Culture of Health Blog

The brain is an exquisitely sensitive organ—so sensitive that, as recent advances in brain science show us, children who are exposed to violence, abuse, or extreme poverty can suffer the aftereffects well into adulthood. They are more likely to develop cancer or heart disease as they age, for example.

But how to translate these findings into practices and policies that can strengthen families and children? How do caregivers help traumatized children and their families cope with adversity? How can the science be applied to what teachers, doctors, social workers, and others on the front lines do every day? And how should the science affect whole systems, so that every person, at every level, can do their part to help children and families thrive?

As we work to build a Culture of Health for all Americans, it is time to end the stigmatizing distinctions between mental and physical health. After all, the brain and the body are in constant contact, and affect the well-being of each other in too many ways to count. A true Culture of Health recognizes the interdependence of mental and physical health, and places a premium on prevention and early detection of illness, regardless of type.

We commonly provide preemptive treatment or suggest early lifestyle changes for people at risk for diabetes before the condition evolves into full-blown disease. Yet, we typically don’t approach care for serious mental illness in the same way. It’s time for that to change.

The results from a recently released national study of the Early Detection and Intervention for the Prevention of Psychosis Program (EDIPPP), a project RWJF funded between 2006 and 2013, demonstrate that early intervention to prevent the onset or progression of psychosis in teenagers and young adults improves health and well-being. By helping family members, pediatricians, teachers, young people, and other community members identify young people experiencing early symptoms of serious mental health problems, EDIPPP was able to engage and treat these young people early. That early intervention in turn helped them stay in school, remain employed, and maintain vital connections to family and friends. These benefits mitigated the effects of mental illness, and allowed these teens and young adults to lead healthier and more productive lives.

This study should shift our thinking about how we best treat young people at high risk of serious mental illness. It should also remind us to look at good health and good health practices through a much broader lens, because building a Culture of Health means finding and sharing solutions, and celebrating signs of progress.

Read a Washington Post article on the program

Read a first-person post about depression and the best way to support those who are suffering with it

Read a post by Brent Thompson on bipolar disorder and the death of a friend

It has been more than 15 years since the Centers for Disease Control published the Adverse Childhood Experiences (ACES) study. What we learned from that study, and then subsequent research, is that sustained exposure to toxic stress and adverse childhood experiences—including abuse, neglect, neighborhood violence and chronic poverty—without the support of an engaged supportive parent or adult caretaker, can have serious extended effects on children’s subsequent development and success in life. This stress, without intervention, can lead to a lifetime of poorer health, including chronic diseases in adulthood, such as heart disease and diabetes.

In 2012, the American Academy of Pediatrics published a policy statement calling on pediatricians to become leaders in an effort to decrease children’s exposure to toxic stress and to mitigate its negative effects. They acknowledged how much science had taught us about how our environment affects our “learning capacities, adaptive behaviors, lifelong physical and mental health, and adult productivity.” The statement was a significant shift in the conversation. It provided a biological framework and imperative for why we must do something about adverse childhood experiences now.

In the late 1990s, a major study of adverse childhood experiences by Kaiser Permanente in California found that people who had been exposed to traumatic events such as violence or abuse during childhood were much more likely to have serious health problems as adults. Over the next decade, advances in neuroscience explained how childhood trauma can harm brain development and change the way kids feel and act in response to even normal events in their lives.

So, what to do? How do you protect or heal vulnerable children? An article on an innovative pre-school program in the Fixes column of yesterday's New York Times is an example of some solutions that are starting to emerge.

In 2010, the Robert Wood Johnson Foundation (RWJF) partnered with local funders and Crittenton Children's Center in Kansas City, Mo. to pilot a new kind of Head Start program that would provide caring support to pre-schoolers exposed to traumatic events—homelessness, abuse, the loss of a parent, for example. The idea was to create a web of support among all of the adults who would interact with kids throughout their day, including parents, teachers, administrators, even the school bus driver. The school would also give kids specific tools to help them deal with their emotions in a healthy way and build resilience.

Head Start Trauma Smart wanted to ensure that the children would master the skills they need by the time they start kindergarten, because kids who are already falling behind in kindergarten have a much harder time succeeding in school and living a healthy life. The results of the pilot were so promising that in 2013 RWJF gave Crittenton Children's Center a $2.3 million grant to expand the Head Start Trauma Smart model throughout the state of Missouri. 

Watch a new video documenting how Head Start Trauma Smart works. Hear some of the stories of kids who have been exposed to traumatic events that are almost unimaginable and of the caring adults who are helping them heal. 

The parents and school staff are trailblazers, doing inspired and inspiring work to help bring out the best in each and every child. And while there is nothing that they are doing in Missouri’s Head Start programs that couldn’t be done in every community, it’s not easy to get systems of care to adopt this kind of change.

New York Times columnist David Bornstein explains why this program is so significant. “Trauma interventions can be highly effective but the challenge today is extending them from therapeutic settings—which are limited and expensive—into the broad systems that serve larger numbers of children.”

Here at RWJF we think a lot about what it takes to build a culture of health in America. There are few better examples than the Head Start Trauma Smart pre-school, where every child has the chance to thrive, and every adult who crosses their path has an opportunity to be a positive influence. And where great ideas that improve health spread to more communities where they can help more families in need.

On RWJF’s Vulnerable Populations team, we look for ideas that we believe are going to transform a field; that will create the impetus for significant social change. When we find those ideas, our goal is to take them to scale.

Contrary to popular belief, scaling does not mean hiring more people or growing a bigger organization. When we talk about scaling, it’s about supporting an idea to allow for radical transformation. It is our contribution to creating a culture of health.

One of the ideas that we’re currently working to take to scale is the Green House Project, which aims to transform the culture of long-term care. We’ve tested the model repeatedly in a number of locations and now we’re trying to get it greater national visibility so that it can have the significant impact on the field of long-term care that we believe it can—and should.