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Building Bridges, Defining Metrics

The 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 underresourced youth.

The Many Influences on Youth Health and Wellness are Dynamically Linked

Research by Nova Scholar George Kaplan, PhD, 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 Novel, 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 Envision a New Future of Health for Youth

Forty professionals from across the country, including researchers, funders, educators, government leaders, and community program experts, gathered at Nova’s headquarters in Baltimore, Maryland, 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.

Read the Report

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Forum Overview

February 3, 2016
Building Bridges for Better Program Design & Implementation

Contributing diverse perspectives, forum participants explored how to develop interventions that both leverage the strengths of multiple program partners and meet the often differing expectations of various stakeholders.

February 4, 2016
Defining Metrics to Improve Community Program Evaluation

Taking into account the interplay of multiple factors in a real-world setting, forum participants examined and identified effective approaches for community-based program evaluation.

Doing What Matters for Population Health

On February 4, 2016, a dinner symposium featured a keynote presentation with Sandro Galea, MD, MPH, DrPH. Dr. Galea gave an inspirational speech on the urgent need to reorient epidemiology and public health to make a difference in health outcomes. 

Following the keynote presentation, former U.S. Senator Barbara Mikulski and Jay Perman, MD, president of the University of Maryland, Baltimore, also joined Dr. Galea for a panel discussing public health and policies. 

Speakers

Sandro Galea, MD, MPH, DrPH

Keynote
  • Physician and Epidemiologist
  • Dean and Robert A. Knox Professor at Boston University School of Public Health
  • Expert on the intersection of social and psychiatric epidemiology, with a focus on the behavior health consequences of trauma
  • Published more than 700 scientific journal articles, 50 chapters, and 13 books
  • One of the “World’s Most Influential Scientific Minds”— Thompson Reuters

Barbara Mikulski

  • U.S. Senator of Maryland [retired]
  • Professor of Public Policy and Advisor to the President, Johns Hopkins School University

Jay A. Perman, MD

  • President, University of Maryland, Baltimore
  • Co-Chair, University Partnership, Baltimore
  • One of “Maryland’s Most Admired CEOs” — The Daily Record, 2013

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
244_BBDM_02-04-16

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.”

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.
  • 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.”
  • 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.

“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. “…they gradually found relief from suffering and began to exhibit emergent characteristics: a sense of hope, self-acceptance, and a desire to help others—the immediate precursors to healing.”

 In varying degrees, “they were able to transcend their suffering and in some sense to flourish.” 

  • Helping Others: We find meaning in helping others. “Understanding that suffering gives the strength and experience to help others in similar situations.”
  • Hope: We begin to have hope that we will not always feel this bad. A Crohn’s patient said, “I think gradually I realized that I was going to feel better. I did have days when I actually didn’t vomit, when I did feel better. And I think gradually I came to believe that maybe I could have a normal life again.”
  • Self-Acceptance: We see our inherent value and understand that we are not to blame for our suffering. A participant living with HIV said, “I’m really proud of myself. I think that now I still want to live. I don’t want to die, and I really love myself a lot. I have a lot of comfort in myself.”

Suffering is the ongoing pain from wounding. 

There is some debate about whether people always 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.”

Characteristics: How predisposed someone may be to wounding/how many tools and resources someone may have to deal with trauma/illness.

Lifestages: Developmental timing plays an important role in the impact of trauma — young children often do not have the same resources as older adults.

Relationships: Relationships can provide solace and support for those suffering, while lack of healthy relationships can prolong suffering.