 Thank you to Dr. Morsi and Dr. DeConis for an incredible after-lunch session. Thank you so much. At this time, I'd like to welcome our panelists for our final panel on solutions to please come up. So I'm very pleased to welcome our distinguished panelists and I will go ahead and start reading bios since we have heavy hitters up here, which I'm really pleased to be a part of this group and moderate this panel. So I'll start with Ellen Payees is the president and CEO of the Los Angeles Education Partnership, a non-profit that works in high-poverty communities to foster schools that support the personal and academic success of children and youth from birth through high school. She has more than 25 years experience in community building, community relations, and the law. She's a member of the California Community School Network design team and a co-founded the Community Coalition for Quality Public Schools, a school reform, non-profit in Pasadena, California. I'm also joined by Tanette Walker. You're out of order. This is rocking my world. Okay, Tanette Walker is the first lady of Wisconsin. We're thrilled to have you here. Thank you for joining us. In 2011, Mrs. Walker launched the Fostering Futures Initiative, partnering with the Wisconsin Department of Children and Families and private organizations to better recognize, understand, and address the effects of trauma on the lives of children and families in Wisconsin. Through this partnership, she hopes to establish the state of Wisconsin as a national leader in the trauma-informed care movement. Thank you for being here. Sharon, Sharon Hoover is a licensed clinical psychologist and an associate professor at the University of Maryland School of Medicine Division of Child and Adolescent Psychiatry. Dr. Hoover is the principal investigator and co-director of the National Center for School Mental Health, where she currently leads efforts to establish and disseminate national performance standards for quality and sustainability of comprehensive school mental health systems. Trauma responsive schools and trauma exposure among youth and families has been a major emphasis of Dr. Hoover's research and clinical work. Kirsten Stewart. Kirsten is the director of Public Policy and Advocacy for Futures Without Violence, a U.S. based nonprofit that works to end violence against women and children in the U.S. and around the world. In her more than 17 years at futures, Mrs. Stewart has helped guide the creation, implementation, and funding of several major pieces of legislation addressing violence against women and children and has been a frequent spokesperson and trainer on issues of domestic violence, sexual assault, children's exposure to violence, and gender-based violence globally. And at the far end is Sandra Wilkness, program director for the National Governors Association Center for Best Practices Health Division, focusing on issues related to behavioral health and social determinants of health and the innovative integration of these into health system transformation efforts. She leads the NGA centers, technical assistance work with states, advancing programs for high-need, high-cost populations. So I recognize that we're already late and we are already behind schedule. So I will definitely do my best to try to keep us on time and what we would like to do is start with some comments from each of you and then we would love to encourage all of you that are with us still to ask questions of this distinguished group. So please make sure to be ready with those. But let me go ahead and turn it over to you, Ellen, for some introductory comments. Okay, great. To follow the search in general. Oh my gosh. Okay. So at LAEP, we are an educational equity organization that partners, partners with practitioners, parents and community to try to level the playing field so that all children graduate from school ready for college career in life. We view this work as starting at birth and we haven't really talked about that today. So we want to support parents in expanding their knowledge about best practices for nurturing their children's development and connecting them to their local schools so that there's an intentional relationship, relationship between families, parents and children and schools starting at the very beginning. At the school level, we want to build, we build the capacity of the school infrastructure to support rigorous, high-quality instruction, collaborative leadership environment, student self-efficacy and self-direction, college and career readiness, parent engagement and equity. Our vision is that schools are holistic places that are student-centered and great places for the adults to work and that they look at a broad spectrum of data, including achievement, social-emotional well-being, attendance, student interest, community conditions, access to resources, and from all of that data, they build responsive strategies to those students that look beyond the walls of the schools for assistance in meeting those goals and that approach is why I'm here today. The United States has had an on-again-off-again relationship with schools and education being holistic. When John Dewey first promoted public education, we thought about schools as places where we were looking at the whole child, integrating them into society and we're fortunate that there is a federal food program that supports kids being hungry as well as farmers, that there's a federal funding program for after school that keeps kids safe and engaged in enriching activities after school, that we have a Head Start program. But we aren't there yet and I think about the report that was issued in 1983, a Nation at Risk, that said if we don't support all children to be successful, we will have a shortage of qualified workers in our country because we will not be taking full advantage of all of the young people and we will have the disparate environment that we have today. More than half of the nation's school children, approximately 25 million, live in low-income households. The data about their school experience, we know, is clear and that most low-income children attend schools that are inferior to middle and upper-class students. And so what are the characteristics of those schools and why are we addressing this, right? Students are experiencing unmet or inconsistently met needs including dental, mental health, physical health, shelter and a variety of other things. They have a transient population because their families are constantly looking for new housing that they can afford. Often they have parents who were in systems of education that they were not served well by or they came come from education systems that are in a very different culture. Teachers often don't share the cultural experiences or the background of the students in the schools where they work. And they're unfamiliar with the personal life experiences of the students that they are teaching. School leadership frequently changes. There's high teacher turnover because newer and experienced teachers who are not yet at the top of their game are often burned out and teachers who stay are at the brink of retirement and experience poor teaching strategies and low expectations. So in the era of no child left behind, we said we're going to fix the disparity and we're going to focus on instruction. And we spent all of our time doing that and saying nothing about the well-being of the students who were there. And we've tried many initiatives. In California in the 2000s, we had an initiative called Healthy Start where we funded case management for schools where students and families got mental health support that help them be connected to their school community and get the services that they need. But in a district like Los Angeles, that program went away because the funds were needed elsewhere during the recession. And we now don't have that kind of complex structure. We have some mental health supports, but they're not enough. At the moment, we have a national recognition that students cannot learn if their environment is not one that supports their well-being. And that they cannot learn if their brain development has been intervened or is not able to manage what we expect of them and we're not responsive to that brain development. Oh my gosh, okay. So trauma in schools exhibits itself in a variety of ways, right? And we've talked a lot about that today and I would really reference what a lot of people have talked about, those conditions for learning. So we are engaged in an amazing project with Kaiser right now that focuses on the well-being of the adults and their ability to work together at the school site to change the school climate and to change the responsiveness of what's happening at the school. So we're focusing on really three things, increasing adults' knowledge, all adults, not just teachers but everyone at the school site, about brain development and stress, changing their mindset about how they interact with the children that are at the school and focusing time and attention on their own collaboration and well-being. This is important because schools really are places often of well-being and constant change. A few more seconds. Okay, so why is it important that we have an environment where we're building collaboratives of adults working together, building their knowledge and coaching their success because people invest in what they create and when we impose on schools to implement a strategy that they don't understand and they're not invested in and we don't coach their support to success, those strategies are not implemented well and they go away. We also need to focus on the coherence that we were talking about earlier that align the resources and strategies at the school site and that is in part what the RISE project is doing. Great, thank you. Let me turn it over to Mrs. Walker. Thank you. Thank you. So I'm going to be very brief. I will, nope, I'm just like, I want to hear from everyone else. So I'm going to start up by just saying that most of you are probably wondering what I'm doing up here, right? And how I became really passionate about trauma-informed care and that came to me with a dear friend and she brought the ACE study to me and I had what I called my ACE awakening and from there we started an organization in Wisconsin in 2011 called Fostering Futures and really basically what that is is we will talk to anybody and everyone that will listen to us, everyone from the bus driver to the superintendent of schools, to the governor, to the lawmakers, whoever will listen to us about how important trauma-informed care is. And with that, I mean I can go on and tell you about all the wonderful things that are happening in Wisconsin. 50% of the work that we do is county and state government. So it's exciting work, it's trying work, it's trying to build awareness in a much-needed area with government that needs to know about ACEs and trauma-informed care. With that, I'm going to turn it over. Really, I can go on and give you many, many examples of what we're doing in Wisconsin. If you're interested, you can just grab me at the end of the day. Well, and hopefully we'll have time to talk about some of those because I can attest to the great things that are happening in Wisconsin as the National Center for School Mental Health. I have to say we often refer to the efforts in Wisconsin. They have a phenomenal blueprint on comprehensive school mental health and multi-tiered systems of support. So I would grab Mrs. Walker if you have a chance before she departs for the day because they really are doing some phenomenal things. So we were put on the panel of solutions which is always a little bit intimidating given the breadth of the issues that have been talked about today and I've been incredibly inspired. I had a couple of quick points that I want to make and the lens through which I see this work as was mentioned in the introduction is first from the National Center for School Mental Health. Our center has been around since 1995 and we are funded out of HHS actually, specifically out of the Health Resources and Services Administration, the Maternal Child Health Bureau and our mission is to strengthen policies and programs to support student mental health across the country. So we work directly with a lot of schools and districts and states to really advance their school mental health efforts and the other lens through which I see some of the work that we're talking about today is through the partnership that we've had with Kaiser, I've been privileged to serve as a lead member of the evaluation team on the rise work that they've been doing and so together collectively we really have been kind of working to both conceptualize what do trauma informed schools look like and then how do we measure the successes and so what Dr. Murthy spoke to earlier about the idea that we need to be very clear about what our target outcomes are and how we measure those really resonated for me in terms of the work that we're talking about specifically today because in many respects I think we're still in our infancy with respect to doing a good job of measuring the success of trauma informed schools. I think Dr. Dorado's work has been an exemplar in that area and so I was pleased to see her speaking this morning and to hear about some of those outcomes but I would argue that we still have a long way to go in terms of understanding what does it mean to be trauma informed and what do those outcomes look like. So as far as solutions I know there are many. The couple that came to mind for me, one was really just related to workforce again in terms of the idea that we need to better our workforce and not just through one-time trainings. There's a lot of very well-intended schools and districts across the country who are trying to check the trauma informed schools box by doing trainings of their staff both their school employed staff as well as community staff that come in to support mental health and again the intentions are good but we see a lot of poor investment in that area and I would argue that we really do need to be attending more to coaching, implementation support and you know one of the notes I wrote as I was hearing things earlier today is that we do need to whenever we're talking about trauma informed schools need to better leverage our school employed professionals including our school psychologists, social workers, school counselors, our school nurses and not solely rely on community mental health coming into partner in these efforts. I would argue that there needs to be a strong school community partnership to really establish comprehensive school mental health but we do need to be working in direct partnership at a national level with our organizations like the National Association of School Psychologists, School Social Workers of America, American School Counseling Association, National Association of School Nurses they know how to work in schools they've been doing it for decades and they are a critical part of the equation at the same time we do need to train our community mental health workforce on how to better engage in schools it should not be a doc in the box model sorry for the term but it's oftentimes we see again well intended community providers coming in and just kind of setting up shop and not in a way that really integrates across a multi-tiered system of support in schools so there are many workforce issues that I think we need to attend to and that's the mental health side workforce for educators I would argue that we need to be teaching, supporting and measuring two primary areas one is compassion I was pleased again in Dr. Dorado's talk this morning to hear the component of compassionate and dependable relationships I think was the term or the construct that you spoke to and that's something that needs to be taught and supported in order to establish and sustain and then we need to be supporting our educators with specific skills there's a lot of awareness raising and teaching around the impact of trauma on brain development and implications for learning that's important but what we hear very often from teachers is they need to understand what to do in the classroom when this student does X when this student does Y they need skills or tools in their toolbox we've also had the privilege of helping to evaluate a more recently developed initiative Rise Up where they've been where Kaiser has been partnering with schools to actually help teachers with some of those skills to have them modeled for them and engage in the in the practice of that work so that's been exciting for us to witness a second area that I would argue is absolutely critical is that we need to recognize how trauma informed schools aligns with existing initiatives schools and this is important for a couple of reasons one we know schools have initiative fatigue I see the superintendent nodding her head rigorously the schools have so many initiatives that they are trying to put into place and again dr. Dorado mentioned this morning you know this should not be one more thing added to the plate I heard the term strategic abandonment several years ago in terms of how we need to be approaching initiatives in schools before we add one more thing we need to be looking at what works and strategically abandon the things that don't work our center has been working for a number of years under the guidance of HRSA on the shape system which is the school health assessment and performance evaluation system and part of that system is to actually help schools to map what they're doing within their school within the district we now have a state dashboard schools can look across their tears to see what they're doing and how effective it is and that's one of the things we need to do before we come in with one more initiative and then third I just and I alluded to this earlier I think we need to support schools in their school community partnerships we need to help schools become better consumers of community partners as they come in to do trauma informed work mental health work et cetera and that can be done with helping schools establish better designed MOUs to partner with their community partners that really lay out the specifics of what schools or what community providers rather are expected to do when they come in to schools so not just having them come in and kind of do a mysterious mental health work but really align with the initiatives that are taking place in schools I was appreciative of the multi-tiered model where we looked at how does trauma informed schools layer upon efforts like restorative practice trauma PBIS et cetera so I'll stop there and hope we have time for discussion. Good afternoon as was said my name is Kirsten Stewart I am with my teachers and I am honored to be in the room with many people who have been my teachers over the last 20 years in this work and what I say is my job is to take all of this good science and all of this good practice and try to get you paid and try to get the policy out of the way and what I always like to do is preface these policy solutions conversations with a reminder to all that policy is a blunt instrument and often you know I'm listening to these conversations earlier and I'm always trying to apply my lens to the problems that people present and in one respect that's why I love my job because I often I hear problems and I go I can fix that and it's not going to be a straight line and I'm going to need a lot of help and it's not going to be everything that you hope for but I do want to identify some of the policy levers that are out there to help do this work and just so you know futures without violence were based in San Francisco our job is to end violence in our homes in our communities we actually changed our name to futures without violence a few years back in recognition that that's really what our mission was and that we want to identify where there's violence and trauma and ideally ideally ideally prevent it in the first place and where it does exist it doesn't exist by itself we need to be talking and supporting kids and their families and their communities and that's the only way we're going to get it done so I am with that let me launch into a few what I hope will be useful tools and again I'm happy to direct you to websites or answer questions so consider this kind of your policy tasting menu first off there is language in one of the appropriations bills right now for fiscal year 19 that does exactly what we've talked about which is requires the surgeon general to issue a report in the next 180 days on the link between adverse childhood experiences and long-term health and behavioral health outcomes including early initiation of alcohol and tobacco use, substance use, teen pregnancy, violence and increased risk of suicide and with this report it will be a nation's calling card and a report card in essence that says this is a problem these are the links and it's going to identify policy and funding solutions so that's something I'm not sure our appropriations our funding process in case you haven't noticed isn't working great these days but at some point we will pass these bills and we are optimistic that probably not by September 30th to be realistic but I would expect by the end of the year we will have funded fiscal year 2019 I am optimistic that that language will be included in the final report and so that's going to be a real opportunity to have a very prominent report that identifies the issues and some of the solutions there's a program and you heard Chelsea practice talk earlier about ESSA the Every Student Succeeds Act which was the reauthorization of the elementary and secondary education act it's sort of the big law that governs a lot about schools in the country included in that bill was what's known as Title IVA we have to have our jargon here in DC but they are the student support and academic enrichment grants but basically these grants were created in response to what we've heard from many many people for many many years which is we appreciate all of these ideas and we've had them ourselves thank you very much for a long long time now who's going to pay for it and how am I going to have time and great I can come in and do school training on trauma and who's going to pay the subs and where does all of that support come from and it's going to look a little different in rural Oregon than it does in Detroit so what this program does is it merges a whole bunch of other programs and then provides flexibility to districts to do things like school safety health and wellness some technology can do music education it can do AP classes but there are certain requirements about a minimum distribution of these funds and one of the core pockets that the funds are required to be used in are for safe and healthy students in addition any school district that gets a minimum of $30,000 is required to do a needs assessment and this process is happening now and so we were also able probably for all of the wrong reasons to get the appropriations levels up to $1.2 billion it had been previously $400 million given that that was meant to cover all school districts in the country that wasn't enough money at $1.2 billion it's still not enough money but it's a lot more and school districts can do something good with it and they need to do something good with it because to the point that others have brought up constantly coming in and saying we need more money and this isn't enough money to do anything so we didn't do anything is not going to get you more money as the person who's trying to make that case on your behalf so and there's some great work being done right so the plea for those of you who are already implementing some of this is please document what you're doing with the funds please document successful outcomes ideally associated with these funding you know can you bring hearts into your school with this fund that you can and let's show document for us and for your policy makers how this was helpful because the thing I will say and having worked on the hill for many years is many of us don't always agree with every policy maker but they are here because they want to do the right thing for you and your communities that's why they run for office and you need to hold them accountable when they don't do that right so but there needs to be it's a two way conversation and it's really important that we communicate back to policy makers what the things they fight for us accomplish I also still want to say two other things there's also a big big change happening in child welfare funding in the country and I know some of us don't necessarily all deal with child protective services but when we talk about children who are experiencing abuse and neglect and maltreatment most severe outcomes often come into contact with the child protective system and ideally my perspective our child protective system could be doing more than waiting for kids to be really badly hurt before we do some things to help them and their parents so to that end what's called the family first act was passed and what it does starting the first sort of guidance is going out this October and it starts to kick in more officially in October of 2019 but it takes a large percentage of child welfare money that right now the vast majority of which goes to pay for foster care placements and says we can use that money to do prevention services that support parents so if there is a child who is at risk of entering foster care and almost any child involved in the child welfare system is then you can draw down money and it's not a capped amount right these are entitlement programs you can draw down money to do prevention services there are limits on it but the bottom line is this big eight this point eight billion dollar pot of money is now open to do mental health services substance abuse treatment intensive in home family services for some of our most vulnerable families so please partner with your child welfare agencies to identify child welfare programs so they're buying the right treatment not the wrong treatment and help them be successful because that's a real game changer potentially right now you've heard about the opioid money and then I will just also say Medicaid is still the law we still have Medicaid and Medicaid can still cover a lot in terms of services for children it is actually required through the EPSDT program that children who have need to get that need met now we I think can talk about some of the limitations and challenges of EPSDT but at this point if there is a need that a child has for health services it can and should be covered and there's some other ways other new payment models out there around health homes that I can also happily talk to you about where there's some innovative work around using complex trauma as a criteria for a health home that can also get kids and families that can help. So I'll stop there and happy to answer questions. Thank you. Hi Sandra Wilkness again with the National Governors Association I'm going to take us back up to 30,000 feet on the state side and talk to you a little bit about what is of interest right now what the hot ticket items are for governors and state policy leaders and hopefully to stimulate some thinking about how that can be part of your thinking around solutions I am actually in the Center for Best Practices which is really a think tank and consultancy side of the National Governors Association it's a nonprofit entity and our role is primarily to support governor's policy advisors in any policy solutions they're seeking. Our primary mission is evidence based practices bringing those to the fore and helping policy makers digest those and figure out how do we actually move those forward in our states so I just wanted to highlight that so I'm on that side of the National Governors Association I just want to talk about a few initiatives that are really on the forefront right now both through the Center for Best Practices and also the other side of NGA which serves governors and serves in a lobbying role and also to organize governors around best practices and innovations that I think will be of interest to you so the first thing I have to note and Ms. Walker was very modest about her influence in this system is we can talk a lot about Wisconsin but one thing that also happened recently at the governor's winter meeting which is always hosted here in Washington DC and is extremely well attended so that governors can exchange ideas and also speak with the administration and go to the White House. There was a spouses I think we can call it a summit is that fair to say Ms. Walker that was I think pioneered and led primarily by Ms. Walker and a couple of other spouses who are very engaged in this space and was extremely well attended I want to say 16 or 18 first spouses have walked out of that meeting with ideas around initiatives they want to pursue so that is one effort that's going on that I think is a real great opportunity on the state level for folks to engage in and support those efforts that's a very powerful set of stakeholders to be working with so that's number one on the Center for Best Practices side I just want to acknowledge that I sit in the health division which might surprise some of you I'm not in the human services space I'm not in the education space why you know as a lady from the health division here in part because I'm a psychologist and behavioral health is my passion but also because this issue of trauma trauma informed care and ACEs has a really risen to the top of the discussion in the health space why do we care because there's a whole lot of opportunity to invest differently in our systems of care and service when the health teams are also at the table so I wanted to acknowledge that and some of the initiatives that are going on through the work that I've been doing with states include I guess one of the most important issues that's come to the fore is through primarily our public safety and homeland security division it's around school safety so all politics aside this is a very bipartisan request for assistance we work in a very active way so we've heard from 20 states which is a big number for us in 48 hours that they want support in addressing school safety in their states and in their communities so what does that mean for us around here this is a magic moment this is a golden opportunity to really bring an understanding of comprehensive mental health services trauma informed care to the discussion around school resource officers and around the public safety side and we are participating actively in that discussion and people are eating it up there's a real opportunity to bring those worlds together both from the policy side and the practice side and the work force side and the payment side right we won't get there tomorrow but the discussion is happening and it's happening now and so I wanted to highlight that piece of it and we talk a lot about your work so I wanted to highlight that piece of it we are also working on projects around behavioral health somebody earlier said mental health is one, two, and three well guess what in health delivery system and payment reform mental health behavioral health so with substance use disorder is one, two, and three in terms of the requests we get so I think that's really powerful we're moving towards value based purchasing we're moving towards massive delivery and payment system reform on the health side and when those issues are rising to the top in terms of request for assistance that means there's a real opportunity to highlight the win-win-win for policy makers of we really can improve outcomes for a lot of folks with mental health and substance use disorder concerns not just the opioid space but broadly speaking and we really can figure out cost effective ways to do that and before you get nervous about money coming out of the system part of that is a reinvestment strategy so we're having a lot of conversations with states on that front and I think that's really important to notice and to pay attention to what's happening in your states a few other things I'll highlight quickly because I know we're almost out of time social emotional learning very a number of states are moving in that direction we're getting a lot of interest from states on that front and all of this work is now cross cutting for us at NGA so we don't just have education doing their work we've got health education human services all working together to make these cross sectional cross sector opportunities happen suicide comprehensive crisis response systems we just had a meeting in the intermountain western part of the states 13 states attended there was just so much interest in this issue and again we want to get towards prevention but we also want to think about the comprehensive right and cyclical nature of all this work and then finally I wanted to highlight two things so again Miss Walker I know that you said that you're moving towards a three branch institute kind of approach to addressing ACEs and that's something that came out of a project by NGA which I actually didn't lead but Tennessee is another one of those states and three branch means three branches of government so governor Haslam brought together the legislative branch and also just judiciary branch to come up with a comprehensive state strategy around it was around juvenile justice primarily but the focus has been on ACEs and they've done a lot I just want to say two things about it I can tell you more one is they took the approach a resiliency approach and a brain development approach and they said we're going to marry two sciences in this effort brain science and communication science and it's that latter piece I think that is really really important they worked with frameworks which is an organization that uses evidence based strategies to understand how does the message get through into what groups and they came up with a lot of really terrific imagery and metaphors that they use to kind of communicate this and from the research perspective been super effective love to share it with you there are a lot of ways you can communicate this that different audience will hear and understand great thank you thank you all for your brief introductory comments I'd like to encourage folks in the audience to please line up at the microphones to ask your questions of this group of esteemed colleagues here but I'll kick us off with a question as we go forward one of the things I'm interested in is thinking about potentially unintended consequences of some of the direction that we're going in right now whether they be positive or negative so I'd like to just open it up to the entire panel if you have thoughts about some of the unintended consequences of some of the work that's been done to date both that your organizations have been doing but what you also see out there so this is Kirsten I can identify something that we are thinking a lot about and have been for a while and that is ACEs as a screening tool and what the consequences of that are because we're seeing it a lot and we have driven some of that I'll be honest so that we now are collecting data through the behavioral risk cert right we're doing these statewide health data we're now collecting all this ACEs information that's a really good thing so I will say is my organization ignorance is never our value like we never don't want to know what's going on with a child and what's going on with a family what I don't necessarily want to know have is a child disclosing sexual abuse in a classroom full of peers or with a provider or a teacher or somebody who has absolutely no idea what to do with that information and I don't want necessarily that child to disclose after months of trust building and all of a sudden child welfare shows up at their door and they haven't seen their parent and the immigration implications are also becoming hugely challenging because any disclosure of any potential ACE is now that child may never see their family again and we've had some of those instances I can tell some examples so to answer your question which is desperate for help trying to figure this out because we have driven this stuff for a long long time now it's like finally kicking in it's great and then we're starting to see people like oh my god we can't ask we can't ask we can't ask or we're only going to ask some of the questions because then we don't have to report those answers to child welfare and meanwhile kids are like wait why did you ask me these three so please help and let's think that through thank you others I think what you just lifted up is not so much an unintended consequence but it is a big consequence of opening the Pandora's box of when people are really trying to build relationships and you're really trying to get deeper than just saying we're going to implement positive behavior supports if you really want to build positive behavior supports you need to have a shared understanding of what positive behavior supports looks like it means being vulnerable and looking at what the implementation looks like in another classroom across the way but also being there for each other and if you don't know each other and you don't have those relationships then you can't really implement what we're talking about and when we open these conversations and you really start lifting up the latent racism the latent isms that exist in schools you get some really raw things happening before you can get into creating the kinds of kindness and support for each other and so the path is not one of just direct we're going to now be lovey-dovey and we're going to make this school work together it's about supporting all of the twists and turns and the reality of the fact that everybody does have things they have things that they may not be aware of and once you open this Pandora's box whether it's around a child abuse situation or it's around the deep feelings that individuals have you have to be prepared to support them and you can't just abandon this but that is that this opens a box that a lot of us are not necessarily prepared to deal with thank you um take a question from the back thank you um Megan Thompson with Senator Feinstein's office um thank you for one focusing on child trauma um and the question is when we're looking at issues affecting foster youth specifically what from a policy perspective would you recommend we can do to bridge those gaps between child well-being and the child welfare system and the coordination of their healthcare it's a question I've been asking for years and would love some additional thoughts on what else can we do because we know their healthcare is not well coordinated across the board so would you have any good examples would love to hear those we're just debating over here who should start I don't have a terrific example for you it is definitely a problem and of course when we work with states we're very much in the weeds around what is your state law what is your regulatory environment what are your financing and accountability structures that may impede you know really effective continuum of care kinds of approaches there's a lot of interest in part because this is a complex care kind of scenario where there's a potential real win to improve the outcomes for these individuals and actually cost state money so they really there's a focus there um but I would say that those are often the kinds of barriers that states are grappling with and then of course it's been highlighted multiple times the workforce to get the evidence-based practices to these kids is really missing then of course we know that there are a lot of cliff issues with um Medicaid and other health insurers um for kids in that age group so I would add a couple of things so one these kids need health care so that to me is sort of where I begin which is I can imagine a few groups of young people who more need easy systems so that the default is always to enroll a kid right and so I try to say that generally like whatever system you are that is coming into contact with youth you know who are in foster care depending on your state about to age out of foster care how did the triggers automatically take whatever benefits information you already have about that child and automatically get them enrolled in health care whatever that looks like in their state um because they need health care um and that can't and it can be done states are doing it actually quite well um one of the things we advocated for so many of you remember around the affordable care act and one of the most popular provisions was that kids could stay on their parents insurance well right foster kids um they can't stay on their parents insurance that's the whole nature of why they're you know part of being a foster child right so that that kids in foster care immediately have health insurance till they're 26 right so those are some of the kinds of fixes that we can make also youth coming out of um the juvenile justice system unfortunately there's a lot of crossover between our foster youth and our juvenile justice population and so again that there's automatic enrollment um the second a youth comes out of JJ so there's not because they're often in some situations they're getting some frankly some good treatment and for some youth the first time they're getting any sort of mental or behavioral health treatment is in the juvenile justice system they get out um and then that there's these gaps and that often is a problem so those are a couple of things but I'm happy to discuss more Hi there, Nathaniel Counsel with Mental Health America um and my question is about federal legislation and regulation um and in particular if what your thoughts are about and this might be an impossibly challenging question about specific provisions you'd like to see changed in Medicaid, ESSA um IDA the kind of systems that we have to kind of scramble on the ground to get to work together and is there some sort of like critical policy lever that would be especially helpful to change which I think is complicated too by the fact that there's a lot of exciting things going on on the ground that's like feels like easy to kind of cheer on and lift up as models like Oregon's Medicaid redesign and the one Maryland's going through right now um but one more you know is a hardened lobbyist can what can I be doing to change the underlying legislation as well. I'll just say two quick things from a practice level that I think would make a huge difference in terms of being able to provide mental health supports to students in the school setting one is just having Medicaid allow for schools more easily to be a site of service that's a concern we hear from many many states and providers that they can't do the work in schools because it's too difficult to have the schools as a site and then the other is for Medicaid and other insurers to fund what we might think of as complimentary services that are required if you're going to do high quality school mental health services so things like team meetings, teacher consultation we can bill for things like individual family group therapy in schools but then it often feels just like doing outpatient work in schools and we know to do well in schools and to really serve the whole child we need to be funded for those services and there's some states that have done that successfully but to do that more wide-scale would be really critical. So one of the things that schools really struggle with in terms of having students participate in these programs is having the capacity to support the contact with the families to make sure that students actually get the services so an increase in the network of individuals who can make the phone calls, who can make the appointments, who can do the follow-up with the families, the service providers may be there but the schools aren't structured to be able to make sure that the connections actually happen. Hello again, Tina Deb with the Maryland State Education Association so some folks might know that the Washington Post did an article on July 6th about school trauma which was wonderful we were glad to see that they covered it. Ironically enough a couple of days after that a letter to the editor was submitted by Delegate Janelle Wilkins who was literally sitting in this room earlier she's a delegate from the state of Maryland who just happened to introduce in this last legislative session HB 1601 which was trying to create a pilot program for school trauma for trauma informed care pilot program and unfortunately the bill is not successful in this state but she is determined to reintroduce it and I am determined to help her get that past so this question is specifically for Dr. Hoover how can I rope you into that process in large part because one of the things that we were flummoxed by and again this is a legislator who four months out of the year is working as a legislator and the other months out of the year is working as a grassroots organizer with communities that are sort of struggling under resourced etc and working with an educator who could explain together what this looks like and trying to help lawmakers get it they didn't get it it was a big well that should already be happening why isn't it it's a big uh it's a big duh so how do we help lawmakers in the state specifically get this but then what is the messaging that we need to be giving to lawmakers across the country to help them to better understand what student trauma or trauma in general is and that needs to be invested in at the state and national level so the easy answer for my perspective is I'd be happy to be a part of the process but we were aware of the bill probably too late in the process we became familiar with it you know as it was well into session and we're very supportive of the language that was in there and I think as with many of these efforts it takes a couple of rounds unfortunately to have all the people at the table kind of creating the awareness and the momentum around it but I think there are a lot of people who saw that particular bill kind of late into the game and were excited about it but unfortunately it might take another round but I mean in general I think there's a lot we as a national center many of the folks in this room could do to better educate our policy makers our lawmakers around why it's so critical for their constituents for not only for kind of the maybe more obvious health outcomes but for academic and school outcomes of their young people the mental health outcomes substance use outcomes whatever the issues are that they care about trauma informed care is likely to be connected to them and so if we can do a better job of understanding it and I know we have folks at the table who can help us with that process but I'd be happy to be a part of it in Maryland for sure. So not very familiar with the federal government but we were able to pass a resolution by the governor and the senators and along with that came trauma informed care caucus so if you can encourage your lawmakers encourage anyone that is that can help with this process to get this caucus up and running and start educating our lawmakers we would appreciate that so just on another note because I'm learning so much here I can't believe it but the last two questions Wisconsin is doing both of those things so I'm not familiar with them because obviously I am not in this world that you're living in but if you are interested in how it's being done Wisconsin are doing both of those so. Hi my name is Cynthia Greer and I'm associate professor of education and counseling at Trinity Washington University right here in DC and my question is for Dr. Hoover what I have not heard is collaboration with people like myself who are actually preparing people to be teachers and counselors and one of the initiatives that we have taken on at Trinity just recently is first of all to become trauma informed ourselves as we move forward in changing our curriculum so that we can better prepare our future teachers and counselors and we also need help so I'm also asking for anybody out there for help but do you know or anyone else on the panel of other schools of education or other preparation programs that are doing this also that we can look to for models in terms of curriculum. I'm so glad that you brought up this issue because I agree that I think we've attended more to in-service workforce than to pre-service and we know that pre-service is really at the heart of what we need to focus on if we're going to advance our mental health and education workforce so we have been working with a number of universities around this issue. One of the pioneers I would say in terms of better integrating mental health into their education curriculum is in Missouri. They've been doing some of this work for two decades and have created room in their state for their teachers to have required mental health training and other states that have done similar efforts and their universities have spearheaded mental health training for educators and their pre-service training. So I'd be very happy to talk with you more about how we can do a better job of this. I don't know if Wisconsin is doing anything or if there's anything you want to speak to as far as teacher education around mental health not to put you on the spot. I can't talk about teachers but I can talk to you about our Children's Hospital is in a two-year training program so that they can write their own curriculum so that they can train now pediatricians on trauma informed care. Great. The Department of Pediatrics at the UW system. So I would also add to what you were asking about because I think some of this is around the mental health and the trauma that we recognize that comes out of episodic things but I also think that urban residency programs are addressing the traumas that come out of a lot of the isms and I think we need to make sure that we're dealing with both of those traumas and the whole traumas that a lot of the communities are feeling not just episodic kinds of things and so the training programs have to focus on all aspects of trauma causes. Dr. DiConis mentioned sort of what we could do when we leave here today versus what we might do down the line. I'd love to hear from each of you about what you would like folks to leave here today with. So I have two immediate suggestions. One is to just offer one more resource which is we have to the point that the Surgeon General, previous Surgeon General, was identifying earlier which is that we need to raise awareness about the issues of how trauma impacts the child's developing brain and body and the implications across all sectors that we care about. So if you care about school discipline, if you care about school safety, if you care about opioids, if you care about graduation rates you need to care about child trauma, if you care about preventing domestic violence. I mean all of it is there and how do we move it upstream. So one of the just a tool I will offer is what we have called changing minds now which is both awareness raising but it's also mostly a tool kit meant for people who work with adults who work with kids who aren't necessarily deep end clinicians or practitioners but they're adults who work with kids and care about kids and so it's kind of all of this trauma stuff distilled down both the science fact sheets but if you're at a PTA meeting and want to bring up the issues of child trauma we've got some tools for you. So just please check out changingmindsnow.org it's available to you so that's one tool. And then the other thing I would just ask everybody is get active. We are, as was said earlier, we are at a point where people are making a lot of decisions about funding and about policy. So in some places we're seeing people are finally understanding ACEs and trauma and they're trying to infuse it and I'll be honest there are other federal agencies where I just saw it all pulled out and all of the trauma languages that had been in grant requirements for cementoring programs for instance was all pulled out because there's a sense that that's not holding people accountable and so we need to hold young people accountable and this trauma stuff's not holding them accountable. So get engaged, right? Please be involved. I know we're all busy. Take those five minutes, take those extra half hour to write that one phone call do that one email. So just quickly I think what comes to mind for me is that I would encourage folks to ensure that we're clearly defining and measuring what it is that we mean by trauma informed schools and trauma informed practices in schools. I really appreciated one of the questions or remarks earlier today about they're getting kind of pushed back around what is this touchy-feely soft yoga stuff we're doing in schools and we hear this all of the time and so I think in order to really make a case for what we're doing we need to be very clear and concretize what it is that's happening in the classroom at the school level. What do we mean by a trauma informed policy? I know folks are working in this direction but as an evaluator this is hard. It's not easy to really know how do we define what it is that we're doing and then how to define what the target outcomes are and measure those well and not set ourselves up for failure either. When we set ourselves up to say when we do trauma informed practices we're going to change standardized test scores that may not be the thing that we should be looking at and so we need to be careful about the outcomes that we select also and ensure that the interventions are actually geared to targeting those outcomes. So that's where my lens is at this moment. I'm struggling to think of something great to say but I guess one of the things I would leave you with working with state policy makers and the executive branch quite a bit is just maybe a reminder that for most states this is also a very low TTE situation. They are people who are running in a million different directions also very under resource in some ways or under staff I should say and they really thrive on learning lessons learned and best practices from their peers in other states from the community from for example collective impact efforts that really acknowledge what are some of the local uniqueness what are the needs of state policy makers. So I would just encourage you where there are opportunities to engage as stakeholders with your state policy makers please take advantage of that. If you see best practices that simply have to make it up to change send them to me you know I'm desperate for that information and I'm here to tell you that part of my job is just seeking those things out and bringing those to state leaders to kind of figure out how do we do this in our state or how do we tweak it so it does work in our state and how do we change send them to me you know I'm desperate for that information too so I guess I would leave you with that and just one practical thing to highlight for you we're starting a project or launching a second round of a project on children's cabinets children's coordinating bodies in a number of states and there seems to be a real effort on part of many states to develop children's coordinating bodies or children's cabinets and that's an opportunity to really inform cross sector so where you have an opportunity to engage there please do. So we have a children's cabinet in Wisconsin it came out of fostering futures fostering futures has a two year program that you can go into and it's about shifting your perspective on how you do business within your organization so the first thing they do is they hold the mirror up to themselves and say are we a trauma informed care organization do we have HR practices that are trauma informed do we look at how we handle our own employees so we start there so I don't really have anything I can leave you with other than the fact that trauma informed care knowing about ACEs and trauma informed care changed my life changed the way I look at people it changed the way I look at policies when you hear it you can't forget it you can't walk away you can't turn your back and say oh yeah that's them that's not us so I would just continue to bring awareness to anybody and everybody which I do anyone that sits next to me at any given time is in trouble because I'm talking about ACEs and trauma informed care so with that I would just say continue the good work that you're doing and thank you for all that you're doing. So the couple of thoughts that I would add were one in this age of disruption we're always looking for the next shiny object and we need to stay the course we need to make sure that we are focused on this and that we're tying the pieces and not letting other political agendas move things away. Next it's a long way between policymakers and implementers and we need to do a lot more to help people on the ground operate and implement the good ideas but also with the cultural and community relevance of their own neighborhoods so they need some of the freedom and the autonomy and the budget flexibility and the operational flexibility to be able to implement things with their own vision of how it can work for them. We need to support and foster relationships at all levels and give people the time to do it and then last we haven't really talked so much about this but adults and communities have to model the behaviors that we actually want children to see and there's a lot of that not happening right now. Sorry I keep doing that. I'd like to thank this panel for their thoughts and all of the work that you do every day on this issue. Please help me in thanking them. So at this time we're going to transition so I'm going to ask Dawn and Tony to come back on stage.