Kelly McGrady, a school nurse and member of Clinical Scholars’ 2017 cohort, demonstrates the importance of building trust in communities to successfully connect people with the resources they need to thrive. The story is featured on RWJF’s Campaign for Nursing blog. Below is an excerpt; click here to read the full story.

Clinical Scholars Fellow and School Nurse Tackles Youth Suicide in Her Community

Kelly McGrady, a school nurse and fellow in the Robert Wood Johnson Foundation’s (RWJF) Clinical Scholars program, understood the hopelessness felt by the twenty youths who attempted suicide in her first month as a mentor for the New Town, North Dakota, school district. She, too, attempted suicide when she was just 8 and 15.

McGrady is an enrolled member of the Three Affiliated Tribes (Mandan, Hidatsa, and Arikara) and a trusted leader in her community. She grew up on the same reservation as many of her students, surviving many of the same adverse childhood experiences (ACEs). Unfortunately, the story McGrady and her students share is not uncommon. Forty percent of people who die by suicide in American Indian communities are between the ages of 15 and 24. Among adults ages 18 to 24, American Indians have higher suicide rates than any other ethnicity in the United States.

Determined to stop the high number of suicide attempts, McGrady teamed up with pediatrician Anita Martin, psychiatrist Monica Taylor-Desir, and social worker Leolani Ah Quin. With the support of RWJF’s Clinical Scholars program, they initiated a Building Resilience, Building Health program to support youth who are at risk for suicide or who have survived a suicide attempt.

As a trusted community member, McGrady is able to amplify the impact of the program by connecting community members to the help they need, and has built a reputation as the person teens can turn to when they are in crisis.

“I will always answer a text or a call on the weekends, and I get youth help,” she says. “Many of them call me Auntie Kelly because I am genuine in how I care for people, plus I make myself available.”

Knowing that health care professionals face many demands—from long hours to the emotional strain of working with people experiencing pain and trauma—we recently asked Clinical Scholars teams and program co-directors how they nurture themselves to create personal well-being and stay fresh professionally.

We’re sharing their ideas to encourage all health care providers to take a minute to renew their own self-care commitments.

Individual practices

We heard a lot about how our fellows and directors take care of their bodies by exercising, eating healthy, and getting enough sleep. Building good habits is key, they said, and habits are established most effectively if you take small, satisfying steps.

Beyond the physical, they also take care of themselves mentally, emotionally, and spiritually. For some, that means starting the day with half an hour dedicated to journaling or a personal project or taking a real break at lunchtime to recharge. For others, it means using meditation to stay present and aware of their emotions.

Reading 10 pages a day for pleasure or engaging in creative “right brain” activities can help balance the work day. “My most recent hobby is creative writing,” said program co-director Claudia Fernandez. “I love writing because there’s no mess, I can write on a plane, I can share my hobby with my friends, it costs nothing, and it stretches my abilities.”

Getting out of the clinic and into nature came up as a strategy for nurturing, body, mind, heart, and spirit. “My self-care routine is spending time outside regardless of the weather,” said pediatrician Emily Hall, a Clinical Scholars fellow and member of a Montana team.

Personal relationships

Time with others is also a vital element of self-care. “We are social beings and I believe deep, meaningful connections are essential to our well-being,” said program co-director Giselle Corbie-Smith. “Yet the world we live and work in often seems at odds with this fundamental part of our humanity.”

“I try to be intentional about connecting with those I care about at work and home in some way, such as making space in busy days for tea or coffee with a colleague, thinking about meeting structures that allow for exchange of ideas one-on-one or in small groups, or regular breakfasts with my middle school son,” Giselle said.

Big picture views

Some program fellows also noted how important it is to think big picture about their health care systems and to infuse self-care into their workplaces.

“In our work with veterans with mental health issues, substance abuse, and PTSD, we know self-care will need to become an integral component of our organization,” said physical therapist and fellow Jeremy Fletcher, whose team is in Alabama. “Our team is currently discussing our personal values and how we see these integrating into the organization. For example, we begin every team meeting with a time to express our current challenging emotions and conclude each meeting with a prayer or meditation.”

A big picture perspective can also help reframe challenges for both patient and provider. “I do not carry my patients’ pain for them, because I see them as strong, inherently whole, and ultimately very powerful women,” said social worker Samara Grossman, a Clinical Scholars fellow and member of a Massachusetts team. “If they do not yet see themselves this way, I see it as my job to gently and patiently be their guide to that realization.”

We would love to hear your thoughts. Do you see yourself in these reflections? Are there other things you do to nurture yourself?

Please share your thoughts with us by email or on Twitter, where we invite you to tag @CSPfellows and #selfcare4providers.

By Lara Sando, PhD, Matthew Ruderman, MEd, PhD, and Maya Lindemann, RN, BSN

“If the police find me,” Eduardo said to a classmate, “I’ll get to be with my dad in prison.”

Even though Eduardo is only 4 years old, incarceration already loomed large in his vision of his future.

And he is not alone. One out of every five preschoolers in his Santa Monica, Calif., school district has been identified as “at-risk” or “vulnerable” in social-emotional development, which is the foundation on which children learn to navigate the world.

Recognizing how childhood experiences like Eduardo’s can impact long-term emotional and physical health, the three of us teamed up to create the Preschool Wellness Consultation (PWC) model, designed to buffer adversity and help children thrive.

We knew we needed a whole-body approach to a whole-body problem for preschoolers, their families, and their teachers. So the model integrates our expertise as a cross-disciplinary clinical team, combining psychology, social work, nursing, nutrition, and occupational therapy. We envisioned creating a supportive net that would hold not only children, families, and teachers, but also school administrators and service providers.

In the PWC model, trained mental health consultants offer tiered education and training for the entire classroom, the individual child, and the child’s family, to surround each at-risk child. As a result of these early interdisciplinary interventions, children develop holistic wellness strategies that enable them to eat healthily, recognize and appropriately express feelings, and solve problems and negotiate conflicts. Their teachers and family also learn to identify and address the child’s physical and developmental needs in areas such as language, vision, and dental health. Collectively, these strategies build physical and mental well-being and resilience.

Here in Santa Monica, we are putting the PWC model into practice through a local initiative called the Pinwheel Project. With coaching and support from mental health consultants, we see teachers doing a beautiful job helping children appropriately recognize and express their feelings and interact with other students. We also see teachers maintaining an attitude of curiosity and exploration as they seek to understand children’s behaviors through the lens of their specific histories and current stressors. As teachers learn to respond to children’s needs using a trauma-informed approach, we see positive effects rippling out to strengthen families, the rest of the school, and the wider community.

As a result of the Pinwheel Project, Eduardo’s teacher has grown in her understanding of the root causes of his behaviors and is now able to help facilitate his emotional and social growth. Eduardo’s mother has developed effective strategies for giving him the support he needs and is grateful for the coaching she has received. Eduardo himself has made meaningful connections with our team and appears more engaged with adults and peers alike. Additionally, a nurse, dietician, and dental service providers have coordinated much-needed treatment for an abscess that was causing him chronic pain, and have helped his mother learn how to prevent further oral health issues.

Many of us experience adversity at some point in our lives. But significant adversity in childhood can cause lasting individual and societal harm. Supporting children and their families to build resilience can help them create different futures. Eduardo provides inspiration.

The authors are members of a Clinical Scholars team in Santa Monica. Lara is a program coordinator at Providence Saint John’s Health Center; Matthew is a staff psychologist at Providence Saint John’s Health Center; Maya is a school nurse at Santa Monica-Malibu Unified School District.

Photo caption (left to right): Community partner Dr. Susan Samarge-Powell and Clinical Scholars Lara Sando, PhD, Matthew Ruderman, MEd, PhD, and Maya Lindemann, RN, BSN, plan preschool wellness consultation activities.

Step onto the grounds of a plantation in the South. Read the stories, feel the place, and you’ll begin to understand how the lives of enslaved people and their ancestors were affected for generations far beyond emancipation. This is the quintessential history of racial hierarchy and racism in the United States—institutionalized and codified as the law of the land.

Plantations may be defunct, but oppressive and inequitable systems live on. Today we know this as structural inequality: the privilege and inequality that is embedded into our systems, institutions and communities because of the way they were created and are maintained.

A group of fellows from Clinical Scholars, a national leadership development program supported by the Robert Wood Johnson Foundation, recently embarked on an exploration of structural inequalities, one of several special experiences offered to fellows each year. They began as I described above, with a visit to Stagville Plantation in Durham, North Carolina, to ground themselves in the history and lived experience of enslaved people. That was an emotional, powerful and eye-opening experience that sparked deep conversation, and left many people reflecting on how so many details of this painful history have been left out of school curricula and our national narrative.

During the multi-day discussion and training that followed, one especially powerful experience was a “photovoice” project to illustrate fellows’ own stories of structural inequalities in their communities. Through these stories and images we learned about acts of resistance to honor ancestors lost on the Trail of Tears; about the fear and activism of a person married to an undocumented immigrant and living in constant fear for their safety; and how structural inequalities manifest themselves in many communities—our own communities—in many ways. Fellows left this experience with powerful insights on race in America that they are applying in their work and lives.

We will repeat and expand this training around the country—for Clinical Scholars and anyone else who wants to attend—and will post updates at ccphealth.org. Meanwhile here are some questions social workers and other clinicians, community organizations and many others can consider as part of your ongoing journey to create equity and build a Culture of Health.

How is structural inequality being manifested in the situations I am in?
Many clinicians are becoming more aware of the social determinants of health, which are those factors such as access to social and economic opportunities, conditions in the places where people live, and access to healthy options. Those factors affect people’s ability to get to office visits, follow their clinicians’ advice and take care of themselves. Beyond awareness, we need to be very intentional about seeing how our society and institutions create and sustain those factors. Ask, “Why is it that in spite of the quality of care I seek to provide to my patients, they still don’t have good outcomes?” For example, one Clinical Scholars team in Chicago is addressing the challenge of “pharmacy deserts,” a swath of a major U.S. city without access to a pharmacy, and the impact living in those areas has on patients who need to take prescriptions.

How has my discipline, field or institution contributed to structural inequality?
Early research in obstetrics and gynecology in the United States used enslaved women for experimentation. Forced sterilization and other gynecological procedures were used as a tool of oppression. People of color have been denied access to care, to education, and to banking and home ownership. Medical institutions and corporations have purchased land and displaced people. These experiences shape the way our systems continue to function and it’s important that we come to terms with this history. I’m excited about the way academic institutions are beginning to take a close look at themselves and their history with racism, including how they benefited from the slave trade. With your team, explore how people perceive your institution or organization and the history behind that. Are you open and accepting? Do people feel safe coming to you?

How do we dismantle it?
What can you and your team do to address structural inequality? Sometimes it can be hard for clinicians to step back from individual interventions and look at the institutional and systemic issues that affect their patients and their community. But if you ask “what about our clinic/community is making it hard for you to do what you need for your health?” you’ll likely find a place to start. Even a single step like working with the city to keep a bus running later along the route to your clinic can have a significant impact.

How can we engage in partnerships to address the issues of structural inequality?
You don’t have to do this alone, and in fact you’ll likely be more successful if you work in partnership with others. There’s a partnership at the core of the work I’m describing here, one between myself and Giselle Corbie Smith, Co-Director of the Clinical Scholars Program. We’ve known each other for 17 years and have had the opportunity to co-lead projects, submit grants together and much more. Partners can strengthen our work and can help us see things we take for granted or that have become invisible from our own personal context and worldview. Who can you work with in the community, from nonprofits and schools to faith leaders and elected officials, to find and address problems and build new, equitable systems?

It is no small feat to dismantle systems, practices and habits that have become ingrained over generations. But the more your heart and mind are open to seeing the barriers and inequities, the closer we come to solutions together.

Submitted By: Al Richmond, Executive Director, Community-Campus Partnerships for Health