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Spotlight on Public Health: Systemic Change in the Foster Care System

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The purpose of this regular public health column is to shed light on current public health issues; sharing the solutions and innovations that can productively address those challenges and improve the health of diverse populations and the systems that support them.

Each day at La Maida, dozens of individuals participate to improve their health and wellbeing – whether it’s by taking a yoga class, experiencing neurofeedback, going through family therapy, attending a workshop, or any other of the host of integrative offerings. Our impact is significant. We help individuals in our surrounding community, greater Los Angeles, and even have international clients. There’s a broader effect too. Many of the individuals served have an impact on their own families and communities, spreading a more empowered and healing story of health and personal growth.

There’s another side to the work we focus on that extends beyond La Maida’s walls. Part of our vision is to spread the values and practices of integrative health. One of my passion areas, shared by our founder Omid Naim, MD, is to realize systemic change at the institutional level, helping to build the proper conditions for the most vulnerable populations to heal and thrive.

Our current and primary project in this realm is with an organization called McKinley Children’s Center, based in San Dimas, CA. McKinley has been active since the late 1950’s, providing child welfare services for foster youth in Los Angeles and San Bernardino Counties. McKinley is a large organization, operating non-public schools, outpatient mental health services, foster care and adoption services, and a residential treatment facility for boys, aged 7-17. Though we are eventually touching all areas of McKinley, our current effort is to complete an organizational transformation for McKinley’s residential treatment facility. Our project began in January of 2018, and we are thoughtfully designing and implementing a customized system change approach that we’ve named: Trauma-Informed Integrative Care.

Close to 50% of foster care youth in group or residential settings are prescribed at least one psychotropic medication.* Serious mental illness diagnoses are common. Outcomes after aging out of foster care are a challenging reality – jail, streets, gangs are too often the net that catches these youth. The intervention at McKinley’s residential treatment facility is a brief one; the youth are at the facility for six months or less before their next placement. How could we possibly provide a meaningful experience that helps these kids after they leave? How can we help the staff to feel empowered and creative with such a relentlessly difficult job?

With admirable and essential support from McKinley’s leadership, we are designing a program that addresses all dimensions of health; one that’s broadly focused on healing trauma from the bottom-up and is infused at all levels of McKinley’s organization. Working alongside staff, we are collaboratively building a foundation in which self care is a priority for all, aimed to reduce burnout and provide the necessary tools so that staff can be in tune with their own nervous systems and therefore be in tune with the needs of each child. We are creating a shared value system and common language, which is at the heart of Trauma-Informed Integrative Care, guiding trauma-educated leadership, management, and staff in each interaction and toward achieving each youth’s guiding purpose. We are adapting the space and functional areas to provide a safe, healing environment where medical and therapeutic services; cottage structure; daily patterned experiences such as yoga, breathwork, creative activities, and meal prep/sharing work together to create the circumstances for nervous system regulation, healing trauma, and sustainable change.  

At this stage, we’ve completed a pilot training with one of the cottages (the group houses, divided by age, where the boys live) and have finished our discovery and recommendations. We’ve moved into an implementation phase, involving multiple interdisciplinary committees to oversee, create, plan and execute the project’s aims in a way that is inclusive and collaborative, setting up McKinley for a new, empowered approach to helping the youth.

I look forward to updating you all on the project’s progression, and having the opportunity to dive deeper into some of the details surrounding this project as well as other topics surrounding the larger public health conversation.

*US Government Accountability Office, FOSTER CHILDREN: HHS Could Provide Additional Guidance to States Regarding Psychotropic Medications, May 2014 
https://www.gao.gov/products/GAO-14-651T

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