Building Bridges, Defining Metrics

Nova Institute for Health (formerly The Institute for Integrative Health) convened a forum at its headquarters February 3-4, 2016, to envision a new, integrative approach to creating and evaluating community-based programs that improve the health of urban and disadvantaged youth.

The Many Influences on Youth Health and Wellness are Dynamically Linked

Research by George Kaplan, PhD, one of the Institute’s esteemed Scholars, and others has led to a deeper understanding of the complex, interconnected influences on health equity and wellness. School- and community-based programs designed to improve youth health can also impact young people in many ways, with outcomes that connect to or spill over into multiple community and population health interests. This reflects the dynamic link between health influences where an intervention targeting one element may also affect several others. For example, interventions focused on physical or mental health may also help develop resilience and habits that improve functioning for leading productive and healthy lives.

A New, Integrative Approach is Needed

The successful design, implementation and evaluation of community-based programs to improve youth health must take into consideration the complex dynamics of targeting behavioral change in an individual within the context of their community. To achieve this, a new approach must:
  • Build bridges across a variety of sectors to strengthen program design and evaluation;
  • Address the challenges of outcome measurement in real-world, community settings; and
  • Balance diverse stakeholder priorities and expectations.

Leaders Gathered to Envision a Future of Health for Youth

Forty professionals from across the country, including researchers, funders, educators, government leaders, and community program experts, gathered at the Institute’s headquarters in Baltimore for the Building Bridges, Defining Metric forum. During two days of interactive sessions, they openly exchanged ideas and views and developed recommendations for creating robust community-based programs to improve youth health that integrate diverse stakeholder priorities and use appropriate metrics for evaluating outcomes in real-world settings.

Report Published

The Nova Institute (formerly the Institute for Integrative Health) produced a report capturing the ideas and strategies shared at the Building Bridges, Defining Metrics forum. Download the “Building Bridges, Defining Metrics” forum report.
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Steering Committee

  • George Kaplan, PhD
  • Brian Berman, MD
  • Susan Hartnoll Berman
  • Kirsten Aschbacher, PhD
  • Wendy Bohdel
  • Brandin Bowden, MS
  • Christopher D’Adamo, PhD
  • Alicia Diehl
  • Diane Hannemann, PhD
  • Kurt Stange, MD, PhD
  • Claudia Witt, MD, MBA
  • Steven H. Woolf, MD, MPH



Developing safety, persistence, trust

Healing is facilitated through safety, persistence, and trust.

  • Persistence: “People did not simply progress through this sequence and experience healing. The healing journey was a recursive, back and forth process. They found helpers, used the skills/resources that those helpers provided, found other helpers that provided more resources and used those skills and resources. As this process continued, people experienced a gradual amelioration of their suffering. Although many despaired at times, all demonstrated the quality of persistence—they refused to give up.”
  • Safety & Trust: “To connect to helpers, it was essential for people to feel safe in those relationships and able to trust that the person would be a helper and not a barrier to healing. Persons whose wounds included a violation of trust were especially careful about testing the safety of new relationships.”

Acquiring Resources

Resources support us as we heal. They include reframing, responsibility, and positivity. “Making connections enabled participants to acquire and refine resources and skills that were essential in their healing journey. People also brought their own personal strengths to the journey.”

  • Reframing: “A particularly important skill was the ability to reframe—that is to look at suffering through a different lens.” This does NOT mean minimizing trauma or pain, but rather it often means the opposite: understanding what happened was wrong, unfair, or uncontrollable and that we are not to blame for it.
    • “I think I kept trying to convince him I was crazy. And he kept saying, ‘No, you’re not crazy.’ […] You wouldn’t necessarily say a Vietnam Vet was crazy. You’d say they are responding like you’d expect to extraordinary circumstances.”
    • “I’m not the only one who have [sic] this problem. A lots, millions of people, you know. […] They don’t have nothing to do with that. I guess I have to live.”
  • Responsibility: While we don’t have control over what happened to us, we are the only ones who can help ourselves heal. “A third essential resource that people acquired or refined was the ability to take an appropriate amount of responsibility for their healing journeys. They participated actively in the process of healing. Once again, some participants already had developed this skill, and some acquired or refined it from their helpers.”
    “You need a lot of energy and a lot of work … it takes a lot of work. It doesn’t just happen. It’s not like a magic wand.” This patient understood that they had to actively participate in the healing process.
  • Positivity: “Another resource that people acquired or refined during their healing journey was choose to be positive—that is to have some optimism about their situation.” People have varying predispositions to positivity. In the study, positivity was important in helping people heal. This doesn’t mean a toxic positivity, but rather simply finding some good in life and feeling hopeful about our situations.

Helping Relationships

“Connection to others was an essential part of all the healing journeys.” Humans are social creatures, and even the most introverted of us need close relationships. Friends and family add meaning and value to life and help support us, in good times and bad. When we experience relational trauma, relationships can feel scary, but reestablishing safety and trust in relationships is where the healing happens. (To be clear, we do not mean reestablishing safety and trust with abusers, but rather finding other healing relationships.) “When safety and trust had been established, people were able to connect with helpers. The nature of the behaviours of helpers that fostered healing ranged from small acts of kindness to unconditional love.”

  • “Moving from being wounded, through suffering to healing, is possible. It is facilitated by developing safe, trusting relationships and by positive reframing that moves through the weight of responsibility to the ability to respond.”
  • “Relationships with health professionals were among these but were not necessarily any more important to the healing journey than other kinds of helpers, which included family members, friends, spirituality and their God, pets, support groups, administrators, case workers and supervisors.”


Healing probably means different things to different people, but one definition that emerged from the study is: “The re-establishment of a sense of integrity and wholeness.” Healing was an emergent property that resulted from each individuals’ complex healing journey, a result of bridged connections between resources and relationships. Healing, in this sense, does not mean cured—none of the study participants were cured of their ailments—”but all developed a sense of integrity and wholeness despite ongoing pain or other symptoms.” In varying degrees, “they were able to transcend their suffering and in some sense to flourish.” When we begin to heal, we find increased capacity for hope, renewed motivation to help others, and are more able to accept ourselves as we are.


Suffering is the ongoing pain from wounding. There is debate about whether or not one actually needs to experience suffering on the path to healing.


Wounding happens when we experience physical or emotional harm. It can stem from chronic illness or by physical or psychological trauma for which we do not have the tools to cope, or a combination of those factors. “The degree and quality of suffering experienced by each individual is framed by contextual factors that include personal characteristics, timing of their initial or ongoing wounding in the developmental life cycle and prior and current relationships.”