Digital Marketing News 2-15-2019: Google’s Customer Intent Survey and More

welcome to the digital marketing news
I'm Tiffany Allen and with your first story this week I'm Joshua NIte but
before we get in though happy discount at candy day the best day of the year
yeah so consolation prize if you didn't get those just candy yesterday you can
have some delicious discounted candy today just as good half the price if you
want if you did yesterday and you still want some more today I'm not gonna tell
anybody that's fact yeah but the only delicious candy that
I'm gonna offer today is the delicious candy of knowledge right yeah okay so
one of my favorite companies with the initials DnB right next to Dave &
Buster's right but Dave and Buster's junk don't ever release any research
it's fair yeah but to be fair my other favorite dun & bradstreet don't have as
good chicken wings so get on that dun & bradstreet but at least they did release
some new research on programmatic advertising now they feel that it is
unlocking new opportunities for account based marketing really so a programmatic
advertising of course is having computer artificial intelligence who are
basically machine learning do the bidding on your advertising for you they
bid in these auctions that take place in the fraction of a second and that gives
you the ability to get your ads seen and possibly for more cost-effective
definitely in the right spots so what they found was 63% of b2b marketers
worldwide are already buying or selling programmatically 41% expect to spend
more in 2019 so it's happening yeah and 48 percent so almost half have this ABM
style personalization in place already so this is kind of a new thing like
programmatic advertising has been a thing targeted advertising by
programmatic has been and will continue to be a thing but the idea of bringing
them together and using your targeted programmatic to for a specific set of
accounts that seems to be a new practice that is on the rise and definitely worth
keeping I am yeah speaking of things worth keeping an eye on yeah we did it
we did the Segway nice so LinkedIn hashtag client LinkedIn debuted LinkedIn
live this week which is super exciting so it's giving people and organizations
the ability to broadcast real-time video to select groups or to their holdings in
audience and testing yeah so launch versus a beta in the US TBD unexpected
rollout but of course as we talk about ad nauseam every week people like video
content it is engaging as you can tell by what we're doing currently so this is
something worth checking out if you are using LinkedIn you can segment this
video of course but check it out for your company or yourself for sure
do it before lightning crashes right so anybody else remember live the band do
not know I will bet that there is a subreddit for live the band though hmm
yeah maybe it's like slash are throwing copper so much did you look this up I
did not because honestly I don't want to know I don't think wants to go that far
back into the 90s but we're gonna look forward because reddit as I mentioned in
my sweet segue is hitting the big time they just raised 300 million dollars Wow
they have a three billion dollar market valuation and they have some major
investors that have come on board looking to turn reddit into more of a
you know churning engine of unstoppable revenue like your Facebook's and your
instagrams so there has already actually been some controversy in the reddit
community about this one of the investors is 10 cent there's a Chinese
corporation and that brought concerns about censorship and this is a community
that is passionate and angry most of the time I think is fair to say and you know
of course there are millions of people with different interests across the
thing but they are passionate about defending this platform so as we watch
the platform develop I think marketers there is some value here but it is
definitely a place to approach with caution sure their value per user is
still pretty low people aren't yet seeing it as a platform where they go to
see ads and interact with them and that is a process that is probably going to
take a little bit of blood sweat and tears but the audience is there and the
audience is passionate and as I always say if you come into reddit and you keep
it reeling you add some value then they probably won't hurt you too much that's
always the best objective worth a look yeah it doesn't hurt that bad and other
news from other companies other companies
Gary from Google I will not try to pronounce his last name if you go on the
Twitter he tells you to call him Gary from Google so I did
so he'd recently did an AMA on reddit absolutely I did my best so there are a
lot of takeaways here if you haven't looked at the AMA thread take a look in
the blog there's a lot of information available but there are a couple
takeaways I want to make sure everyone here so the first is he urges SEO s to
go back to basics making your site crawlable it wasn't all caps it should
be in all caps make sure that your website can be crawled by Google that is
sort of the whole point of SEO so folks are overlooking he says as well video
and image search as that becomes more popular so making sure that your images
and videos are optimized and the second backlink from a publication which this
is news to to lots of folks also counts more than traditional was them they tell
us so if you've already had a backlink for example from a publication you get
another one it's no it's not no value there are value there and also just
general reminder you should care about user experience when you are yeah
optimizing or having a website because ultimately if it's terrible to use no
one will use it that's pretty fair yeah and it's like we say all a good content
is good SEO good UX is good SEO a lot of those markers that tell Google that a
site is valuable and related to that user experience how long they stay howdy
big navigating queue site so if you pull it up and it looks like geo cities from
the 1990s I mean that's kind of cool but they're probably gonna bounce back
that's it's a throwback in which case we should talk about that yeah please do
check out the Captain Marvel website they designed as a Geo city site it's
beautiful you could find that also on Google we're gonna continue talking
about Google a little bit because they put out a customer intent survey
recently released the result the result of that they looked at 3,000 customer
journeys this was a combined effort from Google and virtual analytics and they
found just looking at the way that people navigated a purchase no two
journeys were like they found that research is a huge part of the process
of making any purchase they had some samples that they had set up that we're
kind of anonymized so you can go through them definitely worth a look but they
found there's up to a hundred and twenty five touch points for a single simple
purchase like of a but makeup Oh somebody who purchased
headphones was one of their examples and he had 345 touch points and it was
starting with the search engine and finding some brands and then going to
YouTube and looking at reviews and going back to search and then finally going to
a mobile location search and buying the thing in person oh so it kind of shows
that you have to be that online and offline together and it showed that the
brands that can stay top of mind through this entire journey are the ones that
are going to went out it wasn't necessarily about the the quantity of
content more so the the quality that they kept showing up in search so it
wasn't just oh I saw this name 345 times here's value here in value here in value
here everywhere I go in this journey they're there oh the other thing that
they found was research does not stop when you make a purchase okay so people
are gonna continue to explore to either add-on or to validate their purchase or
to see where to put a review so all of that customer journey is a lot more
complex than we thought and this gives us a really neat look at it it's true I
mean some of the key takeaways here that on an offline are crucial and they
should work together people do research online but they still do purse purchase
in person let me down again yeah so you need a 360 degree view to understand
really what's happening and it's also important to optimize content both for
your business objectives and for your end user for your customer so that it is
helpful in the right ways for your company of course and you know there's a
difference between paying to acquire profitable customers and paying to
acquire the ones your competition and reject it right it's it is that
optimizing for your relevance to your brand your business objectives and not
just trying to get the most amount of customers that you can yeah absolutely
totally agree and they put out there also that automation is going to be key
for this because there are so many touch points and so many people searching and
that automation is out there that can help you understand intent personalized
at scale and find those missed mentions absolutely so Josh I heard you
saying some kind of rumor around the office this week about some sort of
Forrester list yes we are proud to be foresters we have been foresting for
years no this is research analytics company Forrester put out a list of b2b
agencies this year as they do every year this is an invite-only list of agencies
in North America there are only 39 agencies on this list and guess which
agency is on that list is it us yes yes so we have small medium large agencies
on there they're handling millions of dollars in client work we are pleased to
be invited that we are plat proud to be featured on that list and we are also
super proud that we are the only one on that list that has influencer marketing
listed as a specialty huh b2b influencer marketing who knew that
was gonna be a thing it could be it's gonna be big indoor plumbing of
marketing perfect okay well that's all the news we have for you this week we'll
be back next week with more news if we need more in the meantime you can follow
top ranked and on twitter at top ranked or me at Tiffany underscore Allen you
can find me on twitter at nitrites that's an ite WRI tes and please do
subscribe to our Channel and hit that button for notifications and check out
the blog too thanks for tuning in we'll see you next week you

As found on YouTube

Depression Patient Treated With Brainsway Deep Tms At Belmont Behavioral Health 1

Depressed people are like anybody else. I have a 
million balls to juggle just like everyone does.   It's just everything that you do is ten times 
harder for a person that's depressed than it is   for the average person. My depression was. It a 
serious issue in my life, for me, for my family.   It's very difficult for family to deal 
with something that they can't see.   I met Tina on the inpatient facility here at 
Belmont a little more than two years ago. At   that point, she described this very long ten year 
history of depression with multiple episodes and   culminating to that point where she had to be 
hospitalized.

I was over ten years suffering   and just on and off and on and off and never 
had any consistency. I just thought, you know   what? I've tried everything. I've seen all these 
doctors. I think I really need some major help.   So that's when I came to Belmont originally to 
try to see if I was a candidate for the ECT.   We know that works very well, but she was a 
little concerned about how that might impact her.   Going into nursing school, taking care of a young 
kid, managing her job, managing her married life   and everything. With the anesthesia and everything 
and this being a less invasive procedure   without much hindrance to her lifestyle, we 
chose to do the TTMS.

We started her treatment   somewhere in the beginning of January. 
She was able to get the 20 treatments   and she had a fabulous response. I've been 
incredibly well. The third or fourth treatment,   I'd bring a book and I would read. Two weeks later 
I was down on one medication. Another week later,   I wasn't taking anything for sleep and then I 
wasn't taking anything for pain. My attention   level is so much better. I get up, I make 
breakfast. I'm cooking again. I'm reading again.   I have volley time with my family and I enjoy it. 
I'm a mother, I'm a professional. I'm a nurse.   I am a wife. This is the best I've seen her in 
more than two years. This is the best that her   family has told me she's been ever since they've 
known her in the last ten years. Not even two   months after starting this treatment that I'm in 
remission and I'm so hopeful that this will help   other people on that my remission will stay.

This 
has absolutely exceeded my expectations of what   I was expecting. The responses would be with the 
patience. It's been amazing, like life changing..

As found on YouTube

Public Health and the Care Delivery System – Part 2 | Kaiser Permanente

CECILIA OREGON: Welcome everyone to today's
virtual policy forum, Public Health and the Delivery
System: Vital Connections. We're so glad that you could join us for the second conversation in our series. But today's theme being Building
a Stronger System for the Future. I'm Cecilia Oregon Sessy,
the Executive Director of the Kaiser Permanente
Institute for Health Policy. And at the Institute, we host
events and publish information to shape policy and practice
on important health topics. We often convene experts to share
knowledge, spark discourse, advance collective thinking and explore opportunities to cultivate
healthy communities and promote more accessible
high quality care. With that mission in mind,
we're hosting this forum to discuss public health
and the delivery system. As someone who has started her
career at Alameda Counties Public Health Department
here in California, I'm pleased to open today's conversation.

In the upcoming panel, we'll
hear from leaders who will both reflect on the challenges in
our public health system, many that were laid bare during
the pandemic and consider how we might learn from the current experiences
to build and sustain a better, more prepared public health
system for the future. But first, a few quick house keeping tips. During our panel, we'll
take questions from the audience and you can submit questions through the ask a question box on your screen at any point during the forum. And we'll also be pulling
in questions from those that were submitted
before the event.

But we might not have time
to get to every question, so we'll do our best. If at any point you experience
technical difficulties, please let us know, again,
using the ask a question box. This event is being recorded
and the video will be made available on the Institute for Health Policy's
website in the coming weeks. So, onto today's content. In this conversation,
our esteemed panel will speak to the importance of a strong, well-funded public health system, reflecting on the many
challenges and lessons that have emerged throughout the pandemic. We know that in order to respond
to future public health crises and support long term community
health, we need a strong, well-funded system, yet
the public health sector has long faced structural
and financial challenges.

Today, we'll consider how
we can support an effective public health system and how we might foster stronger connections
between public health and the delivery system moving forward. On Monday, we heard from delivery
system and public health leaders, including our own CEO, Greg Adams, Dr. Barbeau, Patti Hays, Dr. Perotti and Dr. Ramy, who share their experiences
responding to the pandemic. Many important challenges
and lessons learned were raised. The speakers pointed to the need to
improve messaging and communication between health care
and public health systems, as well as to the general public
to rebuild trust in the system, to build upon relationships between public healthcare delivery system and businesses.

We also talked about the need
to collect data and improve information exchange in
a bidirectional way. We heard from more than one speaker about the use of fax machines
to share information between health systems and public health departments early on in the pandemic. And we also need to keep thinking about our frontline staff keeping them safe, keeping them healthy
and especially now while they're dealing with high levels
of exhaustion and burnout. And we don't wanna lose sight of
the other challenges that we're experiencing right now with
exacerbated mental health issues, addiction and certainly
challenges related to people making the decisions
or needing to defer care. And critically, across all of these areas, we need to address racial equity
and elevate leadership from communities disproportionately
affected by public health challenges including
communities of color. So, I'll now turn this
to today's discussion. To get our panel started, I'd
like to introduce our moderator, John Auerbach.

John Auerbach is the director of
Intergovernmental and Strategic Affairs of the Centers for
Disease Control and Prevention. In his role, he's the lead
strategic advisor on CDC engagement with government
agencies at the federal, state, local, tribal
and territorial levels. Over the course of his 30-year
tenure, he's held a senior public health positions at the federal,
state and local levels. He's served as president and CEO
of Trust for America's Health, an associate director at CDC, the Commissioner of Public
Health for the Commonwealth of Massachusetts and Boston's
Health Commissioner. In addition to his government service, John was a professor of
Practice in Health Sciences and the director of the Institute
on Urban Health Research and Practice at Northeastern University.

He was also the director
of the largest women, infants and children
program in Massachusetts. We're so thrilled to have John
lead our panel discussion, so I'll turn it over to you now,
John, to introduce the panel. JOHN AUERBACH: Well, thank you so much, Sessy,
and thank you to Kaiser Permanente for focusing its attention
on this important topic. You're doing so at exactly
the right moment. This is a moment that's
filled with the evidence of the consequences of neglecting
the public health system. In the past 20 months, we've
seen and are continuing to see the cost and hundreds
of thousands of lives in the health of many
millions of people and in the well-being of virtually
everybody in this country. And we've seen the disproportionate
burden imposed by racism, by poverty and social
and economic conditions, which elevate the risk for
historically marginalized populations. But this is also a time
of enormous opportunity.

Policymakers are paying
attention to public health and making unprecedented
resources available. CDC is going to be releasing
a $3 billion grant opportunity to build a public health
workforce in the coming months. Half a billion will be spent to
upgrade the data information system of the public health
sector in the coming months, and there may well be
funding for public health infrastructure in future federal budgets. And we have forums like the one
today where people are debating what needs to be done
that will be meaningful, sustainable and focused
on upstream approaches.

And more and more people who
believe that the solution doesn't just reside in incremental change, by which I mean limited increases in funding to the public health system. So, it just looks like a somewhat better version of what it did in the past. Rather, there's a growing belief
by many in the public health sector that this is a time
for transformative change. That we need a public health
system that's nimble, able to focus on what's needed
to address key health issues, paying attention to strong partnerships, staffed by a highly skilled
and well-treated workforce, utilizing modern data systems that
are both timely and accurate, and also to tap many
different data sources. We also need a myriad of
communication capabilities that can function 24-7,
and we need policies, programs, funding
and staffing that reflect a deep commitment to equity and justice. But we have to take advantage
of the opportunities. They won't last forever. Our panelists will help us understand how to take advantage of those opportunities. They have been on
the frontlines of this effort and we're fortunate to have them join us. So, at this point, I'd like to bring
our panelists on to your screen.

They are: Anand Parekh, who'
the chief medical adviser at the Bipartisan Policy
Center, Mary Pittman, who's the president and CEO of the Public Health Institute and Lauren Smith, who is the chief health
equity and strategy officer at the CDC Foundation. Each of them is an expert in the field of public health and health policy. Each will offer their perspective
about where we are right now, drawing from some of the themes
that were raised on Monday. But their major focus will
be on where we need to go. After hearing from each of the panelists we'll engage them in a discussion, and that discussion will include you. So, please enter your
questions into the chat at any time during
the panelists presentations.

And in fact, some of you
have already done that. You've submitted questions,
and so we'll use some of those questions as we move to
that portion of the event. So, let me move on to our first speaker. He is Dr. Anand Parekh. He is Bipartisan Policy Center's
chief medical adviser, as I said, and he provides clinical and public health expertise across the organization. And prior to joining
the Bipartisan Policy Center, he served as the deputy
assistant secretary for Health in the US Department of
Health and Human Services. He is a board certified
internal medicine physician, a fellow of the American
College of Physicians, an adjunct assistant professor
of medicine at Johns Hopkins University
and an adjunct professor of health and management
and policy at the University of Michigan School of Public Health. So Anand, let me turn things over to you. DR. ANAND PAREKH: John, thank you so much for
that very kind introduction, and it's great to be with you
and great to be with Dr.

Pittman and Dr. Smith as well. I wanna thank Kaiser Permanente
and the Institute for Health Policy for convening
all of us on this just very important and timely
discussion about connectivity between the delivery
system and public health. I wanna spend just
a couple of minutes today discussing one report
that was unveiled just a few hours ago from
the Bipartisan Policy Center as a public health forward task force. This is a task force of 14 individuals, elected officials and multi-sectoral leaders who articulated a five-year vision for governmental public health in the United States and an actionable framework for state and local elected officials and public health
officials to achieve that vision. The work is really built around
a framework that centers health equity and advancing health equity, and to ensure that all
Americans have the opportunity to retain their highest state of health. This is work that has been ongoing
for the last six months or so, led by a coalition of
national public health associations as well as philanthropies.

And the question of why now I think all of us could probably answer that. There has been, as John has said, a significant infusion
of funds that has gone or that is going to
the public health system. It's critical that we
leverage that funding. It's not the long term sustainable
investment that public health needs. We'll talk about that, I'm
sure, a little bit later, but it is still a critical opportunity. We've also seen, unfortunately,
the politicization of the pandemic. And while public health
has been in the news and people are talking
more about public health, it's not always for the right reasons.

And so, this is
an opportunity that in many ways take back public health to educate the public and policymakers
about what public health is to transcend politics. And so, that was really that the impetus for this project public health forward. Again, focused at the state
local level, realizing that, of course, the federal government, the private sector and non-governmental
organizations have a huge role to play in ensuring that we advance
public health in our country. But there's a particular opportunity right now for state local elected officials, as well as public health officials. I hope that all of you will get
a chance to review that report.

It can be now found in
bipartisanpolicy.org. I think it's an opportunity
for policymakers to review all of the investments that are coming down to states
and localities right now, prioritize the recommendations that meet particular jurisdictions and then work with public and private sector partners to implement those recommendations. With respect to the interface between the delivery system and public health, I think that the report really
touches on many aspects of that.

And one of the themes
really is public health is not just a public
health responsibility, it's everybody's responsibility,
including the delivery system. And so, I think when we think
about sort of governmental public health and delivery system connectivity with
the continued acceleration of value based health care transformation and alignment in terms of
the incentives of what the delivery system is trying to do and what
public health is trying to do, I think that there are
a lot of opportunities.

And in fact, I think
the first part of the forum, the initial discussion brought
a lot of these topics to light. The first is, of course, data. We talk about the data infrastructure
on the health care side a lot. Public health data is, in many
ways, a bit more even antiquated. And so, ensuring that there's
bidirectional information flow between health care and public health
through electronic case reporting, through ensuring that demographic
information that is collected, through health care is then
transmitted to public health, all of that are critical
critical opportunities for governmental public health
and the delivery system. A second opportunity is, of course, whenever the delivery system is
embarking in community health needs, assessments and implementation
plans to improve community health. Governmental public health
really needs to be at the table, working hand in hand with the delivery system to improve community health.

And then finally, with respect to
health equity and health disparities, as much as delivery system
works at trying to reduce health disparities until it
works with the community and the public health to reduce
the underlying health inequities, it's very difficult to really
address ultimately those health disparities that we see
on the health care front. And so, I'm sure we'll
talk about many of these, but I think this is the right topic, this is the right time for
the delivery system and public health to start that,
not just talking about. We've been talking about
this for a long time, but now it's really a time for action.

And again, I commend Kaiser Permanente
for really convening all of us and rethinking in this moment of national crisis with the COVID-19 pandemic. It's time to rethink exactly how
we can improve the connectivity between the delivery
system and public health. So, John, I'm really looking
forward to the conversation. Thanks. JOHN AUERBACH: Oh, thank you very much, Anand, and congratulations on
the release of that report, which I think we're all eager to read. Next, we'll hear from Dr. Mary Pittman. Mary is the CEO and president
of the Oakland-based Public Health Institute, one of the country's largest
and oldest independent non-profit public health organizations. At the Public Health Institute
and throughout her career, Mary has been a nationally recognized leader in improving community health, safety net and Medicaid provision
of care for vulnerable populations, addressing health equities,
building the public health workforce and promoting prevention.

Mary is an expert and an advisor
in the field of population health, and she's a leader in efforts to
re-vision how diverse stakeholders can work together to build
healthier communities, stronger hospitals and public
health systems, and importantly, more strategic investments
in community health. Welcome, Mary. We look forward to hearing your comments. DR. MARY PITTMAN: Thank you so much, John,
and thank you to Kaiser Permanente for hosting this really
important conversation today, as announced that it's very timely.

I also wanna thank my fellow
panelists, Anand and Lauren, for the comments that they're
going to share with us as well. When I think about what we need for the public health system of the future, I think about what we've learned
from past public health crises. For example, yesterday was World AIDS Day. We learned a lot from that, but we've learned so much more
during the COVID-19 pandemic. During the first months of the pandemic, the Public Health Institute
was able to swiftly pivot our infrastructure
to partner with local health departments in the Pacific
Northwest and to develop a new model of contact tracing that emphasized
trusted community voices, those who had lived experience
and the necessary language and cultural skills to be able to effectively
service contact tracers.

The success of this model and our ability to rapidly respond to outbreaks, including at food packing plants
and other business venues, led to our work with Kaiser Permanente to implement a similar model in California. And we built off of the clinical expertise of Kaiser Permanente and their engagement, as well as connecting
with the local health departments and community clinics. Tracing Health had 240 contact
tracers in California and 155 in Oregon and Washington. and they effectively
supported county health departments and clinical systems.

It was somewhat a unique
model in that connectivity. The combination of working with
governmental, public health, the state and local health departments, Kaiser Permanente and community clinics, as well as community-based organizations, gave us a unique vantage
point to understand what was happening in the COVID pandemic and really where
the leverage points existed to intervene. It also helped me really crystallize
what we need moving forward to make our public health system and our
overall health system stronger. Community-based organizations have played a critical role in this pandemic. They strengthened equity and justice, and they're extending
the reach and capacity and effectiveness of every
part of our COVID-19 prevention and vaccination efforts.

Many have referred to
community- based organizations as partners in this work, but community-based organizations
are more than partners. They are an integral part of
the public health ecosystem, and we need to think about how
do we shift resources, power, decision making
and different ways of thinking about community based organizations and our next steps of
building that important link between health
care and public health. SPEAKER: During one of
the conversations on Tuesday, the panel highlighted
the need to build trust with communities and most
particularly among communities that have experienced systemic racism. I want to say that
the community based organizations are those trusted messengers,
and they're key.

We've worked with over 2,400
CBOs around the country now, and they know how to address
the barriers that exist for individuals. They're working in more than 50 languages, and they know how to reach
difficult populations that are difficult to reach
through normal channels normal meaning our governmental systems. We often talk about
the three-legged stool, but there are really four pillars that can effectively support
public health infrastructure, health care systems, governmental public health organizations, community-based organizations
and the glue which we have seen, which are the nonprofits. Organizations like PHI and many others who can serve its critical connectors. SPEAKER: We all have a role to
play in public health, and we work best when we work together.

That's why my first recommendation is that we ensure dedicated funding streams and direct support for CBOs as part
of our public health infrastructure. In California, we are championing
Health Equity and Racial Justice Fund that has been
promised to begin in 2022. It would provide $200 million every year to local health jurisdictions across the state and another
$100 million that would support community-based organizations. Second, we need to start
building the workforce of the future of public health
and clinical workforce that looks like speaks
the languages and understands the needs of the communities it serves. This interrupts the medical
racism that exists, and it means better care, and ultimately it means better
outcomes and lower costs. SPEAKER: We do that by lowering barriers
to entry into the field. For example, we don't always
have to have a college degree to be effective in some of
the public health jobs. We have certainly learned that
through our contact tracing program. So if it's not necessary,
I'll put it as a barrier. And for those who are seeking a degree, make sure that you're counting their
lived experience as an important part of consideration
and make sure that we are also providing the wraparound
services that are needed.

Particularly for people who may not
have had some of the advantages, economic advantages in particular. The Department of Health
and Human Services has promised $240 million for
a new program focused on education and on-the-job
training to build a pipeline of public health workers. And I think that that is
something that's very exciting and community-based
organizations, health centers
and faith-based organizations need to be part of that pipeline. We need more of this kind of
programming to make sure that we're getting qualified public
health leaders for the future. Without a renewed commitment to building and expanding the public health workforce. We will not achieve our
healthy people 2030 goals, and we won't be ready for the next phase of COVID-19 or the next pandemic. SPEAKER: Third, as Greg Adams mentioned in
his remarks earlier this week, we must make upstream investments in
the social determinants of health. Clinicians have to address
the social determinants of health. They have to understand the housing, food security and safety
issues of their patients. And then they also have to
be able to connect them to the community assets
that are available. One promising model of this is common spirits-connected community networks.

The networks, including Kaiser Permanente, rely on trusted community conveners and a shared technology
platform to connect community partners who help
individuals with their housing, their mental health,
nutrition and other needs. This is why the Public Health Institute
has joined others in calling for a comprehensive federal
Health Equity for All Act. This is modeled after the Ryan White
Act that we know is effective. It would drive cross-cutting government
investments at the national, state and local level to address
racial and health equity. They includes funding Health
in All Policies program, which we have had in California,
and it has worked effectively. We now need to scale it
on the national level. SPEAKER: And finally, I won't go into
any depth because I think Anand covered it well is
that we need better data, better data systems and more
connected data systems, including telehealth.

So what I'd like to just end on is saying that the lessons that we have learned, whether it's from
community-based organizations, local health departments
or from the health care system is that we all have
the assets to bring to the table. So ,when we look at the future
of public health conversations like the ones that are being
hosted are absolutely critical. And then we need to put the workgroups together to make sure we implement. Thank you, Jim. SPEAKER: Well, thank you, Mary,
and thanks for offering those concrete
and specific recommendations, and I think when we get
into the discussion, we'll have a chance to
dive into the different topics that you'd mentioned. I think those really resonate
well with the report that Anand was releasing today as well. So, a lot for us to get into. But we're looking forward to
our final panellists now, and that is Dr Lawrence Smith. Dr Smith is the Chief
Health Equity and strategy officer for the CDC Foundation.

And in this role, she partners
with the CDC Foundation's other senior leaders to develop and drive strategic efforts to embed
health equity across the foundation's COVID-19
response activities, with an explicit focus on addressing
systemic racism and its impact on the resiliency of vulnerable
populations that admits the pandemic. And previously, Lauren
was the co-CEO of FSG, a social impact consulting firm, and she served as the medical
director and interim commissioner for public health at the Massachusetts
Department of Public Health. So, Lauren, it's great to have you. We look forward to hearing you. SPEAKER: Thank you so much, and I again, I want to echo my colleagues
in really recognizing and applauding Kaiser Permanente
for convening this conversation. And I think that the focus
of being in a place where we can have conversation
and thinking about these issues. But also how we pivot to action and how we pivot to doing something differently, I think is really important.

And I'm excited to be part
of that conversation. I would just want to add
or offer a few reflections on where I think we are now. What are some of the issues that we're going to have to confront in order to move out of this kind of situation
that we're in right of way. The first, I would say,
is I've begun to think about this situation as a crucible moment. And by that, I mean, I know crucible
moment is one of intense challenge or strain in which elements go
into the fire in the crucible, and then they emerge fundamentally
change into something new. And I think Mary and Anand pointed
out very well that the experience of COVID-19 has really indicated that
hat we had before wasn't working, and we knew that it wasn't
working, and we could predict how a pandemic would play out, and it did.

SPEAKER: So what we have to do is to develop
a different way of going forward, not just to recreate or to get back
to what we had before or since. Unfortunately, that wasn't
working for so many. I wanted to just respond also to one of the themes that I think have came up in the prior conversation was about the need for equitable response and recovery that acknowledges the persistent
structural challenges and various community
health and wellbeing, and I know we're going to dive into that.

But that that idea of
the acknowledgment and the reckoning with what we in public health
as well in health care. I'm also a clinician, so I consider
myself part of that field as well. What has been the situation that has led us to be in this persistent place, knowing that so many of us have been working to address this for so long. SPEAKER: The second issue I wanted
to sort of reflect on was just how much
people have stretched, and I think again, both Mary
and Anand have mentioned this over the past 20 or 21 months. People have really stretched
they've expanded their thinking. They've begun to do that
reckoning and acknowledgement in places that maybe
hadn't done so before. But now I think we're
beginning to see a bit of equity a bit of weariness
with some of that, not just weariness
and burnt out and exhaustion from being on the frontlines
of public health. But from having to sort of confront these challenging conclusions about our systems that are deeply uncomfortable to
recognize, and so there's a tendency, I think in our field and in our
society more generally to want to snap back to what was
comfortable and familiar before.

And so we need to be very aware of
this phenomenon and be intentional in terms of how we counteract that in
ways that will allow us to build the kind of resilient
and vibrant communities that we want to do by continuing to challenge and doing
the uncomfortable work that we have done. We've come too far in the past
20 months to sort of backslide and allow ourselves tosort of
snap back into those other, perhaps more comfortable
but not effective situations. SPEAKER: I wanted to pull on a thread that
Mary mentioned about expanding our definition about what
counts as public health and what skills and capacities
are needed in order to practice public health
effectively in the future.

And I think you're mentioning
the connections with community-based organizations and the ability to develop authentic and bi-directional
mutually agreeable and productive relationships
is an example of that. But there's a whole host of other things that really our public health officials, some have but others will need
support in order to grow them, such as the ability and
the experience in applying equity principles across all stages
of the data lifecycle. Both Mary and Anand mentioned
data and the idea of how we decide what questions
to ask where to go, how to involve a community in a meaningful way throughout the whole process, not just in the data extraction
process for many communities. That's what it feels like
it's an extractive process. We go, we take information and we
don't, they don't see us again. So how do we do that in
a really very different way that contributes to the next
topic I want to mention, which was galvanizing public
support shifting the narrative, developing different
narratives for public health. SPEAKER: We need to be even more
sophisticated in how we discuss and convey the essential
role of public health.

So much of what we found out
during the COVID pandemic is that people don't have
an idea or don't have an accurate and credible
idea of what public health is and our role and why
we're so important. I think the analogy is no
community would wait until houses are on fire to build and staff
and train a fire department. It sounds absurd to even say
that, but in a lot of ways, because of the decades of
underfunding of public health. We've decimated it to
the point that that's sort of what we expected to do
during a crisis or pandemic. So we need to work on that. And why is essential to
build that public support. So I'm hopeful that in our conversations that we're just about to have it, we'll be able to dig in
to these pieces around how we can be sure that we don't snap back to a process or
an approach that wasn't serving many of our communities well.

And how can we go forward
and building that kind of deep support for public health to be able to do the kinds of
investments that we know are necessary and need to be sustained? SPEAKER: Well, thank you, Lauren for
raising such important questions and thoughtful questions. And I think those issues
will come up now as we get a little bit deeper
into the discussion. It's clear from
the discussion that took place on Monday and also what the panelists have just highlighted already that
there is both a lot of challenges, a lot of opportunities and just
a lot of issues for us to dive into. And so I want to start out by diving into an issue that maybe it's the hot topic now and that has to do with
infrastructure and what we mean by public health infrastructure.

There's has been said,
we never used to talk about public health infrastructure, and now that is getting
a lot of attention, including from members of Congress. And so I guess I'd like
to ask each of you, what are we talking about when we're talking about the need for a strong, durable, resilient public
health infrastructure? So we're ready for future pandemics. When you hear that term, what do you
think of and what do you think is the most important part
of an infrastructure for us to pay attention to? And by the way, this is going to be
a discussion among the three of you. So I'm not going to direct
a question to one person, but I really hope you will
all dive in to the extent that you have some thoughts about this. So, any one of you please
feel free to start. SPEAKER: I'll start, and I'm sure
my colleagues will add on, we've heard many, many times data. And certainly, most local
health departments and I would say the connectivity between state and local health
departments are antiquated. Our data systems can't
talk to each other well.

We saw that just in the exchange
of data with contact tracing, we couldn't always get a quick turnaround so that the tracing could happen. But it's beyond that. In some places we have data and we don't have people trained to utilize the data. And so we need the professional
workforce to be able to analyze the data to use
predictive analytics. And I would say we also have
to make sure that that data is transparent
and accessible to the community. I talked a lot about
community-based organizations. Sometimes our data is delayed,
and by the time you get that data, if you go out and talk to
people in the community, you find that the whole premise that
you're operating from has changed. So you have to be able to collect
the right data, has to be granular, has to include the social
determinants of health, and it has to be cognizant
of race, ethnicity, language needs of the communities and then making sure we have both the right workforce and
the relationships to understand what that data is telling us.

SPEAKER: That's a great start. So data definitely is a topic we're
going to want to talk about, maybe before we move to other aspects of infrastructure other thoughts about the importance of data and particularly where you see opportunities for us to do something differently now that
will strengthen the data systems. SPEAKER: I think that you know,
totally agree with Mary, with what you were just saying, and I think that's what part of what
I was alluding to as an example in terms of applying robust equity
principles across the entire data lifecycle and not making I think,
what is a common sort of step, which is to comment at the end
and then to involve community or two at that point when you've already
really narrowed what you're going to be able to find out based on
the questions you asked, how you asked, what you were even emphasizing
in terms of a priority.

And certainly the piece around
sort of meaning-making. That is what is the data, what
is the data actually show, and then what do we do with
it and how do we apply it? Yeah, it's a whole separate set of
issues, so I totally concur there. I think the other thing about
data and interoperability, Mary, you mentioned, I think it makes sense to is how
do communities know what data is available and what do we understand
to be rules around who owns the data and who can control how
it's used and how it's described. And how are we doing in terms of
ensuring that there's not a deficit approach to the way data is
talked about and that there's an element there of having an asset
based approach and recognizing that their communities have
strengths and not only deficits.

SPEAKER: And I'll just add to it, Mary and Lauren, ANAND PAREKH: Or say, I think data is
a great example when we talk about Public
Health Infrastructure. And I think, we've seen on
the data front the dearth of data on race and ethnicity when it
comes to COVID-19 testing, as well as vaccines during this pandemic. As has been talked about, I think we need a bidirectional flow of data from local, the state, and Federal Public Health. And then, we need that bidirectional flow between health care and public health. And I think often, from a policy
perspective, what is it that we need? And I think what we need is
we first need to define what is a core public health
dataset that we can agree on. ANAND PAREKH: Then, we need standards for that data set. And then, we need some
funding and accountability, to ensure that public health at
all levels is able to collect, extract, and share that kind of data.

And on the health care front, we also
need incentives and requirements to ensure there's reporting of
the important demographic data. We need to reduce health
disparities and inequities that that electronic case
reporting is occurring. So, the delivery system is getting
information on public health. And so, I think it takes
a number of things. I think it takes policy,
I think it takes some funding. But that's just a great
example, I think John, of data, one aspect of public
health infrastructure. ANAND PAREKH: And maybe this leads
to your next question. But essentially, again,
anything that is critical to tackle any public health challenge, whether it's COVID-19, whether it's
the opioid crisis and mental health, whether it's diabetes and obesity, what are those critical
capabilities like data that are necessary irrespective
of the public health challenge or threat in front of us? That's what it means
to me when I think of, sort of public health infrastructure.

MARY A PITTMAN: I want to build on that last
statement because you really talk to the fact that we don't need
just siloed data systems, you know, that deal with
COVID or deal with the, you know, drug overdose. What we need are much more
integrated data systems, which is part of the barrier
that I think we have now. We were fortunate in California, we
had the Public Health Institute, Southern California
Public Health Alliance, which is built from the health directors. They identified this health
gap years ago and developed a tool called the Healthy Places Index, that served as the basis for
a statewide equity metric so that when we were
dealing with the pandemic. MARY A PITTMAN: That was used by every county to
determine how resources were allocated, and when they moved from
one tier to another, looking at the most disadvantaged quartile of people living in that community. That was really a hands-on implementation, and everybody knew what it meant.

The business leaders knew
because it had relevance. And so, I think we also have to
learn, how do we come up with data that we explained to the general
public that has relevance? People know what the S&P 500 Metrics are, but they don't know what
the Healthy People 2030 Metrics are. So, I think we have some
education to do as well. LAUREN A SMITH: And Mary, I was just gonna jump in. Totally agree about avoiding
the Siloization of data.

And also, the need to connect data that comes from really different sources. So, the clinical data, which is,
you know, at the individual level, we need a repository or a place
where we can connect that and look for patterns with data on housing
conditions that come from HUD, or data on, you know,
educational attainment that might come from
the Department of Education. We need a way to pull in those data sets in an effective way across those silos because we know all of those things
interact at the community level. JOHN AUERBACH: So, let me just ask one follow-up question before we move on with the data.

If you're, you know, we're being
hosted by Kaiser Permanente, who, let's face it, does the most innovative work
in terms of thinking about the connection between clinical
care and community health. Looking at a Kaiser
Permanente, or other health care organization that is interested in working with the public health
sector and thinking about data, well, what are your recommendations
for the health care system in terms of its relationship to public
health when it comes to data? ANAND PAREKH: Well, I think, you know, one of the things that comes to mind is trying to understand what the gaps are right now or
the deficiencies in the current system. So, you know, is the delivery system
able to transmit, for example, data to local or state
public health departments? Is the delivery system able to
ensure that important demographic information gets to local
and public health? You know, what are the barriers there? Do states and the states
legislatures need to get involved and pass laws to allow that
type of information exchange? Are there other kinds of
technological issues? Are there privacy-related issues? ANAND PAREKH: And so, I think, maybe the first
thing would be to understand, what are the barriers preventing that
type of exchange of information.

I think health care and public health, now it's important to
transmit information. But there are certainly barriers, and identifying those barriers
might be the first step. JOHN AUERBACH: Thanks. Well, let me move to a different
topic that I think is often included when we're talking
about infrastructure. And that is having
a highly skilled workforce, doesn't necessarily mean Mary, that they've gone to medical
school, or nursing school, highly skilled can be knowing
their community very well, but highly skilled in terms
of the tasks at hand.

We do have an opportunity. Now, as I was saying, there's
the new funding that's coming from the federal government
to pay for workforce. We have a workforce that's been
hard hit, by the pandemic, both in terms of just the magnitude of the work and in terms
of the public response. JOHN AUERBACH: In many communities, has been
harsh against Public Health. Where do we need to go in
terms of the workforce? Where do you see some of
the key places that you would say, let's pay particular attention
to this aspect of building a highly-skilled public health workforce? LAUREN A SMITH: Well, I'll jump in. And I think, Mary already touched on
one, which is facility where data, all aspects of, you know,
across the whole lifecycle.

I think another area I would bring up is, in public health has generally
been used to doing this. But I think we have to sort of challenge ourselves to do it in a different way, or an evolving way, which
is around community partnership and engagement. And to do that in a way
that's truly authentic, not just informing community, but being attentive to the power
dynamics that come from working in a government agency and going to
communities who have had, you know, different kinds of experiences
with government agencies. LAUREN A SMITH: So, how do you do that? How do you encourage that in your staff? How do you encourage that
in your funding mechanisms, your funding approaches? All those different ways of how
you show up in the community, and how you can engage with
the community in different ways, is, you know, another example
of different skills. MARY A PITTMAN: I think it's really critical that we
focus on new communication skills, public health sometimes
uses the moral high road and the science as their lead
to their communications.

And we have to realize that there are competing values and value systems, and we have to understand
how to communicate so that we can bridge different audiences, different value systems, and that
doesn't undermine the science. But if we do a better job of educating people what public health is about and building up a collective community
public health understanding, then I think it'll be
a lot easier for us to have regular conversations
with business leaders, with elected officials,
with the local community. MARY A PITTMAN: I think too often public health stays
inside their box, if you will, and they need to be out communicating
with people on a regular basis, not wait until there's a crisis. Crisis communication is one thing, but you have to have those
relationships and the facility to be able to communicate
with people about what you're doing day in and day out. And, you know, the other thing
is, in the political process, all you need is a 51% majority. When it comes to a pandemic,
51% is not enough.

So, you can't just pick and choose a few parts of the community to talk to. You really need to talk to all sectors. ANAND PAREKH: I wholeheartedly agree
with Mary and Laura, and, you know, couldn't agree more. You know, the first assistant
secretary of health that I worked for over 15 years ago now, sort of reminded me about
something at the time, I thought it was very elementary. But I've always sort of kept
it in the back of my head. He often used to remind
me that public health is made up of two words, alright? And that it's the second word, health, that we spent a lot of time on,
the science, the evidence, understanding from a policy perspective,
from a service perspective, what works, how to improve health. ANAND PAREKH: But public health also has
that first word of the public, and how imperative it is for
us in public health to ensure that the very public that
we're trying to serve, that we understand their
aspirations, their perceptions, meeting them where they are,
understanding where they are. And I think to Mary and Lauren's point, this is a time not only
to educate the public and other partners about
what public health is and what public health does.

It's also an opportunity to partner
and build trust with the public. And we do that by remembering
that we really need to go out and better understand
the public we're trying to serve. Ultimately, that will help us
optimize health in this country. MARY A PITTMAN: It also calls for those
trusted community messengers to be our partners in doing that. JOHN AUERBACH: I'm thinking back to
the discussion that took place on Monday when the topic
of workforce came up.

And one of the real concerns
that was raised then was, how we support both public
health and for that matter, health care and its workforce, given what they've been
through in this pandemic. We have, you know,
a significant amount of burnout, demoralization within the workforce. And I guess, I wonder,
your thoughts about that. How do we help the workforce recover
where there's some concern, we're gonna lose people from
the public health sector and maybe from the community
public health organizations, if they feel like this is
such a difficult profession? JOHN AUERBACH: Clearly, that's the case, I think, in the health care
delivery system as well. So, as we're thinking about workforce, what are your thoughts about that? How do we how do we recover? How do we build a more resilient
and supported workforce? MARY A PITTMAN: First of all, I think,
recognition that it has been a very tough time for frontline
health care providers, for people in public health,
people in every sector. And so, I think first, we have to
have a little bit of gratitude for what they've done
and show that gratitude.

I think we have to have a bit
of space for people to recover. And if that means extending
some additional time, you can't expect people
to continue to work at the pace they have,
and not hit burnout. We also have to protect
people who have had the general public lashing out at them. We have to realize that while
they're trained professionals, for some people, their lives
are being threatened. MARY A PITTMAN: And that's not acceptable. And that adds a whole
other level of stress.

So, we have to protect them. We have to give them
some space to take time. We have to compensate people adequately. If you take a look at the salary levels for some people in public health, they're well below what they might
be able to earn in other areas. So, their dedication to
the field can get tough to maintain when they have
all these other forces. I also would say, I went to school
on a public health traineeship. I have to say that, the new
graduates that I'm talking to are excited about going
into public health. So, I think we also have to be
nurturing that next generation, and help them pay for their education. LAUREN A SMITH: Yeah, I think that pipeline issue
is really important, Mary. You know, the data that
suggests that applications to public health school
enrollment, you know, have gone up, you know,
as people have seen, this is a really exciting career.

So, that's really important. And that's one of
the reasons I also mentioned about sort of galvanizing public support. It's sort of the opposite of, you
know, picketing people's lawns and, you know, following their children
to school, that kind of thing. But I think it's
the acknowledgment and recognition. LAUREN A SMITH: But it's part of the explanation
of an advance of a crisis, what is public health doing, and why it is important because
so much of what public health does is, when it works well, it's invisible
to the rest of the community. And so, they're not aware that it's there. So, it's hard to get excited
about what you don't know about. But what you don't know, it's protected.

ANAND PAREKH: Yeah, couldn't agree more. You know, I think we use sort
of the term public health, we're all in public health, we
work in public health a lot. But for the, you know, the average
person, if you go, you know, in America and you and you
use the term public health, they may not know what
you're talking about. But if you say, you know, clean
water or you say clean air, or you say infection control, or you say smoking cessation,
or you say injury prevention, and you go down the list,
I think they have a much better idea of the role of public
health, how important it is. ANAND PAREKH: And again, I agree with Lauren that,
that just helps the understanding with the public helps galvanize
them to ensure that, that public health doesn't get demonized and public health doesn't get politicized.

JOHN AUERBACH: Let me shift gears to
another important aspect, I think of the work in
public health of the future, and that is strengthening partnerships. We've had one of the listeners to
this webinar ask the question about, why is it so important that
we should be encouraging strong and lasting partnerships
between public health and other sectors, including
the health care sector? Is that central to building
the public health system of the future? And which sectors are the most important? MARY A PITTMAN: I think it's foundational, that
we have these community-based organizations and other
sectors working together. We found that the Faith Community was
in some places the most effective spokespeople to get recognition
of the value of vaccines.

And we've seen that in many different
cases over the years that the, you know, faith community can be
strong partners in public health. You know, community leaders are
experts in lived experience and understanding what the problems are, so they can both help us
understand what the solutions are. And sometimes they can help us prioritize. MARY A PITTMAN: Our priorities are not always
what the communities are. And if you don't address their priorities, if they're hungry and they
don't have a place to live, expecting them to pay
attention to our public health priorities may not resonate.

So, I think that's important. We also haven't lifted up
the issues in rural areas. And so often, the rural public health folks are wearing two or three hats, as are the community members. So, I think we really need
to provide additional support resources to build
those relationships, and where people are stretched thin
to augment what's already there. JOHN AUERBACH: So, Mary, you really were talking
about a lot of it as grassroots work, really getting to work with the community and the community organizations.

Do other sectors come to mind, as key to building the strength
of the public health system? ANAND PAREKH: I can add a few, you know,
certainly, I think housing, nutrition, and transportation
to me are central. And then, other partners, Mary
mentioned the faith-based community, I think business and health care. Of course, I wanted to spend
a minute on business, and then primary care specifically. But, you know, we've done
a lot of work at the Bipartisan Policy Center as others have as well, looking at the value
proposition between businesses and public health to
improve community health. And there's a lot of alignment
here, a lot of opportunity there, where those two sectors can work together, and really conquer issues related
to trust and resources, et cetera. So, I think that's one
particular one to highlight ANAND PAREKH: Within health care.

I can't think of any more
important relationship that needs to be strengthened, and we've recently written about this then between public health and primary care. Talk about two of probably
the most important sectors out of the $4 trillion we spend on
health in the United States, public health gets roughly
about two percent, and that's that's generous. Primary care only gets about
six to seven percent. These are the two most important
sectors to improve health that focus on prevention,
focus on population health, the synergies there we
recently talked about it with with respect to COVID 19 vaccination, but there's so many areas there
to to leverage partnerships between public health and primary care. And so I think that there
are a lot of opportunities. I think partnerships with sectors and with specific stakeholders are really ripe. JOHN AUERBACH: And let me just ask you a little
bit of a follow up question there. In terms of that partnership
you were mentioning of a health care and public health.

Are there incentives
that can be created that that make that more likely to occur? Or is there is are there policies that can be adopted that can get those parts to, the two sectors to work more closely
than they have historically? ANAND PAREKH: I think that's a great question,
and I do I do think that there are opportunities there
that that are untapped. You know, we usually don't point
our public health departments in in the direction of community
health centers or primary care. We usually don't reimburse
our primary care providers or in point them in
the direction of public health.

But those are (UNKNOWN)
to two sectors that. And there have been a lot
of great connectivity and advances over the years. But but but I think there's much
more that can be done there, John. MARY PITTMAN: Well certainly a primary
care and public health both have prevention at
the center of what they do. And I think that there's a lot of synergy there and I think that there are places where there are really well-developed relationships around specific issues, whether it's dealing with
undernutrition and food deserts or. And and also in positive things
like enhancing maternal outcomes. We've seen a lot of examples
of health care systems, particularly primary
care and public health, working together towards common goals. What we have seen,
I think in COVID is a real gap in a place where we should be focused.

Focusing some energy is in
the long term care and home care area where I think we really need
to be investing in workforce. We need to be investing in technology. And there's an opportunity
for public health and health care to work together. I think health care also really adopted some technologies quickly during COVID. You saw an incredible rise
in the use of telehealth, and we could apply that in
so many places in public health. So I think that there's places
where technology and lessons can be shared and training
could exist as well. JOHN AUERBACH: You know, in our last few minutes,
I want to try to address to two remaining questions about
public policy and its role.

But I want to start by returning
to the the comments that you were making about
the importance of equity and the importance of centering
efforts to overcome racism and discrimination at the core
of the work that we're doing. And so, you know, I guess I'd ask you, what are the concrete ways that we can? Emphasized that work embed that work within the work of the public health sector and and other sectors it's
working with, including health care. What does it really mean to make
equity at its core, at our core? LAUREN SMITH: That is a good question,
John, and I think that there's probably many ways to answer it, but it's one that I would just
sort of throw out first is that. Organize as organizations. We have to identify
and communicate very clearly our equity principles and then
begin to hold ourselves accountable for how those
are getting built into every aspect of the work that we're doing.

And it's not a one and done
kind of phenomenon, you know, like take class or do an all day workshop. You know, those are
important ways of educating and exposing ourselves
and expanding our understanding. But it's really in the work. How do we do our procurement? How do we do our hiring? How do we do our contracting? How do how do we think about
who's eligible and who's not for just the kind
of grant opportunities? What, what, what's included in the grant, the applications, what are required. So to Mary's point about what's required for a role is a college education, a college degree rather required or both. We have to really interrogate
or reflect on assumptions that we've made around how or what, what are the ways we have to work.

And some of the ways we
have to work our habits, but they're not necessarily requirements. And so having that stance of inquiry and sort of that openness to saying, we're going to really
examine the different aspects and then having
a set of principles that you can apply
so that everyone understands what you're doing is not arbitrary, but it's like we're we're using
these principles to apply. MARY PITTMAN: And John, I would say, you know, there's a lesson that I learned
a long time ago is follow the money and build into some of our
programs requirements so that people are not just
doing the right thing, but they're also getting compensated
for doing the right thing. And that's why I mentioned
the federal health equity for all Act, and that's modeled after Ryan
White, which is greatly successful, and it's going to be
putting investments at all levels of government for programs, embedding health equity goals. And so I think you'll start
to see a demonstration of that with programs like that.

We certainly have seen
it through our health in all policies worked here in California, cutting across every different department, including transportation and housing. ANAND PAREKH: Yeah, I agree, I think you have to be
really intentional about embedding health equity in all of
the areas that we've talked about. Data comes to mind as one of
the most important unless we have data with respect to
disparities and inequities. Unless we can collect them,
we're not going to be able to to address some
of these challenges. The Robert Wood Johnson
Foundation has recently been doing great work in that area. So I think being intentional about
this and really embedding it, whether it's workforce or whether
it's financing related issues, as Mary is saying, whether it's data, whether it's with their partnership related activities, ensuring equity is is front
center in all these areas, I think is critical.

JOHN AUERBACH: Well, you know, we've got only about a minute and a half and the three of you have so much to say
and and are so thoughtful rather than ask a question. I think I'm just going to
ask if you have each of you has maybe 30 seconds
of comments issues that may not have been raised
if you want to put on the table for future
conversations, perhaps. So any closing thoughts? MARY PITTMAN: I have one, and that is the expansion
of Medicaid is so critically important to be able to address
health equity in this country, to be able to deal with chronic disease, as well as acute pandemic issues. And so I would say we
have to pay attention to making sure that we see Medicaid expansion and that we prioritize that
that includes comprehensive care.

We haven't spoken about mental health, but the pandemic showed
the critical nature of mental health. JOHN AUERBACH: Yeah, very true. Lauren Anand, your thoughts? LAUREN SMITH: I guess I was just going
to go back to this piece around excellence in strategic and communications
and being able to describe the work to be able to address concerns. I think in some ways sometimes
we've been caught a little bit back on our heels for some of
this and not being as forward. And I think that, for
example, the work that the Public Health
Communications Collaborative, that the CDC Foundation
Trust for America's Health, others are involved in this
sample of really supporting that.

So I think that getting
getting ahead of things with really powerful
strategic communications, I think is important. JOHN AUERBACH: I'm so glad you raised communications. Thanks so much. And Anand ANAND PAREKH: (INAUDIBLE) you know. I think I'll just stand it back
to your initial question, John, about public health infrastructure and the need for sustained
long term investments. And you know, its data, its surveillance, its laboratory capacity and its I.T. There's so many aspects to that. But without a long term commitment,
it's very difficult for the public health system to address or to help
and try to address any challenge. There is some legislation right now and in the Build Back Better Act that would provide a down payment to support our public health infrastructure.

You know, it's not everything that's
required, but it'll be interesting. You know, I've been over the last
six months in Washington, D.C. I've been waiting for public
health and infrastructure to be used in the same sentence. We were talking about everything else with respect to infrastructure, you know? But, you know, public health, we take
it for granted every single day. It's absolutely a part of our
nation's infrastructure and people should be talking about that when
we talk about infrastructure. So I hope that there will be
some more federal support for our nation's public
health infrastructure.

MARY PITTMAN: Maybe everybody in public health
has to raise their voices and proclaim that we're
being heard at the table. JOHN AUERBACH: Public health and health
care and our other partners. Indeed. Well, I want to thank the three of you. You know, this has both been
a wonderful conversation because you all are
so smart and insightful and really are using your
your vast experience to think about where we need to go. It's also been one of
the most frustrating because it's really difficult to
have such a an important conversation within
the constraints of what we always have to do when we we have limited time. So hopefully we've piqued the interest of those who are listening and they'll be following up in terms of many of
the issues that have been raised. And so again, thanks to
the three of you and Cecilia I am turning things back over to you.

CECILIA OREGON: Thank you, John. That was an incredible conversation. I want to thank you for
moderating the discussion, and I want to also thank the panelists for sharing their time and insight with us. And I want to thank our
audience members for tuning in. Will be emailing a link to
the recording and we'll also be posting the recording of the event on our
website in the coming weeks.

But before we go, I'm going to turn
it over to our final speaker, Dr. David Grossman, who will be
offering his own reflections on the conversation that spanned
over two events this week. Dr. Grossman is a pediatrician
and interim senior vice president of social and community
health at Kaiser Permanente. He leads Kaiser Permanente Social
Health Strategy in partnership with Permanente Medical with
the Permanente medical groups, and he leads the organization's public health advocacy and COVID 19 response. Dr. Grossman. Sorry, Dr. Grossman leaves the organization
efforts to advance our social practice that connects members
with social services, programs and resources to
alleviate food insecurity, socialize isolation and other
social needs, as well as to achieve equitable health outcomes for
the communities we serve. So thank you for being with us today, Dr. Grossman, and I'll hand it over
to you for your final word. DAVID GROSSMAN: Thank you very much, Ceci.

First, on behalf of Kaiser Permanente, I wanted to add my thanks
to and deep appreciation to the speakers and also
the moderators of this panel as well as our
previous one this week. You guys are it's been terrific. We've heard from a really
deeply experienced and insightful set of leaders, and I've heard some, I think very
robust ideas and themes expressed. Many, if not most, of these ideas,
I think, are truly actionable. So we all know that this is a critical
policy conversation that needs a lot more attention and focus
by our nation's policymakers, state policymakers to and also
the public and the conversation's timely given the bipartisan policies. Bipartisan Policy Center new
report as outlined by Dr. Perak. And we and we also know
that more is yet to come. So we convene this panel because
keepy Kaiser Permanente does deeply care about
the future of public health. We believe that health care needs to be at the side of public
health as a key partner, supporting its critical work
in so many different ways.

And I just wanted to really highlight a few of the number of key points that I've come across over the last
several days in these conversations. First, the pandemic has revealed the need for a much enhanced infrastructure. We've heard a lot about that. We have a workforce that's
undervalued, overworked, and it's all a result of
many years of underfunding by state and local authorities, something that clearly needs
addressing very fast and fortunately is being addressed with some
of the recent legislation. We also need a public health
structure that can flex up rapidly in times
that are emergent need, and we need actionable data systems and interoperability so that data and and also analytics can flow in real time across systems using common measures. We also heard about the need to address
the complexity of the oversight, finance and also the operations of
our nation's public health system. And then in addition to
that, we also heard about the importance of
relationships and partners partnerships with key
community institutions, businesses and most importantly, as we just heard today
from the public that for the public health to operate effectively, we need really long standing,
trusting relationships.

Public health needs to
refocus on its key customer, the public and as the public's
trust with public health builds, so will trust with policymakers
and relationships with health care, as we've heard about, are
especially important. And we heard from one of
our speakers on Monday about how that mattered so much for her in her local health jurisdiction in Seattle as the COVID pandemic unfolded. Communications is at the foundation
of trust and relationships, and we heard about
the importance of honing, messaging and curating
the messengers when it comes to talking with the public
and with policymakers. We heard that we need to
be facile storytellers and training our workforce to be more adept at communicating
with the public on every channel. We also heard a lot about
the criticality of using a lens of health equity in all public health work
and the need for public health to assert itself with policymakers
and the public in prioritizing and focusing on vulnerable
and lesser advantaged communities.

Stronger community relationships
matter here too so much. And the public health
credibility with communities of color needs significant strengthening. Addressing as we just heard from our
speakers just a few minutes ago, addressing the underlying
social determinants of health like housing
and food insecurity, and also digital equity
is thankfully getting more attention by health care, but needs much more focus by everyone,
including our policymakers. We heard about the fact that
public health has throughout this pandemic been fighting
a multi-front war, that COVID has been front
and center efforts by public health. Many people are not really
aware that there are other major epidemics that are
co-occurring, like violence, like harm from drugs like
mental health conditions that underlie many of these deaths. And so public health must be
outfitted and prepared to fight disease and injury on multiple
fronts simultaneously.

But before we start the rebuild,
let's acknowledge that our public health troops are hurting very
badly and they're under attack, as we heard, and leaving
the workforce in unprecedented numbers, especially our public health leaders. So that means we must work
to bring some healing and trust back to these
incredibly valuable workers who have saved
literally millions of lives through the work that they've done. The community needs to really rally behind public health and health and health care, along with other communities
and stakeholders must have their back. We must be speaking up
for them and with them. So we at Kaiser Permanente look
forward to being a part of this emerging dialogue and also
the problem-solving ahead. We've all learned some very hard
lessons and are now are ready to lock arms and rebuild our
nation's public health system.

Thank you all for joining us here today and for being part of this conversation. We are really looking forward
to your participation in rebuilding public
health across our nation. Thank you again and goodbye..

As found on YouTube

In Silico Modeling of Neurovascular Bundle Stimulation in Sim4Life V7.0

Hi, I’m Cosimo. In this video, we will test several new features
and performance enhancements in Sim4Life v7.0’s T-NEURO module. These improvements were engineered by ZMT
specifically to empower simulations for applications in the emerging field of bioelectronic medicine. For this demo, we will compare the safety
profile and performance of different stimulation and sensing strategies in a model of the median
nerve neurovascular bundle. First, we need to create the neurovascular
bundle geometry. In this case, we’re building our model from
a single, two-dimensional image, which requires that we segment the image into different tissue types. This can be done by importing the image into
Sim4Life and simply drawing contours around the tissues by hand.

Alternatively, we can load the image in ZMT’s
iSEG tool to create and modify segmentations in a semi-automated fashion. Now that we have delineated the tissue types
present in the image, we can extrude a 3D model of our neurovascular bundle in Sim4Life. We begin by generating a 2D mesh from the
labeled image using the surface meshing functionality. Let’s have a look at the results. We can see that each tissue is assigned its
own mesh, with increasing refinement in regions with fine geometric features to ensure accuracy. Now we’re ready to move into the third dimension. For this purpose, we use Sim4Life’s new
2D mesh extrusion feature, which permits the extrusion of surface meshes along arbitrary
trajectories At this point, we need to incorporate our two CAD-based electrode models, one for
each stimulation scenario.

Let’s begin with the intravascular stent. Our stent model consists of a cylindrical
wire mesh with two stimulating contacts. We will generate a 3D mesh from the stent
using the faceter mesh tool, which is optimized for meshing CAD-based geometries with sharp
features. Using this same approach, we can create a
model of the second design that is, a cuff electrode positioned around the nerve
bundle. With these meshes, we can specify patches
over the electrode contacts to assign boundary conditions, and also around the nerve fascicles
to insert perineurial layers. Finally, we are ready to build our two EM
simulations, one for the stent electrode, and one for the cuff electrode. Setting up the simulations is easy both use thesame unstructured mesh of the nerve bundle. All that’s required is to change the dielectric
properties assigned to the different electrode domains, and voila! Now let’s visualize the resulting field
distributions. In clinical practice, stimulation magnitude
is measured in terms of the administered current magnitude. In Sim4Life V7.0, normalizing electric fields
to a specified input current is as simple as selecting the “field-normalizer” option
and inserting the desired current value.

We can couple these fields to models of axonal
dynamics to simulate neural activation. Thanks to an improved interface and a 10X
speedup for axon discretization times, modeling neural dynamics with Sim4Life’s T-NEURO
module is faster and easier than ever before. Let’s get started. First, we populate our fascicles with axonal
fiber trajectories, which are realized as line or spline model objects. In this case we decided to populate each fascicle
in our nerve bundle with 50 linear axon trajectories. Here we’re using two axon models: myelinated
McIntyre-Richardson-Grill double-cable fibers, and unmyelinated Tigerholm fibers. Parameterized implementations of the axon
models are available in Sim4Life, such that only their diameters need to be assigned.

Starting with the cuff electrode, we’ll
simulate a charge-balanced biphasic current pulse of 1 ms per phase. Let’s make sure that the titration option
is active; with this option, our simulation finds the smallest electric exposure scaling
factor for each neuron that will elicit an action potential. In Sim4Life V7.0, users can now perform neural
simulations remotely, meaning that time and resource intensive simulations can be offloaded
to any machine in your network. For stimulation with the intravascular stent,
we will repeat the same procedure used previously for the cuff electrode simulation. Sim4Life makes it easy to visualize EM field distributions, spike initiation locations, and neural titration data. Using this information, we’ll calculate and compare profiles of neural recruitment for the two scenarios. Our model predicts that the two electrode designs exhibit different patterns of neural recruitment, as indicated by percentage of fascicles activated at each current intensity. As the action potential in each
fiber travels down the length of the nerve, a measurable extracellular signal called the
“extracellular compound action potential”, or eCAP, is generated. We can use our cuff and stent electrode simulations
not only for stimulation, but also for sensing to analyze and optimize the eCAP information content.

As these plots demonstrate, the predicted eCAP profiles are sensitive to differences in electrode geometry, electrode location, and tissue composition. Sim4Life allows us to investigate how each of these factors influence our predictions. As we’ve demonstrated here, predicting recruitment
curves and eCAP signals for complex neurovascular bundles is a snap using Sim4Life version 7’s
latest features for the advanced modeling and simulation of neuromodulation. Furthermore, Sim4Life provides the tools required
to develop advanced neuromodulation strategies, such as closed-loop control. Sim4Life’s T-NEURO module will support you
in unlocking new frontiers in your neurostimulation applications, while minimizing risks to patients,
clinical trials, time-to-market, and development costs. Thank you for watching this video..

As found on YouTube

[Part 1] Shocking Facts about Mental Health in North Korea

if a person's mind is sick and rotten then that person's ideology is less and is unable to defend north korea's socialist system or die for the leader [Music] hi everyone it's sian from pyongyang i'm an earthquake escapee and a human rights advocate i'm going to cover mental health in north korea but since this is such a big topic to cover it i'm going to shoot this video in two parts my phd members have voted for this video and i hope this answers any questions you may have so the first point i want to cover is whether north korean people know about the concept of mental health mental health in north korea is a different concept from the west as we understand it in north korea your mind is linked to your ideology so if you have a problem with your mental thinking that means you have a problem with your ideology north korean society constantly stresses its ideology which is the revolutionary beliefs in north korea's monolithic leadership formerly known as chute one of the phrases i heard the most when i was in north korea was if a person's mind is sick and rotten then that person's ideology is less and is unable to defend north korea's socialist system or die for the leader the second point is that north korean people do not understand the correct concept of mental health at all therefore there is no term like depression or stress in north korea i assume that people by now probably have an idea about the term stress and depression through smuggled south korean dramas again as i mentioned if a person is suffering from depression in north korea society will judge that as a sickness of the person's ideology and it will take on a particle dimension and the third point is that there is no mental health department in the hospitals no therapists no counseling you won't find any of those in any north korean hospitals not even in the special medical facilities for the upper elite such as namsan hospital and pongal clinic then you must be curious how the north koreans deal with all of their mental stress anxiety and depression what would happen to those people who are diagnosed as mentally unstable right that will be covered in part two of this video as well the comparison of mental health in north korea and south korea if you want to find out who is mentally healthier and happier please hit that like button and subscribe my channel thank you for watching see you next time you

As found on YouTube

Mental Health and Mental Illness Basics Part 2: Treatment Strategies and Recovery Concept

hey there everybody and welcome to part two of 
mental health and mental illness fundamentals today we're going to review prevention 
strategies for mental illness identify   the fundamentals benefits and drawbacks of the 
most common treatments psychodynamic behavioral   humanistic and pharmacological we'll identify the 
factors that can enhance utilization of services   including providing culturally responsive services 
addressing unique coping styles looking at the   role of fam the family in treatment and exploring 
ways to address cultural barriers including   mistrust and stigma and finally we'll explore the 
recovery concept and its impact on mental health   and mental illness across the lifespan so let's 
start out with prevention because as they say   an ounce of prevention is worth a pound of cure 
prevention has been conceptualized as primary   prevention secondary or tertiary so in primary 
prevention we stop a problem from ever happening   or we delay the onset of a problem but ideally 
we want to stop it from ever occurring so let's   take a medical example cancer i mean ideally 
we prevent somebody from ever getting cancer   but at the very least we help them stay 
cancer free until they get you know 65 75 85   secondary prevention prevents something from 
recurring or worsening so again with cancer   we'll stay with that for the moment we don't want 
to have the cancer to come out of remission or get   worse and metastasized for example and tertiary 
prevention reduces the impact of the problem   so tertiary prevention would keep the 
person from developing major depression and   any kind of other health problems as a result 
of the cancer so let's talk about that in terms   of mental health we want to stop people from ever 
becoming depressed i mean ideally stave that off   now we all experience depressive times in our life 
you know you'll have times where you're grieving   or you're depressed about something that's 
normal um but we want to prevent people from   developing major depressive disorder you know 
whether two three four weeks they just are having   a hard time functioning secondary prevention you 
know if they get a depressive episode okay well   we want to prevent it from recurring if possible 
or worsening we don't want them to become suicidal   if they have um called dysthymia or persistent 
depressive disorder is what we call it now   you know that's kind of like a mild depression 
think like eeyore um and we don't want people to   get worse we don't want them to become severely 
depressed so that's secondary prevention they   already have the issue but let's prevent it from 
getting worse and tertiary prevention reduces the   impact so if they get depression yeah that is or 
become depressed if you want to put it that way   that's unfortunate and it's unpleasant i get it 
but we want to help reduce the impact on their   work on their family life on their self-esteem 
while they deal with depression so those are   the three main types of prevention now we can 
engage in prevention activities by strengthening   knowledge attitudes and behaviors that promote 
emotional and physical well-being so if people   are taking care of themselves if we educate them 
about positive health behaviors we're going to   help them prevent negative health outcomes 
and promoting institutional community and   government policies that further physical social 
and emotional well-being in the community so for   example when you're when we're talking about 
institutional policies that think about school   what kinds of things can schools do to help 
prevent depression they can address bullying   they can provide units in health class on 
coping skills and cognitive restructuring   they can interface with the family and the 
community to identify any particular needs   that may need to be addressed communities 
can do the same thing they can interface with   other agencies mental health agencies and 
schools and businesses to identify the types   of services that people in that community 
need in order to stay happy and healthy   and government policies often revolve more 
around funding for all of these things prevention is based it's not just let's just pull 
it out of thin air sort of thing prevention is   based on theory and research so we do know that 
there are things that we can do that prevent   mental illness prevention addresses the individual 
as well as the micro macro and exo system and if   you think um back to broffen brenner's theory 
if you've gone through that class that i talk   about child development um broff and brenner talk 
talked about the ecological model of counseling   the microsystem you have the individual and all of 
their you know personal traits their temperament   their abilities and disabilities their microsystem 
you know the people that they live with the   then you go out to the macro system and you 
start talking about you know the businesses   and the community that they live in and then 
the exo system is talking about the culture in   general like the country that we live in and 
how all of these things impact the individual   and you're thinking well things on the country 
level don't impact the individual oh yes they   do um political stresses impact the individual 
what is in the media whether it's news media or   on you know prime time television impacts 
the individual and our attitudes about   um other people our attitudes about what we should 
do our attitudes about how we should look you know   all of these things are affected on the macro 
micro and exo system okay so prevention premise   prevention activities need to focus in all of 
these areas not just on the one person because one   person doesn't live in isolation we're impacted 
by lots of different things a person who lives   in the middle of chicago is going to be impacted 
by very very different things than a person who   lives in the middle of rural tennessee they both 
have their stressors but we need to address those   issues that's that macro system that we need to 
look at in order to provide effective prevention   for both people prevention focuses on strengths 
development and enhancing protective factors   instead of trying to get rid of depression we want 
to prevent it from occurring which means we have   to help people have the skills tools and building 
blocks to do what they need to do to prevent it   from happening we do want to reduce risk factors 
i mean prevention means reducing the risk factors   so people don't develop depression but we want 
to reduce those risk factors as much as possible   many mental health problems share some of 
the same risk factors for initial onset   so targeting those factors can result in positive 
outcomes in multiple areas so for example ptsd   anxiety and depression all have some similar risk 
factors including abuse and neglect and this can   be direct abuse where the person is abused 
or indirect where they see their their parent   being abused or they see their sibling being 
abused it doesn't matter either one of those is   very stressful and traumatic to the person family 
discord including just an air of hostility i mean   there doesn't have to be any overt violence 
but if there's a lot of hostility and fighting   and bickering and people are always grumpy 
that contributes to high levels of anxiety and   depression not only in children but also in 
the adults domestic violence obviously can be   traumatic and in some cases divorce can 
be a trigger for depression and anxiety   they identified that as one of the risk factors in 
adverse childhood experiences that are associated   with the development of depression and anxiety low 
self-esteem is another one of those things that   underlies depression anxiety and um you know 
potentially the development of addiction   lack of supportive family or peers we're not 
meant to live in isolation we are meant to   be around other people now we are in large part 
an independent society not an interdependent   society so we don't rely on others for everything 
but as humans you know we crave some sort of a   connection that's why we have an entire hormone 
called oxytocin that's our bonding hormone   so people need to have supportive peers and 
family that they can rely on when especially   when the going gets tough a lack of school 
or work success can lead to people feeling   stuck hopeless helpless anxious and depressed and 
a lack of involvement in pro-social activities   when we get involved in those activities it 
gives us a different perspective it gives it   enhances our sense of self-esteem there are 
a lot of benefits from that so we do want to   ensure people have opportunities to engage 
in pro-social activities that can be   volunteering that can be engaging and 
participating in a book club going to   the gym any of those things can help people 
be around other positive healthy individuals   so protective factors remember i said we 
want to focus on those more than eliminating   deficits self-regulation if children are able 
to self-regulate or if we work with adults who   have difficulty with emotional dysregulation and 
we teach them skills and tools to regulate their   emotions that's a huge protective factor because 
they will feel a greater sense of control over   their life and their you know what's going on 
so they'll there will be likely less anxiety   and less depression secure attachment 
you know that happens in early childhood   but it affects all of our relationships now 
people's attachment styles can be changed but it   often requires going through counseling and 
understanding attachment issues and working   through those abandonment and attachment issues 
before they can securely attach with another adult   human being people need effective communication 
skills and effective interpersonal skills in   order to get that social support we need to be 
able to communicate and play nice in the sandbox   you know we need to understand creating a win-win 
and compromise and empathy and all those things   we need to encourage family and peers to be 
supportive of one another we need to educate   people about different temperaments and different 
love languages so they can be supportive of one   another in meaningful ways consistent discipline 
and rules also creates an environment that is   less chaotic and less stressful which leads to 
less depression and anxiety if with children if   their caregivers are responsive then children 
feel less afraid and less anxious about things   everybody needs a safe environment you need 
to be able to go to sleep whether you're   2 or 62 you need to be able to go to sleep and not 
worry you need to be able to get deep restful and   sleep you need to be able to be in an environment 
that is emotionally and physically safe so you're   not feeling condescended to or criticized all 
the time that's important it doesn't matter what   age you are if you don't feel emotionally and 
physically safe it's going to increase stress   it's going to increase feelings of helplessness 
and hopelessness which translate to depression   support for learning needs to be there you know 
we all learn i learn every day i learn something   new today you know i try to learn something 
every day and sometimes i learn multiple   things but there needs to be support for people 
to learn and grow even into their elder years   there needs to be good school or work engagement 
you know we need to feel like wherever we're   spending the brunt of our waking hours we belong 
and we matter and we have a voice there have to   be positive parent and teacher expectations for 
children and there have to be positive family   and employer expectations for adults you know we 
want employers to believe that their employees   are going to succeed not uh you know let's see 
how long this will this one will last no we   want employers to go we've got a great person 
let's see how we can help that person develop   we want teachers to see children and all of their 
potential instead of seeing children as a number   and a test score we need to make sure that 
people have access to wrap around services   and that's everything but counseling basically 
when we talk about wrap around services and   counseling we're talking about everything 
else that helps the person reduce stress   and achieve their goals and be happy and 
healthy child care financial counseling   employment counseling transportation legal 
legal assistance you know you can name off   two dozen things these are all essential to have 
in your community and we're going to talk about   we're going to talk about it later but this can be 
referred to as a recovery oriented system of care   in a recovery oriented system of care or rosk 
for short the community bonds together and they   say okay what types of resources and services 
do people in our community need in order to be   happy healthy fulfilled yada yada like i said 
in in downtown nashville or downtown chicago   that's going to be different than in downtown 
rural america or even downtown suburban america   we need to take each community specifically and 
figure out what needs they have good coping and   problem solving skills are essential for emotion 
regulation and dealing with life on life's terms   because sometimes life just throws us a pile of 
crap and we got to figure out how to deal with it   so these skills we're not born with them we learn 
them we need to be educating children in school   about how to cope and problem solve we need 
to provide resources online we need to provide   you know coaching resources potentially at your 
employer maybe you have an eap on call that can   answer problems these are all protective 
factors that can help people solve a problem   before it becomes overwhelming and 
untenable and leads to a mental health issue   there need to be opportunities for 
engagement and pro-social activities   the ability to develop high self-esteem and 
self-efficacy so self-esteem is how you feel   about yourself and helping people feel good about 
themselves and say you know what i'm not perfect   but i am a really good person that's what 
we're striving for because nobody's perfect   and self-efficacy is people's individual belief 
that they can achieve their goals self-efficacy   is their that can do attitude if they believe 
that nothing they do is gonna make any difference   then they're going to feel helpless and hopeless a 
lot of times so self-efficacy helps people believe   that they can achieve their goals and change 
their situation as needed appropriate empathy   is a necessary protective factor that ability to 
understand where another person is coming from   and that's part of interpersonal skills but i felt 
it was worth breaking breaking that out because   that is another thing that you know we don't need 
to overtly learn but we do learn as we're growing   up we learn to be empathetic to other people 
and we need to have a little bit of a future   orientation i'm not saying we want to live in the 
future you know i really encourage people to live   in the present and be mindful and say okay i have 
a certain amount of energy let's call it a gallon   i've got a gallon of energy i can either pour a 
bunch of it in the past and pour a bunch in the   future and then have a quarter gallon for 
right now or i can use that gallon to make   right now the best it can be because 
if right now is the best it can be   and helps me move towards my goals then guess what 
the future is going to be pretty daggone bright but we can't eliminate risk factors because 
sometimes or avoid dealing with them because   sometimes they exist so we want to look at 
these and say how can we mitigate these things   neurophysiological deficits which is you know   encompasses a whole bunch of stuff like 
autism epilepsy and cerebral palsy okay   you've got these issues that children may develop 
or adults may develop adults can develop them too   and if they happen they happen there are 
some things we can do to help prevent them   but we don't know for example all of the 
causes we don't know what causes autism   we don't necessarily know what causes epilepsy so 
we may not be able to prevent it from happening   but we can mitigate its impact on people's mood 
so if somebody has autism early intervention   is a way of working with them to prevent the 
development of mental health issues to prevent   the development of depression and anxiety 
later in life where they yes they still are   dealing with their autism diagnosis but they're 
not developing other diagnoses on top of it   a difficult temperament is another risk 
factor that you know some some people are more   difficult to soothe and more you know some 
babies are fussier and you know that it is   what it is but we can work with those people as 
they grow to help them develop self-regulation   skills chronic illness we want to help people 
feel empowered if they've got for example   multiple sclerosis or cystic fibrosis or hiv or 
anything that's some kind of a chronic illness   yes they've got that illness let's prevent that 
from also becoming you know that diagnosis plus   depression plus anxiety so let's help them figure 
out how to live a rich and meaningful life with   their chronic illness below average intelligence 
or learning disability early intervention helps a   lot with both of these things if we can intervene 
research has shown that when students start to   fail in school or people start to flounder 
at work their self-esteem and goes down and   their risk for depression goes way up so we 
do need to make sure that we identify learning   disabilities early so if a student is having 
difficulty reading then because they're they're   dyslexic we can get them early intervention so 
it doesn't impact their self-esteem or their mood   and below average intelligence we want to help 
people make the best of what they've got and   provide reasonable accommodations in order to make 
sure that they are able to function as optimally   as possible family dysfunction is another 
risk factor and we can provide all kinds of   services for family counseling through churches 
through community centers through counseling   but it's important that if family dysfunction 
exists we recognize that we identify it and we   have resources available so the people living 
in that household don't also start developing   mood disorders or addictions abuse and neglect 
you know again we need to have outlets we need to   have things because abuse and neglect can lead to 
post-traumatic stress disorder anxiety depression   a whole range of things social disadvantage 
can lead to having a lack of a stimulating   environment it can lead to high stress in the 
household because parents are worried about money   or you know family members are worried about 
money if we're talking about adults that high   stress level can wear on you over a while after a 
while and turn into anxiety and then depression so   we need to look at in communities how can we 
help people have adequate social advantages   overcrowding or large family size you know when 
you've got six children sleeping in the same room   it can be stressful even if you're an extrovert 
that can be stressful so what can we do to help   families who feel like they're you know 
living like sardines family members with   mental health or addictive disorders can bring 
a lot of stress on the family it can also their   behaviors and the way they communicate can also 
rub off if you will we call it social learning   on other people in the family so we do want 
to make sure that anybody in that household   with a mental health or addictive disorder 
has access to treatment so the other people   in the household are not negatively impacted 
admission to foster care is a risk factor   for the development of anxiety and depression i 
mean think about it if you're a kid and all of a   sudden you're taken from home and put somewhere 
else yeah you're probably going to be anxious   if you feel like you've got no control over 
anything you know you may feel anxious and   depressed there may be some ptsd that just kind of 
goes with your life being suddenly turned upside   down and feeling you have no control so we do need 
to look at ensuring that foster care parents are   adequately prepared to deal with these issues 
reducing the factors that lead to foster care   as much as possible living in a high in an 
area with a high rate of disorganization so   if people are moving in and out constantly that 
can be a risk factor for mood disorders because   you're not able to develop stable relationships 
with people because you're meeting them and then   three months later they're gone and you've got to 
meet somebody else or if there's a high rate of you know people just becoming homeless or whatever 
it is we do need to pay attention to that because   people need to feel a sense of community and 
belonging and finally inadequate schooling   um schools that are not able to meet the needs 
of children especially children who have special   needs can contribute to their development of 
anxiety and depression because that those children   are failing which impacts negatively impacts 
their self-esteem and their sense of self-worth okay so we talked about the different 
risk factors and protective factors and   you know you can brainstorm all kinds of ways that 
you can make these things happen in your community   and it's really i've been on some of 
these steering committees before it's   actually really kind of a energizing process to 
develop a plan for a recovery oriented community   in order to figure out what do we need and where 
are the gaps and see it all come together and have   you know you can look at your community 
and it's just one great big safety net   but so moving on from prevention let's talk about 
treatment because treatment is sometimes necessary   psychodynamic treatment kind of came out of 
psychoanalysis and the role of the past in   shaping the present is emphasized so for example i 
use some psychodynamic approaches when i'm working   with clients we may be talking about their current 
relationship with their their spouse and i may   ask them about prior relationships you know 
maybe with their first love or what their parents   relationships were like things that they learned 
when they're a chuck they were a child and say you   know how is that impacting how you're acting 
in this relationship what did that teach you   and how is that playing out in this relationship 
we may not do a bunch of stuff to address the past   but we want to address the past in 
terms of how it's impacting the present   if when i'm working with trauma victims 
if they were abused when they were a child   okay if they still have a high level of anxiety 
and abandonment and all that kind of stuff   we'll talk about why they're still holding on 
to that they were unsafe when they were six   now they're 26 they're living in their own house 
they have their own rules they have their own keys   so are they still unsafe or are they still 
feeling the way they felt when they were six   psychodynamic approaches believe in the 
unconscious so there's much from the past   that influences our behavior that we're not aware 
of which is why in psychodynamic theory our goal   is to make the unconscious conscious you 
know i start trying to draw connections about   you know well i'm wondering um my mother was 
recently diagnosed with cancer and my stepfather   is you know really struggling with that and you 
know as anyone would but he had had a loss when   he was much younger with his first family with his 
first wife passing on and now that my mother has   potentially got a terminal disease it is bringing 
up that past and opening those old wounds for him   again so you know i pointed out that connection 
and she's like oh i hadn't thought about that   so those are things that we want to be aware 
of and sometimes as clinicians since we are not   in stuck in the midst of it we can see 
things that clients aren't able to see   right then so psychodynamic is can be 
really effective and really awesome   it can be challenging and totally not appropriate 
for clients who have significant cognitive issues   or who have a psychotic disorder and they're you 
know not grounded in our reality at the moment   behavioral approaches focus on current behavior 
and observable actions a strict behavioral   approach does not care about emotions or thoughts 
anything that can't actually be seen and measured   is irrelevant so you know that's a benefit and a 
drawback you don't get distracted by things but   there's a lot about the human experience you miss 
if you don't consider thoughts general principles   of learning are applied to the learning of 
maladaptive as well as adaptive behaviors   so in behaviorism they believe that by 
controlling what's rewarded and what's punished   we can basically help somebody unlearn 
an old behavior and learn a new behavior cognitive behavioral takes that aspect that 
behavioral is not paying attention to i   don't want to say lacking because it's 
you know a very well researched theory   but cognitive behavioral takes those thoughts 
and adds them to the behavior so we look at how   are your thoughts influencing your behaviors and 
your emotions and we call that the cognitive triad cognitive behavioral explores how thoughts and 
environmental stimuli shape the behavioral and   learning and how learning shapes thoughts so for 
example and i use this example a lot so forgive me   but you know if you when you were a kid there was 
a dog that chased you and nipped at your heels   when you were riding your bike now when you see 
a dog that's running and barking you might feel   afraid because that's what you learned you you had 
a bad experience so that was you know unpleasant   so you may have a stress reaction whereas i've 
grown up around animals all my life and you know   have never had such an experience so when i see 
a dog running and barking i'm like oh the puppy   wants to play um we're seeing the same dog we're 
seeing the same dog do the same thing but we have   different thoughts about the situation which 
leads to different emotions about the situation   cognitive behavioral therapy strives to alter 
faulty cognitions or thoughts and replace   them with thoughts and self-statements that 
promote helpful behavior so instead of saying i   can't do this having them say i choose not to that 
gives them an element of choice yes it's semantics   and we also look at unhelpful thoughts like all or 
nothing thinking like this always happens well we   address that by looking at what are the exceptions 
when when does this sometimes not happen   or jumping to conclusions without 
having all the information   there are several cognitive distortions is 
what we call them that we look at when we're   working with people who have anxiety and 
depression issues again this is not a great   approach for somebody who is actively psychotic 
or who has significant cognitive deficits   but for most people cognitive 
behavioral is a good approach and going back to behavioral behavioral approach 
although it doesn't address thoughts is extremely   useful with small children even with adults and 
um with people who who do have cognitive issues   because we're not dealing with cognitions 
we're dealing with rewards and punishments and finally the humanistic approach and that's 
what most of us are trained in as clinicians   when we go through college the central focus of 
humanistic therapy is the immediate experience   of the client what is going on with you right 
now how do you feel and there's an emphasis   on feelings and emotions the emphasis is on the 
present and the potential for future development   rather than on the past and we emphasize immediate 
feelings rather than thoughts or behaviors so   i want to know how you're feeling right now 
what's going through your mind and how can we   help you start feeling better it is rooted in 
the everyday subjective experience of the person   seeking assistance and is much less concerned 
with mental illness than it is with human growth   humanistic approach believes that if people are 
given a warm environment filled with unconditional   positive regard that means the therapist provides 
positive support for people just for being people   not for what they do but just because they're 
humans unconditional positive regards says   i love you for being a good person you know for 
being you not for anything you do or don't do   and that can open the doors a humanistic approach 
to child discipline for example is to remember to   separate the child from the behavior so telling 
the child i love you i did not like this behavior   you know that's a very humanistic approach 
to parenting but we want to help people   grow and humanistic approach believes if we 
create this supportive warm rewarding environment   that people will naturally grow because people 
naturally want to move forward a critical aspect   of humanistic treatment is the relationship 
between the therapist who serves as a guide   in an exploration of self-discovery so you know if 
somebody's feeling bad we might talk about why are   you feeling depressed right now and you know tell 
me about times when you haven't felt depressed you   know how do you think um you can go about feeling 
less depressed what do you think needs to change   so we're using a lot of socratic questioning and 
asking the person to really get in touch with   themselves and their needs humanistic is very warm 
and supportive but it tends to be a lot slower in   providing relief and progression than 
behavioral or cognitive behavioral   and finally pharmacological and you know most 
therapists use a range of approaches we're   not just purely humanistic or purely cognitive 
behavioral or purely pharmacological we use a   range and it's important to know which approaches 
are out there and which tools are out there so you   have the right tool for the right job you don't 
want to use a hammer when you need a screwdriver   so pharmacological treatments include 
antidepressants these are your ssris selective   serotonin reuptake inhibitors which increases 
the amount of serotonin in people's brains   snris your selective norepinephrine reuptake 
inhibitors which increases the amount of   norepinephrine in people's brains norepinephrine 
is helps us with motivation energy and focus   and your tricyclic antidepressants 
which are used a lot less   generally the first line is your ssris or your 
snris but these can be used for depression anxiety   and compulsive behavior like in ocd or you know 
addiction or eating disorders your anxiolytics or   your anti-anxiety medications obviously address 
anxiety and those are your benzodiazepines your   xanax and your valium and those sorts of things 
your antipsychotics you have two types typical and   atypical your atypical or your newer ones these 
are typically used for schizophrenia and psychotic   disorders sometimes you may see them used to help 
address some of the manic symptoms in bipolar   stimulants are used to address add and adhd 
pretty much nothing else mental health-wise   and then anti-manic medications such as lithium 
or anti-convulsant medications like depakote   are used to address mania one thing to be 
aware of is if somebody has bipolar disorder   and they start taking antidepressants 
it can trigger a manic episode so   differential diagnosis of depression 
versus bipolar is super important now this was one thing i learned about doing 
this presentation ethnopsychopharmacology   ethnic and cultural influences alter an 
individual's responses to medications these   differences are both genetic and social in nature 
so you know you're like they range from genetic   variations in drug metabolism due to genetic 
variations in drug metabolism metabolizing enzymes   and that can also um affect people who are 
elderly as well the the levels of enzymes in   their system changes as well so we do need to be 
aware that some people are going to metabolize   stuff faster than others and you may even see 
this you know in day-to-day life for example   you know i know people who take the average adult 
dose of benadryl and they're fine i mean they're   a little groggy but they're fine i take half of an 
adult dose of benadryl and i'm drooling on myself   you know i'm you know i always refer to myself 
as a lightweight but basically i have fewer drug   metaboli metabolizing enzymes for that particular 
drug in all probability so i don't need as much   in order to get a significant effect 
cultural practice practices may affect diet   so you know genetic variations we can understand 
but you're like where does culture come in well   people who eat certain foods or don't eat certain 
foods may respond to medication differently   and i didn't know whether to put it under 
cultural practices or medication adherence   when i worked at the clinic in in florida every 
summer our crisis stabilization unit would have   a super influx of homeless people with 
psychotic symptoms whenever it got hot   and we finally had an attending 
physician that identified the fact that   people who are homeless are not staying adequately 
hydrated and antipsychotics are extremely   sensitive to changes in blood levels 
so changes in hydration alter the blood   level of the antipsychotic which alters its 
effectiveness so in order to keep people stable   one of the things we had to do is make sure they 
stayed adequately hydrated too much hydration or   too little hydration would throw the dosage out 
of whack and they would start becoming symptomatic   so that was an interesting 
thing that i learned back then   but cultural practices can also affect 
diet medication adherence is important   some cultures don't believe in medication so 
getting people to take it you know might be   challenging obviously a lot of that is also 
the client's choice but we need to make sure   that medication is available culturally some 
people may not have access you know they may   financially not have access to certain medications 
or something so we need to make sure that have   availability of the medications and they can 
maintain blood level stability i worked with   another client who was schizophrenic a sweet man 
but and and was very you know on point because   he came in one day to the detox unit and you know 
obviously was under the influence and i i told him   i was really concerned because using the drugs he 
was using with the drugs he was supposed to be on   um was you know really really dangerous and he 
said oh don't worry dr snipes i quit taking my   prescribed medications um on friday so i 
could party all weekend i was like okay well at least you had the forethought 
to do that but that's a problem   so we needed to talk about that sorry y'all okay and the simultaneous 
use of traditional and alternative   healing methods can also um alter levels of 
medications for example certain herbs that   people may take from eastern medicine can 
increase or decrease levels of hormones or   neurotransmitters so if people are also taking 
medication for hormones or neurotransmitters   they could be working against each other or they 
could be exponentially intensifying one another one third of african americans and asian americans 
are slow metabolizers of antipsychotic and   antidepressant medications which means it's easier 
for them to od or experience serotonin syndrome   or on antipsychotic medications they may   experience what we call extra pyramidal side 
effects which are the really bad side effects   from your antipsychotic medications like 
clicking your lips and shuffling your feet where you know a caucasian american may take one 
dose and be fine if you give that same dose to   some african americans it will cause significant 
negative side effects and a lot of times   doctors may not understand this especially general 
practitioners who are prescribing as opposed to   psychiatrists they may not be educated about 
the differences in metabolism between the two   ethnicities so it's really important for 
clients to understand so they can advocate   for themselves and we can advocate for them if 
necessary a lot of times um african americans   and asian americans are started on a lower dose 
than caucasian americans for this very reason   barriers to treatment include demographic factors 
you know some people can't afford it it's just   it's too expensive and they don't have enough 
insurance or their deductible is too high so   they still be paying for it out of out of pocket   ethnicity is a big barrier some people don't want 
to go in if they don't feel like the clinician   they're going to be seeing understands their point 
of view from an ethnicity point of view and age there are only certain people who feel comfortable 
and who are trained to work with children   especially young children and there's there's 
special training to work with an older population   and a lot of people who are older adults want 
to work with somebody who is not the same age   as their grandchild they want to work with 
someone who you know went through the great   depression or something and can understand their 
values and their points of view a little bit more   so we do need to make sure that even if we don't 
have people on our staff that are reflective of   everyone's ethnicity and age group and everything 
that our staff is educated about the special needs   of those particular populations other barriers 
include patient and cultural attitudes such as   shame and stigma we want to dispel shame and 
stigma we want to get out in the community we   want to you know sing it from the rooftops that 
people get depressed people develop anxiety people   have ptsd it doesn't mean they're broken it means 
that they are you know struggling with something   some people believe they don't have the time well 
with the advent of e-therapy that excuses quickly   going out the window because what used to be 
a three-hour ordeal for some people getting   getting to the appointment sitting in the 
appointment and then driving back home   after the appointment having to get child care 
and all that kind of stuff that kind of goes out   the window when you can call your therapist at you 
know two minutes before your appointment have your   appointment and then you know hang up and go give 
your kid a bath so time is less of a barrier now   many people still have a fear of being 
hospitalized you know they're afraid if i tel   if they come in and they tell us that they 
are thinking about committing suicide that we   are going to automatically commit them or if they 
tell us that they've been using cocaine that we're   going to have them arrested or hospitalized so we 
do need to be very clear at the outset about the   limits of confidentiality but also let them know 
you know it is a safe place to talk about things   and along with that kind of goes 
mistrust some people who have been   exposed to this the system for lack of a 
better phrase um have had bad experiences   where people have told them one thing and then did 
something else or they felt manipulated or lied to   so it's really important that from jump 
we are as transparent and open as possible   some people think they can handle it alone and 
you know they have to get to the point where   they're ready to receive help and a lot of times 
it's a balancing act of you know would it be nice   to get another opinion yes but i don't have the 
time and i don't want to fork over the 60 bucks   if we can find ways to provide affordable 
early intervention services that are easily   accessible such as hotlines and you know drop-in 
e-therapy that can help dispel some barriers   sometimes people think that nobody can help 
you know nobody understands or nobody can   make it better and you know there are 
times when people feel really stuck   i have yet to experience working with a client 
who wasn't able to make some progress to improve   things i'm not saying that i can fix everything or 
that clients can fix everything for themselves but   generally there is somebody out there if it's 
not me it's you know this clinician over here who   knows this other technique or this psychiatrist 
over here or an attorney or whatever um   that their problem is so asking for help 
asking for in counseling getting in counseling   can help people connect with the resources that 
can help um and and again as clinicians we need   to make sure we don't bear the weight of the 
world on our shoulders we can't fix everything   we can't fix a lot of things we know what we can 
fix but then we can refer out to for other issues   and a lot of cultures identify mental health 
issues as medical they feel fatigued loss   of appetite irritable not much pleasure 
and stuff change in sleeping habits you   know those are all symptoms of depression 
but they may present to their physician   as being sick or having a thyroid issue or 
something and want it to be something medical   because in that culture mental health 
issue maybe issues may be stigmatized and we've got a fragmented system and that's 
another barrier to use because it can be difficult   to figure out how do i get help do i have 
to get a referral from my primary care   um can i just walk in where do i get it 
from who do i go to and basically we've   got four sectors in the system the specialty 
mental health sector that's us the counselors   the general medical primary care sector that's 
your primary care physicians the human services   sector and those are your case workers those are 
your people who help people get signed up for food   stamps and you know vocational rehabilitation 
and then there's the voluntary support   network sector which is all of your self-help 
groups and support groups but a lot of times we   don't talk very well and we don't communicate 
very well so it's important to recognize what   sector you're in but also be aware of all of the 
other sectors so you can make referrals as needed remember that 28 to 47 percent of the population 
have a diagnosable mental health or substance   abuse disorder in any in in any given lifetime 
only about one third of people who needs treatment   receives treatment in any given year so two-thirds 
of those people are suffering on their own when we talk about culture we need to 
remember that the term culture is used   loosely to denote a common heritage and set 
of beliefs norms and values most people have   multiple ethnic or cultural identities 
for example i'm a caucasian i'm a female   i'm a catholic so those are three different 
cultures right there the level of acculturation   differs between individuals so the values of 
being a woman for example that i embrace may   be different than what somebody else embraces and 
this is a little bit clearer when we talk about um   ethnicities and people who immigrate 
into this country so for example my um uh   stepfather was italian or is was italian 
he still is i guess um and you know he is   relatively fully acculturated to american 
culture now he still eats italian food and   stuff but he does not adhere to the same 
mores and beliefs that his family does over   in italy so he is more acculturated to american 
culture than to italian culture we do need to be   cognizant of that because every person has 
multiple cultures and but very rarely do   people fully embrace the entire culture and for 
them for their own personal you know definition culture impacts how people identify mental health 
issues whether they identify it as shameful   or just a thing whether they identify it as mental 
health or physical culture impacts the meaning   assigned to mental health issues such as is 
it a punishment from god or is it um you know   what caused it culture impact coping skills not 
every culture uses the same coping skills some   pray some use avoidance activities to just try 
not to dwell on it some actively address it   and culture impacts appropriate treatment 
modalities not everybody is going to be   appropriate for group counseling some cultures 
are very opposed to that some cultures   believe that the family should be involved in the 
whole treatment process which is going to affect   your selection of treatment approaches so we do 
need to talk with people about you know how do you   see this best being handled what coping skills do 
you have where do you believe this issue came from   and what are your feelings about 
having a mental health issue finally cultures vary in their use 
of family and community as resources   ties to family and community especially in 
african latino asian and native american   communities is often pretty strong due to the 
need to assist arriving immigrants provide a   sanctuary against discrimination provide a sense 
of belonging and affirm a centrally held cultural   or ethnic identity so they can get together 
and go okay this is this is what we believe   and they can feel a part of something 
they can feel a sense of connectedness   families often play an important role in providing 
support to individuals so we need to engage   the family however that person defines their 
family it may not be their blood relatives   a strong sense of family loyalty means 
that despite feelings of stigma and shame   families are an early and important source 
of assistance in efforts to cope so in some ethnicities in some cultures where it is very 
family-centric and interdependent then this   strong sense of family loyalty will make it even 
more important to engage the family as a resource   minority families may expect to continue to be 
involved in the treatment of a mentally ill member   like i said they may expect to be invited into 
sessions they may expect to be read in on the   treatment plan obviously we need releases of 
information and everything to do these things   but if they're wanting to be involved and 
the patient is wanting them to be involved   then we need to figure out how to make that happen and lastly we're going to talk about this 
recovery concept and in the past few years   it started to become referred to as a 
rosk or recovery-oriented system of care   recovery is a process it can be thought of 
as an outlook a vision or a guiding principle   but it doesn't refer to any specific services 
recovery is sort of a overarching concept   a person with mental illness can recover even 
though the illness is not cured recovery is a way   of living a satisfying hopeful and contributing 
life even with the limitations caused by illness   recovery involves the development of a 
new meaning and purpose in one's life   as one grows beyond the catastrophic 
effects of mental illness now i don't   exactly like that quote but basically it's saying 
recovery is living a rich and meaningful life   despite the fact that you have whatever this is 
going on depression um pain or whatever it is when we use a recovery concept consumers have a 
more optimistic attitude and their expectations   may improve the course of their illness so if 
they have this optimistic attitude and they're   looking at how to create a rich and meaningful 
life and they're seeing positive forward movement   then it's likely going to help 
them in their recovery process   the most common factors associated 
with recovery are medication   for some medication works in about 35 percent of 
the cases community support and case management   self-will or self-monitoring so we need to improve 
mindfulness vocational activity helping people   engage in those pro-social activities and this 
can be volunteer work paid vocation or school   and spirituality again as the person defines 
it not necessarily organized religion   the recovery-oriented system of care has the 
basic principles of using a multi-disciplinary   so you know you have medical you have social 
services you have legal you have financial   counselors you have counselor counselors you 
know everybody and his brother is available in   the safety net so it's multidisciplinary episodic 
system of care so people come in you know they're   in crisis or whatever they come in they get 
into the system they get to a point where   they're stable and maybe they decide okay i need 
to take a break from treatment for a while so they   leave treatment and or whatever you want to call 
what they're going through and they're fine for a   while and then maybe life hands them lemons and so 
they need to come back in so we're looking at this   episodic system we don't need to keep people in 
treatment for years and years and years a lot of   times people can come in reach maximal gains leave 
and then come back when they either need a tune up   or additional skills and this multi-disciplinary 
episodic system of care has no wrong door which   means no matter where the person enters the system 
whether they present at their primary care's   office or they present for counseling or they 
present at social services or even at the jail   they are identified as having a mental health 
issue that needs addressing and the referrals   can be made adequately and expediently emphasis 
is on achieving goals versus removing death   defects so we're really helping people 
achieve that rich and meaningful life   because if they have that then they're likely 
not going to feel as depressed or anxious etc so mental health issues are mediated by brain 
function we learned that um in in part one and   mental disorders are defined by signs symptoms and 
functional impairments so how the person presents   as opposed to causes because we don't 
know what causes depression or anxiety   we know some things that are related remember 
correlated like we talked about in part one   twenty percent of americans experience 
a mental disorder in any given year   but a range of treatments including counseling 
and psychopharmacology are available for most   disorders so if one treatment doesn't work we 
can try another treatment or try a different   combination of treatments and it's important 
to help clients understand that mental health   treatment is part art part science so they need 
to communicate with us about what's helping   so we can keep those parts and what's not helping 
so we can replace those with something else   the consumer movement has increased 
the involvement of individuals with   mental health disorders and their families in 
mutual support services consumer run services   and advocacy so we've got people coming 
out in that self-help sector saying   you know we're going to kind of help fill the gaps 
between what the professionals do and you know   provide some free for free and freely accessible 
services the recovery concept reflects renewed   optimism about the outcomes of mental illness and 
the opportunities for persons with mental illness   to participate to the full extent of their 
abilities in the community of their choice in this presentation we also reviewed prevention 
strategies from mental illnesses and we talked   about in enhancing self-esteem and self-regulation 
communication and interpersonal skills you know   we talked about all those things and we identified 
the fundamentals the benefits and the drawbacks of   psychodynamic behavioral humanistic and 
pharmacological treatments and talked a   little bit about ethnopsychopharmacology which 
if you remember was the use of pharmacological   interventions with people of different 
ethnicities and then we've ended by   identifying factors that enhance utilization 
of services including providing culturally   responsive services responsive not only to race 
and ethnicity but also to age and specific issues   addressing unique coping sky styles 
especially as they relate to the   person's particular ethnicity so if prayer is one 
of their things and they use a spiritual leader   in their treatment then we need to integrate that 
we talked about engaging the family in treatment   to remove some barriers and enhance services 
if they feel like they're working together   and in harmony with their culture and addressing 
cultural barriers including mistrust and stigma thank you for being with me today 
and i will see you next week if you enjoy this podcast please like and 
subscribe either in your podcast player or on   youtube if you want to attend and participate in 
our live webinars with dr snipes you can subscribe   at https when slash slash all 
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As found on YouTube

Intermittent Fasting: Effects On Health, Aging & Disease (Part 2)

To me, I remember reading this article, and
thinking this is a big step because up until now you sort of saw it in a bunch
of other places. You saw it in really in some really good science magazines, like
Nature magazine but finally hits the New England Journal. It's like, okay, no matter
how conservative and old school the doc might be, it becomes really hard to argue
with the point. And so as you start going through this article, it wasn't
original research. It wasn't studies as you know. It was more of a review, and
then really, it became more of a policy statement. Actually, I should have been
showing this image when you were describing what you were describing
because this is the image that gets into… okay,
there's you've got the mitochondria which are the powerhouses.

You've got a
bunch of different metabolic processes going all the way back to the genetic
components. And a recognition that you know what we have the same genetics in
our 20s that we have in our 50s, why are we getting insulin resistant in our 50s?
Maybe it's because you know that I think there's two things I think. There's some
inherent aging, but I also think it's clear that it's not just aging causing
insulin resistance alone.

I think the habit of eating 3 meals a day
minimum for 60 years or 55 years has a little something to do with our
epigenetics, and that's a major component of what happens. Here, we go back and we
start changing the signals, changing the the librarian that has to go back and
look for different enzymes, different genes. If we start getting our body used
to knowing that we're gonna have episodes where we need to pull energy
out of storage and out of trash stimulating autophagy as you know,
it's just a slightly different and a little bit more of an aggressive form of
using internal energy than just burning the glycogen that's in your liver, the
you know, the sugar stores in your liver, and glycogen more so than burning fat.
You're actually burning old beat-up dead mitochondria that if that are just no
longer working and other things as well. So yeah, it did a great job in terms of
describing a lot of the metabolic changes which are attributable to this
process of developing more of a catabolic as opposed to anabolic phase or
getting ketotic.

A couple of points about about that terminology – catabolic and
anabolic. Catabolism is where you're burning stuff that's already stored, you know the three things I mentioned: stored glycogen, stored fat
energy, and stored cell trash. Anabolic is you know you recognize that term
from anabolic steroids. That's where you're wanting to build muscles up, build
cells up. And as long as we're not going through any of these intermittent
fasting states, our body is in a constant anabolic mode. And that may be good for
growth, but it's not good for our basic metabolism, our basic avoidance of the
chronic diseases which are almost all vascular related. It was interesting some
of the points they made about the microbiome in there. And what was also
interesting to me was how they ended up the article talking about, okay, you know
what, we need to have much more of an organized… we need the standard medical
community out there now talking about intermittent fasting.

So that is
interesting. I am curious to see how long they'll take any comments about that.
Well, I'm smiling because you and I both know that's going to be a tough road to
hoe. It is tough sledding to get entrenched behaviors, and so doctors are
just like regular people when it comes to behavior change. Any of us with
entrenched behaviors whatever those are that we talked about for
some furniture, it's hard to change, and the medical establishment is no
different.

And it may be harder because it's so much bigger. But I loved this
chart that was in the article because it is prescriptive for what we should be
doing. So we've had a lot of people ask about how to get into the CIMT event.
We've got a whole schedule on the membership page. I'm gonna take you
some through that real quick.

First of all, you go to PrevMedHeratRisk.com.
That takes you to our website. Click on the membership login page, and membership
is free. You just have to give your email address. Then you'll see you've got a
menu over on the left. Live webinars. Second live webinar. CIMT events. Click
that button, then click the gray button, and you see all of the schedule for
getting a good reliable CIMT near your area. Orlando. Central Western Ohio, just
west of Cincinnati. Austin, Texas. Detroit, Michigan. Rochester. Memphis. Lots of
places. And most of these are thanks to our good friend David Meinz. And again,
CIMT done reliably has got a lot of advantages. Very good way to screen, much
better than stress test, and a lot more comfortable than going to the cath lab.
Thank you for your interest. Go get a good CIMT you near you.

As found on YouTube

7 Balsamic Vinegar Health Benefits | + 2 Recipes

Balsamic vinegar is a deep brown vinegar that’s
made from unfermented grape juice. It’s known for having distinctive, bold,
complex flavors and a tart aftertaste. Real balsamic vinegar is aged in barrels for
months or even years, and it can be quite expensive. Balsamic vinegar has become a popular ingredient
in food preparations, especially salad dressings and marinades. People use it as a low-fat additive and part
of a heart-healthy diet. Some people believe that balsamic vinegar
is good for you all by itself. It’s been suggested that balsamic vinegar
can contribute to weight loss, low cholesterol, and even a glowing complexion. It helps lower cholesterol! Of all of the benefits of balsamic vinegar,
this one is perhaps the most well-documented. Balsamic vinegar is an excellent choice for
those looking to maintain or lower their cholesterol levels. The antioxidants found in balsamic vinegar
target the “scavenger cells” that are toxic to your body and inflate your LDL (unhealthy
cholesterol) levels. By consuming balsamic vinegar as a dressing
or glaze, you can consume enough to help your body protect itself against clogged arteries. It aids in healthy digestion! The main active compound in balsamic vinegar
is acetic acidTrusted Source, which contains strains of probiotic bacteria.

These probiotics don’t just preserve food,
they can also enable healthy digestion and improve gut health. There’s also positive immune system benefits
to having these healthy bacteria called gut biome. The probiotic compounds in acetic acid could
be part of the reason some people swear balsamic vinegar makes them feel full. It supports weight loss! The vinegar family is known for its anti-obesity
characteristics, and balsamic vinegar is no exception. As mentioned before, balsamic vinegar contains
probiotic compounds that help you feel fuller, longer.

Unlike other flavoring agents like butter
and mayonnaise, balsamic vinegar is fat-free. Though it isn’t a magic weight loss potion,
there’s reason to believe that incorporating balsamic vinegar into your diet will help
you reach your weight loss goals. It’s diabetes-friendly! Balsamic vinegar is an anti-glycemic. In a 2006 review, studies even indicated that
after consuming vinegar, people with insulin resistance experience a blood sugar plateau
for up to five hours.

Using balsamic vinegar as a condiment can
make your meals more diabetes-friendly, and help you avoid blood sugar spikes that happen
after eating. It improves blood circulation! Balsamic vinegar contains polyphenols, which
are under investigation for how they help your cardiovascular system. You might not think about it often, but balsamic
vinegar is a fruit product because it’s made from grapes. Grapes have been found to keep your blood
platelets from aggregating, which may prevent cardiac diseases.

This might be part of the reason why Mediterranean
cultures have been using balsamic vinegar for centuries as a “healing” and “anti-aging”
ingredient. It may help with hypertension! Balsamic vinegar’s benefits for your cardiovascular
system extend to your blood pressure, too. A laboratory study from 2001 revealed that
rats with hypertension had better blood pressure after consuming vinegar over a long period
of time. By consuming 1 to 2 teaspoons of balsamic
vinegar as a dressing or marinade, you’re not only making your food more delicious,
you’re helping your heart health, too. It can improve your skin! Other types of vinegar, like apple cider vinegar,
might appeal more as topical acne remedies because the smell of balsamic vinegar is quite
pungent. The dark, stain-prone color of balsamic vinegar
might also put you off from applying it directly to your face. But balsamic vinegar contains both acetic
acid and antimicrobial compounds, as well as antioxidants.

Consuming balsamic vinegar as part of your
regular diet might make your skin look clearer and your complexion brighter. Risks and side effects! The risks of balsamic vinegar are low compared
to the potential health benefits, according to one review of the literature. If you drink raw balsamic vinegar, your throat
may become inflamed and your esophagus could be damaged. There are instances where drinking vinegar
can cause stomach pain or hurt the lining of your stomach. Be careful to monitor how much vinegar you’re
consuming. Stop using balsamic vinegar right away if
you feel it’s contributing to heartburn or gastric issues. Recipes! Balsamic glaze! A balsamic glaze is an easy way to start including
balsamic vinegar in your diet.

All you need is sugar, salt, and a high-quality
bottle of balsamic vinegar. Mix 16 ounces of balsamic vinegar in a saucepan
with a 1/2 cup of sugar and 1 teaspoon of ground sea salt. Turn the saucepan on medium heat and let it
boil. The mixture should cook down to about 8 oz.
as you stir it occasionally. The resulting glaze will be thick and syrupy. Let it cool and store in an airtight container. Caprese salad! For a dose of antioxidants, vitamin C, and
vitamin K, try this classic antipasto recipe. You’ll need: 2 – 3 beefsteak heirloom tomatoes,
8 oz. mozzarella cheese, 2-3 tbsp. balsamic vinegar,
2-3 tbsp. olive oil, fresh basil leaves,
sea salt. Slice the beefsteak tomatoes length-wise. In between the tomato slices, add thinly sliced
fresh mozzarella cheese. Layer basil over the tomatoes and mozzarella. Drizzle with olive oil, sea salt, and balsamic
vinegar to taste.

As found on YouTube