 Wow and in in some ways it seems strange to feel like oh, it's the end of the day To me, this has been just an incredible day and Tony and I were sitting next to each other sort of madly scribbling thinking like well But what on earth do we say to sum this up? you know the amount of expertise that was here and passion that was here and Solutions that were here was just inspiring to me. So I'm I'm gonna venture and say that for me a Day spent on an extremely difficult topic and certainly Tony brought that forward very effectively Leaving with this sense of hope You know truly and and over and over again. I thought out there's a point of light There's another point of light and in this idea of that there are things that are happening To address this is it broad enough? No do enough people know about it? No But we're all part of a solution here. So I just a few kind of highlights. I'm gonna go through not in any particular order, but So learning and awareness as liberating You know and I'm looking here at the first lady of Wisconsin thinking of all the people who sit next to her and and learn And become aware because of her passion That we all have a stake in this you know and this question of what happened to you Not what's the matter with you? Not how do I punish you or control you? But what happened to you that as adults? I love this concept. We have to recognize when our rider is off Right great idea And I loved all the all the metaphors you used were great Tony and I were like that record one is great You know, maybe not as timely as it might be but they're coming back The concept that this is now much broader as a concept than the original aces right the original aces were ten things that might happen to you essentially in your home and It how it has become much broader There was one slide about that about you know the sociocultural trauma that we must be aware of despite people who may Tell us to pipe down about it or you know, that's too touchy-feely or whatever it is Those are real things that have to be held as we're talking about this The people who have suffered trauma need to have a sense of agency Built for them. They need that supportive person who can help them realize their worth and that they can Get through this. I Love the idea of self-regulation and co-regulators Right the idea that that is a lifetime thing. It's not just oh this is something you have to teach kids in a Critical period from zero to five. No, we all have this and I actually I texted one of my colleagues And I said you are one of my co-regulators Because I just realized it was like oh She's in the room. She knows who she is The idea that we want to give people voice and choice You know from from from Tony Cain this this potential for even in the most devastating of circumstances to Overcome right to heal and to break the cycle as she said so powerfully There are 55 languages spoken in Oakland. I work in Oakland. I had no idea there were 55 languages spoken in the Oakland school So talk about the need for sociocultural awareness and cultural humility That one in five People not just adults not just kids spend their day in a school Like schools is an incredibly powerful center to do this work and yet a sense to that Not that schools are too late, but that they're a little further down the pike than we might like and and how do we move Into parenting how do we move into pre-parenting? Are great challenges for us That of course in schools It's it's so easy and compelling to think about kids and that may be the way in and the way you get Policymakers attention and funds and things like that, but we have to think about the teachers We have to think about the staff because everybody is involved in this Investing upstream with accountability And then of course another high point for me is you know Do we want to live in a country of fear or do we want to live in a country of love? Right a Former surgeon general said those words sitting here, and it's not necessarily what you expect from it like former government official, but it's profound And then left, you know also In some sense with with the most hope are the solutions that we heard right this was not a forum where we came and we said boy We really got it. We got to tackle this. What are we gonna do? I don't know we need more research or what you know time after time We heard about programs that are already working whether they are in Oakland or Maryland or Oregon or LA or Wisconsin or at the federal government SAMHSA programs chip providing insurance for kids There's a lot of positive going on in this area, so we should not leave despairing and we should not leave over focused on Whatever the latest news is out of Washington DC because this country is a lot more than the center of the federal of government Right. It really is communities homes schools all those places where these positive things are happening so I will now leave the stage and Ask Tony to speak so Don touched on many of the things that really affected me as I was listening to the conversation as well You did well. I had written a bunch of new to me ideas on on the list and you hit many of them I love the co-regulation Concept, which takes what can be a negative I think concept and flip it over into something that is more constructive than the way people often interact with each other So I thought that was quite quite excellent I love the idea of whole children and you know whole communities that that was wonderful as well I thought strategic abandonment you know Only you know that's that's definitely Something we have to think about it sounds traumatic, but it's actually useful and then dug the Goldilocks, you know notion of the right level of stress because You know the purpose in life can't be to eliminate stress I mean we need stress to grow we need the right amount of stress and then at the same time we need People around us to help us build the resilience that we need in order to make the most of those stressors that exist Which is wonderful Joyce. I'm sorry. You win the metaphor award of the year for all of that stuff I love the riders and horses See you said already said that done, but I needed to reflect on it too and then Tony's story. I thought You know it's it's horrifying But the brilliance that can Transcend the horror I think was so beautifully On display today. I think it was a tremendous gift to have her here And and share her story And you know really talking about how hope and service can be where we go with what we need to do The excellent oakland has been referenced You know, I I think Chelsea you had some great points around the workforce and how And a number of people talked about the the need to integrate taking care of the workforce And the ability to take care of the people they're trying to take care of And only by building systems where we do both of those is really where we're going to go So on you know from a policy You know theme here We will do some work Collecting all of the think that that we've had sam. You're not going to get off the hook by me magically Synthesizing everything that we heard today. That'll be a bunch of work that has to go on But a few thoughts at the outset. I think I think to share one And and ellen this was I think your point toward the end Which I think is a really important macro point, which is that this area and this idea is getting a lot of traction right now And it's compelling and it is something that can be as a story that can be told to people of all types of thinking of of because everyone experiences this in their lives And staying the course is really critical That not getting distracted by the next thing that comes along This is the thing and we need to make sure that policy makers stay focused on this being the thing And not getting pulled off on other things which which could happen But we're getting there's traction in this space. It's in some respects. It's about designing the appropriate Creating the public the public support. We heard a lot about that and then designing programs that are meaningful and and Responsive to the need and can demonstrate good outcomes Clear focus throughout the conversation on on moving upstream Taking the vast amounts of resources that are in the health system and figuring out how to apply some of them upstream One would hope eventually that will pay for itself Um, and that's a question of time and and energy um The the notion of focusing as I was saying about the points that chelsea made workforce staffing capacity training You know the frontline staff is where the stuff happens. We need to figure out how to make sure the right people Um, the people with the right sets of skills are in place Defining what they need to be doing defining what they're there for and making sure that as a society We are resourcing it adequately. There's a huge amount of work to do From a policy's perspective on training and and just putting resources into education Um Taking making sure that funding is appropriately drawn from different resources different sources. One of the main themes of the conversation today was cross functionality We need to make sure cross functionality often dies on sources of funding Um, and that is why everybody in these spaces You know really needs to be reaching across into the other silos and making sure that the others are being thought about when things are being funded Um, and and there's some good stuff going on there. We heard about accountability measures And actually there was a lot of optimism and a recognition that there's a pathway for that already um, and so Continuing to make sure that the good research that's going on demonstrates the outcomes and ties to Um, the work. Um, that's already in place. We we already heard there's Excellent research that's demonstrating the effectiveness of many of these interventions um You know people who don't think about this every day, but have a broader policy Scope need to be taught about that And don't let it just be assumed away and also don't assume that policy makers intuitively know That what's good is good. Um as it is we heard collaboration again cross functionality at This federal state and local levels that is essential to any of these programs going on um Another theme was relationships both in The development of programs and in the policy making process Um, I was I was reflecting on the fact that it's is true And maybe even it's at least as true in in the policy space as it is in the therapeutic space That there needs to be enough vulnerability and trust built up that we can actually make progress We have to transcend the assumptions that we're making about folks who may have different ideas And that requires vulnerability and trust In a policy environment as well um And then there were some great nuts and bolts ideas that were we're Lifted up in the last session as well We'll try to capture all of those the one that stuck with me Was in the foster care system just the basic idea of what we take for granted In intact families and access to care does not exist in the foster care system And we need to build something that actually provides for that So I I actually thought there were a whole host of really excellent ideas in that last session and we will Sam will pull all of those together for all of us and in the reporting out for this meeting We'll try to capture that as much as possible. So, you know in conclusion. I think it was just I learned an enormous amount today. I thought many of the presentations were incredibly compelling Um, and this is just the beginning of of where we're going to go with um, you know as a group Hopefully we will have all met More um interested colleagues with each other and and continue to stay Engaged and and very interested in where we're going from here. So thanks for all of that and sesty. I'm going to turn it to you to close So, thank you everybody for hanging in there till the end of the day Um, I did want to revisit our word cloud from this morning though Um folks may remember we did the poll in the morning And so I wanted to just take a look at it and see if we were able to hit on The topics that you were interested in hearing about earlier this morning. So how do people think we did Good. Oh, I see some thumbs up excellent. Okay, great Great. So we would like to do another poll. Um So if we could turn to the next slide So I think the the poll we'd like to do is if you could give us one word to describe the day So the polling information is at your desk or for folks who participated. Um, hopefully it's easy to log on and go ahead and send that but One word to describe the day These are great words. Thank you These are great. Well, we get copies of this I'd love to share them with the the speakers as well that weren't able to stay for the whole day. Wonderful Thank you all. This is great. This is happy feedback. So thank you for that Um, I think we do have one more poll. Um, which is What next steps would you like us to take? So what next steps would you like us at Kaiser Permanente to take in this issue? So once action policy Advocate Oh, someone wants the list of attendees we could do that We can do that policy development Start a state caucus Great. Thank you all education So again, we'll keep these lists and take a look at them. Please keep sending your thoughts in um So I would like to encourage this group if you're not already to sign up for the institute for health policy newsletter We will be sharing information about the event via our newsletter. So feel free to give us your email address If you're not already receiving that on a monthly basis I do want to thank all of our speakers and the moderators for doing a fantastic job and really producing I think one of our best, um, ihp forums to date. So Thank you all of you for doing that Um, I do also want to thank a number of people that helped produce this event I'd like to thank ridgewell catering who helped out with our food and snack and beverage needs Okay Um a spark street digital which has been helping us for the past few forums and has always done an amazing job So thank you to them I would like to thank erin van luvin for helping out today and being available in the case that anyone wanted to connect with her So really appreciate you being here for the day um I also would like to thank jim nuttle who is our graphic note taker in the back who has done An amazing job capturing the day And images um those images will be available on our website as well We do have a work group and a steering committee that has worked hard over the last few months to help us define These events as we've put them together So I want to thank all of those folks the center for total health staff as well I want to thank all of you for attending and if you haven't already Please fill out your survey and just go ahead and leave it on the table and we'll collect that Our next forum will be in september and it will focus on the mental health workforce, which was came up quite a bit today So, um, we'll take notes from what we heard from you today and try and incorporate that into the day in september So thank you all