Our October 2023 CTIPP CAN call provided tips and strategies to better integrate NEAR science concepts into your trauma-informed education, activism, and advocacy.
NEAR science (Neuroscience, Epigenetics, Adverse Childhood Experiences, and Resilience) is a comprehensive framework to better understand the impacts of trauma, chronic stress, and adversity on well-being. The field produces exciting research that provides a holistic understanding of the intricate interplay between biology, psychology, and the environment to foster healthier people, communities, and systems.
Attendees also received a briefing/update from the U.S. Interagency Task Force on Trauma-Informed Care.
00:00:05 Thank you everyone for being here for the October 2023 CTIPP CAN call. We are so thrilled to have you. And today to get started, the quick agenda and low down is that we're going to have a report out on the progress made by the Inter-Agency Task Force on Trauma-informed Care. And then for the second part of the call, we're going to go through the neuroscience framework and how it can be utilized for advocacy as we promote trauma-informed policies and practices. The Inter-Agency Task Force, this current update is really exciting to be able to hear. The task force was authorized in the Support Act of 2018. And one thing that's just important to note is that the most recent continuing resolution that was passed to keep the federal government from shutting down at the end of September, early October, it, um. It did not include elements of the Support Act to be reauthorized. And so one element of that was the task force. Therefore, the task force has technically sunset in this report. And that Melinda's going to share encompasses the work that has been done by the task force while it was authorized so far. As a result, we do want to invite questions to be submitted in the chat. So as you listen to the report, please feel free to submit your questions. And over time, we'll work to answer as many as possible. But because of that little nuance, Melinda won't be able to answer questions live during the call. And so we just wanted to acknowledge that, and we appreciate your understanding and supporting this very much when we have more answers and hopefully, as the task force continues to move forward, will Melinda will come back to share more. We'll do more engagement with our community as we move forward. But, Melinda, I want to turn it over to you and just welcome you to see CTIPP CAN for the very first time. And I don't think that I said it well. So just very quickly, Melinda led the Inter-Agency Task Force on Trauma-informed Care. Melinda, any other necessary introductions, please feel free to introduce yourself the way that you best would like. But thank you so much for being here with us today.
00:02:35 Well, thank you, Jesse, and I want to thank all of you, because Jesse is a wonderful leader and has been a great support and champion of this work. And so and I know that he draws his strength from many, you know, from you and your ideas. And so thank you. Thank you all for that. So I'm going to see if I can share my screen here. Um. But it's just, he said, I'm Melinda Baldwin and I am a clinical social worker by profession and started my work in the field of child welfare and quickly. Was working with children who had fairly serious mental health concerns and so spent, you know, lots of years in that intersection between child maltreatment and children's mental health and really worked with children and their families who had experienced lots of different kinds of trauma, intergenerational trauma, systemic trauma, racism, all different kinds of things. And so quickly, um, really saw the impact that trauma has on, on children and their families. And so have led this work in, um, at the federal government since 20 2019. So I'm excited to share with you what we've done over the past about a year and a half and to kind of just I was going to say, you know, share with you where we're going. But I can't do that. So let's go ahead and get started. And I know, you know some things about the task force. So I hope some of it's not too repetitive. So if and you guys are seeing the slides advance, right.
00:04:31 It's looking great.
00:04:32 Awesome. Thank you. So as Jessi mentioned, the task force was part of the support act. And what makes this task force unique is that Congress did a couple of very key things. One is they said don't do anything without soliciting input from stakeholders on, you know, everything from the planning that we did to the ongoing work. And then the second unique thing that they did was they said, we want you to develop a strategy for trauma-informed care and then write a plan to tell us how you will implement it. So not just go forth and do, but really come back to us with a plan which we call the operating plan. And, you know, let us weigh in on that before you get started. Um, and in that plan, we want you to do a couple of things. We want you to identify and evaluate and make recommendations regarding best practices. I mean, how can folks in communities really use trauma-informed care? Um, you know, in the in the best ways possible or what do we know about those ways? And the second thing was recognizing that many federal agencies, not just ones that are clinically focused or behavioral health focused, work with individuals and families in their communities that have experienced trauma. So how can these agencies better coordinate their responses and how can we learn from that? And specifically, they called out substance use disorders in the legislation. And so we got there were there are a number of agencies specifically required to participate in the task force in the legislation. So we brought all those folks together. And the first meeting was in May of 2019. And then they met just sporadically. Um, really until the fall of 2019. We had our last in-person meeting in February of 2020, and I remember it vividly because, as you all know, we all went home for the pandemic in March of 2020, and so much of this work was developed while we were home and also during the social justice movements that were happening in 2020. And that made a huge impact on what we thought about and how we can centralize all of this work. And so we needed to start or we felt we needed to start with a problem statement. So you see our problem statement there. The childhood trauma is a serious public health issue, and the communities need support to develop infrastructure and the ability to meet the demand. But we also need an evidence base. So we need to know what works so we don't retraumatize or do other unintentional harms. We also recognize that this needs to be more than just individual clinical interventions. We need to know how to intervene at the system and community levels in order to promote best practices. So along with that problem statement, we developed an outcome statement. So if we are to be successful, where do we want to be. And so we want a national trauma-informed and coordinated strategy that we can disseminate information and we can ensure that folks have the tools they need so they can improve their response. They can recognize trauma, strength and resilience and improve outcomes for children, youth and families. Um, so here are our federal partners, and we do have some extra space there because we have some other agencies that have expressed interest in joining us. So many of these are the ones in the legislation, and others are ones that have joined us since the passage of the legislation. So here are just some other kinds of of information. So our first meeting was in May of 2019, uh, between May 20th. Let's see the fall of 2019 through the summer. We had monthly task force meetings. We had multiple subcommittee meetings. 20 federal agencies are very much engaged. And of course, we've had a number of stakeholder engagement opportunities. But as we talked about, the first thing we needed to do was to develop a national strategy. And so, as you can imagine, you know, you get all these folks in a room. We had so many really cool ideas about how to do this. And so this took a quite a while to narrow it down, to kind of broaden it, bring it back together. And so following with the legislation, we came up with four pillars. And what we recognized was all those these pillars are distinct. They also really intersect in many ways. And so we it was very important to us in having a visualization to represent the strategy was that they were all connected, and they're all in support of a national strategy. And so you see the equity box there at the bottom. And we there were a number of things that kind of crossed over all four pillars. But what was important for us is that equity become the, the back, the, the basis, the foundation, what this was all built on. So this is how this particular graphic came to be to represent the work that we did. Um, the other thing where we had lots of conversation was language. And, you know, although and this is just a small sampling of the terms that we debated and mean, there was at one point, I didn't know if we were going to come to a consensus on some of these definitions, but what we soon learned in, in bringing all these folks together was that although we were proud that SAMHSa published their paper back in 2014, Defining Trauma as the three E's, and you are all very much aware of this, you know, events, the experience of those events and the long lasting adverse effects of the event in terms of looking at trauma, people had taken that definition and run with it and really interesting ways and ways that really brought some new understanding of of what it means, what trauma means, what trauma means to individuals, what it means to communities. However, there wasn't consensus on those definitions. And so we decided to kind of stick with this, knowing that we would need to expand it. Trauma-informed care the same way best practices generated lots of discussion with our scientifically minded colleagues who were looking at random control trials and other kinds of very hard science, and wanting us to define trauma-informed care in a very narrow way, which actually wasn't going to work for a lot of our communities, that sort of tribes and other kinds of of other interventions. And then, of course, equity. We wanted to make sure that we define that, um, in a, in a very unique way. So you can see these four definitions, but also there are more in the appendix of the operating plan. And then for that other piece that the legislation called for was getting stakeholder input. So we wanted stakeholder input in all of this before we sent the operating plan to Congress. And so thank goodness, the United States Digital Service, they had done some work for the school safety.gov website. If any of you have been on that website, it's very cool. And how they had decided to develop that was through a large stakeholder engagement. And so we reached out to them and they led our work in bringing together front line providers and researchers and congressional staff, all different kinds of folks, to really weigh in on our strategy and what they felt were important things for us to consider. So you'll see here seven themes that came out of that work. And just so you know, how we reached the folks that we interviewed was through a snowball methodology, meaning that we would talk to a couple of people, we would ask them for recommendations, and then we'd go with those, and then we just kind of built on, you know, who each person we interviewed felt it was important for us to talk to. So of the seven themes that came up, the importance of language was came up again. The fact that trauma-informed care happens on a spectrum, not just, you know, is not just one thing, that it's really important that we know what trauma-informed outcomes are and how do we measure them. So we heard from lots of folks who said, you know, I've been trained, my staff have been trained, but how do I know I'm doing better by the work that my agency is doing? How can I measure that? Of course, workforce challenges. And we're really seeing that coming out of the pandemic, training, retention, knowing that we need to not only train mental health providers, but health care providers, other kinds of providers, everybody. I don't know. Do some of you have a question?
00:15:05 No. I think that someone came in off mute, so. Oh, no. I'll. I'll keep my eye on the mute.
00:15:12 No worries at all.
00:15:13 Appreciate the responsiveness, though, Melinda. Yeah.
00:15:16 That's okay, I thought. Whoa.
00:15:18 Can't wait to hear what somebody's thinking. Um, the whole person approach to care and acknowledging the complexity of trauma and how important it is to really see ourselves as, you know, part of a context, part of a community. Um, folks told us, listen to us, listen to what we need in terms of resources, and make sure that those resources, we can tailor them, we can adapt them, and we know how to best adapt them, that you help us understand how to adapt them to our communities. And finally, folks talk to us about how do we collect this kind of information, how do we share it, taking into concern, you know, our privacy issues, and how do we ensure that we can better understand the trauma that's presenting in our community? And so the other thing USGS said to us was, we don't think we can come back with and help you develop a plan that will go for five years, but we recommend that you do this in phases. So as you can see, there's three phases. Phase one is laying the groundwork. Phase two would be delivering value to stakeholders. And then three is figuring out how to sustain that change. And so we have completed almost everything in our operating plan that was built into phase one. So we and then I'm going to share with you what we learned. Phase two and phase three are still to be decided. So in order to do this work. And the other difference with the task forces, we are one of the very, very few interagency work groups in the federal government that actually got an appropriation. And that's key because that has allowed us to do this work. So, as you can see, we received $1 million in FY 22. And then in FY 23 we received 2 million, which we have awarded already. And we are just waiting to see how that work will transpire. So I'm going to take a. A minute here to transition to what we've learned, and we're doing okay on time, I think. Should I pause? Jesse, do you have anything you want to add at this point? Because you were very much involved in kind of setting up the task force.
00:17:52 Now, I appreciate that, Melinda. I think you're doing a great job. And just the only thing that I'll add for folks that have joined since I gave the update, we encourage questions to come in through the chat, but because of the continuing resolution and the Inter-Agency Task force technically having sunset, we can answer the questions live on this call. But I see a lot of wonderful questions. And for those who may have missed me saying it earlier, we will answer those over time, but just can't do so on this call. So just encourage folks to continue to ask those questions. But know, Melinda, I think that you're doing a great job sort of level setting where the task force came from. And I want to make sure that you have the time you need to get into the work, but appreciate the opportunity there.
00:18:37 Thanks. And so what I what we've done is organize the work by pillars. And so you'll that's how I'll share with you what we've learned. But you'll also be able to see the connections between them. And then hopefully you'll see the connections between what we learn from the stakeholders in terms of those themes and how the work rolled out. So under Best Practices, you know, the goal in this pillar is to identify and make recommendations. And so when we sat back and thought about, well, how can we best do that? How can we think about, you know, what is trauma-informed care and and how do we measure it? And how do we even decide what a best practices is? We thought about can we develop a core components framework, a taxonomy, so to speak. So when we think about core components, we think about those pieces of an intervention that lead to meaningful change. So if when you guys have implemented, you know, an intervention, there are certain pieces of that intervention that are key to making the outcome happen. And so we think of those as core components. So what we wanted to do was what are the core components of trauma-informed care. And in doing that, we hoped to develop a shared language that would allow us to communicate and to share data and all those other things that we talked about. So we wanted to develop standardized outcomes and the core components that would describe elements of programs that could conceptually group the concrete outcome. So what actually changed and then what parts of the program actually led to that change? So I'm sure some of you are thinking, wait a minute. If you get way down in the weeds with all of this, there's a lot of idiosyncratic, a lot of unusual ways that programs develop, and some of them are very specific. But what we hope to do is by going way deep into the weeds, we hope that then we could come back out and develop this more universal framework that a lot of folks could use. And so you'll see that we came up with four categories of outcomes. So you see children and youth, mental health and mental and behavioral health outcomes. Um, and then outcomes that came, you know outside of that. So when you think about mental and health and relational well-being, social emotional skills, knowledge and attitudes to support that well-being and then traumatic experience that have occurred after they've participated in the program. So these are things that we found in looking at, I think, over 600 research articles. These are the kinds of things people measure when they implement trauma-informed care. Other things they looked at were child placement, stability. So one thing we do know that if you simply assess for trauma in children who are placed in child welfare, that leads to better placement, stability. And we know that children who stay longer in placements and they don't move around a lot often have better outcomes. We saw better physical health outcomes and better academic functioning in school. Then we also looked at caregiver and family outcomes. So how the caregiver and family was doing what their knowledge and attitudes were about trauma and how secure and stable the family was. Then we also looked at. Literature around organizational and program outcomes. So what was the program quality? What were the behavior management practices. So all of that helped us begin to build the taxonomy. There is still some work that we need to do in this space, but we made such an awesome headway. But these are the outcomes that people look at when they're looking for trauma-informed care. Then shifting to the second pillar, which is our research pillar is what our goal in this pillar was to develop a research agenda. So where does the government need to invest their resources to further what we need to know in order to implement trauma-informed care? So to do that, we had two research questions and you can read them there. So we wanted to know what has been studied or evaluated, and then what has been gained from an analysis of what has been studied. One limitation that occurred in doing this pillar was that we thought we would well, we looked at systematic reviews, meaning those reviews that took a whole bunch of different articles and then review them. So like meta analyzes. And so what was important there was that the quality of those system systematic reviews was not the best. And so we learned that to further this we would need to think about, you know, how to move it along, because what we found was we weren't that happy with the rigor of those systematic reviews. Um, but the four main points we learned in all of that review was that the need to address trauma is increasingly recognized as a very important component of effective social service delivery. We need to better define trauma-informed care. There's too little high quality research on trauma-informed care, and that, um, studies are needed to define, measure, and test intervention mechanisms so that we can better understand those components, those aspects of trauma-informed care that lead or fail to lead to positive outcomes. And I want to just let you know that one of the things that you see when you read the literature in this space is we often report on positive outcomes. You don't see a lot of people talking about what didn't work or what didn't lead to any change. But our search covered all of it because it's very important to know not only what does work, but what doesn't work. So we don't replicate that. Um, but we didn't find any literature that talks about that. Talked about what didn't work. The. Moving to the third pillar was around data. And this is something that Jesse has really been instrumental in helping me think about and expand how I'm thinking about this space. But we identified 23 reporting systems that track the, excuse me, that track grants or formula grants in the federal government. And these fall under four agencies education, justice, Health and Human Services and Housing and Urban Development. And so when you think about what they're tracking, they provide very limited or no opportunity to identify children, youth and families who've experienced trauma. So there was no way for us to know how many people had experienced trauma who were receiving services. And although some grants require that the services provided that are being funded by the grant need to be trauma-informed, there's no way of tracking that, and there's no way of tracking whether or not the services being delivered are actually trauma-informed, other than somebody saying that they are and that performance measure. So thinking about both the process and the outcome measures align with the focus of those individual programs and the individual federal agencies rather than. Any kind of overall goal, so there wasn't any way to track this. And then finally our. Federal coordination pillar. So this is the one that I think about is how do we play better in the sandbox. And so one of the ways I think about this is if you think about the development, the child's development of play. Right. And we see, you know, parallel play before we see collaborative and cooperative play. And so it's my hypothesis that the federal agencies are doing really good at, you know, parallel play. We don't do hardly any collaborative play. And so as you see there, most agencies do not coordinate services for people at risk for or affected by trauma, although many of them are servicing the same families and they know this, um, all federal staff need to be educated on trauma and trauma-informed approaches, including how it's relevant to their daily work. Um, and many of the federal activities that incorporate trauma-informed approaches don't have trauma specific programs. Um, and as you see, that last bullet is what we talked about under data. Um, but the interesting thing that happened is, as the federal government implemented the executive order about employment, integrating equity, and really thinking about equity across the federal space, a lot of folks came to the understanding that to implement a trauma-informed approach also helped them advance racial equity and really to provide support for underserved communities. And so this intersection is really exciting for me to see happen because of that recognition. Um, and so, um, so although it wasn't what we hope to find, we did find some really exciting work in the equity and trauma-informed space. And then finally but very, very important. And a critical piece of this work is our stakeholder engagement. And so we have 3 or 3 days of in-person meetings. The first one was in May of this year, where we invited a group of folks to come in and give us feedback on all that work I talked about, so we could incorporate what they were thinking into the work. And then in July, we had two days of meetings where we presented the work, which you just heard a snapshot of today, and we also heard from exciting, very exciting work happening across the country and what that means to how we can better help folks spread that work at the task force level. And so, you see, there were 25 experts and persons with lived experience in all kinds of great dialog. And so I just have a slide with some of my information there. And Jesse, you can share that, but I'll stop there. And, and we have hardly any time for any, any thoughts. But please collect all those questions and I'll help you answer the ones that we can and come back if, if life changes.
00:30:45 Thanks so much, Melinda. Appreciate your time very, very much. There's wonderful engagement in the chat and we will follow up with you. I know that you have a 230, so don't let us hold you up. But thank you so much for your time today and we'll definitely have you back.
00:31:00 Thank you.
00:31:00 All right.
00:31:02 Appreciate it. I just want to give quick credit to the CTIPP community and the trauma-informed movement that appropriations that was one the Inter-Agency task force that was developed back in 2018. That all happened in no small part because of the advocacy that we were all engaged with in, in as a movement. And so while the continuing resolution didn't contain ongoing and be able to re uplift all elements of the Support act, including the Inter-Agency Task force, we will continue to mobilize around the importance of having this inter-agency task force on trauma-informed care so that the work that Melinda has led and the work that you reported on today can continue as we move into future phases of the project. As we know, trauma-informed care is not an like an end goal. It is. It is an ongoing process and commitment to learning and growth over time. And so we look forward to all of us being able to be a part of that. I think that you could see like the whole thing there. So I'm going to go ahead and go to Presenter View. I think that that's better. I am not positive, but we're doing the best we can. Just just appreciate everyone engaging in the chat there. I want to recognize also very quickly before we move on to neurosciences, 200 people is the most that we've ever had on a CTIPP CAN call and a quick personal reflection. Um, it's been a year since Dan Press passed away now. And you know, he started CTIPP CAN back in 2018. Um, I think in no small part be around the support act. And to think about the number of folks that are on this call, the fact that the federal Inter-Agency Task Force just presented and the work that they are doing, I am just reflecting on how happy I know he would be. Um, and that fills my heart very, very much. So appreciate genuinely everyone who joins these calls, everyone who takes action across the country in a variety of ways as we continue to propel this movement forward. So just wanted to say that the second part of the call, we're going to focus on integrating NEAR science, neuroscience, epigenetics, ACS, and resilience into our trauma-informed advocacy. If you scan this QR code or go to this resource, you'll the link that you see on the screen. There, you'll be able to see a resource that our wonderful and brilliant colleague Whitney Maris wrote and developed that dives deeper into the wisdom that we are of emerging NEAR sciences. Then we will dive into today. Today we are going to skim the surface a little bit more and get into how we can leverage the framework through an advocacy, as we continue to promote advocacy to promote trauma-informed policies and practices. But you can find that resource. Share it widely. As with all of Whitney's resources, they are very, very well done. Before I talk any further, I want to pass it over to my other wonderful colleague, Laura Braden, to discuss why computing communicating NEAR science is so important. Laura.
00:34:39 Thanks, Jesse. Can you go to the next slide?
00:34:41 You got it.
00:34:42 Yeah. So just real quick and I'll pass it back to Jesse. But yeah, integrating NEAR science concepts and approaches into your advocacy and communications is so important because it really does provide a foundational credibility to everything that we're advocating for when it comes to policy making and transformational systems change. And so here's just a list of sort of how that reinforces the work that we do. And we have created a free toolkit that's on the same link that's in the chat. And the QR code takes you to the same place. We've created a free toolkit of some social media, graphics and infographics that we encourage everyone to use with their various audiences and networks. Because I think the more that we just educate folks on these, on these principles and concepts and really interesting and innovative research, it just helps. It helps just sort of buttress and build all of the other things that were that we're working towards. Jesse, back to you.
00:35:41 Thanks so much, Laura. So as it was sort of illustrated when Melinda was talking, like Laura just said, neuroscience can help us frame and shape our understanding across micro, macro, primordial levels and supports a contextual understanding of trauma-informed care. As trauma-informed advocates, we want to frame trauma as part of the human experience while recognizing disproportionality across society. And so we will dive into a quick overview of neuroscience. I just want to start by acknowledging that I am no expert. I am a passionate advocate, and the neuroscience framework is really helpful as a layperson to be able to communicate the, the, the complexity of trauma and also what we are learning and be able to get to the importance of systemic approaches. So neuroscience helps us understand brain states and how trauma, stress and adversity impact executive functioning and the power of regulation through a developmental neuroscience lens, as well as neuroplasticity, neurodiversity, and so many other elements. And in addition to being able to build capacities and resources and skills to help ourselves as individuals regulate during stressful times, we know that relationships are the greatest buffer to stress that we have. I believe that that's a Dr. Bruce Perry quote, and one of our board members and a founder of C, Diane Wagon Holes, has a quote that health healing happens in the context of healthy relationships over time. So we cannot just put the burden and onus of individuals or of regulation at the individual level. We need to be able to promote healthy relationships. Going a little bit deeper into neuroscience, this image from Dr. Ariel Schwartz. The brain develops from the bottom up and the inside out, which helps us understand why investments in early childhood and and supports before someone is even born are so critical because those experiences shape how our brain develops over time. The brainstem and midbrain is where, you know, just simple regulation, the processes that we don't need to think about, keep that, keep us alive occur. And when we go into fight, flight, freeze, fawn feint, that is essentially stresses pushing us into that deeper brain state. On top of that is the limbic system, emotions, memory, where relationships are developed more of that mammalian brain as we have continued to evolve. And then above that is the neocortex, prefrontal cortex, which is where executive thinking, abstract thought, long term thinking occurs. That is where we want for people to be able to be as often as possible. But we also need to recognize the ways in which stress and adversity push us toward those deeper brain states. And Dr. Bruce Perry has a tool called the three R's, which is regulate, relate, and reason. So frequently when we see someone who's dysregulated, they are met with people trying to reason with them, and that is not the part of their brain that they are in. We need to recognize that first. We need to help people be able to regulate and taking a deep breath and parallel processing that with them, just pausing, being able to take that deep breath, stay regulated ourselves and being able to walk with that person. And then we get into the relational phase where there's a great John Wooden quote that goes something along the lines of people don't care how much you know until they know how much you care. And so being able to develop those relational buffers to stress that allows for us to get to those conversations where we can reason with people, but we can't just jump right there too frequently when we try to reason with people who are in a dysregulated state, we just perpetuate further dysregulation. And the answer to the questions that I'm seeing in the chat, sorry, I'm trying to keep an eye on it. Yes, we will make these slides available. The E in epigenetics helps explain how nature and nurture not just impact us, but also future generations, as well as how past generations the environments and experiences that our ancestors have had impact us. This suggests that by creating a healthier society, we will have positive ripple effects long into the future. Our environments and experiences impact our gene expression. So DNA is our DNA is not our destiny. Epigenetics helps describe how the body's genes are expressed in depth to behaviors. Variances in environments across the lifespan. And you can see that there are a variety of environmental factors as well as experiences, things that we are able to control, especially through relationships that help to support ongoing epigenetic changes. And again, that promotes the belief that we can work toward a healthier society that will have cascading impacts. The adverse childhood experiences. The field of Aces has done a tremendous amount to promote the importance of trauma-informed care. Those early Ace studies back in the 90s that came out in a study, since that showed how early childhood adversity leads to at a macro social level, physical, social, behavioral health outcomes, and the ways in which developmental adversity and the progression of adversity over the lifespan shape our lives is so critical. We also have learned a lot about positive childhood experiences, isn't that we can create systematic buffers that help to reduce and mitigate the impact of adverse childhood experiences. We do need to recognize that while when done properly, the Ace questionnaire can open up valuable conversation and be used to create conditions of empowerment, a screening, according to the research and what science is currently telling us is an inappropriate use of the science. Aces are not predictive at an individual level. They are a powerful macro social tool. We will continue to look at the science and continue to learn about the best ways to use this infrastructure. But Aces don't necessarily determine the length, the consistency, the proximity of adverse childhood experiences. Nor do they measure the positive childhood experiences and other factors resiliency factors that can buffer against the stress of that adversity. So rather than just merely counting and measuring aces, which burford's and other factors can do at a population level, we should use this information about ACEs PACEsscience to promote universal precaution from a public health and preventative lens, rather than just the clinical treatment approach that is widely promoted today. We can do more to promote well-being of children, adults, families and communities. And so we continue to do work. And there is more work within the Aces field, even that helps us better describe the infinite complexities of trauma. And the multiple realms of Aces are a beautiful way that this is done. And so this is from Smart Start, a great partner of ours down in North Carolina. They do wonderful work. In the middle, you'll see the pair of aces. Tree that Dr. Wendy Ellis, out of the center for Community Resilience developed which the tree is adverse Childhood experiences. And she argued that we need to recognize the ways in which the soil, the communities, the adverse community environments that we are raised in helps to shape the development in life of that tree. And then, as the realms of Aces have continued to manifest, we have seen also the atrocious cultural experiences and the adverse climate experiences that create a more complex and nuanced view of how trauma impacts us across the lifespan. And again, we know that positive childhood experiences serve as an incredible buffer and create hope and strategies to develop universal precautions that allow for us to promote well-being across the lifespan. Um, we want to prevent as many ACEs as possible. We want to promote as many positive childhood experiences as possible, and we want to recognize how the progression of adversity across the lifespan impacts us and care for people across all communities so that every individual, family and community has the opportunity and supports that they need to thrive, which is the Tips mission. The last letter of the acronym in NEAR is resilience and resilience brings hope as we recognize the capacities to build strength through the stresses and adversities that we face. Again, the importance of relational buffers. We cannot expect to just be resilient on our own. Having communities of support, having infrastructures that allow for us to emerge more healthily is so important. We don't. And we also are learning some of the and are recognizing some of the limitations of the term resilience. Not everybody loves it from a definitional perspective, resilience really means to be able to bounce back. And we don't just want to prepare people to be able to bounce back into oppressive systems, into systems that perpetuate stress and adversity. We want to transform society as we move through the adversity and stress that we currently face. So that way we are in a healthier society and community all around. And that is where terms like transformational resilience are coming to life. There are domains of resilience at an individual level that are important to recognize, and there are also domains of resilience at a community level that are important to recognize. Again, as we build capacity to support well-being today, as well as as we move toward future generations. So again, I know that was just a very quick landscape of NEAR science. I know I am going very fast. I invite and Laura, if you're able to. Put into the chat the resource that Whitney developed that goes much deeper because of time had to skirt over NEAR sciences. But that is an initial understanding of how NEAR science is framed and can help us to contextualize trauma and trauma-informed approaches. And so now, as we move into how we can put NEAR science into our advocacy practice, we can look at our own histories through a NEAR science framework to make the case for trauma-informed policy and practice. And then and I went a little bit quickly, this story of self story of a story of now framework is by Marshall Ganz. And we at CTIPP have used this a number of times. If you've seen the advocacy series that Whitney developed, you'll see this as a worksheet. And we will go into at about the 3:00 hour, a worksheet to put our own experiences for advocacy into this story of self, story of a story of now framework through a NEAR science lens. So we look at the story of ourselves, and then the story of us broadens to the current state of our society and the prevalence of trauma and the universality of aspects, while also recognizing differentiability that call for the need for new approaches to promote well-being. And then we get to the story of now. It shows the opportunities to transform our society from the current status quo, because we know that there are so many things to do, and there is also so much that we still need to learn. Like Melinda was saying earlier, both of these call for increased investments and action, and the time to do that is now the time it's been now. The time has been now for some time, and we will continue to build this movement to be able to promote trauma-informed practices. So very quickly, my own story in the Story of self, I'll take that off for a second and work to be vulnerable here. But when I was 13, I had an eating disorder. I choked on a piece of food and for four months of my life at that point, whenever food was near my mouth, I would I would have flashbacks and vicious anxiety attacks. My midbrain was chronically activated. I wasn't able to engage well in long term thought, because I was in a survival mode where I was essentially in fight, flight, freeze constantly, and unable to emerge beyond that because I was so afraid of my own mortality, really. And so I would switch between hypervigilance and dissociation as I navigated through each day. I've always wondered, because my ancestors immigrated from Eastern Europe to flee antisemitism at the beginning of the 20th century, and my grandparents lived through the Great Depression. If their own food insecurity to some degree impacted my own anxiety, that further perpetuated the stress of not eating and my starving myself that I experienced through this time of my life. Fortunately, I had people around me who supported me through this time. I had family, friends, teachers, coaches, camp counselors that helped me get through this time. And it's important to recognize that I came from a family that could access and afford therapy medications. Because I couldn't eat. I had to drink in shore every day just to get the caloric intake that I need. And all of that is not promised. We need to make those opportunities and supports accessible for all people. I was so fortunate to have that family and of course, most importantly, people around me loved me as best as they could. While this was obviously a traumatic experience, it wouldn't be considered a traditional ace. We need to recognize the infinite complexity of trauma and pick up on signs to create universal precautions that allow for all people to thrive. Being forced in therapy at times to relive the choking incident over and over again, retraumatized me and my healing came as much or more from sports, from being in community, than did the traditional therapeutic context. Those sports, for me it was baseball, gave me hope and something to live for each day. Despite my state of constant terror, it gave me an escape that let me navigate those really difficult days. And as I started to eat again and healed, I learned to never take a day for granted. This led me to love deeper, to try new things and to work the best that I could each day. I stopped waiting for some day to come and took better advantage of the opportunities each day presented to me, which gives hope to us through the construct of post-traumatic growth and post-traumatic wisdom that can be so important. My healing, though, was not linear. I then when I was 15, about two years later, my best friend passed away in a plane crash. And again, I think that those epigenetic factors, the stresses, the trauma response that I had interpreted myself led me to more quickly lead go to a traumatized brain. And I struggled again in school. I was placed on I was placed on medications because the school environment didn't have the trauma-informed or the awareness to understand that I was going through complex grief. The question that was never asked was, when you're 15 and you've been best friends with someone since you were three, every day that you're in school with, you are reminded of that person. And so I was essentially reminded of Doug and the bigger questions about life that I was navigating at that time felt so much more important to me than did geometry, than did chemistry, and that is where I was at. Fast forward to the beginning of my professional career, and we had I worked in a Philadelphia public high school, and I had incredible. I got the privilege to work with incredibly smart, talented students who had so much promise but experienced at a at a wide scale, so much more stress and adversity than I had with far fewer supports and resources. And that is where I saw the need for us to create more systemic approaches to allowing everybody to reach their full potential. We we need to realize that stress and adversity create predictable outcomes, and that people are put into that suffocation, whether literally or metaphorically, that place where they are just working to survive. And we do not have a society that enables all people to thrive in our world today. We have a tremendous number of negative outcomes. There is a state of youth mental health emergency that has been in place for the last two years. It has been going on for longer, but the rates have just exacerbated so badly. Substance misuse, the opioid epidemic and other overdose deaths are continuing to rise in cascade. Violence rates are cascading. We have more and more burnout as well. And in addition to that, we are living in a world that has more extreme weather events, more wide traumatic moments. We didn't acknowledge it on this call, which feels like a missed opportunity. I apologize, but obviously with the ongoing global tensions, there is increased stress and adversity that impact all of us differently. And at the same time, we have a government and systems that are compiling more and more debt and don't function as well as they could. And that is in no small part because we engage in patchwork policies. We have siloed thinking that addresses. Is the various petals of this endemic, but so infrequently works to address the root cause that drives so many negative outcomes throughout our society, which is why we wanted to share the work that Melinda has done. And hopefully we are able to reinstate the Trauma-informed Care Task Force. So that way it can continue to do this work of coordinating and aligning within the federal government. And we see more states and community and local and tribal governments do this as well, because we know that while so frequently the burden and onus of trauma and resilience is placed at the individual level, trauma impacts systems and communities as well. The siloing and fragmentation that we see across our society is indicative of systemic trauma, and so frequently we fail to recognize how traumatized systems perpetuate stress and adversity disproportionately on marginalized communities that then create predictable outcomes at an individual, family, and community level throughout generations. But we know that policy can create conditions that allow for individuals, families, and communities to truly thrive. We have a public health framework where we can address more through a systems level preventative approaches that reduce the amount of preventable stress and adversity that currently perpetuates throughout our society. Again, part of being alive is that trauma will occur, but so much of the chronic stress, the overwhelming adversity that comes through our society is truly preventable. And we can do more to systems level than right now. We currently have a little bit of a treatment first approach, and that is burdening and fragmenting the treatment and intervention systems that we currently have. And we can't keep up with the need. We need to do more around a systems level approach. And this is not a fantasy. We have seen successful implementation and integration of these ideas into successful policy that has led to tremendous outcomes over within communities and for many, many people, one of the best researched and widest literature. Places that we see evidence of this is from the work of the Washington State Family Policy Council from 1994 to 2011, which is now called Self Healing Communities. You can find more about the Self Healing Communities model. Or if you were a Google that there's a Robert Wood Johnson Foundation report. Whitney also a few months ago wrote a guide to trauma-informed community change that looks at a lot of the key elements of self healing communities and other frameworks that we have seen be successful. But by engaging in leadership expansion and developing agency and empowerment within communities and across all community members, building skills and capacities and a shared language and understanding of how stress and adversity impact the human mind, body and spirit, as well as the regulation skills necessary for people with different perspectives to sit down together to address the deep needs that their communities face, with a focus on layering, learning over time, and sustained funding that allowed for them to not just have to work toward those individualistic outcomes, but allowed for us to address those deeper needs and the trauma that existed within communities, and a lot of those more complex needs over time. By layering learning, we created tremendous results over time and IT centered community. On the right, you can see some of those outcomes where in one county, nine youth suicide and suicide attempts over the course of a decade reduced by 98%. At the same time you saw reductions in teen pregnancy reductions in high school dropout rates, you saw reductions in juvenile justice system involvement and so many other negative outcomes. And as a result. If my computer will cooperate. The state also recognized a tremendous number of savings. The state in cost avoidance, saved over $1.1 billion, and this was a 35 x return on investment. And so this would have allowed for sustainability and scale of these initiatives. And we can reengage in this. And if we had gotten to the 20 2530 year point or the 40 5060 year point, we would have expected for the return on investment to be exponential as intergenerational transmission reduced and the outcomes that it perpetuated continued to grow upon themselves, we could have sustained and scaled those initiatives as well as worked in various other areas. But unfortunately, that came to an end after 17 years in 2011. This slide is from Bob Doppel. We did a briefing on the Community Mental Wellness and Resilience Act, which I'll discuss more in a second. But the ability within communities to create a well coordinated and decentralized approach to building cross-sector community coalitions to recreate the power of creating conditions of empowerment and safety, and developing agency across the community. For people to own their own well-being is possible, and we have seen it work in many communities. And so that is why the campaign for Trauma-informed Policy and Practice, our partners, and all of you as advocates, continue to promote and engage in advocacy opportunities to promote cross-sector community coalitions. There are two opportunities to engage in this right now. The first one is arise from Trauma Act, which creates a new grant program to fund cross-sector community coalitions that are working to address ACEs and prevent trauma. There are also other elements, such as a grant program to reduce hospital readmission rates, trained frontline service providers, and also in this Congress bill re uplift elements of the 2023 Support Act, like the Inter-Agency Task Force on Trauma-informed Care, the Community Mental Wellness and Resilience Act, the CMS Ora would help for communities to proactively develop cross-sector community coalitions to better address the needs that emerge because of cascading extreme weather events, they are becoming more predictable as well as other disasters, unfortunately. And so the reactionary approach of coming in only when disaster occurs is not going to be as efficient or as effective as building local capacity to be able to respond effectively if and when widely traumatizing events do come to pass. Bob, who has been a real leader and the leader to promoting this to many of the members of Congress who have become the congressional leaders around the CMS, he talks about the need to build population level resilience in the face of cascading disasters. And so that is what the CMS is working to promote. You can scan either of those QR codes, and I'll put a link in the chat, um, on that you can take action, share resources to continue to get more spread for these two bills. And we will do other work, such as continuing to try and re uplift and re in a missing a word there. But to make sure that the Trauma-informed Care Task force, the Inter-Agency Task Force, continues moving forward as well. So I just spoke a lot. I know that I went really quickly. I was trying to keep up with the chat while also speaking and again, encourage folks to go into that NEAR science resource. But for now, we're also going to go into our own little workshop session for about 7 minutes or 8 minutes to sort of jot down some notes for those who want to engage with how we can use the story of self, story of a story of now, and also a NEAR science framing in our own advocacy. And so if you scan this document and again, I'll put the link there, I'll put the public narrative planning tool. In the chat right now as well. You can get a document and take some notes on how we can integrate neuroscience into story of self, story of our story of now and then we will come back together. And for those who would want, we're going to go into dyads and triads to just share some initial thoughts for about ten minutes. I know that we don't have a ton of time, um, but want to make sure that people who want to have the opportunity to network and share some initial ideas. And so I'm going to stop talking and take a breath, and I'll play two songs that last about eight minutes, and then after those songs will come back together, we'll break out into dyads and triads, and then we will finish up the call after that. So again, I will put the link back in the chat. If you have any questions, feel free to discuss there. But if you have those links up, please feel free to jot down notes. And yeah, we look forward to coming back together in a few minutes here.
01:05:02 I love it, Jesse. Getting better. Innovation. Growing wild. Beautiful, beautiful.
01:05:11 Thank you. James.
01:05:31 I. It's a little tense. Oh, and just like the river I've been running. Ever since. It's been a long. Long time coming. But. Change goal call. Oh, yes it will. It's been. But I'm afraid to die. I don't know what's up there. The sky. It's been a long. Time coming, but I love. Changed all the. Oh, yes. Apple. Two. So. Somebody keep telling me, though? It's been a long, a long time coming, but no. She got her. Oh, yes. We. That I go to my. I say, brother, help me please. Or he was. Wasn't. Not in. Fact. I could all. Oh. Now. Thank you sir. Yeah, it's been a long. Long time coming, but no. Okay.
01:08:09 I do not want to speak over Sam Cooke and I feel badly for doing so. But I see two questions in the chat, which I appreciate. We will put folks into breakouts after one more song that's going to last about three minutes. And for those who are unclear on what you're doing, I appreciate that and apologize very much. I will put the link to the worksheet back in, but just jotting down some notes on how we can integrate.
01:08:36 That will.
01:08:37 Restart that song in a second. How we can integrate NEAR sciences into the story of self, story of us, story of now framework. As we continue to promote advocacy for trauma-informed policies and practices, is what we're doing for the next three minutes or so, and then we'll go into breakout rooms.
01:08:56 Never thought there could be so much doubt. All the blaming, hate, the self hurt and the heartbreak. This that kept holding me down and I. Was my own worst enemy. If I. Found my way through it all I see I'm just delighted and ready for many. With that I stand, hold my heart in the palm of my hand. And I live my life like nobody else can stand. And I'm here. The. I am enough for the life that I'm hurt and for my older dreams. Yeah. Cause everything from my soul to my truck is exactly what it's supposed to be. You know that's something. I'm gonna remind myself. Yeah. You can stand around my. Neck. Nobody. I am in love. Justice. I feel ready to. Put my heart in the palm of my hand. And out of their mind like nobody else in. The lives of me got the better of me. Never thought there could be so much doubt.
01:11:58 Love those songs. Laura put in a link to our Spotify channel that if you have any other songs that you would like to suggest, we are happy to add. I'm going to go ahead and open up the breakout rooms in a second. But before I do just want to share very quickly some community agreements. So that way we continue to create conditions of empowerment and safety for everybody that participates in these calls. All of you are enough to the call or to the song that was just playing. And we want to make sure that your diverse, lived experience and wisdom are valued and cherished in these calls, while also creating the opportunities to connect with others, doing incredible work across the country so everybody has the right to participate while also having a right to pass. We want to demonstrate mutual respect throughout these rooms, and we want to engage in curiosity and compassion rather than judgment. And shame. In modeling the model, we need to recognize that many of us have our own trauma experiences and have different lived experiences. And so we see the world through different lenses and want to honor that. During the ten minutes that we're in our breakout rooms together, feel we want to encourage folks to engage in ongoing self reflection and self care and make sure that in these rooms we are speaking from our own experience, and when we come back from these calls, we don't want to speak for other people's stories. I've heard a wonderful example saying of the story, stay and the lessons leave because we want to take what we learn from these calls, certainly while also holding on to confidentiality. We want to take space and also make space. We want for everybody to be seen and valued and heard and cared for during these calls, and to the best of our ability. Use inclusive language that is accessible to varying levels of knowledge and familiarity. And so I have a breakout rooms pulled up. And also you can find more in our guide to trauma-informed conversations and meetings that is on our website. If you like those community agreements and to find out more. Looking at the breakout rooms, it looks like there's a few rooms that I will have to combine because some folks dropped off since I created the breakout rooms, but I will do that. We'll open up the rooms. I hope that you all engage in meaningful and wonderful conversation with one another. Feel free to make the conversation your own, and share and reflect on the ways that we can use this framework for advocacy and anything else that struck you from the resource or the presentation today. And we will see you all back here in about ten minutes. And so thank you all for staying with us. We're really excited to close out when we come back together and learn from all that. You discuss opening the rooms now. We'll. Recording back in progress. Appreciate the process and the ongoing learning and growth, and hopefully wonderful connections that were developed in the breakout rooms. For anybody that faced the technical difficulties of my moderate zoom literacy, I apologize, but hope that at the time that we were able to spend together was good. Zero pressure to do so, but are there any initial thoughts or wonderment or curiosities or learnings that came out of your time together? Just some quick. I know that we're coming up to the half hour, but just some quick things that we learned or discussed if anybody wants to.
01:15:53 What do I do?
01:15:55 Go ahead, James, start us off.
01:15:57 Okay. It seems like at first I was being punished. I was in a room all by myself. But then came a person that needed my. Specialty expertise. So it worked out fine. Thank you. And it was what it was. What I can help her with and what. She, you know, need it at the time. So God's will be done.
01:16:32 I'm so glad that you were able to be there, James. And that was not intentional punishment, that is. That is a perfect example of my zoom. Illiteracy overtook those breakout rooms for that session. But thank you for sharing, James. Amanda, I see your hand up.
01:16:46 Yeah. I think one of the things that Katie and I talked about was that came up was this idea of like, fragile neighborhoods and even, like working in that, like meso level of like, okay, we're working in our community. Maybe we are working with individuals, but also like, what does that look like? And how? For me, I work on a federal level. So I go to Washington, D.C. to advocate for all these things. But when I come back home, I don't engage with my neighbors around me. And so how can I live out some of those things that I'm advocating for on a federal level in my own community?
01:17:25 Thank you so much for sharing that, Amanda. It can be difficult at times. We only have so much capacity so to do both the policy work and the practice. But it's so important as we work to build community in those connections, in the various locus of control that we hold. Thank you for sharing. Are there any other thoughts that emerged?
01:17:49 I'll share. Um, we got to know each other a little bit. We didn't have very much time. I'll share what I talked about and my, my, the biggest thought I had is about peer support and about if we evangelize our own stories. And b and make this the, you know, allow somebody to listen to us and to say, oh, that, you know, she's still standing there and she hadn't, you know, she didn't run away and she's not ashamed. And, you know, and allow other people to see those examples, I think because that's kind of like the spider web that can, you know, one of the. The easiest ways to be able to is just having our selves tell our own stories and be open about our own issues.
01:18:47 Thank you for sharing that.
01:18:48 Can I add, Jesse? I was with Marilyn and then we spoke about providing those safe spaces for us to share our stories and to allow others to share their stories, too. I come from early childhood background, and I shared with Marilyn that having us recognized as educators what we come with into our classrooms, and how we then support children who come with our own stories of Aces or trauma, and how trauma inform is really important. When we were building foundations for children as they enter the k 12 world. So we spoke a little bit about that, and the safe space was, I think, what resonated to me, providing that safe space for us to share our stories that then allow other people to share their stories too. And it might be the first time that they ever share that story and how amazing it is to have somebody with be lifted like that. Yeah.
01:19:51 That sounds like it was an incredible conversation. I know that you both ran into my zoom illiteracy as well, so I'm sorry that you didn't have more time, but it sounds like the time you had was for wonderful conversation. Linda, I see your hand.
01:20:04 Hi. Yes. So I wanted to share when I was doing the worksheet. You know, the main struggle that comes up for me, I'm in health care and I'm a trauma-informed care manager, and I do have a 40 hour curriculum to train teammates. However, trauma-informed care has become a buzzword where folks that don't have any background in it within the medical system think that it's a training program. And because we don't have a national standardized protocol for health care, it is often very much diminished, and it takes a lot of effort and work to turn their understanding around. And I hope in the future, somewhere from a legislative standpoint or, you know, health and human services standpoint, there are more concrete guidelines that can help, you know, health care executive leaders, physicians understand that this is more than just a checkbox and that there's something there that we can follow and that it is financially profitable because there's so much kickback on. They only have so many minutes with a patient, and they feel adding one more thing would minimize, you know, finances or we create financial loss. So we are doing our own research in our health care system to help demonstrate that that's not the case. And I appreciate the slides earlier that showed the financial components of it.
01:21:43 Thank you so much for sharing that Lanita. I just shared in the chat if it's helpful last month. See tip can call Whitney had developed a really comprehensive report on trauma-informed women's health care that has a lot of general health care pointers as well. So if there's anything from that resource and then don't want to dominate the floor here, but I'll also put a workforce or a trauma-informed workplace toolkit that Whitney developed earlier this year. If those can be helpful as you continue to do your research and try to make these cases. I'll put that in the chat. Godwin, I saw your hand for a second, so no, no pressure. I just want to make sure that I'm not ignoring you.
01:22:26 Okay. Real quick. It's interesting that you put me with Ms.. Hoagland from Maui, and we're both from Hawaii, but we're talking about I just want to suggest this to everyone. There's always new learnings, and we hear about trauma inform, and we have all the experts talk to us about trauma-informed. But I went to Maui because of the disaster of the fire three weeks after the fire and in my whole life experience with children and all that. But it was such a huge impact and I learned so much at and was highly suggest if you have any unfortunate disasters, get over there and volunteer because you learn so much by hands on and got frustrated and got emotional. But you realize the importance of our work. We're here for that. We have to spread this and really understand that people are really hurting the people that have siblings that died or people that died in the fire. You're right in front of them and you can see the toxic stress that they're going through. But it was so, so a great experience. Unfortunately, throughout my life, I'm going to remember this. I was there for a week, but just the devastation and the hurt that's going on in there. So highly suggest that whenever you can get out there and help the community and. Find out for yourself, your knowledge and your compassion about why Jesse is doing this. Why do we meet monthly and the importance of understanding trauma and resilience? So thank you.
01:24:08 Thank you for sharing, Godwin. That's that's incredible. And definitely one of those lifelong experiences. But thank you for creating those relational buffers and showing up for people in a time of need. Mary Lynn, I just want to quickly recognize I just saw the time. If you need to go, please feel free. But we'll stay on for a while. So, Marilyn, I see your hand.
01:24:31 So one of the things that I'm very excited about in Frederick County, Maryland, is our local Health Improvement Board has put together a mental health workgroup. And from that we are putting together through an anti stigma art campaign, which we don't like that title, we're going to change it. But a ten month program focusing on various activities that will take place and raising the conversation through the arts and, you know, special events and talking to businesses and churches and just beginning to allow the spread of the you know, we are talking about trauma. We are talking about it's okay to come forward about it, making it like giving the we're trying to give our community permission to speak and permission to understand through the work that we will be doing, and we will be doing some storytelling of our own situations and things. But it's a ten month program and we have funding, and we're just really excited to be able to launch this.
01:25:59 That's exciting. Thank you for sharing. I saw a lot of smiles and nods as you were sharing what that program is going to be about. I think that we're all excited to hear how that goes. Are there any final thoughts and reflections? Appreciate all of you staying on.
01:26:17 I just want to thank you. This is such a gift. You know, I literally try never to miss any of these to be with like minded people. Um, Amanda was a gift today. Like, literally. I had just recalled 18 years ago volunteering in Houston for Hurricane Katrina relief, and it hadn't even. You know, that's such a core thing of why I'm driven to do this that you just reminded me of. So thank you for your words and everybody's dedication to this.
01:26:49 Thank you so much for sharing, Katie. And we love having you. We love these calls and getting to be with all of you each month. We hope as our capacity grows, we can do more of it as well. It's so important for us for you, for for everyone. Right? So thank you for sharing, Adrian.
01:27:10 HRC. Yeah, I love these conversations and presentations to. And I just put into the chat there just you know, I know we've talked about this for, for years since we've worked on various projects together, but. I just have to keep. Keep going on my soapbox about, you know, just continuing to make sure that our budgets, whether it's a federal budget or a state budget or even from a private foundation budget, that it is always removing barriers for participation, especially with populations experiencing multiple adversities. And so, you know, that includes the, you know, food and childcare and transportation assistance and, and even compensation for while they are participating. Because if they're juggling multiple jobs and you're wanting them to participate, they're losing money to put food on the table for their family. And so what we have found with some of the, you know, various funding streams is that. It. That type of community engagement is not allowed or there are restrictions. And so what we have found is as long as you're tying it with quality improvement feedback that you are as they are participating, they are helping to write that code, design that, that feedback into making their communities better then that justifies the payment and the expenses of removing barriers for participation. So just encouraging everyone to keep including that in your budgets and and think as as we become more trauma-informed that that will be more clearly stated in our grant applications. And so that's always exciting to see that movement increase. So thank you. That's my $0.02.
01:29:12 Thank you for that Adrian. We we love that soapbox. Like I always say we see the truth. It's easy to say words and pay lip service. We see values within a budget. So if we want to honor and uplift and value diverse lived experience, then we need to be able to build capacity around that. It's not possible for for everyone to engage when that is and other supports aren't there. So thank you for that very important soapbox. Your your words. I would just call it very important advocacy. Note that we will continue to uplift and advocate for. In closing, want to share again for folks who didn't get it, the guide and graphics around NEAR sciences that were shared. And so those were shared like a dozen times. But one, they are truly wonderful. Whitney put a ton of effort. Laura put a ton of effort into the social media graphics to develop and continue to promote the importance of neurosciences, and next month we will be talking about advocating for trauma-informed federal legislation and legislation across multiple levels. Because of our capacity, our focus is predominantly on the federal level. You can register at that sign or at that link. And the zoom link is the same for every one of these calls. So you can also just use the same zoom link. It's always the third Wednesday of the month from 2 to 330 eastern time. And we always appreciate your feedback. I know that this call went long, but if you have any feedback thoughts about how we can improve these calls moving forward, please don't hesitate to share. Next month, we'll be sure to include more time for connection and reflection. I know that this month got a little bit jammed, but just a lot of good learning and information sharing. But just we always are open to, again, that commitment to an ongoing process of learning and growth. We will not get everything perfect, but we want to continue to work toward better. And so with that, I will stop the recording.