Letters: Cleveland systems show how providers can promote long-term community health

I want to commend Modern Healthcare for the recent series looking at how Cleveland health systems are attempting to address the social determinants of health.

It’s a remarkable turn of events in just a few short years. Ten years ago I served as Ohio’s Medicaid director and I can assure you that Cleveland hospitals weren’t talking to me then about social determinants of health or about what was transpiring outside the walls of their hospitals. They were more concerned with raising reimbursement rates than with whether their patients had a place to live, food to eat, or access to a good job or education.

That began to change with the passage of the Affordable Care Act and the expansion of Medicaid in Ohio. Hospitals and systems like MetroHealth, which previously struggled with tens of millions of dollars in uncompensated care, suddenly saw that unpaid care plummet and were able to shift attention toward hospital transformation, but even more importantly was a new focus on community transformation.

It’s these latter efforts, whether through high schools, employment programs, affordable housing development, or a food pharmacy, that may hold the most promise for improving health and long-term transformation. Moving forward it will be important to evaluate these programs and to share results broadly so that what is working Cleveland can be replicated across the country. It’s good to know you are among those watching.

John Corlett
President and executive director
Center for Community Solutions
Cleveland

Regarding “Kaiser Permanente seeks to address trauma in 25,000 schools by 2023,” as an advocate in the mental health provider community, I applaud Kaiser for addressing a critical and missing service in our schools.

According to the National Survey of Children’s Health, almost half of children in the U.S. have experienced at least one or more types of serious childhood trauma; and nearly a third of U.S. youth ages 12-17 have experienced two or more types of childhood adversity.

Children who have experienced a traumatic event are vulnerable to the lasting impact of the trauma. When exposed to repeated or chronic trauma, a child’s underdeveloped brain remains at a heightened state of stress. This can affect emotional development and physical health, and causes changes in emotional, behavioral and cognitive functioning. These changes are the brain’s way of simply trying to survive.

As a forensic practitioner, I regularly consult on criminal cases where the defendants are minors. In most cases, the defendants have a long history of multiple traumas. Whether they have experienced the death of a parent, addiction, bouncing around the foster-care system, child abuse or neglect, all of these circumstances are traumatic events for a child and play a significant role in shaping their futures.

Recently, I served on a panel with experts from Communities in Schools to address the issue of childhood trauma in schools in Chicago. A portion of the discussion centered around the need for more trained mental health counselors in schools to help navigate issues associated with childhood trauma and how it affects learning.

Symptoms of childhood trauma can mimic behavioral and social issues. Early on, school staff may misread these symptoms as defiance or ambivalence. Having an awareness of trauma and implementing trauma-informed practices can help create environments for children to do their best learning and develop positive social-emotional learning skills which will stay with them throughout their time at school and beyond.

Gil Singletary, Ph.D.
Senior director, School of Healthcare Professions
Chamberlain University