The Inexpensive Way to Lift New Moms Out of Postpartum Depression

Judy’s first pregnancy was planned, and she was looking forward to having a baby. Yet, halfway through the pregnancy, something changed. She began to feel down and bad about herself. She had less energy and struggled to concentrate. Thinking this was a normal part of pregnancy, she ignored it.
After she delivered her son, it all got worse. She felt as if she was in a black hole of sadness. She often gave her son to her mother, thinking he was better off without her. It wasn’t until a year and a half later, when she came out of the depression on her own, that she realized that she had not been herself.
Judy is a composite figure, based on the thousands of women for whom we have cared for or met during our clinical work and research. Her story demonstrates the profound impact that depression can have on mothers and their children.
Having a baby can be extraordinarily challenging. Women are extremely vulnerable to emotional changes during pregnancy and the year after delivery. In fact, depression is the most common complication of pregnancy. But women often have absolutely no idea they have depression, nor do anyone in their circle of influence, including their medical providers.
We believe there’s a missed opportunity to address depression in obstetric and pediatric settings: settings in which women are seen often during pregnancy and the year after birth. Women like Judy often drown in their illness, without anyone ever speaking to them about the possibility of depression. How and why does the health care system let this happen?

THE COSTS OF UNTREATED DEPRESSION

One in seven women experience depression during pregnancy and after birth. Depression negatively impacts mothers, children and families. It can affect birth outcomes, the way moms bond with their baby and children’s mental health later in life.
When untreated, depression can also lead to tragic outcomes, including suicide or infanticide. In fact, suicide is the leading cause of death among postpartum women with depression.
This illness is also costly. One case of untreated depression is estimated to cost over $22,000 annually per mother and baby pair.
Despite being a common illness with profound negative effects, most depression among pregnant and postpartum women goes unrecognized and untreated. Of the 4 million women who give birth in the U.S. every year, about 14 percent will experience depression. At least 80 percent will not generally get treatment.
There’s historically been no system in place to detect depression or help women get care. But professional societies and policymakers are starting to recommend screenings, while medical practices are beginning to integrate depression into obstetric and pediatric care.
This is a great first step. However, screening is not enough. After screening, the health system must ensure women get appropriately diagnosed and treated. Unfortunately, many providers aren’t trained or equipped with the proper resources to help women with depression, or may be reluctant to do so.

HELPING PROVIDERS HELP MOMS

In response to this need, our team is working on integrating depression into obstetric care in our state.
Our Massachusetts Child Psychiatry Access Program for Moms, launched in July 2014, helps frontline medical providers screen for and treat depression and other mental health concerns among pregnant and postpartum women.
MCPAP for Moms provides training and toolkits for providers, as well as telephone and face-to-face psychiatric consultation. For example, Judy’s obstetric provider could call MCPAP for Moms and talk to a psychiatrist to get guidance on how to treat, and with consultation, decide on a treatment plan that would include therapy. MCPAP for Moms also offers resources directly to women with ongoing mental health care.
Every provider in Massachusetts can access our services free of charge. MCPAP for Moms is funded through the MA Department of Mental Health. It also offers access to mental health care to pregnant and postpartum women in Massachusetts for less than $1 per month per woman. We are now evaluating how the program has affected outcomes for the more than 4,000 patients directly served since launch.
The ConversationTwo other states, Washington and Wisconsin, are starting programs like MCPAP for Moms, and 17 others are seeking funding. Especially exciting, next year’s federal budget includes grant money for other states to establish such programs. We envision a health care system where all providers caring for pregnant and postpartum women are armed with the resources they need to support women with depression.

Tiffany Moore Simas is an associate professor of obstetrics-gynecology and pediatrics, and Nancy Byatt is an associate professor of psychiatry and obstetrics-gynecology, both at the University of Massachusetts Medical School. This article was originally published on The Conversation

The Impressive Top-to-Bottom Makeover of the Massachusetts Juvenile Justice System

Teenagers make mistakes. They sneak out past curfew to drink at a house party, shoplift clothes, graffiti their names in bathroom stalls, talk back to authorities and throw punches in heated moments. Our juvenile justice system views some of these violations as youthful folly; others are deemed criminal offenses. Unjustly, skin color or socioeconomic status might determine how the behavior is categorized. Suburban white youth are tsk-tsked, while urban black children are handcuffed and jailed.
Massachusetts created the nation’s first juvenile correctional system around 1846, and it also led the first reforms by shutting down Dickensian “training schools.” But during the high-crime spike of the 1990s, the punitive model common to most states made a resurgence. However, while laws passed making it easier to try kids as adults, a group of fed-up employees teamed up to reform youth courts, juvenile detention facilities and probation offices from within. While much of the country continues to arrest more than 1.02 million children every year, Massachusetts reduced the number in custody down to a daily average of about 190 youth, or 2,240 admissions annually. These state workers also dramatically slashed the number of children under age 14 placed in secure facilities from roughly 500 to just a handful.
What changed? The state wised up to normal teenage behavior and its institutions’ role in either furthering or freezing maturity. Reformers implemented what they call “positive youth development” as the main priority. Under this philosophy, which draws much of its insight from developmental psychology, the Massachusetts juvenile justice system stopped focusing on the bad things kids shouldn’t do and started promoting positive outcomes. When a child makes a mistake, the state steps in as the de facto parent, teacher, mentor and neighbor. Recognizing that youth need to grasp a sense of their own future in order to avoid a life of crime, college graduation and job placement replace recidivism as measures of success.
“For example, the kid who comes into court for fighting at school will ordinarily be put on probation, where he’s told, ‘Don’t fight, follow all the rules, keep a curfew.’ But if this is an 8th grade boy who’s old enough to be in high school and reading at a 2nd grade level, he’ll never succeed on probation. It’s never enough to order children to behave better. We need to look at their life circumstances and ask, ‘What resources, opportunities, services or supports are they going to need in order to be able to behave better?’ asks Joshua Dohan, head of the state public defenders’ juvenile unit. “As adults, we need to do something kids are not good at, which is taking the long view. What do we need to invest in over the long run so that we can nurture a healthy adult, as opposed to punishing a kid because he missed school one day?”
A little over a decade ago, Dohan, a public defender representing youth in Boston reached out to one of the men in charge of the state’s juvenile detention facilities. Dohan wanted to know if the official (who regularly locked up plenty of teenagers) wanted to join him at an upcoming conference on juvenile defense. “Ignorant” of the role good defense attorneys played in a child’s case, Edward Dolan, then deputy commissioner of Massachusetts’s Department of Youth Services, accepted. In an unexpected turning point, Massachusetts’s entire juvenile justice system started to flip. As the top leadership started collaborating, a punitive model slowly lost out to a restorative one.
For too long, each separate agency in the criminal justice system — from the lawyers in court, to guards in detention facilities, to officers in probation — had been caught up in its own institutional inertia, carrying out policies because that’s how they had always been done. There’d been some dissenting voices, most prominently Ned Loughran, a former priest who had agitated against harsh retribution for juveniles as head of DYS from 1985–1993. But on the whole, the agencies remained trapped within their respective silos. At the conference, focused on the entire juvenile justice system, Dohan and Dolan had their first chance to look outside their own roles, question the underlying rules and realign the system in kids’ best interests.
“Even though I’m in the business, it was the first time I was seeing the world through [the public defenders’] eyes. I put myself in their position, looking from a kid’s perspective and a…mother’s perspective at some of the things we did as an agency. We were like a machine,” Dolan says. “[Juvenile detention] was a pretty troubled agency at the time, overwhelmed and overcrowded. Even for the big leadership in the organization, we didn’t feel good about the way we were doing things. We were looking for a better pathway forward.”
Starting with that one conference where defense attorneys and a juvenile jailor found common ground, the agencies initiated a conversation about their overlapping roles in helping youth. Side by side, they could no longer blame other parts of the system for the dysfunction. From there, a group of bureaucrats started to rewrite the system together, unified under the banner of an approach that made more sense for children.
“Positive youth development” generally defines the field of academics applying insights from neuroscience and knowledge of human development to criminal justice. As practitioners, attorneys and officers usually don’t have time to get an advanced degree in social work, says Dohan. “The people who apply it have taken it on as their task to sort through and operationalize [the research] for youth workers, teachers, lawyers and probation officers to give us guidance about what works and what doesn’t and why.”
At the height of the War on Drugs, policymakers generally split along partisan lines about how to respond to criminal acts by youth. The right wing saw unchangeable “super-predators” who needed to be incarcerated to restore law and order, while leftists saw victims of poverty who needed counseling and therapy, says Dr. Jeffrey Butts, director of John Jay College of Criminal Justice’s Research & Evaluation Center.
Both of these viewpoints are “incredibly biased in terms of class and race,” adds Butts, best known as one of the field’s founders, because they assume teens from high-crime communities are inherently more criminal than their peers elsewhere. The developmental approach, in contrast, doesn’t take a child’s actions as indicative of their character. Butts’s theory holds that the best way to stop crime is to encourage youth to acquire skills. Unlike the other two models, “the fact that a 17-year-old stole a bike doesn’t mean he’s destined to be an adult criminal,” Butts says.
Positive youth development maintains that five assets enable teens to mature into law-abiding citizens: strong bonds with adults and prosocial peers, a safe home, a healthy lifestyle, opportunities for civic engagement and an effective education and success in the labor market. Possessing these resources will make youth naturally begin to see that belonging to conventional society is more valuable, says Butts, than the short-term advantage one might accrue from committing a crime. If a young person feels connected to his community, “there’s more to lose by being caught stealing someone’s phone than by saving the few hundred dollars to buy a new one,” he adds.
“We have to be at least as good as criminal street gangs. They know exactly how to bring a 10-year-old into a group, how to increase their sense of purpose until they become very loyal,” Butts adds. “We need to be at least that good in attaching young people to our community.”
Positive development takes place at every step of the Massachusetts juvenile justice system — from when a public defender meets a client in lockup to the last appointment with a probation officer. For them, it’s not about creating a “feel-good” system, so much as designing systems that will reduce recidivism and lead to positive outcomes. Unlike most other states, Massachusetts offers a network of highly specialized public defenders for juveniles — a benchmark few under-resourced legal aid societies across the country have met. “What makes juvenile defense such a critical area of specialized practice is that in order to be effective, you need to have all the skills of an effective criminal defense lawyer and all the knowledge of adolescent development,” says Mary Ann Scali, head of the National Juvenile Defender Center. “In places like Massachusetts…, we know that we can provide constitutionally mandated access to counsel and effective counsel all the time.”
In Massachusetts, Dohan built the Committee for Public Counsel Services’s Youth Advocacy Department into a premier league of 36 staff attorneys and over 500 private attorneys who receive regular trainings on juvenile-specific topics. That’s a big feat considering these lawyers sign up for an unforgiving job. “The pay is terrible. Juvenile is the hardest place to make a living because there’s no private clients,” Dohan explains. (Still, you won’t hear him brag about what he’s developed; when NationSwell reached out to profile him for this story, the humble attorney sent back a list of 18 other sources to interview.)
Even when these experienced defense lawyers can’t argue their client’s innocence, the child is still in good hands in the Department of Youth Services, which leverages every connection it has to ensure kids receive the services they need. DYS tries to offer “all those things that you’d want for your own 17-year-old teenager,” says Peter Forbes, DYS commissioner. Indeed, kids seem to grasp the value, because half continue to go back to DYS for services (like tutoring, job training, coaching and counseling) for up to three years after they’re released. Most return for about six months on average, Forbes reports — something that would be unheard of at a jail like New York’s Rikers Island or a prison like San Quentin in California.
And finally, once a child is put on probation, her public defender will argue for a reasonable plan that’s created to advance her best interests. It’s a stark contrast with the old model — “trail ‘em and nail ‘em,” as Dohan calls it. The new system’s main goal is to ensure conditions are achievable. Much of this advocacy centers on education. As Dohan’s seen from experience, an 8th grader reading at a 2nd grade level feels like they’re being “tortured.” Bored, frustrated or humiliated, these students are prone to acting out. To help a child catch up, the lawyers are trained to involve the school system. “It’s not enough not to be expelled. We also get them into a program in which they can succeed,” Dohan describes. Kids won’t march themselves into a principal’s office to request this fix, but their lawyers in Massachusetts will. “Our job is not just to make the kid look good in the courtroom,” he adds. “Our job is to litigate but then put them in a much better position to succeed when the case is over.”
In implementing this program, the Massachusetts reformers, at first, fought an uphill battle to win funding from legislators. “In fairness to legislators, you are asking them to make an investment of the public’s money. They should expect a return on that investment,” Dolan says. They quickly saw a payback, in the form of reduced recidivism, and legislators soon allowed money saved from reduced caseloads to be reinvested into other initiatives. (Where that funding didn’t suffice, agencies turned to nonprofits outside the state system to supplement their work, assistance they still rely on today.) As evidence accrues, it’s getting easier to sell the developmental approach.
Even as this model gains traction, it still presents problems to be solved. Up next? The reformers are trying to confront racial and ethnic discrimination that’s endemic to the system by rigorously studying the data to locate what Dolan calls “unintentional but undeniable” disparities in treatment, offering classes on implicit bias and working with partners outside corrections to generate awareness. If they get it right, there’s much that can be used in correctional systems — both juvenile and adult — nationwide. Dohan, Dolan and Forbes started out with the intention of helping kids see their future; in the process, they’ve defined what’s next for a justice system in sore need of a new direction.
MORE: When Traditional Disciplinary Actions Don’t Work, Restorative Justice Can Bring About the Healing Process

Mindfulness at Work: 7 Places Where Employees Benefit from Meditation

Mindfulness, the practice of being awake to the present moment, is now in vogue in American workplaces as varied as Google, Goldman Sachs, Aetna and General Mills. Backed by scientific research of the cognitive benefits of ancient Buddhist meditation, corporate types thinking of productivity and the bottom line quickly trained their workers how to focus using mindfulness. Outside of finance, tech and manufacturing industries, NationSwell found seven more workplaces where you find employees reaping the benefits of meditating on a regular basis.

1. Concert Hall

Where: Tempe, Ariz.
After studying mindfulness for four decades, Ellen Langer, a professor of psychology at Harvard, is renowned as the field’s mother. Her concept of mindfulness differs from the common practice, in that she believes no meditation is necessary to change the brain’s chemistry; instead, she achieves mindfulness by existing in a state of “actively noticing new things,” she tells NationSwell.
As part of her research, she once split the Arizona State University Symphony Orchestra into two groups and instructed each to play a piece of music by Johannes Brahms, which she recorded. Langer asked the first group to remember their best performance of the familiar piece and try their best to replicate it. She told the other group of musicians to vary the classical piece with subtle riffs that only they would recognize. Langer taped both performances and played them side-by-side for an audience. Overwhelmingly, listeners preferred the second one. To Langer, it seemed that the more choices we make deliberately — in a word, mindfully — as opposed to the mindless repetition, the better our end-product will be. The most important implication for Langer came later, when she was writing up the study: In America, she says, we so often prize a “strong leader to tell people what to do,” but as the orchestra’s performance proves, when an individual takes the lead instead of doing what someone instructs her to do, a superior result is the likely outcome.

2. Primary School

Where: East Village, New York City
“The research is pretty conclusive: when kids feel better, they learn better. One precedes the other,” declares Alan Brown, a consultant with Mindful Schools where he offers mindfulness training to the private school’s freshman and sophomores. Brown incorporated a serious practice into his life at a week-long silent retreat, after “jumping out of my skin, reading the toilet paper, doing anything but to be with your own thoughts and with yourself.” He now teaches kids how to be attuned to themselves and recognize feelings that may be subconsciously guiding their lives, like when they’re hyped up with sugar or are stressed out about a test. (Solutions: spending a moment in a designated corner calming down, breathing through a freakout to restore higher cognitive functions.)
As someone in the caregiving profession, Brown reminds himself and his fellow teachers they need to adopt mindfulness practices as well. With them, “the way I interact with others comes from a place of much greater compassion for the kids: clearly this young person, who is not a fully-formed, self-regulating adult, is probably trying their best and probably has some really significant hurdles outside the classroom. I’m not going to let that get to me.” If teachers expect similarly enlightened behavior from their kids, Brown adds, they have to know, “You can’t teach what you don’t have in your own body” and better embrace a meditative practice to see the results at every desk.

The UMass Mindfulness in Medicine program teaches the benefits of meditation to their staff members.

3. Hospital

Where: Shrewsbury, Mass.
Modern mindfulness was formalized in 1979 at the University of Massachusetts Medical School, where Jon Kabat-Zinn created an eight-week meditation routine to reduce stress for the hospital’s chronically ill patients that’s now replicated worldwide. Back on the medical campus where it all started, a new mindfulness program is being offered this summer for the people on the other side of treatment: the physicians, nurse practitioners and care managers.
The Mindfulness in Medicine program works to combat the frequent feeling of dissatisfaction about a lack of patient interaction among doctors. Instructor Carl Fulwiler gives lectures about the clinical research on meditation’s benefits, teaches 90-minute workshops for busy staffers and leads full-blown courses for a dedicated few. His teachings focus on how to avoid burnout with strategic pauses; by taking a breath immediately prior to seeing a patient, doctors can focus solely on the interaction. “Often they’re thinking about what’s the next thing they have to do or the documentation. They’re not even hearing a lot of what the patient is saying,” Fulwiler observes. With mindfulness, they can see what “might be contributing to a bad encounter, what’s preventing us from being empathetic, compassionate and more efficient in our style of communication?” The whole interaction may be over in three minutes, but having that time be meaningful is vital for helping the healers themselves feel the rewards of a demanding job.

4. Government

Where: Washington, D.C.
Change rarely comes to our nation’s capital, but that’s okay in Rep. Tim Ryan’s mind. A meditative practice equipped him to deal with legislative gridlock and partisan bickering. The seven-term Democrat representing northeastern Ohio practices mindfulness in a half lotus position for roughly 40 minutes daily — a regimen he began after attending one of Kabat-Zinn’s retreats in 2008, after which he gained “a whole new way of relating with what was going on in the world,” Ryan tells The Atlantic. “And like any good thing that a congressman finds — a new technology, a new policy idea — immediately I said, ‘How do we get this out?’” Ryan first wrote the book “A Mindful Nation,” exploring the ways mindfulness is being implemented across America, and today, in sessions of the House Appropriations Committee on which he sits, the representative advocates for more funds to be deployed to teach meditation tactics. The money may not be forthcoming just yet, but that hasn’t stopped mindfulness from gaining more new converts like Ryan every day.

5. Police Department

Where: Hillsboro, Ore.
Last month, Americans watched videos of officer-involved shootings in Baton Rouge, La.; St. Paul, Minn; and North Miami, and they read about the five cops who died in a sniper attack in Dallas. While those crises were deeply felt by civilians nationwide, they were only a glimpse of what cops encounter regularly. “Law enforcement is a profession that is deeply impacted by trauma. On a daily basis, we bump up against human suffering,” says Lt. Richard Goerling, head of Hillsboro Police Department’s investigative division and a faculty member at Pacific University. “It doesn’t take very long for police officers’ well-being to erode dramatically,” he adds, ticking off studies that track early mortality and cardiovascular issues among public safety professionals.
Through the organization Mindful Badge, Goerling teaches several police departments in the Portland area and in Northern California how mindfulness can better cops’ performance: sharpening their attention to life-or-death details, cultivating empathy and compassion that’s crucial for stops and searches and building resilience before encountering trauma. The theory goes that once an officer receives mental training, he can sense when a stressor in his environment is activating his flight-or-flight reactions and then check those instincts. “If a police officer is in their own crisis,” Goerling suggests, “they’re not going to meet that person in a way that’s totally effective.” The lieutenant is aware mindfulness isn’t a cure-all for “a landscape of suffering,” but he believes it’s a first step to changing a “broken” police culture that takes its officers’ health for granted.

6. Athletic Competition

Where: San Diego, Calif.
BMX bikers may not seem like a group that’s primed for meditation, but when an elite biker stuttered with anxiety at the starting line, his coach James Herrera looked into any way to solve the problem of managing stress before a high-stakes event. Herrera soon got in touch with the Center for Mindfulness at the University of California, San Diego, and he signed up his seven-man team for a small study into the effects of meditation on “very healthy guys who are at the top of their sport,” lead author Lori Haase tells NationSwell. Over seven weeks, the bikers practiced a normal mindfulness routine, but with extra impediments like having their hands submerged in a bucket of icy water to teach them to feel the sensation of pain, rather than reacting to it cognitively. As the weeks went on, their bodies seemed to prepare for a physical shock, without an accompanying psychological panic. In other words, participants’ bodies were so amped up and hyperaware that they didn’t need to react as strongly to the stressor itself compared to an average person. The study didn’t test whether it made them faster on the course, but it seemed to suggest that reaction times could be sped up by using mindfulness to slow down.

7. Military

Where: Honolulu, Hawaii
Like cops, members of the military have much to gain from situational awareness. A couple seconds’ of lead-time for a soldier to notice someone in a bulky jacket running into a public square could prevent a suicide bomb from taking out dozens of civilians and comrades abroad. But that’s not all mindfulness is good for in a service member’s line of duty.
Before soldiers even leave home, they must deal with leaving family and putting other aspects of their lives on hold. To prepare soldiers for deployment, University of Miami neuroscientist Amishi Jha offered mindfulness trainings at an Army outpost on Oahu to soldiers heading to Afghanistan. To fit the program into an already crowded training regimen, Jha drastically cut down the standard 40-hour model to an eight-hour practice scattered throughout eight weeks. Despite the stress of leaving that could sap the mind’s attention and working memory — “everything they need to do the job well when they’re there,” Jha notes — the mindfulness trainings prevented their minds from wandering. Tentative research Jha’s still conducting suggests those benefits persist post-deployment. Her session was just like boot camp, Jha found, only for the brain.

MORE: How Meditation Is Bringing Calm to San Francisco’s Toughest Schools

A Bold Law Aims to Eliminate the Gender Wage Gap, School Integration Finally Gets the Funding It Deserves and More

Illegal in Massachusetts: Asking Your Salary in a Job Interview, New York Times
With women only making 79 cents for every dollar earned by a man, how to close the gender wage gap is a hotly debated topic. Will bipartisan legislation in New England, which attempts to level the playing field by forbidding businesses from asking a prospect’s previous salary, be a model for other states to follow?
Is School Integration Finally Making the Grade?, New America Weekly
Dozens of studies prove that school integration leads to student success. President Obama’s new “Stronger Together” grant program encourages districts to fully integrate by income, not ethnicity — giving low-income children of all races the opportunity to receive a better education.
Meet the Mothers Who Have Been Fighting Police Brutality for Decades, BuzzFeed
Described as “ultimate activist mother,” Iris Baez founded the grassroots group Parents Against Police Brutality after her son was killed in 1994. Working alongside fellow grieving mothers, Baez already has scored several important policing reform victories, but the 70-year-old isn’t letting age slow her advocacy work.
MORE: 5 Ways to Strengthen Ties Between Cops and Citizens
 

How One School System Is Fighting Back Against the Achievement Gap, A Better Way to Help the Homeless and More

 
What Are Massachusetts Public Schools Doing Right? The Atlantic
The Bay State may be tops when it comes to reading and math, but officials aren’t resting on their laurels. Instead, they’re directing resources towards Massachusetts’s achievement gap, which remains stubbornly high. Can a focus on social-emotional learning and childhood trauma bring disadvantaged students up to the same level as their more affluent peers?
Give Directly to the Homeless Through a New Sharing Economy App, Fast Co.Exist
Known as the “City of Goodwill,” Seattle is living up to its moniker. Thanks to one tech entrepreneur and an advocate for the homeless, residents can now use the WeCount app to donate unwanted items (think: blankets, coats, sleeping bags) directly to those most in need. With homelessness an ongoing problem in many urban areas, let’s hope this technology spreads across the country — fast.
What If Mental Health First Aid Were as Widespread as CPR? New York City’s Planning to Do It, Yes! Magazine
Often, law enforcement encounter people suffering from mental illness, yet many haven’t received the education necessary to recognize and provide assistance (instead of arrest). In response, the New York Police Department is joining forces with the National Council for Behavioral Health to provide 250,000 first responders with mental health first aid training. The ultimate goal? To prevent suicide, which currently takes 40,000 lives each year.
MORE: Dine Out, Feed the Hungry

Why Youthful Indiscretions Shouldn’t Result in Jail Sentences, How to Save Babies Born with Opioid Addictions and More

 
A Prosecutor’s Vision For A Better Justice System, TED
Adam Foss, a prosecutor with the Suffolk County District Attorney’s Office in Boston, recently asked a group of TED participants how many had ever drank underage, tried an illegal drug, shoplifted or gotten into a physical fight. While viewed by most as youthful indiscretions, these same offenses often land black and brown youth in criminal court, viewed as being dangerous to society. Which is why Foss is using prosecutorial discretion to dismiss minor cases that aren’t worthy of a criminal record.
Tiny Opioid Patients Need Help Easing Into Life, Kaiser Health News and NPR
In this country, addiction to heroin and prescription painkillers like hydrocodone, oxycodone or morphine continues to rise, even afflicting new moms. During pregnancy, these mothers must decide between getting clean and risking a miscarriage or delivering a baby that’s likely to experience drug withdrawal. With about 21,000 infants suffering from withdrawal each year, doctors in Rhode Island, nurses in Connecticut, researchers in Pennsylvania and public health officials in Ohio are all working on solutions to help these new families.

Website Seeks to Make Government Data Easier to Sift Through, New York Times
Just because the government releases endless pages of data to the public doesn’t mean it’s easy to turn those statistics into something that you can actually comprehend and use. DataUSA, an open source brainchild coming from the M.I.T. Media Lab, organizes and visualizes the information, presenting it in charts, graphs and written synopses. Thanks to this project, instead of just hearing a statistic of how many people in Flint, Mich., live in poverty, for example,  you can see it visually represented on a map.

The Van That’s Saving the Lives of Homeless Kids, a Better Way to Govern Locally and More

 
Mobile Clinic Serves California’s Growing Homeless Youth Population, KQED News
In the Golden State, the number of school-age homeless children has jumped by a third in just three short years. Unstable living environments wreak havoc on these youngsters, resulting in increased risk of chronic illness, mental health disorders and trauma. Doctors aboard the Teen Health Van provide free medical (both physical and mental), nutritional and substance abuse care to hundreds of uninsured and homeless youth.
In Snow Removal, a Model for Change, Governing
City officials in St. Paul, Minn., set out to improve how snow was removed from roadways, but in the process, found a smarter method of governing. The unique approach (which should be replicated nationwide) involved teams consisting of outside consultants, working pro bono, and members of the Department of Public Works, who could provide internal perspectives. (Normally, consultants work on their own to create recommendations.) The result of this public-private pairing? More effective snow removal, and innovative, restructuring changes that DPW employees embraced.
When Families Travel for Medical Care, Strangers Open Their Homes — and Arms, Stat News
Health insurance can help defray the costs of medical expenses, but little financial assistance is available for housing expenses incurred by patients and their families when they must receive life-saving treatments at hospitals far from their homes. Since 1983, the nonprofit Hospitality Homes has been connecting out-of-towners (most are low-income) with host families providing a free place to stay in Boston, where the average hotel room costs more than $100 each night.

3 Colleges That Have the Formula for Making Higher Education Affordable

Just about every news story reporting on this country’s college debt climate uses the same word: crisis.
It’s an accurate descriptor — or so the numbers seems to indicate. Public college tuition costs have risen 250 percent over the last 30 years, while median family income grew only 16 percent during the same period. The average student is looking at $26,000 of debt when they graduate. Even President Obama labels the situation as a crisis, as the poorest students are saddled with more and more debt.
In an effort to combat the problem, the Department of Education created the College Scorecard, which provides students and families with a new kind of ranking by taking into account graduation rates, financial aid offerings, post-grad earnings — and most importantly — average debt. On it, these three liberal arts schools stand out as valuable options for low-income students, thanks to their high graduation rates, low student loan debt and the percentage of students eligible for federal Pell grants, which are available to those whose family incomes do not exceed $30,000 a year.
In stark contrast to many other universities, each of these colleges keep their students’ loan debt at least 50 percent lower than the national average. How do they remain academically solvent while not piling debt on their graduates?

Berea students hang out between classes. Courtesy of Berea College.

Berea College, Berea, Ky.

If you’ve never heard of Berea College in Kentucky, keep reading. It’s the only residential liberal arts school in America offering a completely free education to its nearly 1,600 students.
As President Lyle Roelofs explains, “nearly everything is different.”
Like other colleges with strong financial aid programs, Berea is selective, but it isn’t need-blind. It only accepts students whose family incomes fall beneath an income ceiling, providing a higher education opportunity — as Roelofs puts it — “to students wouldn’t get one otherwise.”
Berea is a very efficient educational experience, says Roelofs. Each student works part-time while on campus, holding jobs in numerous fields, from woodworking to hotel administration, to contribute to the $27,000 to $28,000 annual price of school. “We’re never interested in whether we can send some money to shareholders at the end of the year… We are much more like an entrepreneurial business with the idea that profits and successes get ploughed back into the enterprise,” he notes. To cover costs, 75 percent of tuition is handled by the endowment the college has accrued over its lengthy history. Only 15 percent comes from loan sources, primarily Pell grants (99 percent of students qualify) and similar state grants. A third of students don’t borrow anything at all, with the remainder receiving an average of about $6,700 in loans, almost 4 times less than the national average.
Perhaps more important is Berea’s graduation rate: 64 percent of its students receive a diploma. The average graduation rate for similar-income students nationwide is a dismal 9 percent. Roelofs attributes this jump to the focus that the school puts on each student and their families.
But can every college follow the Berea model? It would take something of a paradigm shift in approach, admits Roelofs. “Institutions are usually quite preoccupied with dealing with immediate challenges; they don’t consider radical changes,” he says. Still, other colleges could consider a more frugal approach. “If you don’t charge tuition, you can make much more sensible decisions on what the students actually need,” Roelofs notes. “People don’t look the gift horse in the mouth.”
“One of my favorite sayings is that just because an education is free doesn’t mean you can cut the corners. It still has to be first rate. Otherwise, our students would finish in four years and have nowhere to go.” Which would defeat the purpose of a place like Berea entirely.

The campus at WIlliams College. Courtesy of Williams College.

Williams College, Williamstown, Mass.

Williams College, located in western Massachusetts, is tiny and idyllic. It’s also the top-ranked national liberal arts college by U.S. News & Word Report, and it is one of the 50 most expensive colleges in the U.S., with an annual price tag of around $65,000. But it has a need-blind financial aid policy, making the average loan debt just over $13,000 (about half the national average), and many of the students who qualify for financial aid (more than 50 percent are eligible) are free of loans altogether.
How does Williams do it? By maintaining a strong endowment and an individualized approach to financial aid packages, says Paul Boyer, director of financial aid at Williams.
As one of the first schools in the country to make available a net price calculator for prospective students, Williams tries to evaluate each student, case by case, to ensure it’s offering the best plan. The school also makes a concerted effort to recruit students from diverse socioeconomic backgrounds, seeking out lower-income applicants. About 20 percent of current students receive Pell grants, double the amount at most other liberal arts colleges — and it’s increasing. “It’s been rising maybe 1 percent per year,” says Boyer. That may not sound like much, but it’s a far cry from most other schools (including Harvard, which hasn’t been able to crack a 10 percent ceiling).
Earning an average income of $58,000 a decade after graduation, students that receive financial aid, in general, have little trouble paying back their loans. The U.S. Department of Education even ranked Williams in its top 23 schools with low costs that lead to high incomes.
 

A spring day at Amherst College. Courtesy of Amherst College.

Amherst College, Amherst, Mass.

There must be something in the water in Massachusetts: Amherst, number two in U.S. News’s liberal arts ranking, also comes with a $65,000 yearly price tag. But just like Williams, its need-blind financial aid opportunities — which 58 percent of students qualify for — minimize its real cost. In fact, what students pay, on average, is actually half of the annual sticker price: $33,000.
Amherst is strictly anti-debt. “The most distinctive thing is our approach of not including loans, as we meet students’ full demonstrated need,” says Gail Holt, Amherst’s dean of financial aid. About 70 percent of students graduate with no debt whatsoever.
That’s an achievement that Amherst should be particularly proud of, considering that college costs and incomes aren’t rising at the same level in this country. As a result, more qualify for financial aid, and resources must be distributed among a wider number of students. At Amherst, Holt and her team try to serve a full spectrum of families and financial capabilities. “The hardest part is meeting the needs of such diverse populations.” With 24 percent of students eligible for Pell grants, it seems to be making headway.
 
Fortunately, for their students, these three schools earn As in crisis management. Will other universities be able to make the grade?

The Prescription for Healthier Citizens: Cleaning Up America’s Medical Facilities

Twenty-six centuries ago, a Greek physician urged his medical colleagues to remember that a doctor does “not treat a fever chart [or] a cancerous growth, but a sick human being” who has a life and responsibilities outside of a hospital wing. That level of care — a tenet of the Hippocratic Oath — is already difficult to realize, but Gary Cohen, a travel writer turned healthcare advocate, is pushing medical centers to think even bigger, realizing the connections between a patient’s sickness and its roots in an unhealthy community.
Cohen, one of this year’s recipients of the MacArthur Foundation’s “genius” fellowships, co-founded the global nonprofit Healthcare Without Harm (HWH), which is headquartered in the Washington, D.C. suburb of Reston, Va., in 1996. As the organization campaigned to eradicate toxic chemicals from medical equipment — mercury in thermometers, dioxins in incinerated plastic IV bags and tubes — Cohen argued that healthcare providers shouldn’t be making people sick. After significant victories, Cohen recently decided to broaden the focus of HWH from “do no harm” (another classical dictum) to actively bettering community health. With more than 500 partner organizations in 53 countries, including three of the largest nonprofit hospital systems in the U.S.: Catholic Health Initiatives, Kaiser Permanente and Dignity Health, Cohen’s raison d’être is to help doctors heal their profession.
“When we started, we were trying to get hospitals to take the Hippocratic Oath internally, applying the same set of values to their environmental footprint: to reduce the use of fossil fuels, detox the supply chain, get rid of sugar-sweetened junk food,” Cohen says. “But the bigger questions are, ‘How can you be an anchor for community and planetary health? How can you move from being these cathedrals of chronic disease to being centers of community wellness and sustainability? How can you leverage your incredible moral authority, your mission and economic clout to support healthier communities?'”
Cohen’s first job after college was writing guidebooks for top tourist destinations — London, Paris, New York — until a friend asked if he would write a primer on toxic chemicals. Not knowing anything about the topic, Cohen conducted interviews to learn more. “I sat around kitchen tables with mothers and fathers. They had no political power, no money, no technical expertise, but they were fighting for their family’s lives,” he recalls. “Their kids were sick. ‘Why does my daughter have this rare form of cancer? Why does my son wake up in the middle of the night choking for air? Why does the water taste so bad?’” The political organizing manual Cohen subsequently wrote, “Fighting Toxics,” launched what has turned into a lifelong fight for environmental safety. In 1986, he helped pass the first national right-to-know law, alerting consumers about possible chemical exposure.
A decade later, a report by the U.S. Environmental Protection Agency that warned of on-site medical incinerators (which burn a portion of the 26 pounds of waste generated daily by each patient in a staffed hospital bed) turned Cohen’s attention to hospitals. Incineration removes one biohazard by burning pathogens, but the burning plastic sends other dangerous chemicals into the atmosphere. Tests found dioxin in children’s body fat and traces of mercury in infants’ blood. “The healthcare system is a major polluter,” Cohen says, realizing that, “the very institution devoted to healing people is poisoning them.”
Starting with a team of 28 organizers, Cohen’s advocacy has helped reduce the number of on-site medical waste incinerators in the U.S. from a high of 5,600 to just 70 a decade later. And those hazardous measuring devices containing mercury? HWH’s work has resulted in them, for all practical purposes, being eliminated from hospitals and pharmacies.
What’s unique about HWH’s approach is that these reforms went into effect “without basically any legislation at the federal level,” Cohen says. “We started, you might say, in the basement,” talking with the facility managers and architects. As the cause gained momentum and sustainability worked its way into hospital chains’ strategic priorities, Cohen now has access to meet with vice presidents and CEOs.
Recently, HWH worked with hospitals to reduce their greenhouse gas emissions, convincing medical facilities not only to buy solar panels for hospital rooftops, but also to subsidize them for employees’ homes. The organization has also helped school systems and hospitals partner to generate demand for local, sustainably produced food. And it’s demonstrated that the construction of new hospital wings can strategically promote economic development in poorer parts of a city.
HWH has also been bolstered by President Barack Obama’s signature healthcare legislation, the Affordable Care Act, which requires hospitals to conduct community health needs assessments (essentially tabulating why people come to the emergency room). “What conditions in the community are contributing to diseases? Is there food insecurity? Is there pollution? Is there poor housing, violence and poverty? These are the things that are making people sick in the first place,” Cohen says. He adds that the same principles apply to climate change. After witnessing Hurricane Katrina and Superstorm Sandy, doctors can’t avoid seeing that global warming’s added risk of flooding or extreme heat as essential to their work. “If you’re a person in Cleveland and you think climate change is all about polar bears and melting ice caps, then you’ve got other stuff to worry about. But when you understand that it has to do with [a patient’s] asthma, the spread of West Nile virus or dengue fever, that reality can no longer be ignored. Now I’m paying attention.”
Cohen’s larger hope is that changes in the healthcare profession, which accounts for $2.9 trillion in spending, resonates throughout the broader economy. Because hospitals must prioritize a patient’s wellbeing, they can invest the extra dollars needed to drive innovation and scale greener practices. Once they prove the business model is viable, other corporations might take notice.
If you ask American citizens which profession they trust most, as Gallup has since 1976, doctors and nurses consistently rank among the most honest and ethical. Eighty percent report high trust in nurses; compared to just 7 percent for members of Congress. Cohen believes medical professionals must live up to this respect by watching out for our health — even when we ourselves don’t want to. Not just whether we’re running a high temperature or have a cough, but the broad influences on the health of our cities.
“I will apply, for the benefit of the sick, all measures which are required,” doctors pledge in the Hippocratic Oath. “I remain a member of society,” they add, “with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.” Cohen will be holding them to their word.

A Second Life For Old Shipping Containers: Farms, Shops and Housing

You’ve seen them stacked six high on cargo ships pulling into port, the multi-colored mosaic of corrugated metal boxes carrying products from the other end of the ocean. Built for seamless transition between ships, trucks and trains, the standard size for these crates of steel or aluminum is usually 20-feet long. Worldwide, there’s the equivalent of 34.5 million at that length.

The container’s best asset is its near-endless reusability, a quality that’s attracted those outside the maritime industry. We at NationSwell have written before about how these boxes revitalized downtown Cleveland by lining empty parking lots with pop-up shops, how a homeless man lived in one while he cleaned up a Southern California beach, and how they could be converted into solar power cubes. Seemingly all-purpose, we decided to look into some of the other surprising ways shipping containers are being (re)used to solve social problems. Here’s three inspiring projects we found:

Urban Agriculture

The United States imported more than $100 billion in food in 2013, the bulk of which is grown overseas in places like China, India, France and Chile. Rather than having our produce shipped to us in a container, two Massachusetts entrepreneurs — Brad McNamara and Jon Friedman — converted the boxes into Freight Farms. Inside their containers, dense stacks of plants and vegetables grow hydroponically, meaning their roots reach into a mineral-rich solution rather than dirt. “Our goal was to create a system that works the same in Alaska as it does in Dallas,” Friedman tells Outside magazine. It’s all controlled by computer — the intensity of the LED grow lights, the water’s pH balance, the density of nutrients released through the irrigation system — so crops can grow year-round. “Each farm is a WiFi-enabled hotspot, so your farm gets put down, it’s plugged in and it’s immediately on the web,” McNamara tells the local public radio station. Using a mobile app, farmers can set alerts and alarms. “So if you’re at home and it’s really cold outside, your farm’s covered in snow, you don’t actually have to leave your house to go check on things,” he adds. Each container can produce the equivalent of one acre’s worth of food.

Commercial Redevelopment

Reclaiming industrial materials is often a go-to for urban redevelopment. On the Jersey Shore, shipping containers that might have once been docked in the Newark Bay ports are being converted into stores and artists studios on the beach. In Asbury Park, N.J., Eddie Catalano sells ice cream; on a boardwalk nearby, another container run by Sari Perlstein offers boutique clothing. “I actually never thought it would be possible to get all the equipment that I need in such a small space,” Catalano tells the local paper. “Lo and behold, six years later, it works. It definitely works.” He says the structures aren’t the “most attractive,” but they’re highly functional. “It handles the elements well, it handles the weather well,” he adds. During Hurricane Sandy, the big box stayed firm on the boardwalk. Perlstein’s brick-and-mortar store, on the other hand, wasn’t spared from the flooding. It’s why she moved her operation into the box on the boardwalk. Now, “if there were a horrific storm we can get a crane and move that thing off. We can take it away,” she says. “That is a plus. Because if it was a building again, you’d just wave it goodbye.”

Homes for the Homeless

Hardy structures, watertight and designed not to rust, shipping containers have been proposed as a solution to our housing crunch. In Myrtle Beach, S.C., the Veterans Housing Development, a recently founded nonprofit, is refurbishing shipping containers into a permanent place for homeless veterans to stay. “Anyone notices and sees homeless veterans on street corners and in tent cities around the Horry County area, and around the country. … I have a passion for this because I hate seeing veterans out there on the streets,” Brad Jordan, a disabled veteran and the nonprofit’s executive director, tells The State. “There’s a lot of funding available for veterans housing, but not a lot of housing available.” The group recently finished their first one-bedroom home and displayed it at a fundraiser. Their ultimate goal is to create a gated village somewhere in town, “a secure and safe environment with programs that are going to assist the veterans,” Jordan adds. “If we build 40 [homes], there would be 40 filled tomorrow. The need is there.”