations related to child abuse and neglect.

Three Services Under One Roof

McMillon and her team began to identify exactly how they wanted the clinic to look. Over that first year, they were able to develop a plan that became an integrated health care model for children in the child welfare system. They began by hiring a care manager and a child psychiatrist, and adding a psychiatric and behavioral health component to the existing model of medical and dental care. By putting all three services under one roof, HCPS created vital communication flows between medical, dental and behavioral health. They were able to make referrals within one setting, while also working with caregivers and children for specialty care and referrals outside of the system.

Family-Centered Support

HCPS understood that families needed very basic support and were stressed by the system. In response, HCPS created a Family Support Navigator position funded by a grant from the Harris County Hospital District Foundation. The Family Support Navigator has personal, lived experience, having been involved with child protective services, worked through the system, or had a child with behavioral health issues.

Initial Success

Results from the pilot program point to an extremely promising approach with clear, early results. Following the initial planning phase, HCPS successfully launched their integrated health care initiative in June 2014, creating a program in which:

  • Care management and psychiatric services are provided on-site and in collaboration with primary care
  • 194 unique clients were served as of September 2015
  • There has been an increase in patient satisfaction and number of visits
  • Caregivers and stakeholders report that the program fills important service gaps (e.g. care management and psychiatric services).

The integrated health care project provides comprehensive health care to children in kinship and foster care, allows caregivers to focus on prevention and wellness, and results in better health outcomes.

Learn more at Hogg.UTexas.edu.

Home Visits Help Strengthen Maternal, Infant Health in Native American Communities

A baby’s first laugh, in Navajo culture, is cause for formal celebration. Whoever provokes that milestone moment wins the privilege of hosting a “first laugh ceremony” to mark the infant’s full arrival into the earthly world. “That laugh sounds to the world, ‘This is me and this is who I am,'” says Crystal Kee, a Navajo health educator based in Chinle, Arizona. Though the tradition is unique to the Navajo, Kee finds it resonates across a variety of American Indian communities that take part in Family Spirit, a home-visiting program that supports maternal and infant health. “There is a thirst for some connection to the culture, and the ways our ancestors and people have always thought,” says Kee, who works as a training and implementation manager for Family Spirit.

The program was designed both for and by Native tribal communities. It grew out of the Johns Hopkins Center for American Indian Health in the mid-1990s, when program leaders began working in partnership with the Navajo Nation and White Mountain Apache and San Carlos Apache tribes. Today Family Spirit is active in more than 100 tribal communities across 16 states, with the Hopkins center—part of the Bloomberg School of Public Health—disseminating the model to affiliate health centers and organizations.

The program trains people from the local community to deliver regular one-on-one home visits to mothers (and often fathers, too) from pregnancy through the first three years of the child’s life. The general goal is to share best practices for parenting and early childhood health, covering topics like budgeting and breastfeeding. But because the program is so personalized, it often wades into deeper issues the families are facing, such as employment challenges or drug abuse. Kee notes that opioid and methamphetamine problems are on the rise for tribal communities, requiring “patience and care” from Family Spirit home visitors while they “remain neutral.” And since many participants in Family Spirit are still in their teens and early 20s, the program often grapples with the risks and complexities of parenting at a young age.

With evidence showing successful outcomes—including decreases in depression and emotional problems for mothers, and reduced behavioral problems for their children—Family Spirit has expanded over the years beyond its initial rural settings in Arizona and New Mexico. It’s now used in several urban communities with American Indian populations, including in Oakland, California, and Oklahoma City.

Beyond that, the program is showing promise even for non-tribal communities—an adapted model has served low-income, predominantly black or Latino populations at sites in St. Louis and Chicago, according to Kee. “We get a lot of requests for translating the curriculum into Spanish,” she says.

In addition to reaching out to other populations, Nicole Neault, a field manager for Family Spirit, says future directions may include digitizing the curriculum and continuing to build an offshoot model, Family Spirit Nurture, that targets childhood obesity.

Learn more at HUB, Johns Hopkins University’s news center.

National Latinx AIDS Awareness Day (Oct. 15th)

October 15 is National Latinx AIDS Awareness Day (NLAAD). The 2017 NLAAD theme is “To Defeat HIV You’re a Superhero. Use Your Superpowers.”

The Latino Commission on AIDS (LCOA), the Hispanic Federation and other organizations organize this day to build capacity for non-profit organizations and health departments to reach Latino/Hispanic communities, promote HIV testing, and provide HIV prevention information and access to care.

Hispanic/Latinos in the United States (US) are disproportionately impacted by HIV/AIDS. They represent 18% of the US population yet accounted for almost 1 in 4 (24%) infections among adults and adolescents in 2015.1 Factors such as lack of health insurance, language barriers, lack of familiarity with the US healthcare system and stigma often limit the health care access of Hispanics/Latinos in the US, thereby limiting opportunities for HIV/AIDS screening and treatment. Given that Hispanics/Latinos are the largest and fastest growing minority group in the US, addressing HIV/AIDS in their community is important to the nation’s health. At the end of 2014, there were roughly 216,000 Hispanic/Latinos living with HIV in the U.S. but only 27% of the 85% that were diagnosed and aware of their affliction achieved viral suppression.

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Learn more at HIV.gov.