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Research shows that children and moms benefit when dads are actively engaged in their kids’ health and development. A new study examines barriers that make it difficult for some fathers to be involved and how to overcome them.

This Sunday, families around the country will celebrate Father’s Day and pay tribute to the special caregivers in their lives. It’s a time when I find myself feeling especially grateful for all the positive ways my own father has influenced my life and the crucial role my husband plays in raising our daughters.

I also think about the many dads I have been lucky enough to meet throughout my life. These are the special dads who are determined to make sure that all kids--both their own and others--have every opportunity to grow up healthy and happy.

One such father who stands out for me is Steve Spencer. I learned of Steve a couple of years ago when he represented his home state of Oregon at Zero to Three’s Strolling Thunder event. The event brings together parents from across the country to meet their Members of Congress and share what babies and families need to thrive. As a single dad raising two boys, Steve is a knowledgeable and passionate advocate for the kind of supportive services parents rely on to give their kids the healthiest start.

Steve put it best when he outlined the day-to-day realities of parenting, "It's really hard to put focus in trying to figure out a way to keep the apartment and get food in these kids' bellies and so on and so forth on top of taking care of him [his four-month-old son] and not sleeping."

Despite the constant juggling that comes with parenting, Steve is just one of many fathers who takes an active role in in his children’s health and development. And, according to a recent study in the journal Obesity, if the barriers that make participation difficult were removed, more fathers (and likely more mothers and caregivers in general!) could attend the many appointments and meetings that are essential to raising healthy kids. These include prenatal and pediatric care appointments, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) visits, home visits for pregnant women and families with young children, and Early Head Start activities, all of which help form the “circle of care” of a young child’s first few years.

The study, Engaging Fathers in Early Obesity Prevention During the First 1,000 Days: Policy, Systems, and Environmental Change Strategies funded by RWJF’s national nutrition research program, Healthy Eating Research (HER), looked at ways to engage more fathers in programs and practices that could help prevent childhood obesity during a child’s earliest years. The study highlighted emerging evidence about the “unique role” fathers play in childhood obesity prevention.

One of the pieces of research it references to support this found that “increases in fathers’ participation in physical child care (e.g., giving the kids a bath and getting them dressed) and the frequency of taking children outside to walk/play (which dads tend to do more of than bathing/dressing activities) were associated with decreases in the odds of childhood obesity from age 2 to age 4.”

And, the benefits extend beyond physical health. According to a study highlighted by the National Institute for Children’s Health Quality, “when fathers are more engaged with their children, their children have better developmental outcomes ... including fewer behavioral problems and improved cognitive and mental health outcomes.”

Most families divvy up routine child-care tasks like bathing, dressing and playing, among multiple caregivers in the way that works best for them. But it’s harder to do this with the programs and appointments examined in the HER-funded study, all of which specifically integrate obesity prevention services. This is because providers manage factors such as patient access and scheduling, so parents have less control.

We know that the earlier dads are involved, the better it is for moms and babies. But we lack robust evidence and a good understanding of participation rates and levels of engagement in the programs that serve kids and families during those first few years of childhood. As the study outlines, we are more informed about barriers to involvement and potential ways to address them. Some of these barriers include:

  • Inability to schedule appointments outside of regular (9-5) working hours and long wait times in clinics. Evening and weekend availability would help all dads and moms accompany their babies to appointments whether they’re at the local WIC office or with their pediatrician.
  • Lack of materials and information with images and messages that resonate with dads. Health care provider offices, WIC clinics, and home visiting and early Head Start programs are great resources to gather information about how to care for babies. But, handouts and booklets are dominated by pictures of moms and portray mom-centric activities such as breastfeeding. This can inadvertently leave dads feeling that their participation is not important, which is clearly not the case. Developing materials that are better tailored to fathers by sharing guidance on their specific roles could help create more inclusive experiences.
  • Programs like home visiting and Early Head Start have few male providers on staff who might be more comfortable/effective working with and engaging dads. More broadly, many program and clinic staff do not have much experience or formal training on how to effectively engage fathers. Hiring more male staff and implementing a robust program-wide “father-engagement training curriculum” may improve interactions with dads during appointments.  

And, the most significant challenge, which creates and/or contributes to the smaller-scale barriers listed above is the “lack of long-term, stable funding specifically earmarked for father-engagement activities.” Funding specifically designated to engage fathers would certainly make “father-focused programming, hiring of male providers, and the ability to offer extended-hour appointments” more feasible.

In the spirit of the holiday, let’s acknowledge the many wonderful ways dads show up for their kids. Then, when Sunday comes to a close, let’s commit together to continue addressing the challenges that so many dads (and moms!) face when it comes to giving their kids the best start from their very first days.

What other steps can support fathers in playing a more active role in their children’s health? Share your ideas in the comments below!

About the author

Jamie Bussel, MPH, a senior program officer who joined RWJF in 2002, is an inspiring, hands-on leader with extensive experience in developing programs and policies that promote the health of children and families. Read her bio.

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This 2018 Culture of Health Prize winner helps officers and the people they serve deal with the ‘bad things’ they witness and experience every day.

A veteran police officer in Cicero, Illinois, is quick with an answer when the therapist asks him: “What’s the worst thing you’ve witnessed on the job?”

Instantly, it’s 2010, an icy Valentine’s Day, and Officer Joseph Melone is staring in horror as flames engulf a three-story house. Melone is an arson specialist, and when the fire subsides, it’s his job to pick through the rubble. Seven people are missing. The oldest is 20; the youngest is that man’s newborn.

Melone finds the remains of the three-day-old baby.

“The 911 call from inside that place will haunt me until the day I die,” the 47-year-old Melone, now a sergeant, recalls. “You can hear the fire crackling around the caller and nobody could get in there.”

The story spills out from Melone as part of a training to give officers with the Cicero Police Department better tools for dealing with trauma in the lives of crime victims, as well as their own. The 8-hour course was built from scratch and tailored to the needs of the Cicero Police Department by local nonprofit staff from Youth Crossroads and the domestic violence agency Sarah’s Inn, as well as a psychologist from the local school district.

The idea for the course arose from a conversation the two of us had in early 2017 about the high suicide rate for members of the Chicago Police Department, which was 60 percent more than the national average, according to the Chicago Sun-Times. While the police department in Cicero is a tiny fraction of neighboring Chicago’s—160 versus 12,000—the pressure bearing down on officers is the same.

We recognized that in a community like Cicero, which is recovering from a history of gang violence, police need the tools for dealing not only with their own exposure to trauma, but also for helping community members overcome the effects of adverse experiences. It’s a way of shifting how law enforcement approaches and interacts with the citizens they are sworn to protect.

From those conversations, we worked together to put in place a trauma training course for every officer. And officers appreciate what they have learned.

Police officers are exposed to bad things every single day. They get used to it and don’t realize it, but over time the effects accumulate.

Learn how Cicero, Illinois—a Latino-majority town—is empowering residents of all ages to improve community health.

“It’s very important for police to understand the community,” says Cicero Police Superintendent Jerry Chlada, Jr. “If we’re going to be a partner, we have to understand everything.”

In one-on-one sessions, police officers gave direct input on what the course should cover. They talked about the types of situations that had the deepest impact on them, the supports they had, and the people they felt they could talk to.

The course focuses on three areas: what is trauma; how can an understanding of it shape how police do their jobs; and how police can manage trauma in their own lives.  

In the first part, the trainers give words to situations the officers have observed in the line of duty—like adverse childhood experiences (ACEs). They explain how repeated exposure to stressful or violent events can affect someone emotionally, developmentally, and physically. They walk through particular situations, like dealing with victims of domestic violence who may not want to cooperate. 

In the second part, officers are guided through how to better interact with crime victims, using a technique developed by the military known as the forensic experiential trauma interview (FETI), which aims to calm a victim or crime witness in order to draw better information about an experience.

The last part of the course turns the table and looks at how trauma affects police. When they witness violence, trauma, and death, they can develop PTSD of their own. They often think, “I shouldn’t feel like this” and brush their feelings off. To give officers somewhere to turn for help, the training ends with information on resources, including counseling services and a 24-hour crisis hotline (Serve and Protect, 615-373-8000).

The positive feedback we’ve gotten from officers after trainings is overwhelming. Now, we have a therapist on call to help officers after intense, stressful incidents, and the department has created a wellness committee and peer support program to address stress and ways to improve the health of its officers. The group would like to train officers to help each other after traumatic events, so they’ll always have someone to tell their stories to. Someone who’ll understand when they say, “I’m not feeling right.”  

Training police is just one way we’re dealing with community trauma and building resilence in Cicero. We’re also engaging parents and school personnel to help transform Cicero public schools into welcoming, safe environments for their children. In the years-long effort to build a healthier community, everyone—including police—has a role to play.

Learn more about Cicero’s efforts to build a Culture of Health.

County Health Rankings and Roadmaps, an RWJF project, is hosting a webinar on how Cicero is addressing community trauma on June 18 at 3 p.m. Eastern. Learn more and register.

ABOUT THE AUTHORs

Vincent Acevez is a 20-year veteran of Cicero, Illinois’ police department, where he is deputy superintendent of the Patrol Division. He is a member of the department’s wellness committee.

Jaclyn Wallen is a licensed clinical professional counselor at Youth Crossroads, a nonprofit that works with young people in Cicero, Illinois. She helped design Cicero Police Department’s trauma training for officers.

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What does it take to build fair opportunities for health in rural communities? A passionate advocate shares firsthand insights, as well as a new funding opportunity aimed to help build on existing lessons.

My family lives in Athens, Tenn., population 13,000, and we are familiar with the truths of an economy that has changed. We shake our fists at spotty broadband and crumbling roads. And we know what it’s like to watch main street awnings turn yellow and old factory stacks rust and crack in the sun, to lose family farms to corporate agribusiness, and see health care specialists move to medical centers 70 miles up the road.

But these challenges obscure a much deeper truth about my hometown and other places in the countryside: we keep showing up in many ways and in many roles as public servants, entrepreneurs, social change agents, and keepers of community memory.

For us, the key is to acknowledge that change is inevitable, that growth is necessary, and that communities should be the drivers of their own destinies.

My hometown is a proving ground for leadership and imagination. We may not have a gig of broadband, but we know how to assemble a community potluck on the fly. We know the ins and outs of local systems and relationships, and we’re pretty good at negotiating them. We’re used to living, working, and worshipping alongside folks with whom we agree and disagree, and this gives us a head start when it comes to bridging divides and joining forces in ways that improve health, equity and opportunity.  

For example, recently our YMCA partnered with The Arts Center to provide programming to at-risk youth in after-school care. And our public library regularly links up with our local public schools to provide STEM programming and coding classes to elementary school kids.

Our extension office partners with local health care providers to offer workshops on healthy living and facilitates Tai-chi classes for all ages in public spaces across town.

And we’re seeing steady progress—through the combined efforts of small business owners, city officials, local industry, and nonprofits—to revitalize our downtown. We recently achieved accreditation as a Main Street community.

So while many rural places lack more recognizable financial and civic resources, those assets take alternative forms: personal and family relationships; cultural cohesion; connection to place; or civic and religious infrastructure. Our devotion to social and civic rituals affect our mental and physical well-being, and can even extend how long we live. And a growing body of research shows that social connection is at the heart of good health.

Make no mistake, these collaborations are driven by relationships. A wise Athenian once told me that “real change moves at the pace of relationships.”

Lessons Learned Along the Way

At a time when we are trying to understand how ZIP codes influence our health and quality of life, rural people have lessons to share about what it takes to build equity and opportunity in their communities.

Here are lessons I’ve learned in my work with the Robert Wood Johnson Foundation:

  • Work with and through local and regional intermediaries. When it comes to making change in rural communities, you have to start with the schools; community-based organizations; regional health centers; faith-based institutions; and small businesses. Small businesses, for example, play a vital role in rural America, creating roughly two-thirds of new jobs and supporting the economic and social well-being of their communities.
  • Grow and engage leaders of different kinds and at different levels to get the work done together. This isn’t about another leadership training, but about finding champions in each community and helping them develop the skills they need to facilitate change. In Well-Connected Communities, volunteer leaders are helping their neighbors be healthier at every stage of life by coming together. In Athens, we are learning how to engage new messengers in small and big ways. At our quarterly Civic Saturdays, readers and speakers are strategically selected to bring new voice and experience to our civic rituals.
  • Connect people within and across sectors and geographies for peer learning and collective action. When you bring a diversity of perspectives to the table, you are more likely to generate the right energy and strategy around the solutions rural communities need most. Within our own Rural Assembly, we represent a diversity of cultures, geographies, and ethnicities, as well as a diversity in interests and expertise for our hometowns and communities. These range from climate and energy solutions to creative placemaking initiatives, from economic transitions to restoring our democracy.
  • Develop and strengthen the infrastructure for local, state, regional and national resource and information-sharing. Urban and rural boundaries are porous and our residents are itinerant; the roads leading in and out carry people, goods, and ideas without regard to ZIP code, making the futures of rural and urban places intertwined.
How You Can Be a Part of This Journey

RWJF just announced a new call for proposals to identify a Rural Learning and Coordinating Center that will build on these lessons. The aim is to better connect the work happening to improve community conditions for better health in rural America; advance the research and evidence that can support this work; and identify policy and systems solutions that support change in rural places because—despite talk of divides, we belong to each other. And to advance equity where we all live, rural must be part of the frame.

If your organization is committed to rural opportunity and well-being, we invite you to learn more about a new funding opportunity.

 

ABOUT THE AUTHOR

Whitney Kimball Coe serves as coordinator of the National Rural Assembly, a rural movement made up of activities and partnerships geared toward building better policy and more opportunity across the country. Her focus on building civic courage in communities is directly tied to a practice of participation in her hometown of Athens, Tenn., where she lives with her husband Matt and daughters, Lucy and Susannah.

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State policymakers have more flexibility than ever to advance health-promoting policies and programs, and to showcase effective strategies from which other states—and the nation as a whole—might learn. RWJF helps inform their efforts through research and analysis, technical assistance and training, and advocacy.

Why States Matter

States have long been laboratories for innovations that influence the health and well-being of their residents. This role has only expanded with the greater flexibility being given to the states, especially as gridlock in Washington, D.C. inspires more local action. The bevvy of new governors and state legislators who took office early this year also widens the door to creativity.

Medicaid is perhaps the most familiar example of state leadership on health. With costs and decisions shared by state and federal governments, the program allows state policymakers to tailor strategies that meet the unique needs of their residents. Among other examples, efforts are underway in California to expand Medicaid access to undocumented adults, and in Montana to connect unemployed Medicaid beneficiaries to employment training and supports.

In Washington state and elsewhere, Medicaid dollars can now cover supportive housing services, while Michigan is among the states requiring Medicaid managed care organizations to submit detailed plans explaining how they address social determinants of health for their enrollees. All of this experimentation is happening as states struggle to control the growth of their health care spending—a balancing act of immense proportions.

States are taking action on early childhood health as well. For example, while subsidized child care for low-income families is funded primarily by the federal government through the Child Care and Development Block Grant (which got a record-breaking $5.8 billion boost from Congress in 2018), states have a big say in who qualifies for subsidies and whether to offer additional supports. This can lead to substantial variation across the country. Wyoming and Minnesota, for example, maintain child care copayments of $100/month or less from a family of three earning $30,000/year,­ while 14 states offer no subsidy at all for families at that income level, meaning they must pay fully out of pocket for child care. One in four states provide additional assistance, supplementing childcare subsidies with refundable tax credits to help families cover the costs of child and dependent care.

Not all state policies have a positive influence on health. Decisions about who qualifies for public benefits, ways to generate new state revenue, and how to implement and enforce laws related to housing, education, and civil rights can put well-being at risk, particularly for marginalized populations, if they are not carefully considered. States must be vigilant about their choices and pay attention to intended and unintended consequences.

To meet that responsibility, policymakers need access to the best available evidence, lessons from other states, and data and stories that can make the case for new investments and health-promoting policies. When policymaking is fully informed, it can help close persistent gaps in well-being and lead to breakthroughs that spread to other states and even to the nation as a whole.

How RWJF Supports the States

At the Robert Wood Johnson Foundation (RWJF), we keep a close eye on what is happening in state capitols because of their crucial role in building a Culture of Health. Look no further than state budgets: health care and education typically account for the largest outlays and both, of course, are core building blocks of individual and community well-being.

To have a voice in all this, our state-level work falls into three categories:

Research and Analysis: We fund assessments of the potential impacts of policy proposals, offer guidance to help states monitor and evaluate new programs, and study the results of policies once adopted. Without such analysis, experimentation can’t lead to new knowledge.

An example is From Safety Net to Solid Ground, an Urban Institute initiative that looks at how states are responding to federal safety net reforms in the context of nutrition assistance, housing supports, and Medicaid. Part of that work tracks the effects of adding or tightening work requirements in public benefit programs. We are also exploring how state fiscal decisions affect the public’s health, essentially showing that A Good State Budget is the Best Medicine.

Technical Assistance and Training: We provide non-partisan technical support to policymakers facing tricky policy design and implementation challenges. These stages in the policy cycle are crucial but underappreciated opportunities for promoting health equity.

One of our longest running and most successful technical assistance programs is State Health & Value Strategies, which helps states transform their health and health care systems. We also support longitudinal training and peer learning opportunities for state leaders, including health agency heads, Medicaid directors, and officials involved with children’s issues.

Advocacy: We invest in coalition building, storytelling, and policymaker education (without supporting lobbying). These activities raise public and decision-maker awareness of pressing issues, explain the implications of various policy approaches, and mobilize state residents, researchers, and private sector groups to support appropriate solutions.

One of our largest state-focused advocacy efforts—Voices for Healthy Kids—has  worked to build the capacity of advocacy organizations addressing childhood obesity and has ultimately contributed to the adoption of more than 120 childhood obesity prevention policies in 46 states. We also work to advance health-promoting policies related to early education, family social and economic supports, and health care coverage.

The November 2018 elections brought 20 new governors and thousands of new and exceptionally diverse state legislators into office, making this a timely moment for outreach. While some officials have strong governing and legislative records, many are new to the policy arena. And most state legislatures operate part time, with little staff to do any legwork. All of that makes state policymakers hungry for evidence and practical lessons to inform their decisions.

At RWJF, we have just publicly released a series of information-packed issue briefs—seven on Medicaid and six on early childhood development, all written with a state policy and decision-maker audience in mind. They address the basics of program structure, financing, and operations; summarize the available research on health impacts; forecast the most pressing challenges state leaders will face; and point toward best practices from around the country. These briefs provide another set of tools to support states in implementing policies that will improve health and well-being within their own borders, and across the country, in the most equitable manner possible.  

Learn more about the role states can play in promoting health from RWJF’s new briefing series: Key Medicaid Issues for New State Policy Makers and Giving Kids a Healthy Start to Life.

About the Authors

Giridhar Mallya, MD, MSHP, is a public health physician and health policy expert. Working to advance the role of policy in building a Culture of Health, particularly at the state and local level, he views the Foundation as “a national leader in marshaling the evidence used to shape policies that foster healthier people, communities, and institutions.” Read his full bio.

Tara Oakman, PhD, is a senior program officer working to improve the value of our investments in health and health care and also to help ensure that all young children—supported by their families and communities—have the building blocks for lifelong health and well-being. Read her full bio.

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State Medicaid agencies and managed care organizations will now be able to estimate the health impact and health care cost savings of investing in childhood obesity prevention initiatives.

Today, nearly 50 percent of children—over 35.5 million—are enrolled in Medicaid or the Children’s Health Insurance Program. These programs are essential to low-income children, and particularly children of color, who are more likely to lack access to other forms of health coverage. Both programs have been providing medical care to kids for about half a century.

However, the treatment of chronic illness, special needs, and adverse birth outcomes often receive higher priority attention than preventive interventions. This is because treatment for medically complex conditions drives costs in the health care system. So it is where state Medicaid agencies, and the managed care organizations (MCOs) that help them control cost, utilization and quality, invest their time and energy.

With most of the focus on treatment, it’s often difficult to make the case for community-based, family-centered prevention. But some states have started to implement prevention activities addressing childhood obesity and other areas of health promotion and disease prevention.

In Alabama, the Children’s Center for Weight Management started a program, for which it receives Medicaid reimbursement that sends nurses and social workers to assess home environments of children with obesity. Through the program, nurses provide education, counseling, and medication adherence assistance. Washington D.C. offers a program at a community center, funded in part by its local Medicaid agency that includes obesity awareness and prevention, weight management counseling, cooking demonstrations, food shopping field trips, and exercise and dance classes. These are examples of states thinking outside the box to offer health services in nontraditional ways. With some recent innovations, more states will hopefully be encouraged to follow suit.

Making the Business Case for Prevention

Both private insurance companies and public programs like Medicaid play a crucial role in the healthy development of children. It’s important they connect enrollees with services that will best help them live a healthy and happy life even when the solutions go beyond the clinical setting.

This is why Nemours Children’s Health System developed the Prevention Business Case Financial Simulation Tool and accompanying user guide. While exploring strategies for Medicaid investment in preventative health services, Nemours discovered that there was a lack of tools and resources available to state Medicaid agencies and MCOs to make a business case for investing in prevention. To help these organizations fill this need, Nemours developed the Financial Simulation tool using existing research literature and partnering with the Maryland Department of Health to test and validate the tool with Maryland Medicaid data. The Financial Simulation tool provides key “return on investment” (ROI) information to any state interested in exploring and implementing childhood obesity prevention interventions.

The tool allows states’ Medicaid agencies and MCOs to estimate the cost of investing in various childhood obesity treatment and prevention services; health care cost savings resulting from intervention; expected short and medium-term health benefits; and a timeline of savings in order to provide evidence of the business case for Medicaid obesity prevention interventions.

It will be especially useful to state Medicaid agencies and MCOs that can use this data to make the financial case for investing in childhood obesity prevention. A lack of evidence on the costs, savings, and expected health outcomes of child obesity prevention interventions inhibits investment by Medicaid and MCOs. Policymakers searching for reliable evidence to make the case for cost-effective prevention can also use the tool as a resource when deciding legislative and budget priorities. Additionally, local and state health officers can use it to build the urgent case for continued support of Medicaid and can offer solutions of how to best use limited dollars. 

Beyond the immediate benefits of the tool, it also underscores the value of prevention for Medicaid agencies and can help shift decision-making toward prevention and medium and long-term ROI for many chronic health issues. Childhood obesity is a good place to start because of its relevance to lifelong health.

In addition to considering childhood obesity prevention, one strategy many states are exploring is Medicaid financing for home visiting, which offers home/community-based prevention services for pregnant women and families with young children. A recent report titled Medicaid and Home Visiting explored different states’ approaches to financing home visiting services with Medicaid. It would be great to build the “business case model” for interventions like home visiting and others that promote children’s physical, mental and emotional development so states could learn more about the myriad benefits of investing in these approaches.  

Both patients and health systems fare better when prevention and early intervention are used to meet the triple aim: care, cost, and outcomes. And, childhood obesity is a challenge for which prevention is particularly relevant.

If you’re part of a Medicaid agency or MCO, or a policymaker or advocate working on Medicaid-related issues, we encourage you to check out the Financial Simulation tool to learn about the various cost-effective childhood obesity prevention strategies that can be implemented in your state’s Medicaid program.

Learn more about the tool to help states estimate the Medicaid and MCO costs of investing in childhood obesity prevention on Nemours’ Moving Health Care Upstream Website.

About the Author

Martha Davis, MSS, joined the Robert Wood Johnson Foundation in 2014 as a senior program officer. Her work focuses on the root causes of violence, including child abuse and intimate partner violence. Read her full bio.

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For far too long laws and policies have been used to promote the health of some, but not all. A new guide from ChangeLab Solutions puts the blueprint for change in everyone’s hands.

Change is not easy and it takes time. It can be especially challenging when we’re working to change policies and systems that have been in place for decades. But we know change is necessary because many people in America still face discrimination, live in poverty, and do not have the basics they need to be healthy.

We also know that some places are making progress to replace policies that are driving inequities with new policies that can help close health gaps. Places like Newark, N.J., where a unique collaboration led by the state’s largest health care system is accelerating a movement to transform the community’s food system.

Case Study: Partnering to Tackle Food Insecurity in Newark

RWJBarnabas Health (no affiliation with the Robert Wood Johnson Foundation) is New Jersey’s largest health care system, providing treatment and services to more than 5 million residents each year. In 2017, RWJBarnabas launched a new effort to tackle underlying factors that can make it more difficult for some to be healthy. These include poor housing, unsafe streets and lack of affordable, nutritious foods.

The Social Impact and Community Investment (SICI) practice works closely with local organizations and residents to understand their needs and vision for a healthier future. Led by Michellene Davis, executive vice president and chief corporate affairs officer at RWJBarnabas, the SICI practice truly puts health equity at the forefront.

“Health equity ensures that everyone, no matter who they are, receives access to the services and supports they need,” says Davis. “It takes all of us to provide the services and sustainable system changes we need to move the needle and ensure improved outcomes.”

The SICI practice conducted a community needs assessment that identified food insecurity as a driver of health inequities in Newark. In the city’s South Ward alone, more than 5,000 residents receive benefits from the federal Supplemental Nutrition Assistance Program (SNAP), commonly known as food stamps.

Watch A Blueprint for Changemakers video.

Working with local partners, the SICI practice held convenings throughout the city’s five wards. Those events sparked discussions that informed strategies for changing the city’s policies and systems to help more low-income residents access affordable, healthy food.

Together with the Greater Newark Community Advisory Board, area nonprofits, hospitals and other local organizations, the SICI practice has helped to accelerate changes that are creating a thriving food system in Newark—including urban agriculture plots, farmers’ markets, and community gardens. The practice is also working to streamline access to SNAP, WIC and other important programs that support low-income residents.

Davis believes these accomplishments are just the beginning of their work to proactively make their community healthier. She adds, “We’re looking to serve as a model for other communities with similar issues.

Achieving a Healthier, More Equitable America Starts One Community at a Time

There are more examples like Newark—places where leaders, universities, hospitals, businesses, churches, and philanthropies are working together to create opportunities so all residents have healthier choices.

Newark is one of eight communities that partnered with ChangeLab Solutions to reshape the city’s laws and policies. ChangeLab Solutions provides technical assistance—funded by RWJF—to help state and local leaders use policy change to improve health for all residents.

Using Law and Policy to Reshape Our Communities—and Improve Health for All

For more than 20 years, the ChangeLab team has been working alongside communities to help them create lasting changes that will help all residents live a healthy life. We know many places are working to achieve equitable outcomes but are struggling with how to do it.

A new resource, A Blueprint for Changemakers (Blueprint), is the how-to guide that answers this question. It is grounded in our work to help residents and policymakers develop and advance home-grown solutions that reflect their lived experiences and is designed to create healthy, equitable communities.

It is a guide to educate decision-makers, practitioners, and communities about legal and policy strategies that benefit children, their families, and the communities where they live. It is a gamechanger for all of us who are working to advance health equity.

Four Guiding Principles for Health Equity

The Blueprint explains the fundamental drivers of inequity—structural racism; income inequality; poverty; disparities in opportunity and power; governance that limits meaningful participation—and provides strategies for addressing each of them. All of the strategies in the Blueprint are grounded in four guiding principles that can help inform new laws and policies intended to spur equitable outcomes.

1.    Engage Community Members

Actively involve those who will be most affected by the laws and policies you are working to change. This means ensuring that residents understand potential trade-offs and indirect consequences of policy decisions and have a say in what happens. Community convenings and other efforts that encourage regular dialogues and meaningful participation can help to build trust between policymakers and residents. This is a win-win that affords residents more control over their environment and allows decision-makers to gain support for policy changes.

2.    Build Capacity

Assess your community’s needs first. Do you need to build more awareness or do you already have the political will needed to take action? As you’re identifying partners and developing leaders, consider a broad range of stakeholders that represent the community. With more organizations and resources at the table, you’re more likely to reform policies and achieve your health equity goals.

3.    Understand the Roots of the Problem

In order to develop a shared vision and plan for a healthier, more equitable community, take steps to understand local problems and the systemic issues that are causing them. Ask questions about where and how health issues originated. Use data to describe inequities and map disparities. Work with partners to determine whether the disparities are based on race, socioeconomic status, or other factors.

4.    Align Action to Solve Core Community Problems

Work together with your partners to map out the systems and conditions that contribute to those disparities and prioritize targets for collective action. Strategically aligning your work across sectors helps prevent resources from spreading too thin; pools capital for priority actions; and ensures that the issues you’ve identified are addressed from as many directions as possible.

What Can You Do?

We believe law and policy can be one of the most effective paths forward to a healthier, more equitable America. And you don’t have to be a lawyer or an elected official to use law and policy as a tool.

A Blueprint for Changemakers is a guide for all of us. Use it to start conversations. Use it to build partnerships. Use it to transform your community into a place where everyone has the opportunity to make healthy choices.

Learn more about how you can start promoting health equity in your community with A Blueprint for Changemakers.

About the Authors

Monica Hobbs Vinluan joind RWJF in 2015 as a senior program officer, and has been a passionate professional advocate for health promotion and a distinguished government relations professional on a variety of health and well-being issues for two decades.

Shauneequa Owusu is senior vice president of innovation and impact at ChangeLab Solutions, where she works at the intersection of community development and health.

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A safe, secure home is where health begins. To build more equitable, healthier communities, we need to boost people’s ability to afford a good place to live.

A roof over our heads. Shelter from the storm. A beautiful day in the neighborhood. Home is where the heart is.

None of these phrases directly talks about health. But in our common language, we clearly recognize the centrality to our well-being and our happiness of the homes and neighborhoods in which we live.

In fact, there is a strong and growing evidence base linking our homes to our health. Where we can afford to live impacts where we live—and our neighborhood’s location can make it easier or harder to get a quality education and earn living wages, to afford to eat nutritious food, and to enjoy active lifestyles. And when we’re spending too much of our income on rent or a mortgage, that leaves little to pay for transportation to work or the doctor or to put healthy food on the table for our kids.

No one in America should have less of a chance to be healthy or to live in a safe, secure, affordable home because of how much money they make, where they live, or the color of their skin.

This year’s County Health Rankings show us we still have work to do to reach that goal. More than one in 10 U.S. households spends more than half of what they earn on rent or mortgage payments, according to the 2019 Rankings. And the Rankings show stark differences across and within counties in whether residents can live in affordable homes, especially for those with low incomes and people of color.

Housing Burden

As housing expenses have outpaced local incomes, many families experience the burden of severe housing cost—meaning they pay more than half their income on housing. The 2019 Rankings find:

  • Renters are more likely to be severely cost-burdened than homeowners.
  • For low-income renters, the burden is particularly harsh. With less income to draw on, at least 1 in 2 pays more than 50 percent of their paychecks on rent.
  • Severe housing cost burden also disproportionately impacts blacks, who are more likely to rent than own.

Severe housing costs are associated with deep health and social costs for communities, according to the 2019 Rankings. Across counties, as the share of households experiencing the burden of severe housing costs increases, there are more children in poverty, more people who don’t know where their next meal will come from, and more people in poor health.

Policy and Practice Solutions

Housing policy, including discriminatory practices such as redlining, has historically influenced place-based inequities. Today, equitable housing policy and practice can be powerful tools for giving everyone a fair shot at a safe, secure, affordable place to live that promotes their health and well-being. We must keep in mind, however, that there is no single solution to high housing costs. Every community must look at the challenges in their neighborhoods and address the most pressing needs. Some places to start include:

  • Building and preserving affordable homes and strengthening neighborhoods in ways that engage community members in local decision-making and avoid displacement of longtime residents.
  • Connecting families to resources for affordable housing, like vouchers for low-income households.
  • Increasing housing stability and reducing the risk of homelessness by ensuring basic needs are met and improving access to social services.
  • Enforcing fair housing laws.

We’ve seen such approaches work in places like the 24:1 Community in North St. Louis County, Missouri. The community came together across sectors to make affordable housing a priority. Chris Krehmeyer, president and CEO of the neighborhood development group Beyond Housing, estimated that the 24:1 Community lost six or seven percent of its 15,000 households during the 2008 foreclosure crisis and had not rebounded since then. In a place where more than nine in 10 of public-school students qualified for free or reduced-price lunch and the unemployment rate was three times the county norm, a lack of affordable housing was a major issue. The majority of residents were renters, subject to a lack of stability and risk of homelessness when faced with high rents and low incomes.

Owning a home is an important vehicle for families to build wealth for their children and grandchildren, but we know from the Rankings data that not everyone has had a fair chance to pursue this valued American dream. The nationwide rate of homeownership for white families is 20 to 30 percent higher than the rate for families of color.

So the 24:1 Community sought to make affordable home ownership possible, and build wealth to create stability and opportunity across generations. In their innovative, comprehensive approach, residents own their homes, but lease the land, which is owned by a nonprofit land trust. The houses stay affordable because the trust controls the price owners receive when they sell. Buyers receive financial and homeownership counseling before they buy and supportive services after they sign the contract. There are early signs of success with increased stability for 98 percent of Beyond Housing families with school-aged children. And since the initiative launched, youth obesity has declined in the community, and the child poverty rate has come down significantly.

The Rankings release provides a timely opportunity for every community to have its own conversations and come to the solutions that will work best there. If you’d like to learn more about policies your community could implement, resources abound, such as Local Housing Solutions from the NYU Furman Center and What Works for Health from County Health Rankings and Roadmaps.

Many sectors—private developers, health systems, philanthropy, advocacy and citizen organizations, and local governments—will need to work together on comprehensive approaches to make safe, secure and affordable housing available to all. Because we cannot thrive as a nation when the factors that contribute to good health are available to some, but denied to others.

About the Author

Amy Gillman, who joined the Robert Wood Johnson Foundation in 2017, is a senior program officer with the Foundation’s work to promote healthy, more equitable communities. She seeks to elevate community development as a key strategy to advance RWJF’s efforts to build a national Culture of Health. Read her full bio.

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A leader committed to the mental health and healing of black communities shares his insights.

A few years ago, I read a painfully insightful account in the New York Times of what it means to be a black American struggling with mental health. The author vividly describes how socio-historical “trauma lives in our blood,” materializing in our daily lives, and ultimately affecting our mental health.

A groundbreaking 2017 poll that the Robert Wood Johnson Foundation (RWJF) supported offers more insight into how discrimination fuels persistent stress. This stress leads to physiological responses that raise the risk of heart disease, stroke, and diabetes. Trauma and violence are also more likely to affect the lives of boys and young men of color, often leaving them with unresolved psychological wounds.

Compounding these problems are the many barriers that prevent African-Americans from receiving adequate mental health services. These include stigma, and a lack of representation among and trust of providers.

An inspiring leader I recently met—Mr. Yolo Akili Robinson—is dedicated to addressing this very problem. Robinson received a 2018 RWJF Award for Health Equity, which honors leaders who are changing systems and showing how solutions at the community level can lead to health equity. He is the executive director of BEAM, which stands for Black Emotional and Mental Health Collective. BEAM trains health care providers and community activists to be sensitive to the issues that plague black communities. BEAM has many programs that focus on men, boys, and nongender-conforming people.

I was pleased to delve deeper into Robinson’s work in the following Q&A:

What led you to your work in mental health advocacy?

I’ve been working in public health for the past 15 years, focusing on wellness, mental health, violence prevention, and HIV/AIDS. I saw huge pieces that were missing almost everywhere. I saw people who were visiting community-based organizations and hearing stigmatizing messages. For example, when I was working at an institution in Atlanta, a young man confided in an HIV testing counselor, “Sometimes I hear voices.”

The counselor’s response was unsettling. “Oh, my God, that sounds really bad. That’s crazy. You need to talk to somebody,” he said.

As a result, the young man grew fearful, shut down, and altogether avoided discussing what troubled him. Clearly, these kinds of messages and negative terminology are re-traumatizing and made him afraid to move forward with talking to a mental health worker and getting care.

What are the top mistakes that people within organizations might make in serving black clients—from receptionists to doctors—even though they’re trying to help?

It’s important to think critically about how we subconsciously respond to black people. For example, research suggests that medical students and residents may hold and use false beliefs about biological differences between blacks and whites to inform medical judgement. This may contribute to disparities in how they assess and treat pain, leading them to make different decisions about treatment than they would for white patients.

We all grow up internalizing things we hear, whether we like them or not. BEAM's approach to unconscious bias is that all of us grow up learning racism, sexism and other “isms.” So for me as someone raised and perceived as male, it would be impossible to not, in my 37 years of life, have learned biases toward women or have been taught behaviors that encouraged me to dominate, silence, or diminish them. That's an unfortunate aspect of American culture. Instead of denying or pretending to be "color or gender blind," we need honest exploration about the toxic things we learned and this can help us unlearn them, along with ongoing assessment. For example, as a man, am I taking up too much space? How am I using my power to support women? How could I be engaging other men to stop a culture of violence against women? That work is ongoing—and that means I need to always be cognizant when I am engaging someone different that I may embody privilege in relation to them. 

Can you mention a few of the unique barriers African-Americans experiencing mental health problems encounter when seeking care?

The biggest systemic-level barriers that many black people face are access and community. When I say access, I mean having health insurance and money for a co-pay; having transportation to get to and from services (especially in rural communities); and finding culturally competent, sensitive enrollment processes that take into consideration the burden and fear that engaging therapy will bring up for many in our community.  

Another barrier is the community. When our churches teach us that we can pray it all away, or our families believe that a "whoopin" or discipline is the issue instead of legitimate psychological distress, they keep us from getting the care we need and the intergenerational trauma continues. These issues, compounded with the structural barriers of ableism, transphobia, racism, homophobia, and black mental health myths are considerable challenges.  

If I’m not paying attention to my own wellness and biases, that may become a barrier that shows up in interactions with those in my care.

BEAM responds to these barriers in many ways. Our Black Mental Health & Healing Justice Training trains educators, activists, religious leaders, and many more who work in black communities on accurate mental health information, peer support skills, and strategies to dismantle mental health myths. Our training also holds space for the unique way racism, transphobia, sexism, and homophobia impact mental health, something few other mental health literacy interventions in the country do. This intervention helps really address community-level barriers.  

For systemic-level barriers, we provide training and technical assistance to organizations to help them integrate healing justice/mental health into their direct service and operations. Our Transforming Our Systems, Transforming Ourselves initiative also specifically supports organizations with assessing the wellness of their staff, as well as how they are impacting communities. I also have to mention our Southern Healing Support Fund, which offers micro-grants to black therapists, yoga teachers, and herbalists doing care support work in the rural deep South. 

You also work with African-American college-age men, helping them address rigid masculine norms that may contribute to poor mental health. What are these issues?

The unique intersection of race and culture has led to what we now call black masculinity. This is, among other things, the idea that black men should embrace hardness, which is emotionally harmful and counterintuitive to our well-being. This notion of masculinity is perpetuated across racial and ethnic categories. However, because of the economic disadvantages for black men, there is pressure to perform in ways that are debatably more rigid than for white men.

Through our efforts around Masculinity & Mental Health Training, we work with people who identify as men, asking them, “How did you learn about masculinity, and how did that influence your relationship to your emotional or mental health? How are the women in your life impacted because of being in a relationship with a person who doesn’t want to commit to their well-being? How does that create loneliness, violence, isolation, misogyny, and transphobia?”

Our program also involves a community project, so people can bring lessons into churches, fraternities, and schools. It’s not just the 20 or 30 folks in the room [hearing these conversations]—that dialogue is going to your dad and your uncle. We’re hoping this leads to further learning and empowers young people who come to believe, “I can interrupt violence when I see my friend or my boy being disruptive, and that doesn’t make me less of a man.” We have a lot of unlearning to do, but we can be different kinds of men and people. We can create a world that centers on healing and doesn’t create harm.

You also focus on helping caretakers to look after themselves. Why?

Many of us—who are doing healing justice, mental health, or other support work in our communities—are drawn to it because of our own trauma. We may be survivors of the very issues we are trying to address, such as assault or chronic illness. We develop an altruism that leads us to become self-sacrificial in our approach toward how we nurture others. We push ourselves aside, minimizing our own needs. Healing others actually becomes an avoidance mechanism.

Also, people can say things that trigger and awaken our own anxiety, like when I talked to a man about how he beat his daughter. These aren’t always amicable clinical interactions either. When you’re facing and listening to so much distress, it lands in your heart.

If I’m not paying attention to my own wellness and biases, that may become a barrier that shows up in interactions with those in my care. I can be more aggressive or short with someone, or I can burn out and become indifferent, or so exhausted that I don’t come to work. We need to recognize this and attend to wellness and make space for it. Some of my own self-care involves getting the basic essentials like sleeping, eating healthy foods (with the occasional sweet treat), getting downtime and going to therapy, which is honestly amazing. Having an hour to focus on my feelings and processing has meant everything. This is not something extra that you do after work. This is the work.

Learn more about the RWJF Award for Health Equity.

About the Author

Dwayne Proctor, senior adviser to the president, believes that the Foundation’s vision for building a Culture of Health presents a unique opportunity to achieve health equity by advancing and promoting innovative systems changes related to the social determinants of health. Read his full bio.

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The Southeastern San Diego Cardiac Disparities Project works with faith organizations to provide holistic heart health programs in African-American communities. Its first steps are confronting racism and building trust.

Editor’s Note: This post originally appeared on the National Civic League website and has been reprinted with permission.

The Southeastern San Diego Cardiac Disparities Project is improving the cardiovascular health of black residents in South San Diego by altering two fundamental systems that can influence their health: faith organizations and health care providers.

Two winners of the 2017 Robert Wood Johnson Foundation Award for Health Equity—Elizabeth Bustos, director of community engagement for Be There San Diego, and Reverend Gerald Brown, executive director at United African American Ministerial Action Council—are leading the effort.

The heart of this project is trust—as well as its power to heal and build. The project focuses on Southeastern San Diego, the city’s African-American hub—the community experiencing the county’s highest rates of heart attack and stroke. Its goal is to improve cardiovascular health in the 6,400 black adults living there by transforming faith organizations and health care, two influencers of health.

Southeastern San Diego is comprised of a cluster of working-class neighborhoods where over fifty percent of families earn less than the self-sufficiency standard. It has barren parks, too many liquor stores and fast-food restaurants, yet just one supermarket.

Bustos and Brown were not the first people to approach black congregations in Southeastern San Diego in hopes of forming a partnership around health. But previous efforts that over-promised and under-delivered left many congregations mistrustful of such partnerships. Over the years, many pastors had opened their congregations to researchers who came then disappeared. As Senior Pastor William Benson explained, “We were concerned about people coming into the community with passion, but what they really wanted was our numbers, our data...they would put in for grants and get the money, and it never came back to the community. We were tired of being played.”

A New Approach

Where others might gloss over or ignore the legacy of race and racism in shaping health in African-American communities, Bustos and Brown recognize that these are truths that must be discussed, confronted, and considered.

Brown pledged to his fellow pastors that, “We’re going to do things differently.” And indeed, they have. Bustos and Brown took the time to listen to these concerns, to acknowledge the community’s history, and to build relationships. Work meetings became forums for candid dialogue about the roles that race, exploitation, and neglect had played—and continue to play—in the community.

The pastors demanded that the project be transparent for them to consider joining. They wanted to know what data was going to be collected, who was going to collect it, and how it was going to be used. The project director developed a data stewardship agreement that gave the pastors the transparency they wanted and ownership of their data. It took nearly a year of listening, learning, and conversations to build the trust necessary to act.

The project puts the community in the driver’s seat. It calls for each congregation to develop its own “heart-healthy plan” to reduce heart attacks and strokes, based on its unique demographics, resources and needs. The plan must have three components: nutrition education; exercise and health monitoring; and tracking participants’ blood pressure and weight. The pastors also agreed to come together once a month to learn from one another. And they agreed to meet with clinicians, particularly doctors, to share their experiences with them. To date, 20 churches and a mosque have full-fledged programs to combat heart disease and strokes, and these are as varied as the faith organizations themselves.

As Bustos and Brown explain, this approach is not simply about creating a heart-healthy intervention. Rather, “it builds a structure for African-Americans to improve their health on their terms, relying on their trusted leaders, and controlling the way they interact with other powerful entities.”

Creating a Culture of Health Within Congregations

At Immanuel Chapel Christian Church, Pastor Christian developed a plan that calls for monthly meetings on a Saturday morning with her congregants. In her opening prayer at the meetings, she tells them that scripture calls for taking care of one’s body to be able to serve God. Afterward, they take a brisk “gospel walk” around the neighborhood, singing an inspirational hymn. They pass businesses, dilapidated houses and empty lots. Each month, they add another block or two to their walk.

Next, as they settle into the pews, the congregants hear from a featured speaker, usually an African-American health professional. The speaker explains the scientific and medical causes of cardiovascular disease and offers practical, culturally appropriate recommendations.

Afterwards, the participants each have their blood pressure and weight registered by a member of the congregation who isa retired nurse. If she sees a problem, she recommends they see their doctor or may gingerly nudge them with suggestions on how to step up their efforts to lose weight. It’s low-key and nonjudgmental.

As morning gives way to noon, the participants enjoy a healthy lunch and fellowship. In a single morning, they’ve nourished their soul, fed their body, participated in group exercise, and received disease prevention information from a trusted source in a language they understand—all paving the way for them to take action in protecting their health.

This work is not only transforming mindsets about health, it connects pastors more closely to their congregations. The doctors, nurses, personal trainers, teachers, and healthy cooking aficionados that pastors find among their congregants are then invited to form health ministries. These lay leaders implement the church’s heart-healthy plan; engage congregants in self-care; and uncover health issues. To date, the congregations are tracking around 2,000 people.

In messages to their flock, the pastors regularly speak on ways to prevent heart attack and stroke with small lifestyle changes. They encourage the congregation to take steps to become healthier: “Don’t forget to stop by to get your blood pressure checked;” “I’m looking forward to next weekend’s health class;” “Remember, no fried food at our monthly reception.” Many congregants publicly announce that they are trying to eat healthier and to lose weight.

Many attendants in these congregations are in their 60s, 70s or older. It’s worth noting, however, that many are the main caretakers of their grandchildren. The project underscores that prevention begins at an early age, and that these project participants are in a position to influence a younger generation.

Trust and Transformation

The legacy of racism and neglect hangs heavily over health discussions in these congregations. Mistreatment breeds mistrust. The pastors tell stories about how some of their congregants do not trust doctors. “There is such a huge trust issue,” Christian told the health care providers at the project’s annual health summit. “People are fearful. They remember what happened to their grandmother, to their sister, their next door neighbor.”

At the same time, the clinicians expressed frustration at how some of their African-American patients do not adhere to their medication regimen, and often follow a relative’s lead, instead of taking what is prescribed.

The project has created safe spaces for clinicians, particularly doctors, to interact with faith leaders. These exchanges provide insights not easily gained elsewhere, raising awareness among clinicians of the history and culture of African-Americans—with the goal of informing all levels of health care—from the treatment of individual patients to how a health system treats a community.

At one event, the ACC/AHA Cardiovascular Risk Calculator was introduced to the health care providers, many of whom were unfamiliar with it. The online calculator estimates the risk of the patient having a heart attack or stroke depending on a variety of factors, including race. Black patients face a significantly higher risk. On the spot, many doctors expressed an interest in beginning to use it. Furthermore, these community-clinical linkages have resulted in doctors volunteering to help the health ministries.

The collective impact of this project contributes to a Culture of Health by fostering a healthy lifestyle from the ground up: Pastors raising awareness of cardiovascular disease from the pulpit; congregants taking steps to reduce their disease risk; doctors and other health practitioners becoming more aware of African-American history. As Bustos and Brown will tell you, “It all begins with a willingness to build trust in a community, and trusting its members to lead the way to lasting solutions.”

Learn more about the RWJF Award for Health Equity.

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Social emotional development is key to every child’s education and paves a path to life-long health. A new report shares specific recommendations for research, practice and policy to promote all students’ social, emotional and academic development.

Dr. James Comer is a pioneer. Decades before the science of learning and development caught up to him, he understood that all children need well-rounded developmental experiences in order to seize opportunities in life. His parents hailed from the deeply segregated South, but they helped him thrive in the era of Jim Crow, investing in his social and emotional well-being and providing safe, supportive, nurturing and demanding educational experiences.

Through that lived experience and Dr. Comer’s work as a physician and child psychiatrist, he understood that one of the most important ways to support children was to focus on where they spend a substantial part of their day: schools. He also understood that many children did not have opportunities to benefit from an environment that supported their well-being and their ability to have a full learning experience. He set out to change this through a remarkable model that has earned him the moniker “the godfather of social and emotional learning.”

The fundamental basis for Dr. Comer’s work is that in order for children to realize their full potential, their diverse backgrounds and circumstances must be recognized. When schools meet children this way, students feel valued, challenged, and free to express their agency.

The research supporting Dr. Comer’s work has endured and is being amplified each year. Learning is social and emotional, and we must focus on supporting the whole learner. The positive impacts of investing in a child’s social and emotional well-being begin early in life. One major 20-year study found that kindergartners with stronger social and emotional skills—who were more likely to share, cooperate, and help peers—attained higher education and well-paying jobs as adults. These kids became healthier, successful adults.

This evidence was once again brought to bear through the National Commission on Social Emotional and Academic Development (the "Commission"), for which Dr. Comer serves as honorary co-chair. The Commission released recommendations about how to ensure that children land in schools that foster their full development.  

Dr. Comer describes the need to support young people’s comprehensive development based on his more than 50 years immersed in this work.
Getting to Brass Tacks

The final report is based on what the Commission learned from school leaders, educators, parents, and young people from all over the country. It makes recommendations across research, policy, and practice and focuses on the conditions that are critical to ensure every school in the country supports the whole child.

The Robert Wood Johnson Foundation (RWJF) has been proud to support the work of the Commission since its earliest phases of planning. Its work embodies our belief that every child deserves the opportunity to thrive in safe, stable environments, starting from the earliest ages.

While the recommendations are primarily focused on schools, they also acknowledge the broader contexts in which children and youth develop. They include:

1.    Set a clear vision that broadens the definition of student success to prioritize the whole child. Success in life depends not just on traditional academics, but on social and emotional skills such as collaborating well with peers, setting and working toward goals, and being aware of how one’s emotions and actions impact others.

2.    Transform learning settings so they are safe and supportive for all young people. This is about BOTH physical and psychological safety. We need to acknowledge that students come from diverse backgrounds and experiences and be sure to create spaces and conditions in schools that are welcoming to all.

3.    Change instruction to teach social, emotional, and cognitive skills; embed these skills in academics and in schoolwide practices. School leadership can bring a strategic approach to teaching students social emotional skills at all levels. Like all skills, these take time to develop. To be effective, they must be integrated throughout the school day, and not set up as an isolated class or activity.

4.    Build adult expertise in child development. Supporting the whole learner means supporting the caregivers and educators around them as well. All school staff—teachers, administrators, counselors, paraprofessionals, and others—must have access to professional development that integrates components of social emotional learning for youth of all ages.

5.    Align resources and leverage partners in the community to address the whole child. While schools are often the focus, we know they are not the only place where this work happens. School districts and leaders need to work together to build partnerships among other groups youth interact with, whether afterschool programs, recreation centers, etc.

6.    Forge closer connections between research and practice. The practices schools and community partners use must be based on the best available evidence. In order to make that happen, we all must work to more closely connect the researchers in this field with those putting that evidence to work.

Moving Forward

The good news is that Dr. Comer is now a leader among many. In December, the Prevention Research Center at Penn State University published a research brief that nicely encapsulates what decades of research show us about the impact social emotional development can have on kids, and principles of how to do it well. Penn State has published a series of briefs over the last two years, examining social emotional learning in early childhood and at every school level. The briefs have also explored how factors like school climate impact social emotional learning, and how to approach these strategies equitably, so that all children benefit. The work Penn State is doing to synthesize research on social emotional learning will continue this year as well.

RWJF also is excited work with MDRC on further evidence related to how approaches grounded in equity and social emotional learning can support the whole learner. CASEL, the Collaborative for Academic, Social, and Emotional Learning, will continue to work with states and districts across the country, sharing practices for what works. Child Trends has just released an analysis that shows that most states have policies that support parts of social emotional learning, but that those policies can be limited. That assessment is also part of a broader, comprehensive analysis of state laws and policies that elevate how states are advancing well-being of children across the nation.  

A child’s well-being and their education are inextricably linked. Children who succeed in education have the promise of better health later in life. And children who are healthier are more likely to go to and do well in school.

Dr. Comer’s prescient vision for children was brought to bear in the Commission’s report, and hundreds of stakeholders are rallying around it. We’re one of them, because we believe that every child deserves an opportunity to be their healthiest and live the fullest life possible.   

Read the Commission’s recommendations and share your comments on how else schools can support the whole child.

ABout the Author

Jennifer Ng’andu is the interim managing director–program at RWJF. She helps lead grantmaking activities to advance social and environmental changes that help ensure that all children and their families have the full range of opportunities to lead healthy lives, while providing a strong and stable start for every child in the nation. Read her full bio

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