In this issue:
CHAD MORRIS, Ph.D., Director
Greetings DIMENSIONS Readers,
It’s part of our mission at BHWP to develop programs that meet the needs of interdisciplinary providers who work in a rapidly changing healthcare and public health environments. Currently, we have two training programs in development to meet these shifting needs. The first is a refinement of our DIMENSIONS: Well Body Program. This program is focused on providing trainees with the tools to assist their clients to live well, including strategies for healthy eating, healthy activity, healthy sleep, and decreased stress. With the ever-growing evidence base related to these areas, we felt it was time to revitalize our program. We expect this training to be available by Fall 2016. We are also very excited to announce that BHWP will soon unveil its Motivational Interviewing Training Institute. This institute has been a goal of ours as MI is a true passion and a foundation for our team. Over the last year, we’ve increased our training capacity and we will offer multi-level onsite programs beginning February 2017. More information on this will be forthcoming.
The end of the fiscal year is a busy time at BHWP punctuated by a flurry of end-of-year reports and planning. With all this going on, it’s a testament to this team that we have had such a full training schedule over the last two months. Our appreciation goes out to the sites who hosted us and to those who attended our trainings:
• Association for Addiction Professionals – Anchorage, AK – Tobacco Cessation for Person with Addictions
• St. Clair County Community Mental Health – Port Huron, MI – DIMENSIONS: Tobacco Free Program
• Denver, CO – Rocky Mountain Tobacco Treatment Specialist Certification (RMTTS-C) Program
• Texas Department of State Health Services – Austin, TX – Rocky Mountain Tobacco Treatment Specialist Certification (RMTTS-C) Program
• Recovery Institute – Kalamazoo, MI – DIMENSIONS: Tobacco Free Program
• Unity Consortium – Cherry Hill, NJ – Healthcare Provider Vaccination Recommendation Training
• Jackson County Health & Human Services – Medford, OR – DIMENSIONS: Tobacco Free Fundamentals Program
• National Behavioral Health Network for Tobacco and Cancer Control – Denver, CO – Community of Practice Meetings for State and Tribal Governments and Community Behavioral Health Organizations
In other news, we have only two more months left in our first round of the Build A Clinic (BAC) Learning Community. If you haven’t looked into the educational webinars created for this program, you can view all archived webinars on our website. If you are interested in joining the next BAC Learning Community, we are calling for proposals now. Email Jim Pavlik at [email protected] for more information.
And finally, we’d like to welcome Mary Mancuso to our team. Mary received her master’s degree in counseling psychology from Pacific University in Forest Grove, Oregon. Mary comes to us from the University of Colorado Hospital where she has spent the last few years developing health literacy materials and working on a variety of research, quality improvement, and evidence-based practice initiatives for nurse research scientists. She’s agreed to contribute to this edition of the newsletter, so look for her column below. We are extremely excited to have her on our team.
A Study in Wellness
Early Foundations for a Lifetime of Health and Wellness
CHRISTINE GARVER-APGAR, Ph.D., Research Associate
In 1998, a landmark study of over 17,000 adults found a strong association between childhood exposure to abuse or household dysfunction and multiple risk factors for several of the leading causes of death in adults.1 The more different types of adversity a person experienced during childhood, the higher their risk for heart disease, lung disease, cancer, substance abuse, depression and suicide, obesity, and risky sexual behavior later in life. This study helped pave the way for a paradigmatic shift in the pediatric community’s approach to health and well-being. Reducing the incidence of infectious disease is no longer the sole (or even primary) concern for pediatric healthcare providers. In a recent policy statement, the American Academy of Pediatrics said, “Protecting young children from adversity is a promising, science-based strategy to address many of the most persistent and costly problems facing contemporary society, including limited educational achievement, diminished economic productivity, criminality, and disparities in health.” Indeed, persistent stress and adversity in early childhood now play an important causal role in the intergenerational transmission of poor health and disease.
Whether burdens come from the hardships of poverty, parental behavioral health conditions, or the threats of recurrent violence or chronic neglect, the single most common finding is that children who thrive under such adversity have had at least one stable, committed relationship with a supportive parent, caregiver, or other adult. These relationships provide the responsiveness, scaffolding, and protection that buffer children from developmental disruption. They also allow for healthy development of key capacities such as the ability to plan, regulate behavior, and adapt to changing circumstances – all critical components of resilience. When children lack the buffering influence of secure adult relationships, chronic adversity impacts the development of children’s physiologic stress response systems – a phenomenon called, “Toxic Stress.” Converging empirical findings from genomics, immunology, endocrinology, and the behavioral sciences show that early traumatic stress has life-long impacts on immune function, hormonal systems, and gene transcription, as well as on learning and cognition, emotion, and behavior.
At BHWP, we have begun to broaden our efforts to promote health and wellness across the lifespan, starting at the beginning – early childhood. We are working with multiple programs dedicated to improving the health and wellness of vulnerable new families through tobacco cessation efforts, as well as intensive parenting programs. And we are developing a new research program dedicated to reducing toxic stress in economically disadvantaged families with the goal of increasing young children’s (and caregivers’) self-regulatory capacities and resilience. We are looking forward to developing this research program further and forming new partnerships in our effort to address one of the most pressing public health challenges of our time.
1 Felitti, V.J., Anda, R.F., Nordenberg, M.D., Williamson, M.S., Spitz, A.M., … & Marks, J.S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14, 245-258.
Wellness in Practice
CINDY MORRIS, Psy.D., Clinical Director
As a child of immigrant parents, I learned early to be independent. Not only did I learn to be resourceful out of necessity, I was taught specifically to be self-sufficient. My mother would tell me, “You don’t want to have to depend on anyone—you just never know.” While in theory, this made good sense in my child’s mind—and ultimately my adult mind—it never really worked in practice. For one, close relationships are very important to me. Two, I care deeply for people. And three, it’s fun to engage in interdependent and collaborative relationships.
But old lessons can be hard to unlearn. And, if I’m honest, it is still hard for me to ask for help. Some may even say that I can be controlling because of my desire to do it all myself. There are also other unintended consequences. Being overly self-sufficient can keep me emotionally distant. It gets in the way of creative collaboration. And from being open to receiving. All things that I want to invite into my daily experience.
Breaking a habit takes practice. It’s a good thing that there is an abundance of opportunities to do so. When I invite friends to my home and they offer to bring something, I say, “Yes” and ask what they want to contribute. I remember how good it feels to do something for someone else so I ask family, friends, and colleagues for their support and help as much as I can. Even if I can do it myself. Especially, when I can do it alone. I’m learning that it is just more fun that way. Every day, I have countless opportunities to make a different choice. A choice that matches my intention. While I may not take advantage of every opportunity, each day I am more aware. And with this awareness, my opportunities grow. As do I.
SUSAN YOUNG, Ph.D., Research Director
Recently I attended a workshop for parents and kids offering strategies to support positive, prosocial behavior in social media activities. The speakers urged the kids to be proactive by watching for and discouraging hurtful gossip and other kinds of bullying. Part of the message was also about how, unlike snarky remarks made on the playground, posting negative comments creates a permanent record that almost never gets completely deleted from virtual space. The audience was instructed to leave the workshop with a plan for creating a family “social media contract” containing rules (and specific consequences for breaking them), which should be negotiated and signed by all parties involved.
Many of the parents in attendance (including myself) seemed to be drawn to the workshop by a degree of intentional ignorance about social media. We did not have Facebook pages or Twitter accounts, nor did we even know what Snapchat was. I don’t think the speakers set out to shame us, but rather to convince us that we can help keep our kids be safe on the web, but only if we are playing the game, too. I’m sure they are right, but REALLY?! Can’t I just sneak in their rooms, read their diaries, or eavesdrop on their conversations? …kidding. My pushback comes, in part, from an old-fashioned notion that socializing means seeing friends’ actual faces (not just their profile pictures), or at least hearing their voices. I worry that we are creating generations who will lack the nuanced social skills, like the ability to read between the lines, using body language, facial expressions, and subtle messages in someone’s tone of voice. Plus, a digital hug just doesn’t cut it.
Despite my concerns, I left the workshop convinced that social media is here to stay, and whether I like it or not, it will be my kids’ central line of communication. It is becoming their world, and I want to be a part of that world. So, reluctantly, I have caved and dipped my toe into a couple of social media platforms. It’s only been a short time, but I am already annoyed by the narcissism of the endless photos of everyone’s fabulous lives. Okay, maybe I’m too private, or a nerd, or just too tired to create and maintain my own set of fantasy photos, favorite bands, or Twitter feed of my celebrity crushes. So I will play along just enough to stay connected to my kids’ virtual life, but frankly, I’d rather just call an old friend.
Resolutions in Harmony
MARY MANCUSO, M.A., Clinical Associate
The thunder clouds loom threateningly. A flash of lightning splits the dark sky. Still they stream toward the pavilion in droves, bundled in colorful rain slickers, bearing umbrellas, rainbow flags, and candles. I am at Cheeseman Park, along with hundreds of others, at the vigil for the 49 individuals who lost their lives in the recent Orlando gay nightclub shootings.
Our community is in agony over this loss. A friend called Sunday morning, choking on tears, “I just heard the news about Orlando,” her voice trailed off wracked with sobs. There are so many unanswered questions about this tragic event. How could one person irrevocably change the lives of so many in one fateful night? The irony is that many individuals frequented the nightclub because it was a haven. Some of those lost had not yet told their families they were gay; they were outed only through death.
The pavilion is becoming more and more crowded. Young and old; gay, straight, and transgender move together in mourning. They hold hands, wrap arms around one another, and wipe each other’s tears. The speaker encourages people to let go of what is not serving them and to open their hearts to what is needed. “Understanding,” “love,” “forgiveness,” “acceptance of diversity,” “togetherness,” “gun control,” “unity,” are some of the words shouted from the gathering. The names of the victims are read, and a man with an orange glass globe candle initiates the string of lights. One after another, neighbors reach toward each other, sharing flickering flames from the slender white tapers, passing light along until the assembly is aglow.
“Love is stronger than hate. Love will overcome. Love will endure!” the speaker bellows triumphantly.
We move through loss and sorrow with tears, grief, and mourning. But we also find that shared pain, remembrance, and comforting one another is healing. Another bolt of lightning splits the sky, the candles burn low, and the soulful sound of the Denver Gay Men’s Chorus breaks through the darkness. A song of peace, healing, and hope sooths the aching crowd.
The shared togetherness of community. This is social wellness. This is harmony.
The mission of the Behavioral Health and Wellness Program is to improve quality of life by facilitating evidence-based health behavior change for communities, organizations, and individuals.