Innovation Ecosystem

How to build a collaborative strategy around reducing toxic stress in RI

A conversation/convergence will be held this week at Rhode Island College to catalyze development of an inclusive strategy moving forward

A conversation/convergence, entitled "Building a Collaborative Strategy To Reduce Toxic Stress in Rhode Island," will be held on Wednesday, Oct. 28, at Rhode Island College

By Richard Asinof
Posted 10/26/15
For the first time, advocates and experts across a broad spectrum working on toxic stress in Rhode Island will convene in an effort to build a collaborative strategy. The event is envisioned as the starting point in an ongoing conversation that brings together numerous disciplines, research, advocates and practitioners.
Will the efforts by the Providence Plan’s DataSpark to develop a digital mapping process visualizing the numerous initiatives now underway, from neuroscience research to pediatric diagnoses to healthy housing programs, showcase a new way in which health innovation can be told as a data story? Will the efforts to reduce toxic stress be a better fit for community-based health equity zones rather than the health care delivery system? How will the world-class neuroscience research now underway at Brown University change the nature of how we address brain disorders, including toxic stress, addiction, schizophrenia and epilepsy?
The potential of creating a new collaborative strategy to reduce toxic stress in Rhode Island, with all of its resulting potential positive, measurable outcomes, does not even appear as a small blip on the radar screen under the state’s economic development strategy, or for that matter, as a potential driver for investment by the health innovation ecosystem. We often see the apparent results of toxic stress run amuck in our society and the resultant crises: mass incarceration, the prison system functioning as mental health hospital, agencies such as DCYF in disarray, an epidemic in drug overdoses – the list goes on and on. Why not put more focus on making investments in children in Rhode Island, and improving their quality of life, as the best future economic development strategy?

PROVIDENCE – Imagine if you could design a program of health innovation in Rhode Island with the potential to improve the economy, better academic achievement in schools, reduce the cost of health care, reduce the amount of violence and sexual abuse, increase the value of housing, decrease the population in prison, improve health outcomes, strengthen families and neighborhoods, promote wellness and prevention, and slow the epidemic of substance abuse.

And, to have its progress measured by evidence-based research, with benchmarks to evaluate outcomes and results – and to measure the return-on-investment.

Rhode Island appears to be poised on the verge of developing just such a far-reaching program of health innovation – a cutting-edge, collaborative strategy to reduce toxic stress in children and young adults.

The effort places Rhode Island at the forefront of national leadership in changing the approach to health care innovation.

What is toxic stress?
A new definition developed by the R.I. Department of Health, in partnership with the R.I. chapter of the American Academy of Pediatrics, says:

“Stress is a part of everyday life, and most of us do not have long-lasting problems adjusting to stress. To cope with everyday events, children invoke biological, psychological, social, and/or physical-action responses.”

In the face of adverse or traumatic events, the definition continues, “a child’s mobilized responses are more likely to be ineffective, resulting in the stress response remaining active. Such prolonged activation increases the potential for enduring changes in physiologic and neurologic systems.”

When such enduring changes compromise children’s adaptation, the definition concludes: “We refer to this long-term series of events as toxic stress.”

Advancing a collaborative strategy on toxic stress
To help catalyze the development of an innovative, collaborative strategy on toxic stress, an event, entitled “Building a Collaborative Strategy To Reduce Toxic Stress in Rhode Island: A Conversation/Convergence,” will be held on Wednesday, Oct. 28, from 10 a.m. to 12 noon, at Rhode Island College.

The event, which has been organized by Kalina Brabeck, chair of the RIC Department of Counseling, Educational Leadership and School Psychology, in partnership with ConvergenceRI, brings together experts from numerous disciplines – neuroscience research, early childhood, pediatrics, counseling, family visiting, nursing, social work and healthy housing – to find common ground in how to move forward.

The experts include:
Dr. Peter Simon, pediatrician, epidemiologist;
Ruth Ann Norton, president and CEO, Green & Healthy Homes Initiative;
Kevin Bath, neuroscientist, Cognitive, Linguistic & Psychological Sciences, Brown University;
Elizabeth Burke Bryant, executive director, Rhode Island KIDS COUNT;
Dr. Ailis Clyne, medical director, R.I. Department of Health;
Rita Capotosto, clinical director at Adoption RI; and
Angela Ankoma, board chair, West Elmwood Neighborhood Housing, Sankofa Initiative.

The panelists will participate in a discussion moderated by WPRO reporter Steve Klamkin.

Talking with, not at, each other
Among the questions the panelists will wrestle with are:

•  What are there evidence-based strategies to respond to toxic stress? What works? What doesn’t?

•  How does toxic stress change the equation for how to look at brain disorders, mental and behavioral health, and substance abuse?

•  How should toxic stress from environmental factors, such as lead or mercury, or those that can serve as a catalyst for the onset of asthma, be included in the conversation?

•  How do the social determinants of health and language and racial barriers and other sources of discrimination influence toxic stress? Is it a matter of health equity?

•  Rhode Island KIDS COUNT is now tracking toxic stress as a benchmark for children’s health and well-being. What other kinds of data need to developed and shared? Is there a need for better data stories to be told?

•  Why does housing so often get left out of the equation? Is it because it doesn’t fit easily within the continuum of care as defined by the health delivery system?

•  What are the strategies for effectively engaging caregivers and families in the prevention and treatment of toxic stress?

•  How do you think clinical and therapeutic treatments and interventions should be paid for?

Following the panel discussion, the experts will join with the audience to engage in facilitated conversations to discuss what the next steps will be in the coming months.

The conversation/convergence will close with a “Call To Action” by Dr. Pamela High, director, Developmental-Behavioral Pediatrics, Hasbro Children’s Hospital.

Participants will then be invited to shop at a mobile market set up by “Food on the Move,” an initiative developed by the R.I. Public Health Institute to combat food insecurity, which provides the opportunity for residents to shop and to buy healthy fresh fruits and vegetables.

The next generation
The converging efforts around reducing toxic stress in children – including a pediatric definition that identifies diagnosis, treatment and referral options – puts the focus on allowing Rhode Island’s children to grow up in conditions that allow them to achieve their full potential.

“Every child in Rhode Island deserves to grow up in conditions that allow them to achieve their full health potential and full life potential, no matter what zip code they come from. This means that we must address the underlying social and environmental determinants of health, including toxic stress,” said Dr. Nicole Alexander-Scott, director of the R.I. Department of Health.

“By bringing neuroscientists, early childhood advocates, pediatricians, healthy housing advocates, and many others to the same table, this conference is establishing the kind of collaborative framework that we must maintain, “Dr. Alexander-Scott continued. “Changes we make now can have real impacts for generations to come on the health of our communities and the health of our state as a whole.”

The future workforce
One of the reasons for holding the event at Rhode Island College was to engage with students and include them in the discussion.

“Many of our Rhode Island College students will soon be on the frontlines in Rhode Island's workforce as nurses, counselors, social workers, youth workers, coaches, teachers and educators,” said Kalina Brabeck, chair of the Counseling, Educational Leadership and School Psychology Department at Rhode Island College.

“They will be responsible for shaping the strategies for effectively engaging caregivers and families in the prevention of toxic stress, as well as helping to shift the life trajectories of those children whose development has been impacted by toxic stress through evidence-based, trauma-informed, and culturally responsive treatment,” Brabeck continued.

Brabeck continued: “This event directly involves these students in the conversation on how best to move forward in a collaborative fashion and to engage in the cutting-edge critical thinking and practice to promote the wellness and healthy development of all children and families.”

Visualizing the convergence
As part of the event, The Providence Plan’s DataSparkRI is preparing a visualization document of all the different initiatives, interventions, programs, and research now underway in Rhode Island, to be available online.

The sponsors of the conversation/convergence include: R.I. Department of Health, Care New England, Green & Healthy Homes Initiative, South County Health System, Rhode Island KIDS COUNT, The Providence Plan, Rhode Island Public Health Institute, and the R.I. Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals.

Support from the Rhode Island College departments includes: Social Work; Special Education; Elementary Education; Early Childhood; Counseling, Educational Leadership and School Psychology; Nursing; Psychology; Chemical Dependency & Addictions; Environmental Studies; Youth Development; and Health and Physical Education.

The twitter handle is @toxicstressri, and the hashtag is #toxicstressri.

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