Check out the October 2019 issue of FFI’s newsletter featuring voices from the field, thoughts on the importance of centering wellbeing in our healthcare system and much more!
Archives for 2019
Before coming to FFI, I spent most of my career practicing medicine in a small and privileged corner of the field that provides highly coordinated care to older people with frailty, complex illness, and chronic mental health issues. This system represents the best we have today, the gold standard of high-quality integrated and coordinated care. And yet. And yet, there is something else that was happening in this setting that was making people better that was more than the coordination of services and improved transitions between hospital and home. Over my last years in this work, I became extremely curious about what this “special sauce” was. Did it have a name, a language? Could we shine a light on it, scale it, build systems around it? These questions are what led me to the Full Frame Initiative.
I now believe that we do have a language and structure for this work, for what was happening in our clinic almost as a side effect of our work, and yet had powerful positive repercussions for the people in our clinic. This is the language and framework of a wellbeing orientation.
Let me share another story. Dr. Atul Gawande wrote in his Hot Spotters article about a patient who Dr. Jeffrey Brenner was able to work with who helped shape Dr. Brenner’s work with the Camden Coalition. This patient was receiving thousands of dollars of medical care and was not getting better. Was it bad care? Or the wrong care? This patient had heart failure, diabetes, morbid obesity, a history of alcohol and cocaine use and had been in the hospital a full half of the last three years. Why? Dr. Brenner spent time with this man, getting to know him and learning his story. As the story unfolds, we see that eventually, this patient gets better. His diabetes and heart failure are controlled, he stops using substances and he loses 200 pounds. What magical medicines or advanced technological interventions did Dr. Brenner use? None. He attended to this man’s wellbeing: the set of needs and experiences that we all require for health and hope.
Dr. Brenner’s team encouraged stability and routine in this man’s life, which included moving from a welfare motel to an apartment, as well as attending church and AA meetings regularly. They watched him reconnect with his girlfriend and children and benefit from the increased safety in his new apartment, as compared to his previous neighborhood. His team encouraged him to return to his prior trade, cooking. Over the next two years, there is no one magical intervention but this gentleman increased his assets in all areas of wellbeing—safety, stability, social connectedness, mastery and meaningful access to resources—and his health improved. It was attention to his wellbeing that led directly to improved health outcomes. He did not return to the hospital. This is almost miraculous. Except that it is so simple. It reflects the deep truth of what we all need and acknowledges that certain groups in this country have greater or lesser access to wellbeing.
We all know that our healthcare system, while so powerful in some ways, is failing us in others. This widespread acknowledgment has led to a welcome imperative for innovation, especially around addressing the social determinants of health. The time is ripe for exploring new models and new approaches. Healthcare is also in the midst of shifting payment structures to allow for funding of services, communities, and people who are supporting wellbeing. We have an opportunity right now to build something that addresses more than care coordination. We can build networks that support wellbeing and equity in our communities
I deeply believe that if we in healthcare attend to wellbeing, if we truly focus resources, innovation, and creativity in building access to wellbeing for all of us, individually and in communities, we will reap significant rewards in improved health outcomes. Let’s build a movement for wellbeing, a movement for increased access to wellbeing for all of us, and let’s put it at the heart of our work in health. I’m in, are you?
Rachel joined FFI having made a leap from medicine to systems and social change. After some time working from the outside in, Rachel has chosen to return to practicing medicine to create change from the inside out. FFI will be recruiting a new Director of Healthcare Transformation. Look for the job announcement and posting towards the end of the year.
FFI has been privileged to work with exceptional leaders in a range of fields and professions who are deeply committed to increasing equitable access to wellbeing. One such leader is Cheryl Campbell, Director, St. Louis County Juvenile Detention Center. After a long and illustrious career Cheryl recently announced her decision to retire. As her weeks were winding down, FFI asked Cheryl to share some reflections and thoughts on her work and the impact a wellbeing orientation has made on the children in her care.
Q: What brought you to this field/work?
A: I was a sophomore in high school and we did a field trip to St. Louis County Juvenile Detention Center. I was spellbound that a place like this existed and that kids were locked up away from family, friends, and school. Hearing from the staff who worked there influenced me the most. They were very kind and loved what they did to help kids turn around. I decided that I would write Superintendent Dale Duggan to see what I needed to do in order to work at the Center.
To my delight, he took the time to respond to my handwritten letter and suggested that I finish high school, go on to college and take up criminal justice, social work or human services. I took his suggestion to heart and decided to go to Missouri Valley College because they had a program that would give me a Bachelor of Science in Social Work.
I wrote Superintendent Duggan another letter requesting to do a practicum at the Detention Center, which he allowed me to do. I was definitely hooked. I finished my degree in three years completing my Bachelor of Science in Social Work. When I returned to St. Louis, I worked briefly for the Human Development Corporation and Division of Family Services. I was hired as a Detention Unit Leader in December of 1977. I was eager to begin my journey of making a difference in the lives of children.
Q: What makes you passionate about the work?
A: We have the potential to change the lives of the juveniles we serve by exposing them to things they never believed possible. It could be as simple as learning to read, participating in classical guitar lessons, or just letting them know that someone cares. Each day we learn something from someone, and it builds connections that can shape how our future can be. If I had not taken the tour of the Detention Center when I was in high school, my life would have been missing an extraordinary piece of my future. Every day that I come to work, I learn something new from staff and residents. No day is the same, although it may look that way until you find just a hint of something that can make a difference to someone. The next task is trying to see how we can make that a reality; that takes time and commitment. This is a team effort and all the parts of the team need to have the same mission. That is the difficult part because everyone has his or her own idea about how to accomplish that goal. Bottom line is that we all know that we can make a difference and never give up making sure that the kids we serve deserve our best in helping them grow and make better choices for their future. Some days are harder than others, but ultimately seeing that twinkle in the eye of someone who has accomplished something they never dreamed they could do makes it all worth it.
Q: What have been the moments that have made you the most proud?
A: Having someone that did not know how to read learn how to read and actually start a book club when they left the Center. Having someone stop me in the drive-through window at a fast food restaurant and say, “Remember me?” Even if I do not always remember them, I tell them I am proud that they are doing well. Hearing a young lady say that she was the first person in her family to graduate from high school. Her great-grandmother, her grandmother and her mother did not complete high school, but she earned her high school diploma here at the Center. In fact, she called back to let our staff know that she enrolled in a cosmetology program. A young man gets out of prison, returns to see me, and says, “I should have listened to you, but I didn’t. Now I want to do something so no one has to go down the path I chose.” Not only did that individual do what he said, he also started his own non-profit organization. In addition, he has volunteered to help at-risk juveniles for more than 16 years. That is the hope that we have when we reach out and give back, letting those we serve know that we all make mistakes, we can learn from them, and may make the same mistake again. But we learn and do better each time.
You never know what impact you will have on a young person’s life. But when they walk up to you at the mall, grocery store or even in the Courthouse and want to let you know that they are doing good, it makes you proud that you had a small part in making a difference in their lives.
Q: What do you see as the most important trends and changes happening in the field right now?
A: When the Juvenile Court changed into the Family Court in 1993, it took on a new focus. We were communicating with all parties through a single Family Court Judge for all matters involving a minor and his/her family. This opened up opportunities for us to look at a juvenile through a new lens, with increased continuity and consistency throughout the judicial process.
The biggest change has been making sure we examine the root causes of why a young person is in the system, and how we can go about making the necessary changes in the system as well as outside the system to make a difference in their lives. After looking at the “full frame,” we build on what we know and what we will need to help the juveniles we serve be successful in the future. Through our Juvenile Detention Alternatives Initiative, we are communicating with a broad network of individuals, agencies and advocates, asking for assistance in ensuring that Court involved youth have equitable access to resources and relationships so they can experience success at school, in their families and in the community.
Q: Why are you drawn to a wellbeing orientation and the full frame approach?
A: It fits perfectly with the direction we are headed towards in making a difference in the lives of the juveniles we serve. We cannot just look at what is on the surface; we need to delve into what the constellation of needs is for the individual as well as their family. Everyone has basic needs, and if you can meet those you can then move on to find the underlying cause of the problem. That allows us to develop a relationship, so that each resident feels comfortable sharing with us. Building on that foundation, while fostering growth in the individual, results in change. Everyone needs to meet the five domains of wellbeing (social connectedness, stability, safety, mastery and meaningful access to relevant resources) and if we take the time to find out what individuals need, we can make positive, long-lasting changes for our families.
Q: What has been the value and impact of integrating a wellbeing approach into your work?
A: When I look at the five domains of wellbeing, it makes sense that we can get more accomplished with this model rather than any other behavior modification theory that we currently use. You really get to know the child and connect with them. Likewise, the child understands that you are trying to help them resolve their own problems in a more constructive manner. You are dealing with them as individuals in a way that is specific to their needs and concerns.
Our Tier system was developed with the five domains of wellbeing in mind. It has been successful in helping residents become more accountable and obtain a sense of accomplishment in a way that the previous token economy system failed to provide. Residents can achieve whatever they want to achieve; they have choices. The bottom line is that they have to put in the work in order to be successful. Some achieve mastery while others chose to stay where they feel safe, or have a social connection, and do not want to go any higher within the system.
We can provide our youth resources, but at the end of the day, they have to make the choice to choose the path that will be right for them.
Over the past decade, FFI has forged strong relationships with exceptional leaders in a range of fields and professions who are deeply committed to increasing equitable access to wellbeing. We are thrilled that one of those leaders, Phyllis Becker, former Director of the Missouri Division of Youth Services, has joined us as a Fellow. Phyllis brings her commitment and passion to help build visibility and reach for a wellbeing orientation in juvenile justice. In our Q&A with Phyllis she reflects on her career, trends in the juvenile justice field and the potential of connecting wellbeing with juvenile justice reform efforts.
Q: FFI built a relationship with you as part of our partnership work with the Missouri Division of Youth Services (DYS). You served in a variety of roles at DYS over the years from front line manager and direct treatment staff to Deputy Director responsible for leadership development and quality improvement to your appointment as Director. As you look back on your time with DYS, what do you see as the most significant factors that helped you all get closer to your vision that every young person served by DYS will become a productive citizen and lead a fulfilling life? What are you most proud of during your time at DYS?
A: I came back to DYS in 2009 to give back to a system that shaped me as an individual and how I have worked with children, youth, families, and communities in significant and positive ways. And as they say, all things come full circle – so during my second “tour” with DYS, I was able to draw from what I learned in the past, combined with what I have learned now. Factors in my career with DYS that contributed to and continue to fulfill DYS’ vision include:
- During my first years of service with DYS, as frontline staff, I had the great fortune to be a part of the evolution of the treatment approach in DYS. I was part of a team led by an innovative leader (Gayle Hobbs) from whom I learned what it means to be relentless in one’s advocacy and positive treatment of youth and families. I also learned and continue to be mindful about the importance of healthy culture, teamwork, staying focused on the mission and of investing in staff capacity.
- When I came back to DYS and began working with Tim Decker who was the Director, the DYS leadership and staff teams, it was all about building on the many strengths in the organization, and that continued to be my focus as a Director.
- In addition, working with partners such as the DYS Advisory Board, the Family and Community Trust/ Community Partnerships, the Local Investment Commission, Families and Schools Together, Midwest Center for Nonprofit Leadership, the Annie E. Casey Foundation, the Full Frame Initiative and others was an investment in DYS leadership and the staff who work with the youth every day.
- A systemic approach to the work was critical in responding to real issues and needs vs. reacting to symptoms. The work with FFI helped DYS to maintain that systemic viewpoint, solidify a focus on wellbeing and revitalize our treatment planning process to better build on the strengths and address the needs of our youth and their families.
- DYS’ deepening commitment to the vision, values, mission that supports the wellbeing of youth and family could only be accomplished and put into operation by the leaders and staff who care about young people and do the work to guide and support them on a positive trajectory.
During all my combined years at DYS, I am most proud and appreciative of all the past and present leaders and staff teams who have built and continue to strengthen an approach that results in positive outcomes for youth (many who had been given up on) and their families who dreamed of a better future for their children.
Q: A lot has changed in the juvenile justice field. What do you see as the most important trends and changes happening in the field right now?
A: I believe there is a growing understanding and consensus of what works for youth and families in juvenile justice and also what does not work. Young people bring into the juvenile justice system their strengths, needs, family dynamics, and how they have been impacted by their communities. We know that focusing on wellbeing, having a developmental and systemic approach, understanding adolescence and brain development, addressing youth’s history and cultural challenges works. Supporting young people’s wellbeing is the pathway to build resilience, understand the impact of trauma, and the challenges they face in their lives. There is a synergy and growing body of research to support these approaches and optimal practices, including the work at FFI.
Q: We are certainly thrilled that you have decided to take on the role of Fellow with FFI and that you remain an active leader around the issues you care about. How do you see wellbeing being connected to juvenile justice reform efforts? What do you think the potential is of integrating a wellbeing lens into these efforts?
A: A wellbeing approach in juvenile justice is a natural framework to integrate what we know and are learning about adolescence and positive youth development, and the importance of supporting and building resilience in the face of and aftermath of trauma. In addition, this framework encompasses the intersection of external factors impacting our youth and families in their communities and in our country. The systemic focus of a wellbeing approach and of moving beyond initial change to sustainable change is also very helpful in wrapping one’s arms around the complicated and complex issues and needs of those touching the Juvenile Justice system.
Ten years ago, FFI was a small but mighty group of allies working on a research-informed hunch that if we orient systems and services around what makes people more alike than different, rather than designing around what makes people different, outcomes improve.
Pretty early on, we realized this is bigger than systems and services. This is about all of us because what connects us all is our universal drive for wellbeing—the set of needs and experiences universally required in combination and balance to weather challenges and have health and hope.
In the decade since, a growing staff and board, with partners and allies, have been guided by a North Star that we know guides many of you, too: a country where everyone has a fair shot at wellbeing. We’ve been joined by systems and communities in Missouri, Massachusetts and California, and nonprofits in more than a dozen other states. Funders and board members from around the country have supported the testing of our hunch, the building of knowledge, the deep-dive work with partners, all of which is demonstrating how shifting from short-term fixes to fostering wellbeing supports durable change in people’s lives and greater equity in society. Our toolkits and resources are used around the country by philanthropy, nonprofits and government to shift from focusing just on what’s wrong, to focusing on what matters: wellbeing.
It’s been a tremendous, successful journey, as we’ll spell out more in newsletters to come. For now, in keeping with the theme of this newsletter, it’s vital to understand the role of context in FFI’s work and our trajectory.
The context of social change work has changed in the last decade. For example, ten years ago, the systemic racism baked into our criminal justice system was all-too-well understood by communities of color, but not seen by systems nor part of the generalized (white) national narrative. That’s shifted. Ten years ago, hate and division weren’t both normalized and sensationalized as they are now. That’s shifted, too. These and many other shifts take us all toward or away from everyone having a fair shot at wellbeing. These contextual shifts have also unleashed demand for FFI’s work that is greater and deeper than we had imagined.
So in this context, we’re seizing opportunities and meeting demand. We’re moving into healthcare and exploring invitations to expand geographically. We’ve got plans to increase our “entry points” for individuals who want to be part of increasing access to wellbeing in their community and workspaces and homes. We’re doubling down on data and evaluation and ramping up communications and amplification of our partners’ impact in increasing access to wellbeing.
How FFI helps shape the context of our country for the next decade depends on strong partnerships with other social change organizations, neighborhoods, government agencies, nonprofits, and funders. Gordon and Lulie Gund and their family have challenged us to fuel up for this journey, with an extraordinary challenge: they will provide $2 million for our growth if others provide an additional $2 million by December 1st. Read more here, and join us in seizing this opportunity for change.
Whether you’ve been on this journey with us for ten years or ten days, thank you for being an FFI ally, and for believing that everyone deserves a fair shot at wellbeing.
In collaboration with Alliance for Hope International, FFI is pleased to announce the release of From Safety Planning to Wellbeing Planning: A Toolkit for Change. This resource is designed primarily for programs that focus their work with people who have experienced domestic and sexual violence. It provides actionable information, exercises, and tools to help shift from a singular focus on short-term safety toward increasing survivor safety in the context of creating opportunities to support long-term wellbeing. Request your copy of the toolkit today!
FFI is excited to announce that we have a new opportunity for an experienced, passionate and relentlessly curious Director of Development to join our team! Learn more about this newly created role on our Jobs and Internships page.
What would it mean to fundamentally shift our focus from fixing problems to fostering wellbeing—the needs and experiences essential for health and hope? For organizations, systems and communities working to stop the wicked cycles of poverty, violence, trauma and oppression, starting with wellbeing creates possibilities for lasting change in people’s lives and opens the door to greater equity in society. Join FFI for a webinar that will explore the principles of a wellbeing orientation and provide an overview of the Five Domains of Wellbeing. Join us and learn about first steps you can take to help increase equitable access to wellbeing. Register today!
We stand with the communities in Christchurch as they bury the victims of the horrific Islamophobic, anti-immigrant attack and move toward healing and justice. FFI’s Rachel Broudy shares her reflection and hopes in this blog post.
I’ve always thought about New Zealand as my escape fantasy. I’ve never been there but know it is a beautiful country and I’ve heard stories of the kindness and hospitality of the people who live there. My husband spent time there and often joins me in my fantasy of moving to New Zealand to escape the craziness of politics in the U.S. In fact, my daughter’s middle name even comes from New Zealand, as we carried on a family tradition of giving middle names that mark beautiful places in the world and build our own connections to a global reality.
In the wake of the massacres in Christchurch, I felt like there was no escape. No escape from the violent racist attacks and news stories, spreading terror in defense of white supremacy. But there was a kernel of hopefulness in this for me. If there is no escape, then the need to build another story is even more critical. The need to connect our work and our countries and our people across hope and strength is critical.
I want to tell another story, a story that connects us through our search for wellbeing and our sharing of ourselves.
So today I share the story of the Haka given as a gift by the Black Power Maori biker group at the Al Noor Mosque. The man who led the haka stated “This is a dance of love. This happened here in our community. This is all of our communities.”
I share the story of the Kindness Institute, and Kristina Cavit, who is working with young people in schools, prison and poverty to offer mindfulness and yoga teachings and is having positive outcomes on youth anxiety, depression and mental health.
Join me in the revolutionary act of telling a different narrative–a narrative of equity, justice and peace, of community building, a story of us building a global pathway to wellbeing.
Do you have a story to share?
Rachel Broudy, M.D. is Director of Healthcare Transformation at the Full Frame initiative. Rachel is passionate about building a future where healthcare is based on wellbeing, where our clinical interventions integrate older people more fully into our communities, and our systems of care prioritize and encourage agency, social connection, and sense of purpose.