NWX-SAMHSA

Moderator: Mary Pat King
June 23‚ 2011
2:00 pm CT

Coordinator: Welcome and thank you for standing by. At this time all participants are in a listen only mode. During the question and answer session please press star 1 on your touchtone phone.

Today’s conference is being recorded. If you have any objections you may disconnect at this time.

Now I’ll turn the meeting over to Ms. Mary Pat King. Ma’am, you may begin.

Mary Pat King: Thank you. Hello, and welcome for Forging a Path Towards Social Inclusion: Collaboration Among Individuals, Community Partners and Public Systems.

Today’s teleconference is sponsored by the Substance Abuse and Mental Health Services Administrations Resource Center to Promote Acceptance, Dignity and Social Inclusion associated with mental health also known as the ADS Center.

SAMHSA is the lead federal agency on mental health and substance abuse and is located in the US Department of Health and Human Services.

Please join the ADS Center listserv to learn more about social inclusion including upcoming teleconferences, new resources and events.

This training teleconference will be recorded. The presentation, audio recording and a written transcript will be posted to SAMHSA’s ADS Center Web site in July.

The views expressed in this teleconference do not necessarily represent the views, policies and positions of the Center for Mental Health Services, the Substance Abuse and Mental Health Services Administration or the US Department of Health and Human Services.

Our presentation today will take place during the first hour and will be followed by a 30-minute question and answer session at which time you must press star 1 on your telephone keypad to ask a question.

You will enter a queue and you will be able to ask your question in the order in which it is received. Upon hearing the conference operator announce your first name and then please proceed with your question.

Due to limited time we may not be able to get to all questions. If your question isn’t answered or you wish further information, presenters contact information will be provided so that you can contact them directly.

Today we are pleased to learn about the path towards social inclusion from three different perspectives, an international researcher and policy advisor, an expert in successful community building using the strength-based approach and a survivor of trauma, addiction, homelessness and the psychiatric and criminal justice system.

Our first presenter, Lindsey Dawson, is the Health Policy Advisor at the Centre for Economic and Social Inclusion-US. She is currently contracting with the Kaiser Family Foundation’s Medicare Policy Project in Washington, DC and she previously worked in London.

Ms. Dawson’s expertise spans evidence-based policy, qualitative methodologies and research epics. She is interested in the multi-dimensional relationship between social inclusion, health and access to healthcare.

Ms. Dawson will provide us with a foundation for understanding social inclusion and specifically it’s impact on poverty as well as mental health policy and service delivery.

She’ll tell us a bit about the National Social Inclusion Strategy in the UK and specifically transferable concepts and lessons learned from this strategy.

Ms. Dawson?

Lindsey Dawson: Good afternoon. I’m very pleased to be at everybody virtually today and start off the presentations. What I hope to do is to set a stage so that we have a common language and a common way of speaking about the concepts that the rest of the presenters will go through.

I’ll discuss what social inclusion is and we’ll discuss how it can be used as a framework to address problems of social exclusion.

I’ll identify it as a concept that’s particularly useful in talking about mental health exclusion and we’ll look to the UK as a case study of an example of a place that has embraced social inclusion strategy.

So first what is social exclusion? It’s the exclusion - it’s the systematic marginalization of groups of people from resources, from rights and opportunities that are typically available to the rest of society and they are key for participation in the mainstream of community life.

This might be things like institutions, like hospitals and schools or community groups. It could be parent/teacher organizations, youth groups, it could be the local government and it’s about not feeling welcome in services such as healthcare or mental healthcare services or education. It’s the experience of feeling isolated from or even discriminated by these groups and services.

Sometimes this is a result of an engrained behavior but other times it happens more intentionally. And social inclusion is a response to social exclusion. It’s the process of reversing exclusionary indicators and moving excluded groups towards specific engagement with full rights and access to community resources.

And inclusion is achieved when the margins of society secure a place in the community. So it’s both a practice and it’s a concept. And in terms of being a concept it can be used to underpin policies and strategies. We’ll discuss more about it as a concept today and think about how it might be applied to mental health polices and practices.

So, social inclusion as a concept is one that’s multidimensional and moving rather than uni-directional. It avoids siloed thinking. What this means is that it looks to people and communities and to institutions and inequalities and looks for connections between these. And it’s the opposite of siloed thinking which is self-contained. It’s narrow in scope and it ignores the outside world.

It’s dynamic rather than static. It allows for transitional stages and episodic circumstances, it considers compounding and implanting factors like race and class and gender. It’s positive in its approach. It considers the individual and the uniqueness of individuals, uniqueness of communities, customers and service users. It addresses community rather than individual responsibility and its solution oriented.

One of the best ways to understand the concept is to use an example so I’m going to show how poverty looks when we see it as it’s typically seen in the US and how it looks under the lens of a social inclusion framework.

So first in the United States poverties typically seen as looking at the federal poverty level which is a federally determined income level for an individual in 2010 it was $10,830. This looks only a dollar based income and it ignores all of the other factors that contribute to deprivation so sickness that somebody’s experiencing, educational attainment, the availability of jobs in an area.

And it describes a symptom rather than a problem or a solution. It also points to the individual rather than systems or communities. Social inclusion will look at poverty quite differently. It would look at income because that’s important but it would also look at the factors that contribute to an income; unemployment, education, homelessness, housing quality, healthcare access, inqualities in healthcare access, general and mental health condition, access to services, whether or not substance misuse is occurring and any other number of factors that are happening in the individuals life or in a communities life that leads to or contributes to the experience of poverty.

It looks for interconnectivity, causation and reinforcement between these factors. It looks at structures and systems and it holds communities accountable rather than individuals.

So it’s not the individuals fault for having less income but it’s a community responsibility to improve opportunities and access.

It explores underlying inequalities in systems and structures and it encourages—encourages us to have a different set of conversations and ask a different set of solutions of questions and suggest a different set of solutions.

And it isn’t that a solution would necessarily be simplistic. It’s not necessarily simply promoting an income subsidy or creating an opportunity in employment. That might be part of the system - that might be part of a solution certainly. It’s looking at the matrix of factors that contribute to deprivation and trying to address those.

The solution inclusion can be thought of in a way to design responses and see problems of social exclusion through a more dynamic and proactive lens. It lends itself particularly well to mental health policy and service delivery for a number of reasons. It considers the social and physical institutions involved in developing a strategy.

So physical institutions would be things like schools and hospitals and treatment centers and whether or not how we can improve access to those or feelings of inclusion in those centers. And social institutions are things like family and language and religion.

Social inclusion indicators also dovetail on the social determinants of health. And the social determinants of health are the things that predict whether or not we’ll lead healthy lives or the circumstances in which we live and which we’re born and which we grow and we work and we age. And it includes the healthcare systems we access and it’s an understanding that these circumstances are shaped by our age, our race, our class, gender, religion, geography, whether or not we have access to wealth, power or resources.

And the social determinant of health are the very indicators that social inclusions looks to in creating social inclusive strategy. Social inclusions also addresses differences between individuals in groups and it’s multi-dimensional, it’s moving and it’s changing and it allows for episodic circumstances.

So this is particularly useful in looking at mental health which, in and of itself, is often an episodic experience. So, for example, somebody has a mental health episode and misses work which leads to job loss and associated healthcare loss and then on to homelessness.

You might experience fear, shame, isolation, stress, associated safety issues which could be to substance abuse and incarceration and ultimately to worse mental and physical health problems. So you can see how addressing social inclusion for somebody with mental health problems is much better aligned to a dynamic approach.

I’m now going to turn to the United Kingdom because the UK has demonstrated a commitment to social inclusion strategies across a range of social excluded groups and has specifically used social inclusion to ground mental health policy.

Starting in 1997 they founded the Social Exclusion Unit which became a social exclusion taskforce and it sought to link-up services across government and communities and address a range of social issues. Some of those included homelessness, teen pregnancy, incarceration, ex offenders and youth engagement.

They also developed strategies specific to mental health in 2004 and created an action plan which sought to reduce and remove barriers to employment, mainstream services and community participation for those of mental health problems.

The UK’s social inclusion strategies overall target specific areas of life that they determined are impacted by social exclusion and these include community engagement, employment, education and skills, housing, arts and culture, leadership opportunities and socially inclusive practices.

Specifically related to their mental health strategy, they’ve developed six categories or avenues and ways that social inclusion should be promoted. These are the target stigma and discrimination through challenging negative stereotype, negative attitudes and promoting awareness; looking at health and social care, implementing evidenced-based practice and services and enabling integration into the community to create employment opportunities for sustained work and reflecting skill basis, to support family and community participation, to ensure basic rights including access to decent home, financial advice and transportation.

And their sixth point was to make it happen, to make sure that there were clear arrangements for implementing these programs and maintaining momentum rather than just have it be a conceptual idea about how we would like to behave.

One of the benefits of looking to somewhere else, how they’ve used a strategy or a policy is that we can learn from their experiences and the UK has identified several lessons that they’ve learned either because they’ve been best practices or because they’ve been problems they’ve needed to come up with solutions for.

The transferable concepts they’ve identified are that it’s important to create positive goals with realistic timeframes, that it’s important to develop and disseminate appropriate and measurable targets to the used and agreed upon definitions, to move away from siloed thinking, to share best practices between communities, departments and sectors, to identify key stakeholders; and to use senior stakeholders to broker relationships.

To include the user voice and make sure it’s a center part of policy; to build on customers local experiences and developing strategies and measurements to engage the service user to communicate project messages; to ensure team approaches are welcoming to different groups. And to foster links between customers, practitioners and researchers and to create individualized pathways to health.

What I hope I’ve done this afternoon is to bring us to a similar understanding of terms and concepts, to give us a common language for social inclusion and to give us a way of thinking about what reimagining a socially inclusive mental health strategy might look like.

And looking to the UK we’ve seen an example of a government and taken the idea of social inclusion very seriously. And we benefit by learning lessons from their best practices.

There certainly isn’t an easy answer to a complex set of problems. Instead, it offers us a way to re-conceptualize care for people who experience mental health difficulties in a more integrated and inclusive framework and in no ways is policy a solution. It’s the easy part. But I do believe that theory and policy are going to inform practice.

So, thank you very much and I look forward to Jody and Jacki’s presentations and to any questions you might have at the end of the call.

Mary Pat King: Thanks so much Lindsey. Thanks for establishing that foundation for us and sharing so many insights about social inclusion from the UK.

Now we’re going to hear from Dr. John Kretzmann whose better know as Jody. Jody’s the Co-founder and Co-director of the Asset-based Community Development Institute or ABCD Institute of the School of Education and Social Policy at Northwestern University.

At the ABCD Institute Jody works with community building leaders across North American and five other continents to support community-based efforts to rediscover local capacities and mobilize citizen’s resources to solve problems.

A much traveled speaker and trainer, Jody brings more than four decades of community-based work and study into his current position. He has worked as a community organizer and community development leader in Chicago neighborhoods and he’s also been a consultant on a range of neighborhood groups and to develop community friendly policies in the city at the regional, state, national and international levels.

Jody will enlighten us with ways to shift our thinking from deficits to assets while we pursue social inclusions.

Jody?

John Kretzmann: Thank you Mary Pat. I’m delighted to be with everybody who is on the invisible side of this conversation at this point and I look forward to any kinds of reactions you might have and to being in conversation both with you at the end of this call and if you wanted to beyond these remarks today.

I want to - appreciate very much Lindsey your remarks and the clarity with which you’ve sort of put the social inclusion set of approaches in front of us. I think that’s a very, very useful import from the UK and we’ve been lucky enough to work with friends in the UK on the development of the social inclusion project over the last decade and have learned an immense amount from them. So thank you so much for that.

And I look forward to Jacki’s remarks as somebody who has really been in the frontlines of redefining our whole approach to mental health.

So it’s a delight to be here.

As we move to my first slide it is a very, very simple minded cliché. The half full, half empty glass and it’s just a reminder that the work that we’ve been doing at the Asset-based Community Development Institute over the last decades with basically struggling communities and people who are within those struggling communities struggling with their own individual problems.

But our findings constantly are that people and communities are like this half full, half empty glass. Individuals and communities certainly experience emptiness. They have problems. They have needs. They have deficiencies. But it is also true that individual people and neighborhoods or communities have degrees of fullness. At the individual level there are gifts and capacities and skills and commitments and enthusiasms; everybody has them including people experiencing mental health challenges and it’s also true that every community, no matter how devastated it might appear from the outside, every community has resources and assets and fullness of its own to celebrate.

Unfortunately though, as we move to the next slide, we are reminded that many times when we think about communities in trouble we tend to think about them only through a deficit lens, only as if they are mostly empty, needy and problematic.

So when we think about native peoples reservations or when we think about public housing or inner city neighborhoods we tend to be bombarded with images of crime and child abuse and welfare and lead poisoning and dropouts and all of the negative images that get reinforced by mass media and get reinforced to some degree by the workings of funders whether those are private philanthropy or government programs; all of whom first ask for a list of needs, a needs survey, a portrait, if you will, of this kind of a needs map. Convince us that you’re in the worst shape possible and we will give you programs and help from the outside.

We think the next slide demonstrates some of the negative consequences which are very, very powerful of viewing communities only as problematic, only as needy and deficient. Sometimes, unfortunately, even though that conception of a community might be promulgated by people with a good deal of power on the outside of the community, sometimes local residents then internalize that idea.

If I’m a low-income mom on the west side of Chicago I might say I’ve been told so often that I don’t know enough to raise my kids or I don’t have the skills to enter the labor market that I internalize that. And the reality is that that then makes it harder and harder for me to come back into the middle of the community as a contributing member.

And just a couple more comments on the kinds of consequences which the reality of viewing communities as mainly deficient makes real and peoples lives. If we don’t think we’ve got any resources in our community why would we turn to our neighbors for help?

And it’s true that we’ve all learned in our lives that relationships are like muscles. We need to exercise them, use them constantly. And if we don’t think local relationships are going to be useful those relationships wither and die and we instead are made dependent on outside programs and help.

The idea that communities are mainly deficit and needy determines how money comes into the community, categorical funding, narrowly defined. Money often directed mainly towards professional helpers, not residents. Money that allows communities to identify leaders whose main skill is getting money and who therefore are really good at telling the outside world how bad things are.

And all of that sort of leads to a downward spiral in so many communities that we’ve worked in over the years.

The good news is though, and much of this is reported in our main book; Building Communities from the Inside Out, as the next slide demonstrates, there is an alternative. Many, many creative communities have begun to substitute an asset map for the needs map. They don’t deny the fact that there is emptiness and neediness and deficiency in the community. They simply say that’s not our whole reality. We also have fullness and this sort of sketchy asset map begins to identify some of the elements of fullness. Individuals in the community recognized for their gifts not just for their deficiencies including people who are battling mental health issues.

Citizens associations whether those are self-help groups or block clubs or religious groups or cultural groups or sports groups, all of the ways in which people get together without getting paid to express their capacities. And then the final category here points to the power of local institutions; public, private and non-profit.

This has expanded, this asset map, if you will, into six categories on the next slide where I report briefly a discovery that we’ve made in our decades of working with devastated communities and watching them discover what deformus looks like. We now are bold enough to suggest that every community in the United States no matter how devastated it looks like from the outside and now that we’ve done a lot of international work in the last couple of decades I would say that every community on the earth basically is characterized by its own unique combination, and let me emphasize that, every community is unique but every community has six basic kinds of assets.

This is not rocket science but let me just go through them very briefly. Let’s think about everybody in this community, every individual, the people just coming out of jail, the people who are experiencing episodes of mental illness, the people—the young people in trouble, the people who are experiencing welfare. Let’s think about those folks not for their deficiencies and their challenges but as talented and skilled.

So, let’s construct things. Many communities have done this like capacity inventories. I’ll show you an example of one in a moment. Skills inventories, gift inventories, let’s figure out what our neighbors can do, what they know about, what they’re enthusiastic about. And then use those talents and skills as ingredients for making the community even more healthy and more vital.

Second, let’s make sure that we’re aware of all of the voluntary associations, all of the networks of relationships that people have entered into to express their talents and skills and to make the community a more powerful reality.

And third, let’s make sure that those public, private and non-profit institutions are all engaged in the task of making the community more vital.

Fourth, this was not on the previous page, asset map, but it’s a critical - it’s the next one; the fourth, fifth and sixth are critically important assets in a community. The physical assets whether we’re talking about a rural community or whether we’re talking about an inner city neighborhood, assets are there; the land, the property, the buildings, the infrastructure, the transportation. All of the things in the physical world that give us more tools to make the community stronger and more vital and more healthy and more welcoming to people.

A fifth, every community, no matter how low income, is its own economy. People produce things, people consume things. There are local business assets there. There are often barter arrangements in many, many communities. Obviously in some communities some of the economic activity is so-called, off the books, or informal. It doesn’t mean that it’s not an important asset to take advantage of and to be aware of.

And then finally every community, when we start getting to know it and begin knowing some of the natural leaders and some of the carriers of the culture of the community, every community does have a culture, a history and we’re particularly interested in the stories of the community, the stories which make a community special, define it as it’s own very, very unique place.

And we’re particularly interested in success stories. When was this community most successful in your eyes? When did you feel most valued in this community? And how then can we understand what made those success stories happen and how can we make more of them happen in the future.

So that our discovery in building communities from the inside out, our basic volume and in the 25 or so workbooks that we’ve produced since them, working with communities, often learning, sitting at the feet of community builders, have taught us that there are these six categories. And that community building consists of finding these, that’s sometimes called asset mapping, connecting them with each other. So if you have a young person in trouble note that that young person might also have a wonderful singing voice and you might want to connect them to the second categories and assets; an association called a choir who might then lead that young person into a more productive economic future maybe through using a physical asset like a recording studio. So we’re constantly connecting assets and then often mobilizing them around a hopeful vision for the future.

Finally I want to spend just a moment on two examples, if you will, back to the individual level. Let’s leave the community level aside for just a moment we have two ways of viewing individuals. We can view individuals as deficient, needy and problematic and the challenges that so many of our major institutions, particularly those institutions who really want to be helpful. We have to be careful here because motivation is not the question here, effect is, and often unintended consequences are. So what I wanted to share very briefly here is an actual summary of a questionnaire which was focused on the problems faced by people on welfare.

So if you could imagine a 20 minute conversation over a cup of coffee. A welfare worker enters you in, say, a young single mom who’s beginning the difficult trek from welfare to work and here are the categories that the state, I won’t name the state, has asked this welfare worker to find out about.

And so the questions are tell me about your inadequate housing, your limited job seeking skills, the work history you don’t have, how often you’ve been fired or quit jobs, your high rate of absenteeism. Maybe we have a neutral question here that’s not necessarily focused on deficiency, how old are you? But then we get back to the deficiency questions. Are you a pregnant teen? Do you have no childcare available? The next slide. You don’t have reliable transportation? You’ve got sick dependents, no skill? You don’t communicate very well, do you? Tell me about your history of mental illness or substance abuse? Let’s make sure that we know all about that.

Your family issues in the next slide. You have your felony record. Tell me about your bad eyes and your bad ears and your bad teeth and other medical problems and your family and friends won’t be very supportive. And the last slide of this wonderful survey, how often you’ve lost your benefits and the career goals that you don’t have or you do have goals but they’re uncertain or unrealistic and the cloths that you don’t have.

Can you imagine what that psychological dynamic is of this interchange? If I’m the person being interviewed here I can imagine myself slumping down into my chair thinking of myself as the 20 minute slog to an end as ever more deficient, ever more needy, every more incapable of taking charge of my life.

The bad news is that we at the Asset-based Community Development Institute, our friends across the country and world know that we’re interested in these dynamics of creation and reinforcement of deficiency in individuals.

So they send us these surveys. And the bad news is we’ve got stacks of these; not only targeted at people with welfare but certainly targeted at people who experience mental illness, certainly targeted at people with disabilities. Always about what can’t you do, not what can you do.

We have stacks of them targeted to young people. The first time a young person gets into trouble with the law they are often sat down and asked a series of questions about how often they’ve thought about suicide, about their drugs and alcohol problems, how often they were beaten as a young person and what they’ve failed at in school.

And so we’ve begun to identify a kind of process of marginalizing people by stigmatizing them, by making sure that they think about themselves in the way that major institutions think about them and that is as empty, needy and problematic.

We think that that is a process that needs to be halted and reversed. And the good news is, the next slide, that in fact our stacks of examples from community folks, and this is not things that we do ourselves but the communities report to us, of the opposite have grown exponentially.

And so the last thing I want to share with you is a wonderful example that’s very moving to me of a group of people who ran a huge soup kitchen operation in Cincinnati, Ohio feeding about 300 people a night and who transformed the soup kitchen by entering into a discussion, a series of interviews and conversations with people in the soup kitchen.

The brief background is that the people who ran the soup kitchen in the New Prospect Baptist Church which is the largest African American church in Cincinnati, Pastor Damon Lynch and his (lay) leaders in the congregation decided that they would like to do something more effective to make the lives of the people that they serve the food every night to make them maybe more positive, maybe more connected to the community, maybe more economically and socially viable.

And when they asked themselves why they weren’t doing that they discovered that they didn’t know enough about the people. They knew enough about their difficulties, their substance abuse difficulties, maybe their homelessness, their bouts of mental illness but what they didn’t know very much about was the full part of their glass.

So, this and the next page are their simple survey questions focused at how do we discover, rediscover, the full part of the glass of the people in the soup kitchen? Their declaration of belief, basically we believe that everybody has God-given talents and gifts that can be used to benefit the community.

I want to spend a few minutes talking to you about your gifts and skills. Gifts are abilities we’re born with. We can develop them but nobody has to give them. I love the way the questions are phrased. They’re so respectful and they assume that the person that they’re talking to has knowledge and experience and valuable insight to share. What positive qualities do people say you have? Who are the people in your life that you give to? And then skills, what do you enjoy doing? If you could start a business what would it be? What do you do best? Have you ever made anything? Ever fixed anything?

And then dreams; what are your dreams? If you could snap your fingers and be doing anything what would that be? And these are not people who have been asked very frequently about their dreams.

Let me end by describing what happened when the folks in the soup kitchen who were running it had completed a couple hundred of these interviews of people who had come to the soup kitchen for a meal.

They discovered immense examples of gifts and skills and dreams. For example, they discovered in their first couple of hundred interviews, more than 40 people who described themselves as having musical skills and that explained why when I visited the soup kitchen some six months after they started this project, I had visited before many times but this time it was different because when I went in for the evening meal, there in one corner of the room on a little riser was a 15 voice choir made up of people from the soup kitchen who had discovered each other to have vocal skills and some choral experience. And they were beginning then to provide music to the soup kitchen.

They were followed for the second half of the dinner hour in the soup kitchen by a five-piece jazz quintet. Again, people who had discovered each other through this gift interview process. Other people had discovered each other as folks who shared carpentry skills. And I learned that the month before I visited a group of 15 of these guys, they were all guys as it happened, had formed themselves into a neighborhood carpentry co-op that had begun working on abandoned buildings both commercial and residential in the community.

They also discovered, and this was the one that really blew me away I think, that when they asked people, what do you do best, what do you like to do best? In the context of a soup kitchen there was one answer that came forward many more times than any other answer and the answer was, I love to cook in a soup kitchen.

So the folks recognized after a bit that they weren’t just hearing an answer about cooking. They were hearing from people saying I don’t want to be on the side of the table with you serving me and cooking me. I want to be on the other side of the table cooking, serving, contributing because as long as you’re over there cooking for me and I’m over here just eating what you cook, you are a fully valued member of the community and I’m not.

And so what they did was open up the kitchen so that the people in the soup kitchen who wanted to joined the cooking team and other people stepped forward and helped with the serving and helped with the cleanup and helped with the food delivery.

So what I saw was no longer a soup kitchen with people who are designed as not having deficiencies serving people who were defined as deficient but I saw a place that was a real community.

And in a real community everybody gives and everybody receives and that’s what we think the strong community is; everybody who was diagnosed with mental illness is recognized as a person whose definition is not just that, but as a person who also has gifts and skills and contributions to make and they become part of that community as we all do when we are asked to contribute those gifts.

So social inclusion asks people to come back to the center of the community, back to the center of economy and become neighbors and become co-contributors and that’s the power of social inclusion and its promise for all of our communities.

Thank you so much and I look forward, Jacki, to your remarks about how all of this plays out in a wonderfully rich life like your own.

Jacki McKinney: Thank you very much.

Mary Pat King: Thank you Jody so much, you’ve given us so much to think about and such great resources on Slide 29 and 30 to help guide our (efforts) as we work towards social inclusion.

Thank you again.

Now we’re delighted to welcome Jacki McKinney who is well known for her presentations on issues such as seclusion and restraint, inner generational family support and minority issues in public health especially mental health.

Jacki is Co-founder of the Current Trauma Movement, the first African American women to receive Mental Health America’s Clifford Beers Award and a national expert on trauma informed programs, practice and policy.

As director and co-founder of the National People of Color Consumer/Survivor Network, Jacki has worked as a consultant to numerous national and social policy research groups as well as federal agencies including SAMHSA.

She’s played a key role in integrating people with lived experience of trauma into the study on women co-occurring disorders and violence.

Jacki’s the Director of the Trauma Knowledge Utilization Project and also serves on the Board of Directors of the Bazelon Center for Mental Health Law as well as Mental Health America.

A survivor of trauma, addition, homelessness and the psychiatric and criminal justice system Jacki will share her thoughts about and vision for social inclusion as well as the important role of peers who make it happen.

Jacki? You can begin Jacki.

Jacki, I think you might be on mute still if you can open up the lines.

Jacki McKinney: Is it open now?

Mary Pat King: It sure is.

Jacki McKinney: Hello and thank you very much and I call myself Ms. Jacki because of my age. I’m calling from Temple University Collaborative on Community Inclusion today. They are hosting my presence and I want to thank them.

I want to start with talking about what social inclusion really means being and feeling alone. When consumers first began to push back we were alone. We had to fight every step of the way and we were socially excluded in every way.

I might go a little faster than the previous speakers because I’m a fast speaker so. I want to talk just a minute about the other two speakers and how their work really feels like an invitation to me. It is really like an invitation to a larger world, a world that’s thinking about change that we all desire; social inclusion.

They’ve made me feel welcome and I hope they’ve made the other peers feel welcome with all of our baggage, especially mine. I can be the change agent to create a meaningful purposeful life for myself and my peers and I thank you.

How far we’ve come to get here. 30 years ago peer specialists where a pilot research project and I worked on the very first one that existed. Now there are 100’s across the country earning Medicaid reimbursement for their lived experience.

Hundreds of people are turning their scars into stars. That is certainly an important step in the path to social inclusion.

Shame and blame were our legacy and moving out against anything was moving out against conditions. In our time if we were fortunate enough to be getting anything, anything, then they warned us against being a part of that in any way.

Speaking out about our condition was really just discouraged because, you know, it was a time of secrecy. Seeing mental health and mental illness as a lifetime legacy of failure and never ever being able to think and have hope in our ability to do something different.

So, we start - I want to start off with the first thing that I remember which is called nuts and bolts. It’s a name of a book that was developed by consumers using and utilizing, the work from many other consumers and technical assistance groups. This particular consumer group created a technical assistance guide for mental health consumer survivors and self-help groups.

Two miracles happened there. One is that we were able to talk to ourselves telling ourselves what to do, guiding ourselves on what we learned and coming up with a plan to direct our own lives and actions. But also, we were beginning to learn that we could not replicate other people’s material so this one was different. Anyone could take our materials and adapt them. There was no hold on them and I’ve never forgotten that time.

But for the first time providers of the support consumers called then, and benefactors of the services consumers, regarded each other as equals setting the stage for what we now all experience.

Consumers often speak about moments of transformation and - sorry, that’s the wrong one. Should I - that’s the last one actually.

Man: Oh you don't ...

Jacki McKinney: Our peer support groups are vehicles for social inclusion. We all have talents, gifts - I’m sorry. I’m really getting mixed up here. I thought I did nuts and bolts. That was the one I just did.

Man: Right.

Jacki McKinney: All right, so now we’re on 38.

Man: Okay.

Jacki McKinney: Okay, how peer support groups are our vehicle for social inclusion. We all have talents, gifts, skills and dreams as John has said that today. But consumer support groups realize that and use it as a capacity building strategy for ourselves as individuals.

We use our lived experience sharing coping strategies and skills with other peers to create a bridge from joblessness to workforce.

What does that mean for us?

Jacki McKinney: Okay. How peer groups are a vehicle for social inclusion. Peer groups are a vehicle for social inclusion, Jodi has reminded us, again, that we have these things. We created our own welcoming community first through support groups which were first developed in drop-in centers. Through these groups members began examining and getting support for living fully including developing skills to get and keep jobs, essential component for us of social inclusion.

Consumers and peers began using support groups as an approach for creating social inclusion for group members to create consumer communities from the inside out. Support groups were our capacity building strategy in addition to story telling.

Two facts about those; one is they didn’t cost any money and we didn’t have any and two, we could all participate. Using their lived experience peers shared coping strategies and skills with other peers to create a bridge from joblessness to workforce. Consumers developed support groups and drop-in centers that now focused on developing job skills in addition to talking about monitoring medication, keeping appointments, talking to people about their interest, creating volunteer opportunities, teaching people expected behaviors as a worker rather than members and their behaviors.

Utilization of peer support groups brings people together with others who share a common framework that includes shared attitudes, beliefs and behaviors.

It affords opportunities to people who have been excluded because of culture, gender bias and mental health problems. Addressing trauma - we’re on. Addressing trauma removes the last batch of secrecy from our movement. That, for me, was a turning point in my relationship to the rest of the peers because what brings us together wasn’t just our desire to heal and be well, but we found a way to turn back the dark cloud of trauma into something positive that gives the life experience that we brought, all of us; meaning and purpose.

I just want to talk a little bit before I finish, and maybe I really went really fast - I really want to talk just a little bit more about trauma and difficult conversations. Telling our full story including shedding light on the secrets that we’ve held on to began to release the hold that traumatic experiences can have on survivors.

Unfortunately in our experience such secrets can be one of the most difficult aspects of trauma for us to talk about, to understand and for others to hear. We have developed and began to address the difficult aspect of dealing from trauma and talking about and unlocking the secrets associated with trauma. We have compiled these tips and talked about them in a list because we see them as a release of our secrets as critical to our survival and healing and the quality of life that we really wish to attain.

Finally, I’m looking for my last slide...Trauma is our common denominator. Feeling is the common goal. What brings us together isn’t just our desire to heal and be well but to find a way to turn the dark cloud of trauma into something positive that gives our life experience meaning and purpose. Just as important as anything that has ever happened to us was to recognize what one of our professionals that’s worked with us has often said that it’s not what’s wrong with us it’s what happened to us.

The minute that we discovered that we could say to people or talk to people as if it were not our fault because that is what we had always lived with the shame and blame that we did something that made us like we were. But, with that line, we were free. We were free to say, it’s not what’s wrong with us, it’s what happened to us.

Thank you.

Mary Pat King: Ms. Jacki, thank you so much. You’re so inspiring and motivational and we just really are so thankful for you sharing your experiences and giving us your wisdom.

Each speaker has provided more resources for you to tap into. On Slide 40 and 41 we also provided a list of additional social inclusion organizations and materials including a link to the nuts and bolts technical assistance guide that Ms. Jacki mentioned in her presentation.

Now we’re really excited to open it up to questions from callers. To ask a question please dial star 1 on your telephone to be placed in the queue and give the operator your name.

If you do not wish your full name to be announced just state your first name. Because time is limited please limit yourself to only one question so our presenters can get to even more questions. And after the conference operator announces your name please ask your question.

Once you’ve asked your question your line will be muted so the presenters may respond.

Operator, the first question please?

Coordinator: Our first question comes from Amy Moore.

Mary Pat King: Hi Amy.

Amy Moore: Hi there. This is (Amy Moore), I’m calling from Lansing, Michigan. We were thinking about implementing the Seeking Safety Trauma Recovery Program and I wondered if there was other recommendations as far as helping with trauma? This would be within a day center that helps people with mental health disorders, a safe place for them to go during the day.

Mary Pat King: Thank you for your question. Jacki, would you have any suggestions?

Jacki McKinney: I think that there are so many now and I’m so proud to say that. That I think that the best thing to do is to send, is to find, the information to get this callers information and send her a list. We now have lists and she can really choose there. They even break it down based on what the group represents and what you want to do.

So I think that would probably be the best way. I have to go back about 20 years now to just get one. But Seeking Safety is very good.

Mary Pat King: Great. Amy, you can use the chat capability up at the top to send us your email address or you can email it to the ADS Center and the contact information is in this presentation or you can email on Slide 44; Promoteacceptance@samhsa.hhs.gov.

Next question operator.

Coordinator: Our next question comes from Charles Willis. Your line is open.

Charles Willis: Yes. I was interested in listening to Jacki and I was wondering despite what we see happening in terms of focusing on inclusion, what - we’re still up against the fight of being excluded despite all the work that we’re doing.

How and what do you suggest or how do we go about making the difference or doing something in a different way to embrace other communities to support us as we transition into living lives of our choice?

Mary Pat King: Jacki, would you like to take that?

Jacki McKinney: Of course I would. Thank you so much for that question. I think that the answer is to join others. I think the answer - and I think, and this is my reference, I think the new healthcare reform issues that are being mandied about people going into the community - I think this gives us, along with the information that John, Jody, Dr. John gave us, I think this gives us an opportunity to go into the community. I think we’ve done a really wonderful job of educating and supporting each other. And I think that our provider agency, SAMHSA, has been more than a partner for most of us.

I think it’s time for us to actually go into our giving communities and I know we go into our communities but we go into our communities as healthy and strong people. We don’t take our histories with us. I think we have to begin to disclose our communities just as we did early amongst ourselves in small ways and grow with the community using some of the strategies that have been shared with us by the other speakers. I think we’re ready.

Mary Pat King: Do any of the other speakers have anything to add?

Okay. Operator, next call please?

Coordinator: The next question comes from Donna Bug. Your line is open.

Mary Pat King: Hey Donna.

Donna Bug: Hello, hi. It’s Donna Bug. The question I have is in our community we have a committee made up of professionals and consumers that we started a couple of years ago and we’re trying to find similar committees or groups in other areas to collaborate with on how we go about scheduling events because we came up with various things to do in the community to help educate for awareness and stigma reduction.

So, I wonder if anyone has any other committees they can tell us of that we can get in contact with? Thank you.

Mary Pat King: Thanks Donna. Jacki, sorry to put you on the spot again but can you answer this and start us off?

Jacki McKinney: Personally this is a spot I love to be on so it’s fine. I would actually ask the people who live in the community where they believe - and I’m assuming when I say that that I’m talking mostly about the people who are coming with the mental health and trauma issues, I would ask them where would they feel the most invited?

And then create a strategy for inviting some of those people first to our meeting because you already have something good going. You have something that they can see. Invite them but make sure that the people who are making the, who are helping you make the decision, are the ones that are also part of making the invitation.

That’s it.

Mary Pat King: Thanks Jacki. Just to add to that we have, on our Web site on promoteacceptance@samhsa.gov we have a Campaigns and Programs tab where there are a lot of great best practices happening. And many times that includes contact information so we really encourage you to use that tab.

Operator, next question please?

Coordinator: Our next question comes from Richard Bared, your line is open.

Richard Bared: Hi. I’m calling from Philadelphia actually I’m just down the hall from Jacki. One of the - I’m wondering if any of the speakers can tell us a little bit or provide some examples really of community groups, not mental health groups and not necessarily other social services agencies, but community groups or organizations of any kind where there’s been a more open acceptance and engagement with people either as a group or as individuals who have a psychiatric history?

Because I think what the field needs right now is some examples of, as you’ve all said, and this is really a follow-up to the previous two questions of some example where people have gone into the community and participated in community activities which is probably the most effective way to address those issues of stigma. But not with that purpose but really with the purpose of being engaged in community activities. And we’re sort of looking where we work for some examples of that.

Mary Pat King: Thank you so much Richard. Jody, would you like to respond to this?

John Kretzmann: Thank you (Richard). It’s a wonderful question and I think it’s a wonderful question for a number of reasons; one it does sort of invite us to think about the context of inclusion as moving far beyond the professionals who do such good work in the field and involved really ordinary citizens and their groups.

We have run across a number of really quite stunning examples of groups who’s focus is not at all on inclusion of particular populations, especially those dealing with mental illness and trauma, but who’s understanding of community is that it’s healthier when everybody is a contributor.

A number of community organizations and community development groups have that kind of outlook. We had a wonderful set of experiences some years ago in Chicago working with a terrific community organization called the Logan Square Neighborhood Association, LSNA, who did a lot of work for a number of years on getting to know and then include in the community people who were living in group homes.

Many of them people with disabilities. Many of them people facing a variety of mental illness challenges. Getting to know them in the way of identifying their gifts and their skills and their talents and then figuring out where in the community, not treatment, takes place but where gifts can be contributed. So when they find—when they found a women, for example, who loved animals they connected her with a pet store and she began working there and both the pet store and the women involved benefited from that.

They ran into a young man whose major visible gift was the fact that even though he didn’t speak he smiled a lot and he always hugged people. And they ended up connecting him with a local hospital and so he began delivering mail in the local hospital and spreading joy in that hospital which was a place that, according to the neighborhood group, actually needed quite a lot of joy to be spread.

So there was that set of experiences. And then we’re also running across more and more local religious congregations who take seriously the idea that from their faith base in the language that some of the folks use out of there own base that everybody is a child of God. And that therefore everybody is welcome in this place in our faith place.

And so we have encountered in Chicago and in Denver and in San Francisco and in lots of other cities religious congregations whose doors are open and whose members are practicing hospitality and welcoming to lots of different people. And who barely notice after a while that some of the people in their midst might be a little bit different in ways that would otherwise, in different context, stand out. But they don’t standout once they become contributing members of the congregation.

So I think it’s - the real challenge for us is how do we open up the opportunities for more and more people who aren’t sort of professionally and treatment oriented to be part of the inclusion agenda

Mary Pat King: Thank you so much Jody. We have a speaker, or a question, that came through over the email and this is really directed to all speakers so we encourage any of you to jump in and answer.

Has any community done a good job of working with law enforcement or any aspect of the criminal justice system to decrease negative outcomes and increase community integration in creating a safety net to avoid future criminalization?

Speakers?

Jacki McKinney: This is Jacki McKinney, we have actually worked directly with many, many goods such as that because many of our “members,” meaning people with mental health issues have also shared that experience. So that’s been one of the places that it’s been very easy for us to join because for the same amount of years that we’ve been working on ourselves, some 30 years, we’ve been working in that context of people who also share that part of their history of having something to do.

And very often because of living homeless and issues like that we have been involved in some form, maybe not for long-term containment but we have been involved in some way and have had some complaints.

So we have joined with - I also do a volunteer effort with school policemen or school - I think most schools now have some sort of enforcement. They’re not necessarily called policeman but they’re called service guards. They have nice names and most of them are very nice.

But the important thing for me and for other people who share this mental health and perhaps substance abuse background, it’s really helpful to talk to people who are struggling to take care of an be a part of helping other people to behave in ways that we all would prefer.

I want to say that the people are acting out but the children really, really enjoy it when they find that they can talk to the guy who watches them come through. In Philadelphia where I live they have guards, excuse me, at the entrance of the schools very often. And in order for them not to be looked like policeman or act like what the kids think policeman act like I encourage them to learn the children’s names and things like that.

And then when they see a sad child to ask them would you like to talk to someone later and then laughingly say, it will be me. And you know, (as far as that comes). But it’s really - it’s there. There’s many, many places but I believe that that’s one of the places. That’s where I go. That’s one of the places.

The other is faith-based as John was inferring, they’re always looking for volunteers. Anyplace where they don’t have money probably would say (here’s) enough. Thank you.

Mary Pat King: Thanks Ms. Jacki. Okay, any of the other speakers like to respond to that question?

John Kretzmann: Well, let me just say a word about it. I - in our experience those police departments that are most serious about taking the ideas behind community policing seriously are those departments that are more than likely to have people within them who are really interested in building relationships with folks in communities, folks in neighborhoods and including people in those neighborhoods who otherwise they would think of as pretty strange and not people that we would normally interact with.

So those departments that have police walking the beats and being, getting, themselves known and personally related to folks on the block level tend to be departments that are also interested in really getting to know folks of all kinds in the community.

Mary Pat King: Thank you so much Jody. All right, so we have one question. This ones for Lindsey. Lindsey, can you give specific examples of how the UK instills a social inclusive community by integrating different systems?

Lindsey Dawson: Sure. The UK has integrated different systems but also different groups of people and it’s a key to each group of people they look at be it homelessness or people experiencing mental health difficulties or ex offenders to look through those different aspects of life that’s impacted by social exclusion and creating strategies that are responsive not only to the group but the service user input but also along different areas of life.

One specific example they’ve done just recently, I think maybe in the last couple of months or so, they put out a report looking at mental health issues for South Asian community in London called Family Matters. And that’s specific to the way families influence social inclusion or social exclusion and looks to families as sort of this double bind where the family can be a source of creating an inclusive space or where it can lead to social exclusion.

And because it’s a national strategy there we can see differences by burrowed, by different sections of London or different regions in the community so it’s really sort of cross-spanning throughout the country and throughout issues focusing on different groups and on different problems.

So we’ve helped homeless people get into the homeless shelter and then find affordable housing in the opposite direction to help them regain.

Mary Pat King: Thank you so much. Operator, do we have any more callers

Coordinator: Yes, we have some questions. Cindy Mayhew your line is open.

Mary Pat King: Hi Cindy. Thanks for calling.

Cindy Mayhew: Thanks. Hi, yes I just wanted to - I just really wanted to express my gratitude to Jacki and Jody and the first speaker. You’ve really ignited a spark that’s been laying dormant with me and I wanted to ask not only is it not about what’s wrong with us but what happened to us. It’s also not about what is wrong with us but what is strong with us.

And Jody you just reinforced that so much for me with your presentation on asset building. But what I wanted to know Jody is are you familiar with Time Dollar projects and the founder Edgar Cahn and do you know if there’s anything still going on with those? And if you have any information would you be willing to share that with me?

John Kretzmann: Sure, absolutely. Thank you for the question. Edgar Cahn is a close friend and colleague of the Asset-based Community Development Institute. We’ve worked a lot with him over the years. The Time Dollar idea which he really pioneered in senior citizens communities is, we think, a very, very powerful tool, kind of mechanism, for jump starting new stronger bonds and relationships among neighbors.

So for folks who aren’t familiar with it, let me just briefly, very briefly, describe it. It is a set of mechanisms where people contribute some kind of helping behavior to neighbors. And every time they do that, take somebody to the store, mow somebody’s lawn, contribute some babysitting, cook for somebody who’s unable to cook for themselves. Every time they do that they accumulate a virtual dollar, a time dollar. And there’s a time dollar bank that’s kept within the community. And as you accumulate time dollars you can then spend them with other people in the community and get them to do something that you need done.

So it’s a way of - it’s a sort of way of jumpstarting barter systems. You’ll do something for me and I’ll do something for you that is really one of the definitions of what is a good neighborhood like. It’s where people know each other and they do things for each other.

So Edgar Cahn and the Time Dollar Movement we think is a very, very important tool or mechanism in the community building world.

Mary Pat King: Thanks so much Jody and thanks Cindy for asking that question. We’re definitely going to look up that concept and provide more information in the future on it.

Operator, next question?

Coordinator: The next question comes from Dr. William Rines.

William Rines: Yes, I'd like all three speakers to respond to this question please. My question is what role does violence play in social inclusion and community development?

Mary Pat King: Ms. Jacki, would you like to go first?

Jacki McKinney: I'd like to go first because I was, in my history, I have a history of having a great deal of violence which was one of the issues that I brought to the table that was not included in my mental health treatment.

And I think that the first thing, and the piece - the work that we did in trauma which encouraged us to tell our story in their entirety, allowed me to talk about the violence in my life.

It was only then that I began to heal from that same violence. We have - there is a doctor that some of you may know. He created the ACE Study, Adverse Childhood Experience. But very briefly, what he says is what happens to you when you’re young and you’re small is what has the biggest, the largest, the greatest impact on you as an adult.

And so he has a series of approaches to looking at violence and according to him, and I’m speaking specifically to the gentlemen that asked the question, according to him if we don’t address, allow people to talk about the violence, then they will keep that with them for the rest of their lives.

And some of you know that in the mental health community they have discovered, through research, that we die more than 20 years earlier than people who do not have mental health issues.

And, again, there’s a direct correlation between that statistic and the violence that we have experienced in our lives. And that is why we - people who have this opportunity to work in the mental health community who also are survivors of violence and mental health issues are so caught up in this issue of making violence known, of dealing with violence and telling your stories about violence.

And instead of saying to these people don’t talk about it, it’ll go away talking about it will help it to go away because other people will join you and maybe someday we’ll have safe communities.

Thank you for asking.

Mary Pat King: Thank you Ms. Jacki. And do any of the other speakers have anything to add, Jody or Lindsey?

Lindsey Dawson: Yes, this is Lindsey. Hi. I think an important thing to think about is how social inclusions tries to look at violence. And it's concerned not only with the individuals experiencing violence but it's also in looking at violence in and of itself as not a problem simply as crime but as a problem of deprivation.

So what is it that’s happening in the community that leads to circumstances of violence and targeting those underlying issues?

Mary Pat King: So thank you so much Lindsey. Jody, do you have anything to add?

John Kretzmann: Well, I would just agree with both Lindsey and Ms. Jacki. It seems to us that building strong communities is constantly giving people alternative ways of dealing with each other that are not ones that involve violence. There are all kinds of other avenues and we're simply interested in folks who are good at dealing with young people earlier on in their lives to make sure that they recognize that there are conflict resolution possibilities that have nothing to do with violence so it stops short of violence. But allow disagreements to happen, allow some conflict to happen but don't necessarily beat the violence.

Mary Pat King: Thank you and thanks to Dr. Rines for asking that important question.

Operator, do we have additional calls?

Coordinator: Our next caller is Ida.

Mary Pat King:  Hi Ida.

Ida: Hi. First I would like to recommend highly the Time Dollar Program because in small communities, as Jody pointed out, they do work. I have personal knowledge of those working.

Second, with - we’re talking about exclusions. The stigma associated with people who are involved in—with the deficiencies that word consumer, I didn’t think too much about it until I developed a disability, a physical disability. And after that suddenly it took on the original German word of useless eater. And someone uses the word consumer I wince even though I have reestablished my professional life.

Now, is there another - I’d just invite everybody with me to think about - is there another term we can use other than consumer when someone is coming to the table to say, okay, here’s what I used to do. Here are the things I can’t do anymore and I’ve got to rebuild my life?

That’s it.

Mary Pat King: Thanks.

Jacki McKinney:  I’d like to say something just really quickly. We generally call ourselves peers now. And I don’t know what you think of that word and we’d certainly be interested if you have one. But peers we feel - because we now can look toward, look across the isle to each other, and know that we all are standing strong.

Consumer came in the old days where we had no other name accept patient. We fought against ex-patient. We said Judy Chamberland, one of our heroines said, how could I be a patient when I’m not even in the hospital anymore?

So we’ve come to many names and at some point some of us women who have had the violence issues we call ourselves survivors. But the truth is we’re all looking for that day where we’ll just be members of the community and strong.

So, help us out.

Mary Pat King:  Thank you so much Ms. Jacki. All right, we have a question that came in through the Internet.

What efforts are being made within social Web sites with regards to social inclusion in light of the many tragedies that have resulted from social exclusion online?

Thank you.

Does anyone have any experience with social exclusion online and innovative efforts online for social inclusion?

Lindsey Dawson:  Hi, this is Lindsey. I think one great example of this is the It Gets Better Campaign that has recently launched and it targets LGBTU’s who might be isolated and not feeling connections or community connections at home and people are posting YouTube videos; celebrities, politicians, President Obama has posted one, offering hope to get through a difficult time in their lives and letting people know that there’s a community out there willing to support them even if they can’t find it in their hometown.

Mary Pat King:  Lindsey, thanks for bringing that up. That is an awesome campaign.

Jody or Jacki, do you have anything to add?

John Kretzmann: Just - this is Jody. I think that not only in the arena that we’re talking about here during this discussion of social exclusion but in general I think we’ve got a problem here with the Internet and with electronic communications. Because it does, as many people have observed, have at least as part of it’s tendency the tendency to attract people who are like each other and not necessarily to make it easier for people to be in a real conversation with people who are different from each other.

So that bridging capacity, the capacity of getting people to know each other across some boundaries and some gaps I think is a real challenge for us these days.

Mary Pat King: Thank you so much.

Jacki McKinney: Can I just say one thing about the activities of having joined this movement of people who are healing from these disorders that it has been the most joining experience that I’ve ever had in my life and I’m 77. I mean, the idea that it’s your scar that brings you the star has just been just the warmest, one of the most warmest, experiences in my life.

And I would - I don’t really go around the country talking about how happy I am that I was ill but I’m so happy to meet these colleagues that we now call peers.

Mary Pat King: Thank you Ms. Jacki. That’s a wonderful, wonderful thing.

Operator, do we have additional calls?

Coordinator:  Yes. The next question comes from Rachel.

Mary Pat King: Hi Rachel.

Rachel: Thanks for taking my call. I work with a community health collaborative in Rice County Minnesota whose primary mission is building community connectedness. That’s the objective. I’ve seen that it’s a social determinant of health and trying to do that.

And I wondered if any of the speakers had any ideas about the best ways to measure the impact of events or projects or just general work that is being done on supporting the building of that sort of community connectedness.

I know it’s kind of vague but if there are any thoughts or resources I’d love to hear about them.

Mary Pat King:  Great. I think we’ll start with Jody. Jody, do you have any insights or resources?

John Kretzmann: Well, I’m a little bit acquainted with the connections work that’s going on in Minnesota, not particularly in Rice County, but in other parts of the state. I think the challenge of measurement or some people would still use the E word, evaluation, of this kind of community building work is a difficult one.

But I do think that there are ways to be aware of how it is that people build to use the cliché these days to how people are building connections or social capital.

Are the connections multiplying? Do people know each other across some boundaries or gaps that they didn’t know each other six months ago or a year ago? And there are questions that you can begin to ask in conversations in its survey forms that get at this - at least being aware of, if not measuring precisely the multiplication of connections. And then if we’re aware of the power of connections we know that increasing connections, increasing social capital at the local level does lead to better health outcomes, better safety outcomes, better outcomes for the wellbeing of young people and so on.

So these sort of intermediate outcomes of increasing social capital, increasing connections, and asking people about who are you know working with or dealing with or who do you know about or who are you connected to that you weren’t six months ago? What are the new connections that are being made?

There are ways to get that conversation going in a community that begins to validate this community connection emphasis in a way that is pretty powerful in problem solving terms.

Mary Pat King: Thank you so much. Lindsey, do you have anything to add?

Lindsey Dawson: Yes. I agree. I think it’s a serious challenge because I think there’s the reality of us wanting to make changes in our communities but there’s also the reality that we have to prove it. So even if we can sense a difference in the communities we might not get funding in ways of grants and being able to make policy changes without being able to say concretely we’ve gone from Position A to Position B.

I know in the UK they’ve recently also come out with the Time to Change Campaign which is to end discrimination for people with mental health difficulties. And two of the targets that they have set are to create a certain number of jobs have to be filmed by people that they have identified that have been jobless and that have mental health difficulties to fulfill a requirement of having been successful for them.

And another measure they used was they measured a baseline of public opinion, of public attitudes towards people with mental health difficulties. And they are looking to see a 5% change in that public attitude. So those are two examples of sort of more concrete ways to attempt to get a handle on what’s happening in the community.

Mary Pat King: Thank you. That is so great. Ms. Jacki, do you have anything to add?

Jacki McKinney: Well, I was just thinking that what I actually do, and this is directly related to my going around the country speaking to people who have had or are currently experiencing some mental health and substance abuse difficulties, I ask them to do surveys and tell them that the surveys are really money. Because when you have the information about, as one of you spoke earlier, the change over time, very, very quickly you can use that as a part of your appeal to others to come join you not necessarily just to get money but to get people to come and want to be a part of what you’re doing.

People love success. That’s it.

Mary Pat King: Thanks so much Ms. Jacki. Operator, we have time for one last call.

Coordinator:  Okay. The next one comes from Sylvester. Your line is open.

Mary Pat King:  Thanks Sylvester.

Sylvester: Thank you. This is for Ms. Jacki. I caught the part about the trauma and how once we bring it out into the open for them, once they see the trauma how it was developed and it would be better for them in the long run.

Now, when it comes to the mental health portion of the trauma issue, obviously would it be, in your experience, for the professional to bring it out and present it to them or for the professional to bring it out of them to be presented?

Jacki McKinney:  I think that - I have known it in both ways. I’ve known the person with the trauma being invited to the table to talk about trauma bringing it out and I’ve also known professionals who have, in one of our earlier callers mentions it, they are looking to create trauma education forms for trauma education in their communities.

Sometimes, because we are in our, so called peer movement, we have something wonderful that we attend, many of us attend, every year called Alternative where we basically come together, people who have had this issue and many people who are still experiencing some vestiges of it.

And there we openly talk to everyone, anyone there. So it’s really the place that I basically grew up by talking about what was going on with me and now many, many people talk about it. So wherever you feel safe, wherever you feel safe, even if it’s one person where you go into a grocery store and you see an incident and it looks like a child is not doing well or an adult and you just turn to the person and say I just wonder about the trauma in their life. It’s just amazing how people will respond.

So, it’s a number of ways and it doesn’t always have to be your story. You know, in the beginning you can just tell a story. You can tell my story. You can tell anybody’s story and that’s - I just recently went to Hollywood to speak to the Screenwriters Guild about utilizing more of our stories but not just of failure but our success stories so that we as a people would understand more about how we are changing and how...

I’m a member of the Civil Rights community from the oldest days. So I know change can come and I really do believe that it doesn’t take a miracle to do what you’re asking just really if you just find a good trauma story and just tell it to whoever you want to.

My grandchildren say please don’t get caught on the train tracks, waiting for a train or bus to grandma but she sure will tell you about trauma.

So maybe you could become one of those people. Thank you.

Mary Pat King: Sylvester, Ms. Jacki. That’s just the perfect way for us to end this really important dialogue and I want to thank you both. And thank you all for the questions and your thoughtful answers. This has been such a great conversation.

If we’re unable to take your questions you can reach out to the speakers directly. We have their contact information on the screen right now on Slide 43 or you can contact the ADS Center at Promoteacceptance@samhsa.hhs.gov.

You can read more about each speaker on Slide 44, 45 and 46.

We really value your feedback. Within the next 24 hours you’ll receive an email request to participate in a short anonymous online survey about today’s training. It will only take five minutes to complete. Please take the survey and share your feedback with us.

Survey information will be used to help determine what resources, what topic areas, what we need to address in the future.

This conference has been recorded and the audio recording and transcription will be available in late July on the SAMHSA ADS Center Web site.

If you enjoyed this teleconference we encourage you to join the ADS Center listserv to learn more about the information on recovery and social inclusion activities as well as resources in future teleconferences.

Or join the ten by ten wellness listserv to learn more about promoting wellness and increasing life expectancy for people with mental health and substance use problems.

We’ve come to the end of our time today if you have more questions or would like to follow-up with us please contact us by phone, fax or email. The Web site is at www.promoteacceptance.samhsa.gov and it’s listed on Slide 50.

On behalf of all of us at the SAMHSA ADS Center I want to extend our sincere appreciation to Lindsey, Jody and Ms. Jacki for helping us to see how we can work together to forge a path from social exclusions to social inclusions.

Thanks to all of you for listening and taking time out of your day to join us and thank you in advance for completing our survey.

Good bye.

Coordinator: Thank you. This concludes today’s conference call. You may disconnect at this time.

END