 Good morning, everybody. We're gonna go ahead and get started. So if you could please take your seat Good morning and welcome. I'm Cessie Echeberria. I'm executive director with the Institute for Health Policy And on behalf of the Institute and government relations and Kaiser Permanente, I'd like to welcome you to today's forum Today's forum is the fourth forum that we've held We've had a few now on mental health issues We've had one on telehealth and one on drug pricing and we will continue to hold these conversations Into next year as well. We're really excited to do that on behalf of Kaiser Permanente So before we get started, I'd like to do a little bit of housekeeping So restrooms for folks that haven't yet had to use them are down the hall There's another little hall and then to the left. So Please make sure to feel free to get up at any point and use the restrooms as you need The exits today in case of an emergency are right behind us at the back of the room So please exit where you entered in case we need to evacuate for whatever reason But on on another note today's topic addressing trauma and school-age children is a tough topic to talk about It's a tough topic to listen To stories about and we want to make sure that you're able to take care of yourself and your needs during today's conversation So we've done a couple of things differently for this forum than in the past that I'll share with you today the first is that we have set up a lounge in the back of the room across from where breakfast is being served and That lounge is for quiet reflection for folks that need to take you know a step away from the content if necessary and You know give yourself some time to To really think about the issues and think about how you're feeling about them We encourage you if you have a phone call not to use that room that room is for the quiet reflection One of the other things we've done today is that we have asked a Kaiser Permanente social worker Aaron van Luven Aaron. Are you here? Aaron's in the back of the room Aaron is available to connect with anybody that feels like they just need To talk to someone today Many of us come to this work with our own experiences of trauma and we may be Triggered by part of the conversation today. So Aaron is a resource as are the Institute for Health Policy staff So Institute staff have a blue pin on their lapel. So can I have Institute staff? Please Raise your hands and let everybody know who you are So if at any point during the day folks need to connect with someone or looking for resources Maybe looking for Aaron Please connect with anyone that has a blue lapel pin so that we're able to help meet your needs today We are also hoping to make sure that today is interactive and that there are ample opportunities for you to ask questions of our speakers We have a really wonderful agenda plan for everybody today And we're trying to make sure that everybody has a chance to ask questions if they come up So please take advantage of those opportunities. You'll notice that we do have mics in the room There's a few mics over here by the screens So please feel free to make sure to use those mics throughout the day use the notebooks and the pens on the table Please to track your thoughts And make note of your questions Another note is in the folders You do have a survey and we are hoping that you will take time today Before you leave to fill out the survey We use this information to help inform our future planning and to learn what we did Well as well as what we need to improve moving forward So please feel free to use the the survey you can leave it on your table at the end of the day Or you can pass it along to anyone with the blue pin On your table, you'll also note that We are having this conversation on Twitter and we encourage you if you use Twitter to use the hashtags on the table That's hashtag trauma informed and hashtag KPI HP to track the conversation and share your thoughts We will be Sharing a lot of information not just today, but in the future as sort of we wrap up this event So please make note of that and we look forward to hearing your thoughts throughout the day on Twitter The center for total health also offers tours of the facility you may see that there's an exhibit here Please let us know if you're interested in a tour of the center And we can make sure to connect you with the right people to do that Lunch will be available at noon today. So just a note for everybody And then again a reminder the folks with blue pins are here to help So please make sure to reach out to us if there's anything you need to help make your time with us a little more comfortable So now with all of the housekeeping out of the way, I'd like to invite don and tony To come up And while you're doing that i'm going to tell the audience a little bit about you So don mordecai is the Kaiser Permanente national leader for mental health and wellness And director of mental health and chemical dependency services for the Permanente medical group in northern california Prior to these roles don was chief of psychiatry and chief of health promotion for Kaiser Permanente san jose medical center He trained at stanford as a child and adolescent and adult psychiatrist His clinical work is with patients with developmental disorders adhd and the range of general psychiatric psychiatry issues Tony beretta is senior vice president of government relations for Kaiser Permanente He oversees Kaiser Permanente's legislative and regulatory policy efforts Leading a team of legislative advocates and policy professionals in oakland sacramento and dc He directs development of Kaiser Permanente's public policy positions in collaboration with our senior leadership To ensure that Kaiser Permanente maintains a common voice in support of the organization Its members and the communities we serve. So thank you don and tony Thank you sassy. Good morning everybody I'm tempted i'm tempted to do what our ceo likes to do which is like come on people. Good morning everyone I won't do that to you So, uh, I just want to welcome everyone here The colleagues as well as partners from many of the organizations that we have the pleasure of working with at Kaiser Permanente And I just wanted to start things off with a short video Just to kind of ground us as to you know, what we're talking about get get some voices in our head in a sense About um, this issue of trauma and childhood and its potential impact. So if we could have the youth radio video I was eight years old I'll sleep in the top bunk of my bed when I heard guys yelling outside my house Then pop pop pop and a bullet came smashing through my window landing in the wall just inches above my head After that night, I started sleeping on the bottom bunk But that wasn't the only change It was kind of like my innocence was taken away I stopped playing outside like I used to because I carried fear of getting hurt I started paying attention to the noises outside my house and wherever I went I listened for any angry voices or people yelling at each other because arguments can escalate quickly into violence I continued to hear gunshots near my house and it makes me uncomfortable My main fear is that one of my family members not just me could be in danger Instead of feeling fear all the time I decided that it's better to have a plan in mind to deal with shootings At home instead of doing fire drills. I had my little sister's practice what to do if there was another shooting I told them to find a place to hide like under a bed To lay down on the floor and call 9-1-1 if possible But this 4th of july made me wonder how often my little sister thinks about gun violence When firecrackers went off she ran under the bed and laid on the floor She was terrified It took me right back to when the bullet came through my window as a kid Seeing the fear on my sister's face reminded me just how scared I was that night Now I wonder whether or not it's foolish to think there's any way to prepare for the terror of guns So youth radio is an organization based in oakland, california And many of you probably heard youth radio stories on npr The great organization and I just want us to keep That that child's voice in our heads as we go Thinking about trauma suffered in the home thinking about trauma brought to us in our communities Things like that as as we talk so We obviously live in a time of increased awareness of the impact of childhood trauma You hear things like toxic stress or adverse childhood experiences You know opera did a piece on 60 minutes recently that that brought forward this issue So that's a good thing right and we're all part of that increased awareness The original adverse childhood experiences study was actually done in kaiser permanente in southern california About 20 years ago And it involves 17,000 kaiser permanente adult members Who one would not consider traumatized particularly right? They were largely middle class Employed insured people But one of the most important things that I think the study brought out is how common trauma is in our society And this is trauma that can affect us across the lifespan, which was one of the other Key findings of this study is it's not oh it happened in childhood and it's over It's more like it happened in childhood and it and it's still reverberating And that kind of trauma that can affect people over the lifespan Is common all too common. It's as common as Divorce or separation of parents. It's as common as parents who have a substance use disorder. It's as common as neglect And then there are of course the other issues the more Dramatic issues that we know about physical abuse sexual abuse Incarceration of a parent things like that which are also all too common in our society Uh the aces study the adverse childhood experiences study was incredibly simple It basically asked these 17,000 people How many of these 10 types of trauma and and by the way, they were all Sort of domestic trauma. It wasn't about communities and other types of trauma that we've learned about Subsequently and basically said how many of these have you had and the number that you'd had was your score My score would be two And I feel fortunate for that Because a lot of people have scores that are much higher Scores of four or six But to get across how common these things are 70 percent of adults 70 percent of us have at least a score of one About 12 in this sample had a score of four or more and there are populations where it's a lot higher than 12 And what this study found crucially was that there's essentially a dose response relationship between the number of traumas You've had as a child and certain key health outcomes Physical health outcomes as well as mental health outcomes. So we're not this is not just about mental health here And I want to emphasize that too So it's not like oh if I've had one up to three I'm okay and then four and above is a problem, right any amount of trauma has a detectable impact And the findings were startling to me so Not only are they common But the downstream impacts that go on throughout the lifespan are profound if you've had four or more traumas You had twice the likelihood of heart disease twice the likelihood of stroke Seven times the likelihood of a substance use disorder seven times 12 times the likelihood of Making a suicide attempt 12 times So that dose response relationship was incredibly strong and incredibly profound And I would argue that it is possible and maybe even likely that the public health crises that we're talking a lot about today Or I mean, you know in the world today the the increase in suicide In almost all demographics including children very sadly the opioid epidemic Are probably directly correlated with trauma suffered in childhood So Kaiser Permanente is dedicated to improving the health of our members and the communities we serve And if we want to move upstream and address these issues at their root, we have to think about trauma Right, that's why we're here today Um, and in doing that we have to think about not only how do we prevent traumas in the first place? Of course primary prevention, but also secondary prevention. What can we do to help kids who have been traumatized? And then even adults, right? How do we help the adults who suffer these things as children and It's an emerging field. I wish I could say, oh, we you know, we've got all the answers We just have to implement in fact. We know some things that work. We need to know a lot more So how do we get there? How do we create homes and communities that are nurturing and healing and not traumatizing? Our search for solutions has led Kaiser Permanente to invest nearly nine million dollars over the past four years In programs to address and prevent trauma. A lot of our work has been focused on schools So we have a thriving schools program We have something called resilience in school environments or rise that you're going to hear about later today And these are our are sort of putting our marker down to say we think schools Are a unique place a social home if you will where we can have an impact on these issues So you're gonna you'll hear more about those programs later So with that introduction, I'd like to turn things over to tony burrata as you heard our senior vice president for government relations So um, thanks Don. Um, I actually think it's incredibly helpful to ground the conversation in the science behind Behind trauma and how it affects health One of you know, one of the issues um That I think is critical to focus on is exactly what don reflected, which was while we know Some of the science behind this the interventions and what to do about it are still being learned And indeed We are constantly looking within Kaiser Permanente for ways to address what we know is a major problem in society Um, the aces study for me Came to life in part. I was aware of it as a policy professional within Kaiser Permanente for over 20 years But it wasn't until When I was sitting on the board of directors for the east agency for children their CEO josh lennards here today Um, when there was a very specific focus on trauma and the need to organize around trauma Through e-back programs to figure out how to get upstream and how to provide the support for the people in schools And in the clinics who are taking care of these children And what was what I noticed it was at that time that I first read the aces study and I would I had the same reaction I was like, wow, this is super basic stuff um and super obvious stuff and in the public policy space um and being responsible for public policy for Kaiser Permanente They often find my role is Clearing away, you know, all of the chaff because most public policy should be quite simple And this is an area in which I think Taking a simple approach having good understanding and excellent dialogue among the many people who are working on These issues can help us refine And bring forward appropriate policy solutions And so that's what I'm hoping to do today is to listen to all of you who are participating in this to learn more About this subject. That's the reason why we're Putting on these forums I'll note that mental health in general Is one of the key initiatives that we have brought forward as public policy professionals within Kaiser Permanente along with the problems of drug pricing universal coverage and Frankly telehealth in terms of creating better access But mental health has been an area in which we really have wanted to focus over the last two years And I fully expect we'll continue to do that Because it is in this mental health space that we can start to bring together how people live their lives And how it affects health and this is probably where many of the interventions are So I look very much forward to the conversation today I get to do some reflecting at the end So i'll be listening closely and taking some notes But sassy thanks for pulling all this together and Turning back to you Thank you So before we get started With dr. Dorado who's our first speaker I want to take us to some polling. So you may have noticed that on your table There's instructions to participate in a poll So please take a look at that you can pull out your cell phone and it's as easy as sending a text So the question that we're asking is which topics would you like us to cover today? So we know we have speakers lined up and they have an idea of what they'll be presenting But it would be great to know a little bit about what you would like to hear about So please take a few seconds and text What topics you would like us to cover today? And we'll start to see that populated Thank you Thank you. Keep them coming So solutions seems like a big one Vicarious is up there school-based strategies Solutions still sort of the big one um public public health great. Thank you Policy equity Thank you. These are some great responses So I think for some of our speakers that are already in the room We'd love for you to sort of take note of some of these concepts and To the extent possible see if you're able to address some of those in your comments And then we'll check back in with a poll later today