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Building the Movement Session 9: Trauma-Informed Policy & Advocacy

Summary produced by: Leslie Alvarez | Alyssa Besser | Sofia Escalante | Sarah Levine | Thalia Philip (MPH Candidates, Mailman School of Public Health)

Speakers, Organizations, and Contact Information

  • Dr. Diana (Denni) Fishbein | Director of Neuro Prevention Research, University of North Carolina - Frankfurt Graham Child Development Institute, and Co-Director & President, National Prevention Science Coalition to Improve Lives

  • Jesse Kohler | Executive Director, Campaign for Trauma-Informed Policy and Practice

  • Jen Curt | Director of Government Affairs, Campaign for Trauma-Informed Policy and Practice

  • Dr. John Roman | Senior Fellow, NORC at University of Chicago, and Co-Director, National Prevention Science Coalition to Improve Lives

  • Whitney Marris |

  • Manya Chylinski | Communications Specialist, Entrepreneur, and Survivor of Boston Marathon Bombing

  • Maggie Wooden | Legislative Director, Representative Peter Mayer

  • Dan Press | Co-Founder & General Counsel, Campaign for Trauma-Informed Policy and Practice

  • Andrew Hevesi | Assembly Member, New York State

  • Zeke Cohen | Councilman, Baltimore City, and Leading Actor, Healing City Act

  • Dr. Philip J. Leaf, PhD | Building a National Movement and Local Movements to Prevent Trauma and Foster Resilience, Professor, Johns Hopkins Bloomberg School of Public Health with joint appointments in the Schools of Medicine, Nursing, Education, and Arts and Sciences, and Secretary, We Our Us Movement

Workshop Agenda

  • 00:04:32 | Dr. Diana Fishbein & Jesse Kohler | Opening

  • 00:11:21 | Jen Curt | Congress 101 Presentation

  • 00:50:00 | Dr. John Roman | Science-Based Advocacy

  • 01:04:32 | Whitney Marris | Advocacy through Storytelling

  • 01:31:58 | Manya Chylinski | Boston Marathon Survivor

  • 01:46:17 | Maggie Wooden | Post Disaster Mental Health Response Act

  • 01:51:42 | Dr. Diana Fishbein & Jesse Kohler | BRAIN BREAK

  • 02:02:26 | Dan Press | Importance of Oversight Hearing on Childhood Trauma

  • 02:06:38 | Elijah Cummings | Opening Remarks from Hearing

  • 02:16:28 | Bipartisan Caucus | Trauma-Informed Care

  • 02:29:41 | Andrew Hevesi | Remarks

  • 02:35:53 | Zeke Cohen | Baltimore City Council and Healing City Act

  • 03:03:01 | Dr. Philip J. Leaf | Professor Johns Hopkins Bloomberg School of Public Health with Joint Appointments in the Schools of Medicine, Nursing, Education, and Arts and Sciences, and Secretary of We Our Us Movement

  • 03:26:29 | Dan Press & Dr. Diana Fishbein | Opioid Legislation

  • 03:48:06 | Dan Press, Dr. Diana Fishbein, & Jesse Kohler | Advocate of the Year Award and Closing Remarks

Workshop Overview

Overall, the workshop highlights the importance of trauma-informed approaches to policy and the need for comprehensive, unified federal action. It covers various aspects of the Federal Congress, including the legislative process, structure, and political motivations. It also discusses the process of making program and language requests to Congress. Furthermore, the workshop highlights the need for a comprehensive federal approach to mitigating childhood trauma, recognizing its severe impact and prioritizing prevention and treatment. The efforts of dedicated professionals to address childhood trauma are acknowledged, yet efforts at the federal level remain severely underfunded. All people should develop relationships with their local and federal governments to promote trauma-informed policy at every level.

Quality connected relationships, positive examples, and credible messengers are crucial to inspire young people and adults to take action. The session highlighted the Healing City Summit, where young people created a bill that was signed into law, as well as efforts to address trauma in Baltimore through legislative approaches, partnerships, and community-based initiatives are discussed. The workshop concludes with a discussion of the need for systems change to address the opioid epidemic and the impact of intergenerational trauma to fund evidence-based programs that can identify and intervene among at-risk youth.

Why is this Workshop Important?

The workshop specifically addresses the need for federal leadership, funding, and efforts to address trauma through legislative approaches, partnerships, and community-based initiatives. It also emphasizes the importance of positive examples, trustworthy messengers, quality relationships in inspiring action, and the need for system change to address related issues. Overall, the workshop offers useful insights into trauma-informed advocacy, the legislative process, and the roles of government and individuals in advancing public health and well-being, which are imperative to create a unified and evidence-based front.


01:33:45 - 01:33:51 | Manya Chylinski | “I walked away that afternoon without any physical injuries and I thought that meant I was okay and it turns out I wasn't. I really struggled.”

02:07:57 - 02:08:10 | Elijah Cummings | “Throughout the nation, childhood trauma is a pervasive public health issue with long-term negative health effects that cost the United States billions of dollars.”

02:09:06 - 02:09:25 | Elijah Cummings | “The science is powerful. Traumatic experiences can enter the developing brains of children and create lifelong impairments to their ability to manage stress and regulate emotions and significantly increase the likelihood of negative health outcomes.”

02:33:48 - 02:33:55 | Andrew Hevesi | “I have never seen a policy that has more upside to potentially do a positive benefit for society if we focus on it and do it right than childhood trauma.”

02:41:00 - 02:41:12 | Damani, Jayana, and Brianna (Youth Voices City Counsel Hearing) | “You all are spending too much time focused on how to police us when what you need to be doing is focus on how to prevent violence from occurring in the first place.”


5:20: Dr. Diana (Denni) Fishbein, National Prevention Science Coalition to Improve Lives

What we’re going to do today is talk about advocacy, how we put into place all that we've learned, all we've been activated to do during this workshop series to really be able to embed that knowledge in our sectors, and our communities and change policy that supports the systems change that results from our work.

11:24: Jen Curt, Director of Government Affairs, CTIPP

11:48: As Jesse mentioned, I'm the Director of Government Affairs CTIPP. We do primarily federal advocacy, so I know that you're all gaining your tools to be advocates and maybe you'll do that at the municipal level or the state level and we invite you to do that on the federal level. And so today, I’ll be doing a presentation on Congress on the federal level.

13:38: So we'll start with your basic overview of the Legislative Branch. You have a House of Representatives and you have the Senate. In the House, there are 435 seats - one member per Congressional district. Congressional districts are divided based on population - there is an equal population across every Congressional district.

14:02: Members of the House have to be reelected every two years, which has an impact on their work because they're regularly campaigning, they're regularly working towards being reelected.

14:17: In the House, the leadership who drive the agenda includes the Speaker of House, who is Speaker Pelosi currently, was elected. And then you have minority and the majority leader. The Minority Leader is from the minority party, currently Congressman McCarthy, and Majority Leader is Congressman Hoyer. Only the House of Representatives can originate spending legislation

14:47: In the Senate, you have two Senators per state, regardless of population. They serve six terms overlapping, so that gives a little bit more space between election cycles when they’re up for reelection and heavy campaign season. And they don't have speakers. It's a majority and the minority leader.

15:17: But only the Senate can confirm presidential nominations and approve treaties.

15:23: And when I say the word “members” and talk about members of Congress, that's across both branches.

15:32: And if there’s a 50-50 tie in the Senate, so there's 50 Democrats and 50 Republicans, the Vice President will break the tie, which why there is currently a Democrat majority in the Senate because even though there are 50 Democrat senators and 50 Republicans, the Vice President is Democrat.

15:50: It's very important when we're talking about any of this, in my opinion, to start with a conversation about politics. There are two major parties - Democrats and Republicans. And while there are two major parties, each party is not a monolith. So different members of each Chamber, even though they're Democrat, you may feel different on policies and positions and other Democrats, and same on the Republican side. And this is not usually because of the personal opinion of the Member, it’s the range of policy positions among members of the same party is often because of the politics of their state or district. How Republican-leaning or Democrat-leaning their constituents are.

16:45 There’s something called the Cook Partisan Voting Index, or the PBI, which is a measure of how strongly a district or state leans towards the Democrat or Republican party compared to the nation as a whole.

17:20: So when you're advocating to an elected official, it's not just them that needs to be convinced personally - it's their constituency. It matters the make up their constituency.

17:34: Members closer to the middle of the spectrum here are more vulnerable to losing their election to a member of the opposite party, and therefore the opposite parties campaign. Ads matter. They're more likely to break with their party, so vote against something that their party cares about. They're likely to work across party lines to be seen as pragmatic. They need to raise money because oftentimes whoever has more money wins election for better or for worse. And they often get more support from their party leadership so that more of their bills will be passed than other members of their party. They'll get leadership positions in the party because each goal is to keep the majority and so these swing seats really matter. And so, safer seats, those members such as Congressman Cortez, Senator Warren, Senator John Kennedy, they are more likely to introduce those bold, new, less popular ideas, and push the margins of it, whereas those members in the middle and moderate districts are going to champion popular non-controversial ideas. They're going to be opposed to policies that sort of push the boundaries of what's popular.

19:08: And so this really has a heavy impact on the rest of what we’re going to talk about because those members in the middle and the the opposite party, even though they're not in power, they really do dictate a lot of what happens.

19:35: I hope this slide helps explain why an elected official may or may not do what you request of them. And this is a generalization, the extent to which each lawmaker about things depends on many factors. But I think one of the things that drives them is helping people. They run for office to help people and they want to fulfill that, whether that’s doing casework helping people get in touch with the IRS or working on policy.

20:11: The second is representing their diverse constituency well. And so any particular lawmaker represents people who have conflicting views. You may have people who are climate change. Other people who are afraid to lose their career in oil and gas industry, right? You have teachers, business owners, union workers, property owners, low income folks. And so they’re trying to represent all these interests well.

20:41: And of course there’s their passions advancing their own priorities. Whether that's often based on their own life experiences or promises they made when they were campaigning.

20:51: Four is helping their party to take or keep the majority. When you have the majority of seats in a Chamber, that gives you a lot of power. You get to chair the committees, you get to sort of drive the agenda.

21:06: And number five - possibly taking on a leadership role in the party. Maybe they want to be a committee chair, so they're interested in improving themselves. They’ll make strategic partnerships with other lawmakers and national organizations. They want to remain good terms with powerful people in their party. If they’re looking to rise up in the ranks, maybe they want to become leader on certain new policy. They want to create a lane for themselves. There’s a legacy creation and a pride there.

21:43: And then of course, most election officials want to win reelection. So things that will really matter to them are positive news coverage, positive interactions with voters, raising money, avoiding negative campaigns. So they may be constantly adjusting course based on polls. They're sensitive to criticism. They really like to do high impact events with swing voters or as many voters as possible. They want to get in front of their constituents.

22:17: I want to move a little bit now into sort of that legislative process. So we'll get down to business - what do they actually work on. And one of the things of course, the main thing, is legislation. Congress has the the ability to enact and change laws. Every Congress, which refers to a two year period, we’re currently in the 117th Congress, every Congress more than 10,000 bills introduced…only about 1 to 3% of those become law. Not all bills are introduced and are created equal. They may have different intentions or strategies.

23:10: And so here are some of the different categories that I created of different types of legislation. The “Must-pass” category. So these are bills that you can usually assume will become law because of the consequences should that fail to happen. So there's an annual budget… It funds the federal government, all the programs within it. State and local government streams are very important. You can usually assume that will pass once a fiscal year.

23:43: Then you have the NDAA, which is is the annual budget of the Department of Defense. And then certain bills that require reauthorization regularly are in high demand. But even some in this category are struggling to be passed all of a sudden due to some, political tension.

24:00: Then you have “Emergency supplementals”. So if a major disaster like a hurricane happens or responding to COVID or what’s happening in Ukraine, Congress may have to pass, spending bills, emergency supplementals to provide some aid.

24:15: There are then “Priority packages”. So these are packages that might be important to the party that's in charge. So you may have heard of the Build Back Better Act and the Bipartisan Infrastructure Law. So these are packages that the administration, the President and Congress put a lot of weight into trying to get these things done.

24:37: Then there are Messaging or marker bills. These are bills that members, a large chunk of that 10,000 bills that lawmakers introduced without the intention of those bills to become law. And so why would do that? Why would you introduce the bill if you don't have intention that this will…we’re going to try and sign this into law. Well, a few different reasons. One, it could be politically safe to show that you're active on the issue and you care about it, or could be to track popularity. So say you introduce, for example, the Green New Deal in the 116th Congress, maybe you had 50 cosponsors. You introduce it again in the 117th and now you have 75. So you can start to show gaining momentum for the idea and the policies behind it. That’s useful for a lot of different reasons The more cosponsors, the more likely that bill possibly is to become law because you can demonstrate whether or not it can pass. Usually if somebody cosponsors a bill, it means that they’ll vote yes.

25:45: And finally, there are bills that are intended to be provisions for future vehicles. Someone introduce a bill and they plan to offer it as an amendment in the NDAA next year.

26:03: I shared this sort of timeline on introducing bills to give you a sense of the best ways to engage and give feedback. Only members of Congress can introduce legislation, though sometimes the President or a committee will request that they first introduce it.

26:25 And it starts with the policy idea. Then there is what’s called the Legislative Council, where there's nonpartisan lawyers who take the bill idea idea and show you how to create it into legislative text and how to amend the statute and where to do that.

26:44: And then sometimes, the office or the Member will solicit feedback from stakeholders and this is the time when CTIPP will be asked to give technical assistance on a bill to make it more trauma-informed, for example. This is before the introduced, which is relationships with your lawmakers matter. If they don't know you, they can't engage you in these moments. If they're serious about bill, they may also ask for feedback from from the committee of jurisdiction.

27:13: Then sometimes they’ll circulate a “Dear Colleague Letter” asking for original cosponsors on the bill before introduction, then it'll be introduced, it receives a bill number, and is referred to the Committee of Jurisdiction for possible further action.

27:29: Any member of Congress can introduced legislation on any topic, However, Members who sit on the Committee of Jurisdiction are best positions to introduce bills that will advance because they have more resources and guidance from the committee staff and committee members, they can give more input on the agenda of that Committee and they have more knowledge of the chair’s priorities.

27:58: This is a list of all the committees in the House of Representatives and committees in the Senate. Each member Congress be assigned to two or three committees that they’ll sit on. The committee is chaired by a member of the majority party, usually the most senior member on the committee, oftentimes. They are elected, and each of these committees has different jurisdiction, different programs that they oversee.

28:25: The ones I starred here are generally considered the most powerful committees because of the amount of money that they have jurisdiction over, the types of programs have jurisdiction over, and the programs and policies that they manage.

28:44:So when a bill is referred to a committee, it can maybe get a hearing, which is when experts are invited out to give their opinion on topic - experts in favor and opposed to the proposal to weigh in. And then if you're lucky, they'll get a mark up. In order for the bill to advance to the House floor or the Senate floor, typically it has to be passed out of the Committee of Jurisdiction. So mark ups are when other Members on the committee can offer amendments and they take a vote on it. This is often when a lot of lobbyists get involved because it’s sort of the last one, last opportunities to change the bill before it advances and get a floor vote.

29:30: Here’s a quick review of the Legislative Process…The simplest way to get a bill passed is one chamber the bill gets introduced, it gets it passed committee mark up, it gets a floor vote and then the next chamber passes the exact same bill, and the President signs it. This process usually happens with least controversial bills - bills that have a lot of support, bipartisan support, because they can pass the House of Representatives, 2/3 majority and half the Senate unanimously.

30:05: Oftentimes more controversial legislation - there’ll be a longer process where a conference is required, so the annual appropriations bill, For example. One chamber will introduce it , they’ll mark it up, they’ll vote on it. Another chamber will introduce their own version of it, which is different and then they’ll go through the process, and then sometimes there’s a formal conference process where members of each party in each chamber are appointed to a conference committee, that’s temporary, and they try to come to a common ground if possible. If they are able to find compromise, that's version that will then be passed in both chambers

30:52: So let's talk a little bit about…what happens if a bill does get, how does a bill get a vote in each Chamber. And there are different rules for the House and for the Senate. The short version here is it's much more difficult to pass legislation in the Senate than in the House because of something called filibuster, which you may have heard about.

31:26: In the in the House, the Speaker of the House and the Majority Leader, so the party with the most members in the House, decide the floor calendar. So they decide which is going to vote on the floor.

31:40: There’s a few options. One, you can pass it under suspension of the rules, which means you need 2/3 majority to pass it. You can pass…30 of these a week. These move through pretty fast if they have the support they need, you can pass the bill with unanimous consent. Or, you can pass a bill with unanimous consent or you can pass the bill under a special rule, which just needs a simple majority and then there’s often debate amendments, things like that, they’ll pass about one to three of these per session

31:14: “Session” just means like there are certain weeks where members of Congress are in D.C. voting and there are certain weeks when the members are in recess back in their districts where…face-to-face with constituents.

32:26: In the Senate, it’s much more difficult to bring a bill to the floor because it requires the Senate to agree to do that. And so you either need unanimous support, so all Senators agree this bill should get a vote, or, you need a simple majority.

32:51: So the filibuster is essentially where 60% or 60 senators need to agree that the bill should get a vote, right. And so the Senate will have no limit on debate time. And to end debate time and actually vote on something, you, a member has to file cloture. And then they need 60 votes to get that to the final vote. And so, it's rare that one party has more, 60 senators. And that means that in order for building to vote in the Senate, it either has to have unanimous support or 60 senators, meaning it has to be bipartisan. So partisan bills rarely make it through the Senate. The process of passing a bill in the Senate can require a week. It takes significantly longer.

33:50: The only exception to this is the budget reconciliation process. The process is pretty technical, but you may have heard about this process with Build Back Better.

33:59: It’s the only legislative vehicle that can bypass a filibuster. You only need a simple majority to pass it. But with Build Back Better, they couldn't even, they couldn't get that. So there weren't even, they would need all Democrats to support it, for example, and they couldn't get there. And so that's the sticking point with Build Back Better so far.

34:33: The annual Appropriations process. I just want to take a moment to talk about this. This is one of the must pass bills, and it shouldn't be overlooked as an advocate of a way to, try and advance your own priorities and shape the, what gets funded. And the work that we do in the trauma and healing space is often underfunded, right.

35:00: And so I want to highlight the Appropriations process as a good opportunity to engage on that. And appropriations, the annual budget, is where Congress taxes to pay for essential government services. And those services are the entire federal budget, which impacts grants to nonprofits, how much the agencies. But agencies are budgeted at and the offices, the scope of the work that they do, there's a ton in there. It's more than a trillion dollars. It has to be passed annually and often standalone bills will get tucked in there. So it's a way to pass legislation to incorporate it in part of that process.

35:54: And the process for this is that in the beginning of the year, the President will release their ideal budget. This is not binding, just suggestion. And then the House of Representatives will release their budget, the Senate will release their budget, and then the two will conference and try to come up with a compromise, and that's getting more and more difficult in recent years, and more and more delayed.

36:18: If the chambers are not able to come to an agreement by the time funding runs out, they'll have to pass continuing resolution or CR, which provides stopgap funding to avoid a government shutdown until they can reach a deal. CRs are not deal because they're actually, because of inflation, actually like a cut to budgets, but they're passed very, very often.

36:47: And so the types of requests that CTIPP makes and that advocates can make fall into three buckets. You can make a Program Request, which is a term that refers to like the dollar amount that you want to be spent on certain program or a certain office within an agency. So you want it to have more money than last year. Significantly more, less money for some reason. That's about Program Requests.

37:16: You can make a Language Request, which is directions for how to spend that money. So you both have the amount, and then you have directions for okay, so we have $1,000,000 for this office. Here’s what we want the office to focus on this time - we really wanted to do more research on trauma informed care with this extra money. That's a Language Request.

37:38: And then of course I spoke about this in a previous workshop. Congress has brought back Community Project Funding, formerly known as earmarks, which is money in this bill directly for community projects. So building a bridge, climate resiliency infrastructure, building a hospital, doing substance use disorder treatment programming, doing community outreach on mental health, things like that.

38:17: So one of the things that you can do as an advocate is reach out to your member of Congress. What does that look like? Right. Like, are you speaking directly to your, to your legislator? Probably not.

38:31: And so I wanted to share a little bit about the team behind the lawmakers. These are incredibly powerful, incredible people who are public servants and help the member to achieve their goals.

38:47: The Chief of Staff is the top dog in the office, they are closest to the member of Congress and they are responsible for the campaign, the unofficial side and the official side. So what does that mean? Due to ethics rules, the political side or the campaign side is kept separate from the official side. The official side works on policy, they serve constituents. The political side is just reelection, right? So often they don’t even know what each other are working on, which is an effort through ethics to like keep money out of policy essentially.

39:30: So when you request a meeting, if it's related to casework or event in the district, you'll talk to the District Director, which lives in your town and the offices are in town. Or if it's policy related, you'll talk to the legislative team which is made up of the Legislative Director, Legislative Assistants, Legislative Correspondents.

39:58: Each member of the team covers different policy areas. In the Senate, you have larger budgets and you have larger staff, so you can hire specialists, they can hire someone who's just working on healthcare policy who’s a specialist in healthcare policy.

40:16: In the House, the staff is much smaller and so each member of the legislative team has to cover many issues. And it's helpful to keep in mind that many of these staffers are not an expert in all of the issues they cover, right? So they may cover healthcare and the criminal legal system and agriculture policy and military policy. And so they’re really stretched between all of these and trying to learn as they can about all of them. But when you're taking these meetings, it's helpful to know the people that you're meeting with - these are people with their own capacity. And so you want to be patient, be thorough.

41”02: And then of course, the legislative team in a personal office communicates with the committee staff. So each committee has their own staff. The staff of these committee serve the committee chair, as well as all the members on the committee.

41:18: And then I want to talk about the legislative correspondence for a moment, because legislative corespondents are very important. They manage the mail program, so they manage communication with their constituents, so that’s you. So when you write or call into the office, they will look you up. They have a database. They look you up by your e-mail or your address, your phone number. If you are constituent, they'll record your comments, and then they will be responsible for making sure you get a reply from your member of Congress. They will also communicate what you share upwards. So if there's a vote coming up. And they may say to their legislative director, 75% of people who wrote in want you to vote no. That's important information. And so they're responsible communicating that. If you share an idea, they will then share that with whoever the team handles that issue or might be interested in that.

42:22: If you call in and ask for a call back, so you're like, “I'm really interested in hearing your position on this trauma-related bill. Can you call me back?” The person in the office who handles that issue, so not necessarily the legislative correspondent, but the legislative staffer, may give you a call back and talk to you through that. That’s something you can ask for.

47:53: Congress has the power to make and change laws, but the President has veto power. So there's a real incentive for Congress and the President, the Executive Branch, the legislative Branch, to work together.

43:12: Veto power can only be overrided with 2/3 vote in both chambers. And so even if both Chambers of Congress passed the bill, the President can veto it. So the President and Congress work together in a bit of a flow if things are functional, like there's a bit of collaboration there, but sometimes it can be kind of hostile, as you see on the news. Depending on what's going on and where the parties are and things like that. But the President communicates with Congress through occasional meetings with members of Congress, usually leadership or those vulnerable members that we talked about earlier or remember chairs of committees.

44:02: The President shares the annual budget proposal. This is what I think Congress should spend our money on. The President will give a State of the Union Address and share general policy agendas.

44:16: And then Congress communicates with the President through congressional letters to the President. Hey, you should direct your agencies to do this, that I really care about…members of Congress can sometimes be activists and do advocacy work themselves trying to pressure the President to use Executive Order powers to accomplish something that…the President can use that to accomplish, and occasionally they’ll get meetings with the President.

44:48: A note about Executive Orders - so the President can use Executive Orders to accomplish some goals, but they're meant to be for clarifying and furthering existing law, and so they can be challenged and deemed unlawful by federal ports if it’s found that the President sort of was trying to expand statute or create new laws or Executive Orders.

45:17: So as you're thinking about advocacy, reaching out to your elected officials, I wanted to give you a bit of a menu of things that you can advocate for - what are some common requests that policymakers get. And so you can…if you're monitoring what legislation is coming up for a vote either in committee or on the House floor, you can ask them to vote yes or no on the legislation or on any the of the amendments. You can ask them to give a speech, to attend an event that you're hosting. Again, they're more likely to attend events with constituents and many constituents, you can ask them for a meeting.

46:04: You may end up meeting with legislative staff, but the legislative staff are excellent as well. A good use of time too. You can ask them to co-sponsor a bill that’s already been introduced to help that bill gain some steam and momentum and popularity.

46:21: You can ask them to join a caucus. A caucus is not a committee. A caucus is kind of like a working group that are trying to explore and further expertise on a new area.

46:35: You can ask them to introduce a bill or find a legislative fix to a problem, support a request in the appropriations bill or to speak out in support or against an issue. So at X university, we're striking - can you support our strike for our rights at the university?

47:00: And so given all that I sort of covered in this presentation around wanting to make requests that are attractive politically, that build coalition, that are…maybe some that shape the narrative and are furthering a message and others that are you have bipartisan support might pass.

47:25: At CTIPP, we really try and create balanced requests that fulfill a spectrum of goals around raising the profile for the issues that our advocate network really care about while also wanting immediate progress on some other things. Some of the things that we make requests for when we talk to members of Congress is to co-sponsor a bill called the Post-Disaster Mental Health Response Act…So this is introduced in the House and Senate. So House members can co-sponsor it as well.

48:02: There’s a bill called Rise From Trauma Act that we asked Senators to co-sponsor. We’ll ask them to join the House bipartisan trauma-informed care caucus. We, CTIPP, helped lead an effort to advocate for a billion dollars for school-based mental health professionals and trauma-informed schools in the FY23 appropriations bill, which is being worked on right now for the next fiscal year. We’ll ask them to attend events like today. We have a couple of members of Congress who later are going to provide some remarks as well.

50:13: Dr. John Roman, NORC at the University of Chicago, Co-Director of NPSC

52:18: I’m a senior fellow at NORC at University of Chicago, and the co-director with Denni, whose voice you just heard, you saw earlier, at the National Prevention Science Coalition to Improve Lives.

52:31: So I want to do a little bit of an op-ed. A great op-ed is one idea, so I’m going to try and give you all one idea. In my in my job, I go to the Hill eight or ten times a year for the last 15 years or so, and then in 2017, I spent a year as the science director of the mayor’s office of criminal justice in New York City. And we had a huge pot of discretionary money that came from the financial settlements. So I sat on the other side of the table and listened to people’s pitches for what they were interested in having funded. So I wanted to put it all together and say, what is the one big concept if you're advocating for science that you should be attentive to. So this is it.

53:36: This is my story. So we got…the D.C. government had a huge amount of Recovery Act money, not from the pandemic, but from the financial crisis in 2008. So 2009, the Urban Institute where I was at the time had asked us to set up this District of Columbia Crime Policy Institute.

53:59: And the idea of the District of Columbia Crime Policy Institute was to look at the best science and research that was available at the time and make recommendations to the government to reduce violence and improve public safety. And at the time, really the most compelling idea that was out there was this thing from the Washington State Institute for Public Policy which had worked for over 20 years at that point or almost 20 years at that point, to make evidence-based recommendations to the Washington State Legislature about investments in Human Services programs had a strong research base.

54:38: So right when we were starting the D.C. Crime Policy Institute, they made a recommendation to the Washington State Legislature that they should fund a portfolio of prevention intervention programs and not appropriate money for the two prisons that they already authorized. So we thought, this is really cool, let's do this.

55:00: So what they would do was this really hugely complicated effort. They would go out and look at evaluations on every human services prevention or intervention program you can imagine, figure out what it cost, figure out what the effects would be if it was implemented in Washington State, figure out how many people could serve, figure out what the benefits were, what the benefit cost ratio was, and then make recommendations like what I said, fund these prevention intervention programs, don't fund these prisons.

55:32: And we thought, this is great, let's do this in Washington DC. So we set out to replicate the Washington State Institute of Public Policy and we created our own big benefit cost model and we did things like estimate the cost and benefits of community based substance abuse in the District of Columbia and we thought we were really clever and that we designed a better mousetrap because we were worried the government didn't fund these programs because it was risk averse. And when people came to government said you'll save $2 in benefits for every dollar in cost if you fund community based substance use treatment versus what you doing today, that government didn't understand what the risk was.

56:20: So we created these these statistical models that would allow us to tell them what the probability of success and failure was and the probability of big benefits vs little benefits. This was based…the graphic is based on data from evaluations from now, 20 years ago. If you ran that today, the benefit cost ratio of community-based substance abuse treatment would be even better.

56:44: But anyway, we ran all these models, replicated Washington State did and went to the Coordinating Council, the District of Columbia and said, hey, you should fund these three programs. You should functional family therapy and treat hight-risk adolescents in the home instead of institutionalizing them, and you should do electronic monitoring instead of sentencing people to jail and prison. And you should fund much more community based substance abuse treatment because it has all sorts of preventive effects that will lessen the burden on these people's lives and improve the tax base to do these great things. So here's the payoff of all this.

57:25: So we did all this work, all the science, all of this research, and we presented this to the Coordinating Council which was the Chief of Police, which was Kathy Lanier at the time, and the head of the Federal Bureau of Prisons and the Chief Justice and all thirteen of the stakeholders in justice in D.C. And they heard our pitch and they said this is great, let's do this. How do we pay for it? And I said, I don't know, that's your problem. And they said no, that's your problem. And since I didn't have an answer, that was the end of the pitch. That was the great lesson learned. At the end of the day, figuring out how it affects their budget is really the key thing.

58:12: So how do you get their attention to able to get into this debate? So the approach that I like is the story study lesson approach. Once you've heard this and you think about like the Malcolm Gladwell books or the Freakonomics books, you'll see that in fact this is the method that they use in telling their stories in the popular press and it's pretty straightforward. You tell them a compelling anecdote, you get their attention. You present them with some studies and evidence of success that advances the conversation. And the more rigorous, transparent and objective the evidence you present, the more it will appeal to both parties. And then you present the lesson. Budgets constrain all government choices, how will what you're advocating for affect their budget. And this is where the battle more often than not, is what it lost.

59:07: So Joe Biden is sort of famous for saying, “if you show me your budget, I will show you your values,” and he's right. But there's a really important caveat here for this discussion, which is that while the items in the budget may align with your values, not all values and valued activities end up as budget items. So just because your values align with the legislator or policymaker you're interacting with, doesn't mean what you want is going to end up getting into their budget. So how do you get into the budget? How do you get their budget to align with their values? Legislators across party lines want to invest in science-based programs and policies.

59:51: I’ve had, I don't know, 100 of these conversations over the years, probably more, and I can only think of a couple of times where we talked about prevention and science behind it and have somebody on either side of the aisle tell us they weren’t interested, that it didn’t align with their values. They almost all appreciate what trying to do. What they don't want is have to make new appropriation. We’ve heard this this a million times. If you can tell me how to do this without spending money, I’ll do it. They don't want to hire, they don’t want to create additional agencies or departments for divisions and they don’t want to hire new employees unless they have to, because with civil service protections, in their minds, what it means is any growth is permanent, and they want to avoid doing that at the time. And they prefer simple things rather than complicating things. So hear that and you think, well, that's the end of the road. There's no way to get around these objections, but it turns out that actually isn't that hard to get around these objections.

1:00:52: So it's it's all about understanding the rules. And by rules, I mean the rules by which programs operate. And so as people who work in the field, you probably are intimately aware with the rules that guide and govern your field. And so there's lots of ways to make a program better and more efficient without a new appropriation, especially if you can find new ways to expand eligibility and that can be changed by, that can be driven by changing the definition. That could be changed by a definition in who the eligible parties are by expanding ages or income levels or by expanding geographies or whatever it is.

1:01:38: For whatever reason, folks on the Hill don't tend to think of expansions as eligibility as being appropriations even though they clearly are. You can't get new agencies, departments, divisions for the most part unless it's part of some big omnibus project. What you can do is work to get guidance from the Office of Management and Budget to the agencies about how they're supposed to spend the money.

1:02:07: And one of the things we do at the National Prevention Science Coalition is trying to get two words inserted into the guidance anytime we can. And those two words are "and prevention". So this is authorized to spend money on X&Y treatment and we want to get the words X&Y treatment and prevention inserted into the guidance so when the agencies get this funding and et the guidance, they're thinking about how to include prevention, and complication is overcome with simplicity.

1:02:39: And just to wrap up, here's the example. A lot of you are probably familiar with the Pay for Success Movement and Social Impact Bonds. It was really big last decade, and this is a visual model of how that project was designed and intended to work.

1:02:53: Dr. Roman discusses model diagrams

1:04:35: Whitney Marris, Advocacy Through Storytelling

1:05:10: At CTIPP, we have really seen increased change in policy and practice related to advancing a comprehensive approach to addressing and preventing trauma. And we attribute a good deal of this to the power of advocates sharing their values-based stories that disrupt the dominant discourse and activate policymakers around a shared vision of a preferred future. And so it's my best hope that each of you will emerge with some considerations for what you might do to build upon and possibly become even more effective in what you're already doing to advance this important work.

1:06:05: And to begin, I am just going to invite you to just take one moment to pause and consider what do you first think of when you hear the terms “story” and “storytelling”? And for some, it might be parables about life and its lessons passed on orally through the generations. For others, it may be more fantastical thoughts maybe involving epic voyages or dragons or unicorns, and others yet may think about the true stories that make up fact records from past historical eras that we use to learn as we continue to evolve as people.

1:06:42: The point is that there are so many different possible images and thoughts that could be evoked by these terms, and whatever each of you has conjured when I prompted that thought likely speaks to the way that you've experienced and truly been personally shaped by story, and that makes sense.

1:07:04: Neuroscience tells us that our brains are wired to remember, experience, and connect with stories. And it's precisely because stories are so powerful and universal that storytelling is one of the more enduring and impactful tools we have available to us to effect change.

1:07:25: So it's through story that we explore ourselves and develop our own beliefs, values, and identities, which allows us to then make principled choices as individuals, as communities, as nations, and as a larger world based upon those values, identities and beliefs.

1:07:45: We are all storytellers each day with our loved ones, our colleagues, and others that we encounter. So it's really a natural fit to bring that frame to our advocacy efforts, too. Let's talk a little bit about some of the reasons that stories are particularly potent in the context of advancing policy change when you with your legislators.

1:08:08: One of the key points is that stories can vividly explain the work or why the work you're doing matters. Rather, why your legislators ought to care and why the solution that those of us who are working to advance trauma-informed resilience building and healing center change really have the most compelling solution to address the societal issues that there are many other possible paths that could be taken to address.

1:08:38: Stories also illuminate our shared values and help us join and take action to enliven and achieve our best hopes together. So those commonalities that are found in our stories kind of point at once to collective struggles, as well as to collective paths to healing, liberation, and growth that align with our advocacy agenda, which makes for a pretty convincing argument in our experience. And that aspect really helps to cut through the noise of the many, many, many competing demands in the policy space that Jen so eloquently spoke to earlier by helping folks see things through a new lease.

1:09:19: Importantly, stories also help us to engage both the head and the heart. If we were prompted to explain the reason why each of us arrives to this advocacy work, I would wager a guess…I would guess that most of us wouldn't rattle off a list of facts or statistics as the primary draw. That may be a part of our story, sure. And we're also here because of our lived experiences and our desire to make change in alignment with our values, like the capacity for healing, fairness, resilience, equity, preventing harm, and other core beliefs that really drive us in this work.

1:10:04: At the end of the day, for better or for worse, emotions generally influence behavior more than pure logic alone does. So authentically invoking empathy and hope in our stories can truly enhance our power as advocates to open hearts, minds, and, when needed, wallets to advance our priorities and vision.

1:10:28: Going a little deeper into what we know works in an advocacy context. To make our stories particularly impactful, it's important that the stories we choose to tell are both engaging and connected, so they gain and retain the attention and interest of our target audience.

1:10:46: Also crucial is that our stories are factual, authentic, and honest, and that they’re our stories to tell rather than exploiting someone else's story.

1:10:58: Additionally, considering the standards of professional communication is certainly important when interfacing with policymakers, but that doesn't necessarily mean that we have to be super academic to be taken seriously.

1:11:10: So in fact, it's particularly important to translate evidence such that it is really accessible and understandable because most policymakers and stakeholders that you are in front of are not experts on your issue. And as my fabulous colleague Jen emphasized earlier, legislators and their staffers are expected to know a little bit about a lot of topics. There were long list of different topics that they could be presented and have to be relatively proficient in discussing. So they're not likely to be experts in the science of trauma, adversity, and the ways that those aspects inextricably connects to some of the societal issues that they're committed to working towards solving.

1:11:56: It’s important to be really intentional about keeping explanations and language clear and simple and heartfelt and as jargon free as possible. This space has a whole lot of acronyms, a lot of jargon, because we want to make it easier for legislators and their staff to really connect and relate to the happenings of your story.

1:12:18: You may be familiar with Ira Glass - he's a prolific radio broadcast personality, in case you're not, and he has famously said that everything is more compelling when you talk like a human being, when you talk like yourself. And that's solid advice to consider when advocating to your representatives.

1:12:37: On a similar note, keeping things succinct, yet impactful, is another consideration to keep in mind. The legislators and staffers you'll be speaking with are busy, busy, busy, and they may be mired by any number of other internal or external competing demands for their attention.

1:12:55: Another useful tip to maximize impact is to use language as a tool to say solution-focused rather than problem-oriented, because this lens tends to be more effective to really evoke hope and possibility toward change such that your legislator can begin to see a path forward where they themselves can be the hero of the story.

1:13:18: And finally, since the purpose of storytelling and advocacy work is to generate momentum toward change, presenting a call to action that your advocacy targets are engaged by so that they know what's expected, expected of them, rather, and how they fit into your solution that you're proposing is essential.

1:13:52: These are some more just generalized considerations about how to maximize the impact of your story, and we are going to discuss a framework that's really fabulous that integrates all of these considerations in a bit. Before we get to those details, let's talk a little bit about the importance of not just considering your own frame of reference, but also thinking about the significance of understanding the characteristics and values of your legislators.

1:14:21: An important lesson learned by many enthusiastic advocates is that we must start where our target audience actually is at and not where we think they ought to be, where we might wish they were, or where we want them to eventually be. This slide has some considerations to help you just get a sense of what might be helpful information to determine how you might shape the way you tell your story when meeting with legislators.

1:14:52: So first, finding information on how often they've written or supported measures that relate to topics that are relevant to addressing healing and preventing trauma and adversity will absolutely help illuminate common ground to build on. And remember that your representatives don't explicitly maybe have an established history on your issues in every case. It might not be something where there's something that is exactly on target, but you may still be able to find places of alignment with issues that we know to be connected to trauma, like involvement with housing policy or prioritizing improvement in child and family serving systems.

1:15:36: Policymakers may truly not have learned yet about these connections; what an opportunity for you to illuminate that for them. And those points of alignment can be an inroad for you to get them on board with trauma informed solutions to these common issues that you both care about and are doing your part to address.

1:15:58: And of course, depending on your policymaker’s perspective, you may also really not see much of any alignment when it comes to policy that they tend to support. And while that on its face might be discouraging, I really encourage you to not write anyone off because it seems like they might oppose your solutions or because of party affiliation or other preconceived notions.

1:16:21: It is so helpful to look beyond voting history - to who the human in front of you, behind the title, behind the the R or the D or the I or whatever really is. That calls on each of us to look past, look to, rather, their professional history and volunteer history and even public facing personal history as these aspects can really reveal shared beliefs and values that you might not even know are there on the surface based on their legislative history, or what you know based on how your legislator is portrayed in the news or elsewhere.

1:16:58: What you can glean about what experiences may have shaped their journey to being in the change-making role that they're in may give you a sense of what motivates them and what they already value, and connecting with their strongly held core values may get you in the door to be more influential when it comes to some of those more malleable beliefs.

1:17:19: There’s evidence out there that suggests that stories in particular can make us less defensive and more open to new ways of thinking. Empathy can beget empathy, even among those who may seem like unlikely allies, when we make the right connections to our stories.

1:17:38: Before moving on, since we're talking about really thinking about remembering the very multidimensional human in front of you, when you're with your representatives and their staff, which can admittedly be tough given the polarized and sometimes acrimonious nature of politics that we very much see uplifted in the public media and maybe even experience ourselves at times, I do want to offer consideration that legislators and their staff may themselves have lived experience with trauma. So in alignment with the principles of trauma informed advocacy, considering that there are power dynamics at play here in that legislators and staffers really have no choice but to listen to everything the constituents have to say, makes it really important to model the model of being trauma informed. Which means considering letting your audience know that there might be sensitive content in your story that may…that’s what we can do to be intentional about reducing re-traumatization to the extent that we can, which is not only a more humane and compassionate approach, but it's also something that helps the person in front of you take care of themselves in whatever way works best for them, to give themselves whatever they need, so that in anticipation of hearing anything tough, so they will be able to be regulated themselves and they will be able to remain grounded and present to listen to and engage with and be moved by the story you tell.

1:19:13: At the end of the day, growing this movement is about more than just enumerating the admittedly striking facts, and advocating in this space calls upon each of us to consider how we can tell our stories, to grow momentum and action towards meaningful sustainable transformation in our systems and institutions.

1:19:36: So, let's talk a little bit about this useful framework to engage and inspire others to act and ensure this story of self, us and now framework that we are about to go through can help you convey what has called you to this change work, the values that unite us all in this space today in action, and the urgent challenges to those values that we must overcome together.

1:20:02: I want to uplift upfront that the framework for storytelling for advocacy that we're looking at today is from the work of Marshall Gans from the Harvard Kennedy School of Government. He played an instrumental role in shaping Barack Obama's successful grassroots organizing model, which is really rooted in this public narrative framework, which I first was fortunate enough to learn about as political, social work, boot camp, and media training that I received through the Congressional Research Institute for Social Work and Policy.

1:21:00: I do want to acknowledge that your story is your story, and no one knows your story better than you do. You are the expert of you, and this isn't about changing any of the key details of your story. It's really about framing your authentic, true story in an immersive way that will have the greatest advocacy impact.

1:21:21: So with that said, the sequence you see on this slide, challenge, choice and outcome, is interwoven throughout each element that we're about to explore. At a higher level the story begins with a challenge to the status quo.

1:21:35: This is something that resonates with us all. We each have some level of familiarity with noticing an incongruity between the world as it is and the world we want. So we're making the choice to challenge and disrupt the status quo, to get the world to act in alignment with our values and priorities here. And through the storytelling framework, we can use this emotional tension of the world now versus what both ourselves and our audience, based on what we already know about them, believe the world ought to be, to help our representatives connect with our story, as well as to create a context of empowerment and realistic hope toward action.

1:22:18: The choice to act in this way will yield an outcome, which is essentially what we've learned or the meaning or the moral of the story.

1:22:29: So the way we tell our story can encourage audience members to consider their own core values and how each of us, when confronted with any sort of challenge, has the power to actively choose hope over fear, to choose solidarity over isolation and alienation, and to choose self efficacy over self doubt. And framing the story in this way can generate an emotional resonance that can bring legislators to really identify with the protagonist in the story that we tell. So as the research supports, by hearing about someone else's courageous choice to make change in the face of a challenge, our audience is more likely to feel inspired and empowered to act themselves.

1:22:32: Starting with the story of self at a high level - the story of self involves you describing the experiences, challenges, and choices that inspired you to act. And know that as a constituent, as John mentioned, you have tremendous power and your experience really matters here. And so it's important to illuminate the choice points during those moments in our lives where, in the face of uncertainty and challenge, we make that intentional choice to act in alignment with our values, even when it's really tough to do that.

1:23:57: So it helps to be thinking about answering questions like, “how did or when did you first feel like you had to do something here?” “How did you get the courage and the hope to act?” “What are your lessons learned?” So in sum, this part of the story helps us to use the universality of the experience of arriving at those kinds of choice points to really demonstrate that each of us can have a role to play in needing challenging moments with action, rather than turning away or being inhibited by the barriers before us.

1:24:33: The story of us captures the shared values, experiences, and capacities of folks joining together to work toward change, like we are all doing here today, including uplifting both the challenges that the fellow constituents like you as well as the larger community have experienced. A lot of those moments of success and resilience that have already been achieved in the movement…all of these aspects can help open our policymakers’ eyes to the real, tangible progress that's already underway and can also illuminate a sense of hope and possibility that really underpins our vision of a preferred future.

1:25:17: So this is another place where that information gathering we talked about on the “know your audience” slide will be particularly valuable, as you can really shine a spotlight on the common ground that you have. And you can create a sense of unity around the desire to build on this amazing work already being done to shape the world, to be more trauma informed, to be healthier, and to be more resilient.

1:25:43: The story of now outlines the current challenges that lie before us in a way that really presents a vision for change and conveys that a specific potential positive outcome is absolutely within reach if, and only if, your audience, so your legislators, join the effort to transform the world. And a part of this is highlighting the urgency of the situation, which means demonstrating how the world out there is not, as it should be, based on our deeply held shared values.

1:26:16: So summoning your audience to make the deliberate choice themselves, to take concrete next steps to bring about change, comes with you framing the stories of self and us in an effective way that engages your legislators and also to make your ask based on the urgency of now.

1:26:36: So in sum, this framework taken together is basically, “here's the challenge, here's how I'm involved, here's how it's relevant to you and how our fellow community members, i.e. your constituents, are impacted and here's a solution for action grounded in a realistic sense of hope to make a meaningful impact with your help.”

1:27:00: So by weaving together the stories of self, us and now, you can construct compelling, authentic and inspiring narratives in which your legislators can begin to really see themselves as the hero characters of the story, which as we've been talking about today, can move them to act and grow the power and momentum behind the larger movement that those of us on this call today are all joining together to advance.

1:27:27: I also want to uplift that in our experience, continually revisiting how you frame this story based on your target audience as well as the larger conversation happening in the world can be really important to consider. So in the context of the here and now, new needs are emerging every single moment and existing needs are compounding on each other and new understandings about what helps and what hurts are being developed and policy priorities are shifting and research is advancing...And so as the story of now shifts, so too may your framing of the challenge, choice and outcomes in the stories of self and us, which also means, by the way, that your ask might change.

1:28:18: So as I near the end of my time with you today, I'd like to invite you just to take a moment, a very intentional time while we’re together, to reflect on how hearing about this storytelling framework builds on and enhances what has already been talked about today. Some possible reflection points that might connect to include what struck you about this framework that might shape the way you advocate next time and thinking through this framework, what is your core story as in, what elements about your experience in this movement will stay consistent and where is the room for you to be flexible and strategic, to align yourself with your legislators based on what you both value and care about.

1:30:18: As I pass the mic back to Jen to facilitate a conversation with the amazing guests that we're all fortunate enough to be in community with today, it is my best hope that whether you're planning to tell your story in advocacy context for the first time or the 50th time, you’ve emerged from this workshop today with a next small step in mind related to how you can be a driving force in creating transformative change through telling your story, or even by coaching others, in doing so if your role lends itself to that. Because we at CTIPP as I mentioned, really believe it's important to uplift voices and stories of lived experience. And so many of you are already doing fabulous work. Compelling narratives like yours need to be heard to continue to advance this progress. And as constituent advocates, there's no doubt that each of you holds tremendous power with your elected representatives and that finding your words and telling your story is what will move both the needles of public opinion and public policy toward a more compassionate, equitable, trauma-informed, and healing-centered future.

1:32:59: Manya Chylinski, Boston Marathon Survivor

1:33:08: Jen: So, my first question for you, I mentioned a little bit in your introduction. But can you share what prompted you to engage in advocacy around the trauma? What led you here?

1:33:18: Manya: Yes. I got really angry. I think that might be something people can relate to. I was at the finish line of the Boston Marathon in 2013 in the bleacher seats directly across from the first bomb that exploded. It was a confusing, difficult, scary time. Thankfully, I walked away that afternoon without any physical injuries, and I thought that meant I was okay and it turns out I wasn't. I really struggled with all sorts of effects of trauma that I'm sure many folks on the call today can recognize - panic attacks and intrusive thoughts and trouble taking care of myself. The first thing I started to do was watch the news and pay attention to people talking about to find out if other people were experiencing what I was experiencing. And there's nothing, people weren't talking about the emotional effects. And I felt alone and I felt like it was my own fault that I was feeling bad. And, eventually learned that was not the case and started to get really angry that the response didn't include any kind of robust support for people with mental health wounds, not even validation that we experienced was real and that's what kind of led me down the path that ended up talking to you on the phone.

1:34:55: Jen: Thank you so much. And I so benefited from you reaching out. So last year you introduced a bill. We first spoke on the phone, but then you went on to introduce a bill with this member of Congress to support survivors like yourself, people, your experience. Can you share a little about that bill?

1:35:18: Manya: Sure. HR5703, Post Disaster Mental Health Response Act. Jen, you may remember I asked you to send me the text of the bill before I officially endorsed it. And it was two very short paragraphs because I realized it was just making a change to an existing law, the Stafford Act, and expanding the crisis counseling and mental health services support for emergency declarations, not just major disasters, which is what it is now. And to me, I thought, like that's amazing. That's such an easy fix. Whether or not, whether it's going to happen. It's easy to accomplish, but it seems so clear. Yes, we just need to make this simple change.

1:36:08: Jen: Yeah, that's a great summary and I think the bill text is so short, but it's such a big impact with such a simple fix. I mean the crisis counseling program is that community based response that provides free services. It trains your neighbors in mental health response and how to be supportive neighbors, so trauma informed and this bill will just make that available after any sort of disaster whether it's a terrorist attack or a mass violent event or a hurricane or flood or things like that. So you really were the inspiration behind this bill, which is really gaining speed moving through Congress. But it stands to benefit such a diverse group of people and really stand in the gap. But I know that the introduction of that bill didn't happen overnight. And so I want to demystify a little bit. What was that advocacy process like? When did you first reach out to your member of Congress? What was it like working with her office just so other folks on the call can get a sense of what's realistic?

1:37:28: Manya: Sure. I'm going to be honest. When I first reached out to Congressman Pressley's office, I didn't even really know what I was asking. I just knew things had to change. And I felt like I have the story and it's important to tell, and I know that I'm just the tip of the iceberg of people with similar kinds of stories. So it was the summer of 2019. When I reached out to the congresswoman's office, she had recently, at that time, held hearings on childhood trauma. And so I know being a constituent, I knew a little bit about her, but I also knew that trauma was clearly on her agenda. So I reached out, I called the office and I was referred to a staff member. And we had some back and forth over a few months and met in person at the District office and had lots of conversations. And so that was the end of 2019. And then COVID hit and I dropped everything and it was probably about a year, I guess it was early 2021 when I got back into thinking about this is an effort that I can make. And at the time I reached back out to the office, the original staff member wasn't available to help and it took a while to identify who was the right person. And through that process, with reaching out to different team members, I ended up connected with you, which turned out to be the right person.

1:39:09: Jen: I think that's such a good example because relationships really matter, right? These are relationships between human beings. Some people are paid staff members and others are just telling their personal story. But it can take some time to build that relationship and trust, and the timing is always really important. It does take persistence. It can take persistence. I’m grateful you didn't sort of give up as people in office were sort of transitioning. But since the introduction of the bill, you've been asked to do interviews about the bill, coauthor op-eds about the bill, you've appeared in some press articles. How do you manage to continue to tell your story of a really traumatic event while also taking care of yourself and avoiding that re-traumatization?

1:40:14: Manya: Thank you for asking that. I definitely do a lot of compartmentalizing when I'm talking and thinking about this issue. I've done a lot of work on my own healing and I am sort of able to do some of that. But I do plan a lot of self-care and just things to take care of myself, whether that is going for a long walk either before or after maybe I have one of these conversations or taking myself out to dinner or I guess in this case, ordering in for dinner, just kind of taking some of the pressure off myself. And I also admit I don't always do a good job of it. There are times when something will happen or we’ll be having a conversation, and when it's all over, I am just overwhelmed and spent, and then realize, oh, I needed to do a little bit better job thinking how I could take care of myself. So it's a little bit of a learning experience for me. I mean, this whole thing has been a learning experience, but learning how to take care of myself and talking about this difficult subject and trying to sort of maintain realistic expectations. Once the process started and I realized things are happening, that is a constant balancing act, I would say.

1:41:45: Jen: That's such a good point about realistic expectations. Change doesn't happen overnight, and so that's a good point. How can other people who are asking you to tell your story in those moments, whether it's reporters, community members, anyone? How can they create an environment where you feel safe to share your story?

1:42:12: Manya: Things that have been really helpful for me are people understanding it's my story to tell and kind of asking those open-ended questions and tell me your story and then really listening to the response. And it is possible to still ask a question that might feel triggering for some reason. And just when people have been open about saying, “if I ask you a question, you can answer it or you don't want to or we can stop this interview at anytime” - Like those make a really big difference. I think probably a lot of people have had the experience of you're talking to someone and you know that they've got an agenda that isn't necessarily aligned with my own agenda, our own agenda. It can feel very upsetting to have a conversation with somebody like if you don't feel that you can step away. So one of those key things is just giving somebody permission to end the conversation, change the topic. And when I've been working with everyone at the congresswoman's office, have been so empathetic and open and wanting to listen to my story that it makes it very easy to, has made it easy for me to want to share as well. So that openness and and honesty, people have been honest to me with what their own experiences are. And that's also helpful because I know who I'm talking to and I know where they're coming from asking me questions and wanting information.

1:44:02: Jen: Yeah, that's beautiful. Really helpful tips…In closing, do you have…on this call we have a number of people who’ve gone through our workshop series about how do you become a strong advocate? Do you have any advice based on your experience…for people who are new to advocacy?

1:44:25: Manya: So I kind of fell backwards into the advocacy world and have been learning it on the fly as I go. And that’s…it’s a fascinating process. And I think the most important thing I realized is that…I need to be in it for the long haul. Like this isn't a “I could call somebody to check a box and something gets fixed”. It’s telling and retelling the story and it's reminding people why it's important and just being… having energy to be able to do that over the long haul. That's the thing that I came to learn as we were working through this process.

1:45:13: Jen: Well, I'm so glad that you do it. So glad that we know each other, that we met and that we continue to work together….And is there any way for people to continue to follow along with the work that you're doing?

1:45:36: Manya can be reached via her website and Twitter

1:46:39: Maggie Woodin, Congressional Staff Member, Post Disaster Mental Health Response Act

1:46:41: Maggie: As you mentioned, my boss, Congressman Meyer was one of the co-leads on the Post Disaster Mental Health Bill…The bill just actually passed out of the…committee on a unanimous vote, which is great. So really excited to see it moving forward. We hope to see it with this committee progression, we’re hoping that it can get before soon. This bill is of particular interest to my boss, given that he worked…disaster response efforts for Team Rubicon, and so he saw firsthand the effects disasters have on individuals in the communities. Providing this small fix and making mental health resources available to individuals impacted by natural or all sorts of different disasters, natural disasters, events like the terrorist Boston bombing, which I know is kind of what led to your bosses and former business work on this bill, Jen…these are all events that require additional levels of support. We really think this is an important bill that to make sure that there's kind of that whole approach in disaster response. My boss was very happy with to work on it. It’s a great bipartisan effort. In the short remaining months, we’ve got things going on here in Congress before we hit that “lame duck session”.

1:48:43: Jen: Thank you so much, Maggie. Congratulations again on the progress for the bill and I think your remarks just speaks so strongly to what we're talking about earlier with doing research on these representatives and their background really dictates policy priorities and forms, that combined with what the constituents care about and the experiences in the district really can dictate the agenda. And for those who don't know, as legislative director, Maggie is responsible for helping to drive his legislative agenda and advance bills and help some of his priorities get signed into law. And so this is one example of just a lot of success for your boss. And so I'm hopeful, we're cheering and helping mobilize support to get that over the finish line before the end of this Congress as you mentioned. And I want to just thank you for coming out today. Do you have any other anything else to add before we head into our brain break?

1:49:53: Maggie: I do want to preface because I noticed and kind of google scale of this event. There’s a focus on trauma on health care, which in my previous capacity working for Congressman Gallagher, he kind of spearheaded one of the efforts with Congressman… and I was the staff lead on that, and it was just something that I think in your event today, and as you talk to other members and offices and advocacy groups, you'll start to see there definitely has been a shift in members acknowledging the importance of care and where while in the community, in the healthcare professions, education professions and then in the case of this particular bill that Congressman Meyer helped introduce. We have federal resources available to offer this type of support and I think integrating again that whole health approach, mental health, physical health, in responding to in FEMA's case, disasters, is really important and I think this is…and embedding trauma-informed approach to that will also be critical as they are hopefully able to expand their services via the legislation.

1:51:11: Jen: It's such a testament to the role that talented staff can play, and thank you for growing that ripple effect as you work for one member and another. Staff members as trauma-informed champions are important just like congress members as trauma informed champions that can make us such a strong impact, so I appreciate you adding that.

1:51:55: Jesse and Denni lead the Brain Break

1:52:41: Dr. Diana (Denni) Fishbein, National Prevention Science Coalition to Improve Lives

With respect to finding relief on a brain level,…but basically there's a couple of things that helps our brains, like we know on the surface that it helps us feel better and reduce stress. It reduces depression, even anxiety and other sorts of mental health symptoms, including post traumatic stress symptoms.

1:53:13: But not everybody knows exactly how it works. I'm not going to get into like serious neuroanatomical detail here, but some of the things that Jesse has been orchestrating throughout this series of workshops actually work at the brain level. And so what we're going to do here is illustrate how singing works.

1:53:49: But in in preparing some of the things that Jesse had to do early on, was just touch…And you just feel, you can just feel the diffusion. You can feel the emotion just sort of draining, the negative emotion, anxiety that being pent up in front of a computer for several hours already today and the need to just diffuse.

1:54:23: What I suggested is going up and down your arms back to your hands, up and down your arms back to your hands and then going up to your face and rubbing your face and your forehead and around your cheeks and then back down your arms and your hand. And what that does is it actually activates areas of the brain that are responsible for telling your amygdala to cool it. Getting your nasty amygdala to just kind of calm down and get rid of some of these negative emotions. And it focuses your attention on what it feels like for touch and for that bonding and what actually does, even if it's just yourself that works with other people. But even if you're doing this yourself, back and forth around your face, back to your arms and your hands, is it releases oxytocin. Oxytocin, as we know, is the bonding neuropeptide in the brain and it helps us to feel love and attachment and affection towards others, but also self compassion. And so this is increased through this activity.

1:55:53: As you sing, it provides an additional advantage to your brain and then singing increases oxygenation to areas of the brain that help to soothe and increases the the connectivity, the activation between different centers of the brain between the front, the prefrontal cortex and lower center so that you tamp down on some of these negative emotional responses and in doing so you increase what's called respiratory sinus arrhythmia….I know it sounds bad because it sounds like arrhythmia, but you want that because it is a direct stress physiological indicator of relaxation.

2:00:23: And the humor part of it, actually, as Jesse said, is very important in all of this. To some of us, that is our resiliency, is our humor. Laughing, smiling, grinning. Scowl is energy draining. Smiling moves muscles that actually reflect what the brain is doing directly and it's very soothing. It's very much a relief, but it’s very much catharsis when we engage in humor.

2:02:44: Dan Press, Legal Counsel, CTIPP

Hi, I'm Dan Press, the general counsel for CTIPP and when we started, when CTIPP first started going up to Congress and advocating for trauma- informed legislation, we really got blank looks. People didn't know about the ACEs study, even though it's 20 years after the ACEs study. They didn't know about the ramifications of trauma for suicide and substance abuse and diabetes and obesity and all the other things we know about now.

2:03:24: And then in July of 2019, Congressman Elijah Cummings was chairman of the very powerful Oversight Reform Committee in the House. With a lot of encouragement from…Congresswoman Pressley, held the first hearing ever in Congress on trauma. And after that hearing, no one is going to ever forget what trauma is all about. It was the most powerful, impactful hearing I had seen in my 50 years working with Congress.

2:04:03: And what's fascinating about it is there were two panels and it followed the script that we heard earlier today. The second panel was on science. We had academics talking about the physiology, neuroscience of trauma. But the first panel was storytelling, and it was the storytelling panel that the people will never forget. There were four witnesses. Each one had suffered trauma and then had gone on to create an organization to help people who had suffered similar trauma. To heal somebody had suffered sex abuse, somebody who had suffered parental abuse, someone who suffered PTSD, and they each got up and told their stories.

2:04:52: There were 45 Congress people in the room covering the full spectrum of very, very liberal to very, very conservative. And after they finished testifying and answering questions, Congressman Chair Cummings said, “okay, thank you very much." The panel was dismissed. And as they stood up to leave, the Congress people stood up and applauded them. And it's the only time in all of my time working with Congress I've ever seen Congress people get up and applaud the witnesses.

2:05:25: It shows you what an impact the storytelling had reinforced everything that…was telling us. And it's something I’ll never forget. Unfortunately, Congressman Cummings passed away just a few months after the hearing, but hopefully the the memory of that hearing was is now embedded in the minds of so many Congressmen, the 45 of them, who Congressman, Congresswomen who sat in that hearing and will give us the ability to build and create trauma-informed legislation. So with that I urge you to listen to Congressman Cummings because he really had a vision and at the very end of this session, one of his visions for the city of Baltimore that he represented to become trauma-informed, and that has occurred.

2:06:37: Chairman Cummings Opening Statement: Examining Childhood Trauma video

2:15:23: Jesse Kohler, Executive Director, CTIPP

One of the things that sort of came out of follow-up conversations with Chairman Cummings' staff was the need to hear more about the trauma-informed movement, about how trauma and resilience and prevention were impacting representatives’ districts from their constituents, which was actually one of the calls to action, if not the call to action, around the development of the National Trauma Campaign. In the weeks following, the development really came about in the weeks following this hearing back in 2019, so very grateful for the work Chairman Cummings did and will always remember the impact that he continues to have on Congress and really highlight the importance of developing champions and leveraging their position. When we have champions in any legislative body, in the Executive Branch, any stakeholder really, any community member really cultivating those champions cultivating advocates is so, so important.

2:17:17: Congressman Gallagher's video

2:21:45: Congressman Davis' video

2:26:21: Jesse Kohler, Executive Director, CTIPP

You can hear the personal narrative that exists for both of them. Why they're both passionate about issues around trauma-informed care. It is important to continue to highlight that this is a bipartisan or nonpartisan issue. Regardless of where someone falls in that continuum that Jen showed us at beginning of this workshop session, there are reasons that people care about preventing, mitigating against the effects of trauma and reducing trauma across the population, it impacts everybody. And so regardless of which Congressional District you live in, we certainly encourage for you to develop relationships with your congressional offices. Talk about the work that is going on in your districts and continue to just promote calls to action and help us work toward building the movement as we work towards society to prevent trauma and fosters resilience across all, just the entire country. All individuals, families and communities need to have the opportunities and supports necessary to thrive.

2:27:40: As has been said in the chat a few times, this work isn't just at the federal level, of course, because of our capacity right now, CTIPP does focus at the federal level, but there are so many incredible groups doing work at the state level as well. And we want to continue to grow and cultivate advocacy at the state, local, and tribal levels as well. There is a group that Dan and we've had the pleasure of supporting the development of and mobilizing called Lift, which is legislators invested in fighting trauma. Those are state legislators who are working across state lines, co-chaired by Democrat Assemblyman Hevesi…and Representative Sherrie Conley, who is a Republican from Oklahoma. And we continue to see how champions can exist at all levels of government…And we just want to continue to encourage people to develop relationships with their offices, reach out, and continue to promote this important understanding at all levels of government as we funnel resources and supports to the trauma-informed, prevention-focused and healing-centered movements.

2:29:41: Assemblyman Hevesi video

2:34:31: Jesse Kohler, Executive Director, CTIPP

So as you can see across various levels of government…both parties and around the country, addressing these root causes of so many of our society’s most difficult issues that we continue to try to face is critical and that is the role of advocates.

2:35:53: Zeke Cohen, Baltimore City Council and Healing City Act

2:36:28: Alright, so I'm going to talk about Healing City Baltimore, which is legislation that we passed and also a movement that we are proud to be part of in the city of Baltimore. So I think it's important to start with context.

2:36:49: Ours is one of the most segregated cities in America. And the reality in Baltimore City is that if you were born in Roland Park, which is a predominantly white neighborhood, you are expected to live on average more than 20 years longer than if you were born in Sandtown Winchester, where I used to teach, which is prominently Black neighborhood.

2:37:15: I will argue that that is the result of public policies that my forefathers on the Baltimore City Council passed. Beginning in 1910, we were the first city in the United States to legally segregate through city code. We were followed by Dallas and Newark and a number of other cities, but we were a pioneer in that regard. The map you see in front of you, 1937, this is a redlining map where the FHA would tell banks where they should and should not lend. And in the predominantly Black neighborhoods, they would not provide traditional home mortgages.

2:38:02: So people got brought into really predatory contracts and we're not able to attain a home or wealth. Moving forward, we had racial housing covenants where Black folks, Jewish folks were banned from living in neighborhoods by the Community Association that lived there. We had all the different mechanisms by which people can segregate themselves and expropriate wealth and health from Black and brown neighborhoods. We were prime zero for the war on drugs. We were unfortunately devastated by the subprime lending crisis in the mid 2000s. And so Baltimore is really a city that has experienced an enormous amount of disinvestment and plunder from Black communities, which is how we get to where we are today, is a very segregated city.

2:39:05: So our work began in 2019, after a school shooting took place at Frederick Douglass High School. So the school in West Baltimore, a gentleman came in with a gun and shot a school staff during school hours. As you can imagine, this was a devastating event for the students that were there, the staff, really the entire community. Young people described having to duck in place, hearing the sound of gunshots in their school, teachers described just being completely traumatized and violated by what had taken place.

2:39:48: So we decided to hold a hearing in the City Council Education and Youth Committee. And the purpose of the hearing was youth voices, youth violence. And the idea was we wanted to hear directly from young people what they thought we needed to do in order to reduce their exposure to gun violence.

2:40:09: A lot of the adult conversation at the time at the school board level and the legislature was about should we have more metal detectors or should we have our school police be armed while they’re walking around in school with the theory being that a good guy with a gun could prevent a bad guy with a gun from shooting up a school.

2:40:30: The problem is, is that Baltimore is already incredibly over policed and what our young people said, and in front of you is Damani, Jana and Brianna, three juniors that were at Douglass at the time, is we are already over policed. We don't want more metal detectors. Our schools already look like jails. We don't want more guns in our schools. We already have too many guns in our communities. You are spending too much time focused on how to police us, when what you need to be doing is focus on how to prevent violence from occurring in the first place.

2:41:16: And in only the way that young people can do, they named every single adverse childhood experience in the book. They talked about what it was like to grow up without a parent, to grow up experiencing homelessness, to grow up dealing with food insecurity, community violence, just the day-to-day grind of being Black in a city that was one of the birthplaces of redlining. They looked at us and said, “that's what you need to focus on”. Not just this horrible but extremely rare one-off school shooting that took place, but the trauma that collectively is compounded throughout our lives and as part of our day-to-day experience growing up in Baltimore.

2:42:01: I’m a former teacher. I started my career as teacher in West Baltimore and in South Baltimore. When you hear young people as a teacher speak with that level of precision and power, it really behooves you to listen. And so after the hearing, I ran up to these three. And I said to them, listen, I think you're spot on. I think there really is a need for us to focus on trauma instead of just this awful event.

2:42:30: But instead of me going back and writing a bill, why don’t we work on it together? Why don’t we try to write some legislation together? And so we embarked together on a massive city-wide listening tour. We listened at City Hall, in libraries and laundromats, in rec centers, and classrooms.

2:42:51: And what we were trying to find out from people is what we could do to legislatively address trauma, and we heard was a lot of pain, but also a lot of healing. We heard overwhelmingly was that this is a city that has experienced many, many lumps, but we also have so many amazing people in different spaces that are doing great healing work. Physicians, barbers and beauticians, educators, young people.

2:43:27: I’ll never forget one conversation we had with a guy named Troy Stanton. He's a Barber in West Baltimore and he was actually shot in his barbershop, and he survived. And he created this thing, More Than A Shop. It’s a nonprofit. And what they do is they provide blood screenings and helped during COVID with…they passed out COVID tests and they work with people in barbershops.

2:43:55: Troy said to me, “you know Zeke, in places like Baltimore, we, the barbers, are the healers of our communities.” And he said, “when I was shot in my barbershop, I realized something, which is these are healing spaces and when people come into the barbershop, they're vulnerable. They're open. They're able to have some really deep conversations in a way that for a lot of people of color, we feel deeply stigmatized and apathologized when we’re in the hospital, but not in a barbershop.”

2:44:29: The other thing he said was, “there's something really healing about touch. And by the way, we really put our hands on people when you give a haircut.” And he said, “you know, the thing about is that we touch the victims of violence and we touch the shooters. And you will never know as a barber whether that haircut that you gave might have prevented someone from going out and using their gun.”

2:44:59: So all around the city, we heard from folks that not only did we need a legislative approach to solving trauma, but that people wanted to be involved. People wanted to be part of a healing city. Because in Baltimore and I'm sure wherever you all live, one of our challenges that we have, great people doing great work in a lot of spaces but is often very, very siloed, and we have a hard time talking to each other.

2:45:29: So about a year later, we held our first ever Healing City Summit. We went to Morgan State, which is one of our HBCUs in East Baltimore. We had about 350 young people from across the city. We did panels and poetry, and Ted talks on how we could heal from trauma. And it was entirely youth lead.

2:45:57: Then the next day, we went over to Coppin State, which is our other HBCU, and we had a huge community healing fair. And we had our barbers and beauticians giving out free cuts. We had a DJ, we had every nonprofit under the sun. We had so much of Baltimore together in one space, and it was beautiful.

2:46:19: And then we marched over from Coppin back to Frederick Douglass High School, where the three young people, Brianna, Gianna, and Damani, spoke about what it was like to not only have had this horrific, tragic, traumatic experience in their school, but then what it was like to do something about it and to actually write legislation and to have created a bill for the entire city of Baltimore.

2:46:48: And then right there in their school, Mayor Jack Young was our mayor at the time, signed our legislation. We called it the Elijah Cummings Healing City Act and it made Baltimore the first city in America to have legislated trauma-informed care. And I will say that we named it after Congressman Cummings, who I know has been invoked throughout this conference many times, who was, as you all know, a national leader in this work, held that congressional hearing with Jesse and so many other folks, but who also came back to Baltimore, and got a group of us together and said, look if we can't solve this in our own city, what are we doing? And he said to us, I'm not going to be here that much longer. He was very, very sick at the time, he had cancer, and we actually didn't know how sick he was, but he had been sick for a very long time. And he said, you all need to pick up the ball and run with it. He put his arm on my shoulder. He had been an incredible mentor and friend and said run with it. He passed away before we were able to finish the legislation. So we renamed it. We amended the bill and named it the Elijah Cummings Healing City Act.

2:48:10: So what does our legislation do? It creates a task force of 38 people, one of whom is Doctor Phil Leaf, who you're going to hear from next. But these are folks from all walks of life. We have returning citizens, we have students, we have beauticians, we have physicians. We have just a huge mix of people. And that task force is tasked with identifying strategies to reduce trauma across our city.

2:48:40: Our legislation calls for training of all city agencies in trauma-informed care… And then finally, it calls for a review of all of our policies and procedures within our city agencies with our task force to figure out ways, as the previous legislator had mentioned, that we city government are actually causing harm in our communities and how we can reverse ourselves in doing that.

2:49:23: What you'll notice, and what I want to really emphasize here, is that all of these people you see in front of you are Baltimoreans. They are either from our city or they are doing incredible work in our city.

2:49:37: Zeke discusses those involved in Healing City Baltimore

2:50:48: All of what we do is Baltimore-based and Baltimore built. Because one thing that people said to us as we did this listening was don't go getting people from New York or D.C., we can do our own healing right here in our city.

2:51:08: The first city agency that we started with was our library system, the Enoch Pratt Free Library System and it’s Baltimore Bets, and it's on a new type of first responder, the librarian. We started with libraries both because libraries are space of civic innovation, of community uplift. They are not just somewhere to get books in year 2022 in Baltimore, they are part of our social safety net. People go there to find a job, to get online, find housing and also place where folks who’ve experienced a lot of trauma go, whether it's people who’ve experienced homelessness, addiction, just young people. So we want to start with our library system.

2:51:53: One of the things I mentioned, that the third part of our bill calls for each agency to review their policies and procedures with a lens for reducing retraumatization. So, Baltimore, as I mentioned, was ground zero for the war on drugs. In a previous mayor’s administration, we locked up over 100,000 people, of our own people, almost six of our population, just for minor, mostly for minor petty drug offenses. Well, one of the vestiges of the zero tolerance era is that in our library system, we also had a zero tolerance policy where anyone who is thought to be either high or drunk would be immediately written up and kicked out. And you can understand that comes from, you don’t want someone causing chaos in a library.

2:52:48: But in the year 2022, we know that addiction is a disease and it's a public health crisis and it's not a function of criminality. And so to just kick people out who are suffering is both inhumane, ineffective and not trauma-informed.

2:53:08: And so instead of the zero tolerance policy, Enoch Pratt has decided to bring in pure recovery coaches into our libraries. And these are folks who themselves have experienced addiction and they work with people through harm reduction. They provide Narcan if you’re worried about an overdose. They can help people get into treatment. They can help people just get housing if hat's what you need. But we're very proud of Donna Bruce, who is both a peer recovery coach and a member of our Trauma Informed Care Task Force. And we're proud that we took a policy that was really causing harm in our city and we're able to reverse it.

2:53:51: We’re really proud that our legislation in Baltimore went statewide. Too often the work that happens in Baltimore is not well recognized by the state of Maryland. We often come under a lot of fire for challenges in our school system for violence. But what was powerful was that a delegate and Senator Jill Carter decided to take our legislation, the Healing City Act, and make it statewide. And so she turned it into Healing Maryland’s Trauma Act. And it took us two years, but we were able to get it passed at the statewide level. And so we now have a statewide task force that is doing this work.

2:54:41: In terms of funding, it of course costs money. We had some really great early support from Open Society Institute. We have support from private donations and foundations. And then after we operated for a while, the city government, the mayor, made an investment into the work, and then he made even bigger investment through the American Rescue Plan funding. I say all this to say this has really been a function of public private partnership. The private money kind of got the thing moving and then we, the government, came in and supported it.

2:55:35: I will argue to my face turns blue that addressing the impending mental health crisis that we are collectively facing is a really good use of American rescue plan money.

2:55:50: Some of our results - we are proud to be the first city in America to have legislative trauma-informed care into governance. We began by training our mayor, all of his cabinet, and me and my colleagues and our staff on the City Council. And that's because we believe that leadership needs to come first, that you are going to embrace a trauma-informed, healing-centered approach that the people who are in positions of leadership need to be all in. It can't be half this, half that. And so we were really proud to have Mayor Scott go first and do a miniaturized version of our training, and we've now trained 450 librarians across the city. We're also working with security staff over there and we are doing evaluation with a professor at Bloomberg.

2:56:47: Some of the lessons learned - legislation matters. You don't need it, but it is a really good anchor for some of the work. It gives us something to rally around it. When they kick me out or when Mayor Scott goes away, we will still have the Healing City Act, and so we will still be compelled to do this work. It will outlive me and all of my contemporaries. So I would argue that if you're someone who’s thinking about taking this approach in your city, really consider doing it through legislation. The work takes funding. It is not free. One of our principles is everybody that participates in our training and in the work gets paid. We value people's labor, even the young people from the Youth Healing Alliance. We want to pay a good wage because this is work, and so you got to be able to fund it. And finally, we are medicine. And the idea here is we collectively have the ability to heal trauma through relationships, through community mobilization. It doesn't matter whether you're in Toronto, Canada, Baltimore, MD, or Detroit, MI. Every city, every municipality, has the ability to do this kind of thing work, and we ourselves have the ability to help each other heal.

2:58:23: We are getting ready to pivot to our next city agency, which is going to be recreation and parks. We know that trauma is a crisis not just in our libraries but often in our rec centers as well. And that rec and park have some real leverage in being able to address it.

2:58:44: We are exploring scaling to other cities across the world. There's been a lot of interest from folks in Cincinnati, reached out in Seattle, in Toronto, in a number of places in what replication could look like. And so we are starting to think about what that could mean for Baltimore and for the work we're doing because this is from my mind, this is open source. We feel really strongly that you can do it, we were able to do it, and you can too.

2:59:18: And finally we are open for partnership. The reason this work has worked so far, and Phil is a great connector, is that we really want everybody at the table, whether you're a professor at Johns Hopkins Bloomberg, or a returning citizen who is coming back home from incarceration. You have a place at this table. And so I will say to any of the 190 folks that are on this Zoom, we would love to partner you as well. Please reach out…we really are looking for partnership as we move the work forward.

3:00:05: And just wanted to end on this note, which is that, like I said, Baltimore was the first city in the country for legislated residential segregation into law. And we're really proud that we're now the first city in America to have legislated a cure for the harm that it caused. And that is what we intend to do moving forward.

3:03:08: Dr. Phil Leaf, Professor, Johns Hopkins Bloomberg School of Public Health with appointments in the Schools of Medicine, Nursing, Education, and Arts and Sciences, and Secretary of We Our Us Movement

I'm going to pick up on some of the things that Zeke talked about, and also since it’s sort of the last section, linking ends to some of the best practices and other things that we talked about a little bit earlier to be able to sort of make connections, particularly around the fundraising, lobbying, sort of a number of things that are going on here.

3:03:47: So as I mentioned, those are things, but also one of the things that Zeke didn't mention, was even though there's now a task force that the mayor appointed, the We Are Us movement, the Healing Cities movement, has continued to meet, but Zeke’s continued to chair it. So we both have sort of the formal legislatively constituted group, which is able to deal with the legislation, which as he said, talked very much about the agencies be doing, but also continuing the work on the community perspective and what the community groups want to be doing.

3:04:22: Now also a little bit more to think about Baltimore. So Baltimore - the leading cause of death for children is actually homicide. I don't think many other people on the Zoom live in communities where the leading cause of death is homicide and I hope not. And homicides are actually lower in terms of overall numbers and drug overdoses, suicides. And so we have a lot of these kind of traumas. But as Zeke said, we are the home of redlining, and even before redlining we are sort of northern most part of the South. So racism and structural impediments are in existence for Baltimore for a long time, but also as you can see in Baltimore, I think in many communities, even thugs cry.

3:05:14: I think one of the powerful things that he mentioned about our barbers stuff is everybody gets haircuts. And so they're actually able to reach out to some of these folks and help them turn their lives around, because they’ve been cutting their hair since they were kids. Often, and these are again thinking about how do we have these quality connection relationships. The quality connection relationships are something that may be through what I'm doing as academic, but most of what I'm talking about are doing because I actually moved to Baltimore 31 years ago because I was doing epidemiological work and just got really excited about the community, people that I was meeting and the great things that were going on in Baltimore. So Hopkins had been trying to get me to come here for a number of years, but I actually interviewed with the community people to say, here’s what I’m interested in doing. Is that something I could be helpful with? We also have a lot of these pressures around, and each of those bottles is a different person. So when we have these deaths in the city, it's not individuals. And the reason these are outside is in Baltimore, most people don’t have air-conditioned houses and outside is where they need to be. One of the things we started doing 20 years ago is getting the police not to hassle these people on the corners if they weren't disrupting.

3:07:10: As many people said, we're trying to move this paradigm from talking about what's wrong with you, to what happened to you and what is happening to you. Because again, much of what we talked about around the trauma and stresses are not single incidences. Often these are continuing things that are going on and as we're trying to think about support and what to change the processes, we’re really talking about changing processes.

3:07:34: As Zeke emphasized and as many of the speakers have emphasized in earlier sessions, racism, other structural things that develop in many ways because of racism or sexism or other things, really need to get dismantled and changed because working on things one at a time, and many people have used this example before of these little children that are floating down the river and we're working on pulling them out of the river as we see them, and happens to be people need to go upstream and try to figure out who’s throwing them in the river, or why they’re jumping in the river, how do we stop those things.

3:08:09: So a lot of times, we're talking about these things, it's trauma. Just like that, everything was suddenly different. For many of the people that we’re working with, many of the institutions that we're dealing with, it's not something that was suddenly different. This is again institutional trauma, recurrent trauma and that the solutions that we're working on really need to be thinking about how are we dismantling those things and providing longer term supports.

3:08:36: And so we talked about trauma could be one time but it could be multiple long-lasting events, even multi-generational. It can be experienced physically or emotionally or can be life threatening. Sometimes it's subtle, sometimes it's insidious, sometimes it's outright destructive. And those are all things people on this Zoom and the people we’re working with are dealing with and can affect the individuals’ functioning both physical, mental, social, emotional or spiritual.

3:09:04: I think these are important because when we’re thinking about quality, connected relationships, one of the things is how do we get the resources there? How do we do the lobbying? But as Zeke said, I spend lots of times at meeting, making connections. I've been in Baltimore for about 30 years and been doing a lot of work with folks. I'm able to connect people to resources, but more important, connect people with other people that are working on some of the same things. Work on some of these things can be helpful.

3:09:31: A very specific example is we have a program at our hospital that works with people who have been shot. In Baltimore, we have a large number, unfortunately, a large number of females that have been shot and programs around the country weren’t dealing too much with females and they weren’t dealing too much with the children with people who were shot because many of the males who were shot were not living with the children. None of them are, where almost all the females that are shot were living with children. Because for 30 years I've been working with Baltimore City public schools and other people, we had great connections. The person who shot the child stops coming to school, maybe having more problems in school. The people that are the teacher, sometimes the social worker, school psychologist, weren't made aware of the events that were affecting the child and the students. So, we made sure with the parental…permission that we were able to get information out there right away.

3:10:28: If a young child’s going to school and their parent was shot yesterday thinking they're going to keep taking a test tomorrow, I think that they’re going to be thinking about what's going on the classroom. It’s just not really realistic. When the teachers know these things, they’re able to make these accommodations. And that's where we talk about making these really connections across these things.

3:10:44: We often focus on the start, the acute trauma experiences, but we think it's really important to emphasize the historical trauma. The issue of not having resources in the community, transportation to jobs, and how long it takes to get to a job in Baltimore City is important. Baltimore City actually has the second longest average commute of any place in the country. Los Angeles County has the first, Baltimore City has a second. Many of our families have to leave at 6:30 or 7:00 in the morning to get their job. They don't get home until 6:30, 7:00 at night. That means their children are not having a family and the adult, but often the other people in the community also are working.

3:11:28: And so it's really important to be talking about how do we put these supports, how do we have after school programs, community school programs. When we’re thinking about resources and connections, those are things we thinking about. From a trauma perspective, which we sometimes don’t as often, also the community level trauma, these things aggregate in communities. So how do we make sure that we’re getting increased resources to those communities and other kinds of things, because again, a lot of times programs are one person per school or certain number of children getting services. But the violence, the substance abuse, the unsafe housing congregates in our communities, in part because of both the structural racism and the institutional issues such as the redlining, which means we need to make sure allocating resources proportionally to where the challenges are, not sort of randomly or consistent across all the funding sources.

3:12:25: We also have to recognize that in many cases, children’s brains haven't developed. It also means that, as we know from the resources for the adults that are experiencing the trauma, their ability to process things, that includes talking to the doctor and understanding what the doctors say, but also being sort of too complicated.

3:12:44: So we need to make sure that there are people there. One of the things we think about doing is we have expanded community health service workers. In many cases, these are actually college students who are working in the healthcare providers, working in hospitals, to work with the families to make sure they understand the instructions, make sure with the community health workers to go into the communities. We may not think about these as trauma interveners, but they basically both work at the trauma. But equally important, they make sure that people are, whether their children’s school, work, or their health services or other things, are implementing these things when they also may be worrying more important about the basic things, place to live, enough food and enough clothing, that we know that without the additional supports, they’re not going to have as much time to work on the interventions, other kinds of things.

3:13:38: Again, the previous groups over the sessions, and I suspect many of the people who are watching the Zoom or will be watching the Zoom, have attended some of these things, is thinking about the issues of safety, the issues of having choices, making collaborative decisions, incorporating the…talk about making sure it was the youth that we're driving this and we're trying to think about the youth solutions and having institutions that are trustworthy and empowering young people, empowering community workers. We need to think about doing these kind of things.

3:14:08: It also means that if people like myself have relationships with new health Commissioners, new Superintendent of schools, what we do is we invite them to actually meet with young people. And what we found and what the health commissioners have said is, they come into the job thinking they know what the young people might need. They think they know what the adults might need. After about five minutes of listening to the young people, hearing what their issues are, but also the solutions, they actually wind up changing how they are going to be scheduling their programs. They wind up changing their priorities. At least in Baltimore, they also say, “I want to continue to meet with these young people. How can I continue to meet with these people? I need to have a youth advisory group. I need to have a real community advisory group.” These are kind of things that we think about lobbying and other kind of things, but the things that many of us also can be working on facilitating and doing that becomes useful.

3:15:00: So again, I think as the speakers earlier today talk about how we develop meaningful relationships with legislators and also with legislative staff, because legislative staff are often equally important, and have a bit more time sometimes to think about putting solutions together. How do we think about those things? How do we think about addressing the intercessions around trauma and culture, history and race? The structural inequities that exist are all things that have come up in our previous sessions. These are things that…getting stories out there, making these are including in the stories, having positive examples, not just what’s wrong but we have many people that are working on these issues now who have changed their own lives and now they’re credible messengers to the young people and to the adults how to do some of these things.

3:15:47: A good example is we're fortunate in Baltimore. We're less than 50 miles away from Washington D.C. As many people know, 50 miles is the legislative definition of what travel is, which means some people come from Washington to here, they don’t have to get travel expenses. They can just come here the same way as if they were going two blocks away. So what we do is when there's a legislative hiatus and the legislators go home, the staff are staying there, particularly the appropriations and the authorization staff. So we pick him up at 8 o’clock in the morning, give them a little breakfast, we talk to them for the hour or 45 minutes to get them to Baltimore. Then we have them meet with real people in Baltimore, the people that are going to benefit from their program, if it could be expanded or how to expand it, so they really understand not how Dr. Phil thinks about it, but how real people think about this stuff. We give them some food, let them get home, and get back to DC by 1:30. We've gotten three hours with them, but they’ve had some really consequential messages and we moved things like the community. Some of the programs were initially allocated $5 million a year because of these discussions. We've had enough to be $125, $200 million a year. Again, it wasn't us, but again, it was developing relationships, other things.

3:17:02: The redlining is important because essentially, things would happen. So between 51 and 71, 80% to 90% of the 25,000 families that were displaced in Baltimore because of new highways, schools or housing projects were Black. These structural and racial inequities, even when supposedly making things better, we're not necessarily making things better for everybody. And again, thinking about these things, mass incarceration,…we need to be thinking things because sometimes our solutions actually make things worse.

3:17:33: These are things again, that come again to the same people. And again, as we’re thinking about solutions, how do we make them on a positive pathway, but how do we continue to support them?…That just because we've intervened and because they’re doing better, they’re still at higher risk for adversity.

3:17:58: The other thing is our workplaces. We need to make sure that our workplaces are hopeful and healing places. And you yourselves on this Zoom, we need you to make sure that you're thinking about these things and making sure that you're not getting overwhelmed with too much work, too much designs or continuous organizational change or constantly running looking after money. But you have to have hopeful and healing environment. Your human resource organizations have to deal with these kind of things.

3:18:19: So again, as we’re thinking about the opportunities…we have both the positive things, the health, the wellness, hope, recovery. We have a negative things, but we really need to get to the roots. How are we able to do the roots? How do we put in the fertilizer, how do we make sure there’s enough water there? How do we take the plants in if they’ve been planted and we have a freeze? Some of us in this area had this yesterday and the day before, and those are things that necessarily that we do, when I say “we” it’s not like me as a person, but again how do we have these relationships? How do we know other people? How do we support each other?

3:19:03: You guys have lots of information. And the lobbyists in particular. You’re meeting with lots of people on lots of things. The academics - we hear a lot. We provide technical assistance to these state and federal agencies and organizations all the time. Sometimes we hear about things - that that’s not my research project. I'm not going to do that. But there are people in my community that can utilize those things, build on those things. We need to think about how we can transfer this information. And that's where again with Zeke, with the movement, we’ve created this thing. We have both informal and formal ways of getting information out there. I may not know somebody, but when having these regular meetings, somebody else in that meeting knows somebody. We start making transformations and transitions of information.

3:19:44: So again, it’s changing and creating why I am because we are. We have to make these things bigger,…we care how to strengthen these things, build on creating the partnerships, and the partnerships are again one of the things researchers have shown is that it's not the strong connections that have the biggest impact, it's the weak connections. It's finding out information from people and how do you find out information from people and this is the structural inequities. I have the time and resources to be in lots of meetings, I have lots of students, I have lots of colleagues, so I get lots of information. I need to make sure I'm trying to share this information, not just help me write good and high-paying grants. But again I moved to Baltimore. I live in Baltimore because as an old white guy, I couldn’t tell people I'm really interested in Baltimore if I weren’t at least living here and go to lots of meetings and just listen. Also, just not talk to them, but just to listen and potentially share information. These are things you're all doing. We all need to do more of these.

3:20:50: And in remembering resilience does not come in a can. And when we see resilience in a can, that’s probably not the solution we're working on. That's probably not what we want to give lots of people, particularly young people, to try to help them do better. So again, not everything that says a word that is sort of what we're doing is actually what we're trying to do.

3:21:13: And also where we work. So this is Johns Hopkins Hospital. And I got them interested because we showed that within a quarter mile, there were 24 victims of shootings or homicides. Just within a quarter mile, this is where people go to get their cars and park their cars. This is where people go to eat and we had 78 people within a half mile of our hospital institution. The staff then got really interested because they realized this is us.

3:21:41: Then, thinking about funding opportunities. Lots of them that are going on. One of the things we did with the SAMHSA funds that we got small amount of money, we created mental health workers who were actually hired at this time by Johns Hopkins. But what we did is we didn't just hire them for five years. After they got hired, they were able to start billing for some of their services. We then recycled that money so that University of Maryland folks, other folks,…so we went from two to schools that had these expanded mental health services when we started, to 20 that were funded by the grant start that six years later, 90 schools had many health services. They were able to do this because again, they could bill for about 70, 80% of their services. We got the city and the school system to then pick up the cost for the prevention services. Seventeen years after that grant ended, those services are still going in the city.

3:22:31: So again it's not thinking about doing these things Baltimore core. We’re about to get money to hire people to get trained to be community mediators, both hospital mediators, but also community health workers. There's community-based violence things the CDC provides. There's a school-based mental health centers and then Healing Us Together. We’ve trained a lot of both faith leaders and also neighborhood leaders doing these kind of things.

3:23:00: There's a lot of funds out there. And so I looked at three days worth of funding. This is 3 days of funding in the…Violence and trauma is sort of the flavor of the month. I've been doing for 30 years. We used to have to beg to get a little bit of money. Right now there's funds out there, but if we just, if everybody puts funds into its own silo and we don't get collective impact of this, we're not going to be able to create these systems as the collaborations that we're dealing with today and who’ve organized this, they’re trying to do the coalitions. We need to figure out how to breed these funds, use these funds to continue….There’s lots of funds out there. How do we facilitate the people in our own communities who are best able to use these funds, not that myself or any of us on this course, on this particular thing couldn’t be able to do it.

3:24:10: We need to stay grounded. We need to be working together. No one can do everything, but everybody in our community must do something if we’re really going to be dealing with trauma and reducing the trauma and its impacts.

3:26:32: Dr. Diana (Denni) Fishbein, National Prevention Science Coalition to Improve Lives

As I mentioned before, I worked in Baltimore my entire adult life, which is quite long, until a little under seven years ago. And when I first was early in my career working at the university and doing research at the intramural program as a community service, I was very concerned about what the climate was like in Baltimore and some of the things going on.

3:26:57: So given I have some background in neuroscience, I also have some background in criminology, I developed a program for the Baltimore City Jail detainees in the female unit that I call Baby Talk. And with this program, I taught prenatal care and parenting to the females were facility. And given some of the conversation that took place during course of these very hands-on, warm and fuzzy kinds of sessions I was having these women, really interacted with them, something occurred to me, and that was intergenerational trauma.

3:27:28: This is a gazillion years ago, this is 25 years ago, maybe 30 years ago, and I had a group of women in the room in the scorching heat, no air conditioning, no windows, about 60 of them in this room. And I just, this just came over me and I said, "how many of you were abused as children?” And a few of them raised their hands. And I thought, “oh, that's not what I'm hearing.” And this is, this is absolutely accurate. I said, "how many of you were beaten to the point of unconsciousness before the age of 12?” And most of them raised their hands. And my heart bled and I just thought, you want to blame. You want to say, oh, you should not do this, you should not be uncivil. You should not be violent, you should not be violent towards your children. But you see the intergenerational nature of what is going on and you want, you have to do something about that. You have to do something about it.

3:28:46: And so it took me off on a course where I eventually went to the Department of Justice to work on empowerment zones for youth and a number of other issues. It just took me in all kinds of directions in an effort to try and do something.

3:29:00: Now what occurred to me also with these folks, these women, is that their history of child abuse was coincident with their addictions, that they had substance use disorder, they had drug dependence. Now way back when heroin was a staple in Baltimore forever. And so, I was getting into the filed of drug abuse at the time as well, working for the National Institute on Drug Abuse as a fellow in Baltimore in their intramural program, from the neuroscience perspective, but always having this the social context in mind.

3:29:39: So what I've determined, is that this had to be part of what I incorporated into my career in neuroscience. What are the social influences that impact on the brain to lead to these outcomes and how can we reverse, how can we reverse it and instill the resiliency that is there? I'm just going to point out that ACEs and drug abuse are very tied to one another, that we see here - with an ACEs score of greater than five, in white in this graph, that it just jumps up in terms of the extent to which they have had problems with drugs very much related to their ACE score.

3:30:34: As you can see to the left here, the extent to which they experienced emotional abuse, physical abuse, sexual abuse, emotional neglect, physical neglect, is well over 30% in these populations. Shat we know now that is going on with individuals who experience ACEs is that there is a direct connection with substance use.

3:30:58: What we know is that these psychosocial adversities are embedded in our biology and that it changes the extent, the nature and extent to which the brain develops through the course of childhood and adolescence. Adolescence is very protracted until almost the age of 30. It has these effects on the way the brain develops and also it affects our immune system. It causes inflammation, which is a hallmark feature of many of our chronic diseases.

3:31:31: It affects our sympathetic system, which means that it alters our stress physiology, the epigenetics. We know epigenetic modifications are caused by by adversity. And I will mention that these mechanisms are malleable. They are not static. It's not that you get these impacts from stress and trauma, and there's no way to ever change it. That is untrue.

3:31:56: But given what it causes, it leads to this biological embedding in our behavior that's often expressed as a propensity to substance abuse and also other issues, certainly. And so we also know that the specific impacts of stress and abuse and trauma on the brain affect the brain's reward system, the structures that are actually responsible for the reinforcing effects of drugs. There's another biological reason why individuals with ACEs have greater proclivity to use and abuse drugs later on.

3:32:28: And it can damage coping skills and so forth. And especially important when you live in a very threatening environment, unsafe environment. And these are also the same brain regions implicated in mental health research. So mental health is very coincident with all of these issues. So and then when you have a psychiatric disorder on board, when you have poor parenting, family dysfunction, in adverse neighborhood conditions, you’re much more likely to end up with substance use.

3:33:08: Denni explains Child Maltreatment and the Developing Brain diagram

3:33:34: So the brain is plastic. We know for the better or the worse, but again, importantly for the better, because if we can engage systems and policies that provide nurturing neighborhoods and relationships and nurturing environments overall, then we can really reverse this situation and that's we're talking about here,

3:33:56: Substance use - This is just one issue here and so we know that early intervention can help to strengthen these mechanisms that have been delayed or even damage from stress. But it's malleable, it's not lost cause. And so what we need, and I've indicated here as a policy relevant scientific finding at the bottom that I want to point out here, is if we have an integrated system of healthcare, behavioral health and substitute services altogether that are managed by and accountable to local communities and supported by state and regional resources, that has the greatest potential to significantly reduce the substitute disorder issue that we're seeing uptick in, in the COVID pandemic and throughout the opioid use epidemic.

3:34:50: We have interventions that work across the developmental spectrum.

3:35:01: Now there are these really key, fundamental and exciting, really opportunities for systems change by using wisely the pharmaceutical settlement monies that are about to hit in the billions of dollars, are about to hit local communities. And it's so important that our local officials know how wisely to use them in collaboration with our communities, give community voice to all of this. And to be able to use the menu of programs that we have that are- if not evidence based, are promising that they are identifying at-risk youth and at-risk conditions, perhaps even more importantly. That we're able to intervene early through these pharmaceutical settlement monies that will enable us to help avert trajectories away from substances, ultimately that promote the evidence-based investments in technological assistance and a plan, like an implementation plan, so that we can continuously monitor how these interventions are being rolled out. That there's strong community level support, existing infrastructures, so that we have a coordinating body that can oversee it and that we are able to engage an informed, capable workforce.

3:36:37: So on our end, I’m working with the state of North Carolina. We've developed a blueprint, if you will, for local officials to know how to engage with the community and identify what practices are likely to work and where they can get scaffolding, where they can get support for coordinating all of this, the infrastructure that's needed. And we're also working at the national level with ONDCP, with SAMHSA and with the CDC so that we can be sure that we're doing something that is traums-informed given these integral connections and relationships, and that we have a prayer that this is going to work to these integration of systems.

3:37:33: Dan Press, Legal Counsel, CTIPP

In 2018, Congress passed the Support Act to address the opioid epidemic and there wasn't a section in it to address prevention. And now, four years later, we're facing another epidemic with like 100,000 deaths this past year because of it. We need to focus on prevention as well as treatment. So CTIPP has put together a draft piece of legislation to promote prevention in connection with opioid use disorder.

3:38:14: It requires funding, but the funding is there from the settlement to the opioid legislation. What we're hearing is the money is going out, every state is taking a different approach. Some of it’s going to be determined by the legislature, some by the governor, some by the attorney general, some just going to be thrown out to the local communities.

3:38:38: We saw what happened with the tobacco settlement, where the money never really ended up solving the problem. And what we're recommending is that states take control over the settlement money and they adopt comprehensive legislation that takes trauma-informed approaches to resolving the opioid use disorder problem. And what does that legislation involve? It's just components that Denni just laid out.

3:39:17: First, there needs to break down the silos and has a need for an integrated approach. And so we're recommending that states create an interagency council on opioid use disorder and trauma and that its mission is to pull together all the different components, whether it's state or local, that can have a role in prevention and develop a comprehensive strategy as a healthcare system, as the education system, the legal system, the justice system, need for a comprehensive approach. So it creates an interagency council. Those of you who have been involved in it, may have worked with in the homeless area. There's an integrated Federal Interagency Council on homeless. And then many states have adopted Interagency Council on the homeless. And it has been very effective in pulling together the different agencies and breaking down the silos.

3:40:29: Secondly, there needs to be a community effort. The work needs to be done at the community level and it needs to be done in an integrated fashion. So the second thing the legislation does is take some of the money that's coming in and provides for grants to local trauma-informed substance abuse coalitions to develop local strategies to implement trauma informed programs.

3:41:01: Third, it targets some of the areas that are the highest, most I guess, the low hanging fruit for addressing trauma, one of those in schools as Denni just indicated. The adolescent population is particularly vulnerable, but it's also particularly susceptible to treatment, to learning resilience techniques that will keep their trauma from driving them to drugs.

3:41:36: So it provides grants to schools to provide great trauma-informed schools that teach kids there how to regulate their behavior so their trauma, stress doesn't drive them to find solutions and drugs or all the other problems we know are caused by trauma

3:41:59: An a third area is of the prisons. We know that something like 60% of the prisoners and people incarcerated suffered trauma If the trauma is not treated when they go back out on the street, when they’re released, one of the things we know they’re going to do is turn to drugs again. So it also provides grant funding to prisons to implement peer trainers to become trauma informed-program.

3:42:28: One of our earlier workshops, we had a great presentation by Dr. Stephanie Covington about the peer-to-peer counseling program she's implemented in prisons that does the same thing that these programs in high school do. They teach the people incarcerated how to regulate their trauma and it reduces violence in the prisons and reduces recidivism and it will reduce the drug use by those informally incarcerated people.

3:43:00: So the legislation really creates the structure at the state level to create a coordinated, integrated strategy that recognizes if we're going to reduce trauma, we're going to reduce opioid use. We need to work on prevention really at two levels. One is prevent ACEs among the next generation…but also among those who've already suffered trauma to help them teach regulation skills so that they don't resort to drugs as a way of dealing with the stress that trauma caused. So create an integrated statewide strategy and then provide funds to local trauma informed-community groups, funds to schools, funds to prisons. It has an evaluation component in there so that we can track what effect the legislation is having on reducing opioid use and involves monitoring to make sure that the money that is granted to these different entities is used properly.

3:44:34: There are going to be a lot of people out there trying very hard to get their hands on the money. The treatment community is going to say the money should go to treat those people who have already suffered or already suffering from opioid use. And some of the money does need to go there. But if we repeat the mistake that was made in the Support Act and only focus on treatment and not focus on resilience and not focus on prevention, we're not going to solve the problem.

3:45:10: Four years from now, we're going to come back and we'll find that the money that these billions of dollars that the drug companies are paying in the settlement of the opioid abuse epidemic hasn't solved the problem because there's just a new generation coming up. We need to use that money to make sure that the next family, the next community, the next school, isn't subject to severe opioid use disorder. And that means prevention and resilience.

3:45:47: It’s going to take a lot of advocacy. Local groups, statewide groups, arguing that this money needs to be spent in a trauma-effective way, in a way that reflects the science. And that we don't repeat the mistake we made four years ago.

3:46:05: So each one of you can play a role in trying to persuade your local state legislature, your local mayor, your local City Council, that they need to take the money that's coming, or at least a good portion of the money that's coming down in putting it to work for prevention, put it to work for resilience training, and thereby make sure that we're not simply treating problems that already occurred, but that we're also preventing them again, the next generation from suffering from opioid use disorder.

3:46:46: It's great that we have all that money out there, but as we said, again as we saw with tobacco settlement, it didn't do as much as it could have to reduce tobacco use. We need to make sure that the settlement money for the opioid us disorder really helps to knock the legs out under the problem, and that involves the trauma-informed approach that focuses on prevention and focuses on resilience.

3:47:44: This is a piece of legislation that's right in front of you and needs to be enacted if we want to prevent another 100,000 people from dying from substance abuse disorder.

3:48:10: Jesse announces the Advocates of the Year Recipients


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