Amidst the beauty found within the rural communities nestled in the Appalachian Mountains, Northeast Tennessee is a region that sadly is no stranger to challenges. This is a region with overcrowded prisons, hospitals delivering babies whose mothers are addicted to substances at staggering rates, foster care shortfalls, and public-school systems where it’s common to hear phrases like cradle to prison and school to prison pipeline. In 2014, while working for the local Police Department as the Director of a Crime Reduction Project aimed at reducing recidivism rates as well as drug-related and violent crime I first heard the words trauma-informed care and the CDC-Kaiser Permanente Adverse Childhood Experiences Study (ACE Study).
Hearing the message that experiencing childhood adversity without having a healthy support system cannot only derail brain development, but create a significant risk factor for addiction and future life and health disparities impacted me in a way that no other content ever had. Listening to stories of childhood abuse and neglect experienced by those who had previously been incarcerated planted the thought in my mind that trauma is a gateway to drug use. Though childhood trauma is not an excuse for drugs or crime, it offers an explanation for them. I understood that to promote collective prosperity, communities would need to focus less on addressing the drug problem after the fact, which current efforts weren’t winning anyway, and more on addressing trauma upstream by building greater community resilience.
Regionally, the addiction crisis has challenged community leaders to address these difficult problems by looking at the many causal factors involved. So, they turned to resilience science. Although this research on ACEs and trauma-informed care has been available for decades, until recently it was largely overlooked. When I came across this realization, it was as if I was learning the cure for cancer and I felt that if I did not tell my community about it, in some way, I would be held responsible. So, with that sense of urgency, I decided to take action.
As a first step I decided to enlist help in order to educate professionals in our town. In the summer of 2015, I reached out to meet with several faculty members at East Tennessee State University, and my longtime friend and Psychology Professor Dr. Andi Clements attended. I apparently convinced her ,because she agreed to help. During the next three years, we trained over 4,000 professionals about the basics of resilience science. In 2018 representatives from the federal agency known as the Substance Abuse Mental Health Services Administration (SAMHSA) came to Johnson City for a forum we held where they recognized our pioneering work, Northeast TN ACEs Connection, as a model that other cities should follow to reduce the effects of childhood trauma.
Following the SAMHSA Forum, I was offered a role to join a three-state healthcare system as their first Trauma Informed Administrator. Early in 2020, the healthcare CEO met with me and the Chief Academic Officer asking if we would facilitate a conversation with ETSU on forming a partnership to establish an Institute based on advancing resilience science. Simultaneously, Dr. Wallace Dixon, who now serves as the Founding Director of the ETSU Ballad Health Strong BRAIN Institute (SBI), had convened a group of faculty at ETSU who were engaged in ACEs science to explore how ETSU could best pool talent and resources and further the many efforts underway throughout the Appalachian Highlands region. In the spring of 2020, Ballad Health provided a generous one-million-dollar, five-year gift to ETSU in order to form the SBI. I recently had the privilege of interviewing Dr. Dixon.
Question: Dr. Dixon, as the Founding Director of the ETSU Ballad Health Strong BRAIN Institute (SBI), how did you first learn about trauma informed care and the Adverse Childhood Experiences study?
(Dr. Wally Dixon, Founding Director of the ETSU Ballad Health Strong Brain Institute)
In 2015, I was both an ETSU Presidential Fellow and a co-chair of the ETSU Strategic Planning Committee. We had many discussions in the planning committee about how to recognize ETSU’s unique presence in the Appalachian Highlands and we spent many days brainstorming about how best to celebrate this role. At about the same time, ETSU President Brian Noland sent me to Nashville as his designee to attend the first Building Strong Brains Tennessee (BSBTN) Summit. The purpose of the summit was to bring together stakeholders from multiple Tennessee sectors to address then Governor Bill Haslam’s initiative to prevent and mitigate the negative impacts of adverse childhood experiences (ACEs). A main goal of BSBTN was to infuse “trauma-informed” practices across the state, across all sectors.
As a developmental psychologist, I had a great deal of experience conducting infancy research, but none in preventing or mitigating childhood adversity. And as Head of the Department of Psychology, I had administrative experience, but only with university students and faculty, who are obviously not children. I kept attending BSBTN meetings, and kept racking my brain for ways I could contribute. One day the contribution I could make clicked. I could “trauma-inform” ETSU! Such an effort would fulfill the vision of BSBTN while also addressing the strategic planning committee’s objectives. The only problem was that I had no experience in trauma-informing anything.
Question: Describe what next steps you took to bring the message of resilience science to ETSU.
Enter my psychology colleague Dr. Andrea Clements who was brought into this arena through her collaboration with you while you were working for the Johnson City Police Department. Through her partnership with you, Dr. Clements had become extremely knowledgeable about how to trauma-inform agencies and organizations. Her efforts in developing the community-wide system of care were recognized in 2020 when she was named a recipient of the Harold Love Outstanding Community Involvement Award. Enter another colleague, Dr. Michele Moser from the ETSU Center of Excellence for Children in State Custody. She was extremely experienced with implementing trauma-informed trainings statewide across child-serving agencies. The three of us discussed next steps and connected first with other faculty in the Department of Psychology, and then other faculty from other ETSU departments, all of whom were engaged in the education and science around adverse childhood experiences. These other leaders included Dr. Karen Schetzina from ETSU Pediatrics, Dr. Megan Quinn from ETSU Public Health, Dr. Judy McCook from ETSU Nursing, and Dr. Julia Bernard from ETSU Counseling and Human Services. In addition, were Drs. Diana Morelen and Julia Dodd from ETSU Psychology, Dr. David Roane from the ETSU Gatton College of Pharmacy, and Dr. Joe Bidwell from ETSU Biological Science. Soon all of us (and others we found along the way) began meeting regularly to chart a course for our common focus on preventing and mitigating ACEs.
We called ourselves the BRAIN Trust, where BRAIN was an acronym for Building Resilience through ACEs-Informed Networking. We planned curricula and leadership development trainings, identified the need for an Advisory Council composed of ACEs and mental health champions from among other community champions, and ultimately landed on the idea of establishing an Institute.
Question: Bringing about comprehensive change across a university would certainly require the buy in from the university President. Can you describe how you gained his support?
From the outset of his tenure at ETSU, President Brain Noland’s professional mission had been to improve the lives of the citizens of the region. We invited him to a couple of our meetings and pitched the idea of the SBI, emphasizing what the SBI could mean for ETSU and the Appalachian Highlands. It was an immediate sell. He solicited a white paper and a proposed operating budget from us, and we were on our way.
Question: How did the initial BRAIN Trust team evolve into the Strong BRAIN Institute?
Enter Ballad Health CEO Alan Levine. Unbeknownst to us, President Noland had strong connections with Mr. Levine, who was dedicated to leading a healthcare system that would address ACEs as a social determinant of poor health. Dr. Noland and Mr. Levine had initial conversations about forming a partnership in order to advance resilience science in the Appalachian Highlands. In early 2020, Mr. Levine enlisted you, as Ballad’s Trauma Informed Administrator, and Dr. Matthew Loos, as their Chief Academic Officer, to begin a conversation with the BRAIN Trust members on developing a prospectus to outline how we might form an Institute. Then it moved very fast. One minute the SBI was a twinkle in our eye, the next minute we had a 5-year $1 million dollar commitment from Ballad Health. We couldn’t have been more eager to begin implementing the important work of the SBI. In June we held an official press conference to announce this formal partnership between Ballad Health and ETSU to launch the Strong BRAIN Institute.
Question: It seems this work was just getting off the ground when COVID-19 forced communities to shut down. How has this pandemic affected the SBI?
COVID-19, arrived at about the same time as the first installment of the Ballad gift. The world went on hold. ETSU shut-down. BRAIN Trust meetings went online. The work of the SBI became 5 times harder. But we persisted. Our mission was that important. Our genesis was also extremely timely. Just when physical and emotional trauma were being felt globally, the SBI was ready to serve as a resource. A noteworthy example is that we were able to work with the president’s office and university relations personnel to provide resilience informed messaging around COVID-related policies. Our timing was fortuitous.
Question: What goals are now driving the work of the SBI?
The first executive decision was to form two “teams,” a Curricular Team and an Institutional Team. Under the auspices of the Curricular Team, we are establishing certificate training programs and developing models for infusing ACEs content into higher education. The work of the Institutional Team is a much heavier lift. Its objective is to devise a means to “trauma-inform” the entirety of ETSU, without any guidelines or blueprints to go by. To our knowledge, no other university in the nation has attempted such a feat. So, the SBI must rely on the ingenuity of its deeply-talented members for identifying best practices and evidence-based approaches for engaging in large-scale cultural transformation. It is exciting that every action-step the SBI takes is precedent-setting. Another executive decision was to establish an Advisory Council comprised of area leaders from multiple sectors across Tennessee and Virginia that can guide us along the way. These allies were well-known throughout their respective sectors as champions of efforts to prevent and mitigate the negative impacts of ACEs.
Question: Can you give examples of work being done by the two SBI teams thus far?
On the Institutional side, Dr. Diana Morelen spearheaded a Research Development Committee Interdisciplinary Grant of $50,000 to “Resilience-Inform” an entire ETSU Academic College (including Faculty, Staff, Administration). This effort includes Pre- and Post-Measures and the development of a resilience-informed “Intervention.” The work is currently underway in the ETSU Bill Gatton College of Pharmacy and is probably the most interdisciplinary research project ever funded at ETSU. To date this work involves a half dozen SBI team members.
The Curricular Team decided that the first step towards offering training would be to create an introductory continuing education module. The James H. Quillen College of Medicine Continuing Medical Education Office was enlisted to help us create this module. As you know, the basis of this initial module is the 4-hour training you and Dr. Clements have delivered over the past few years and updated for this purpose. We are calling this course, Introduction to ACEs, Using Trauma Informed Approaches, and Fostering Resilience. Revisions include updated graphics explaining the brain science and the ACEs study. A new module on building resilience was added to emphasize that while ACE scores may be fact, they are not fate. Included in this module are survivor story videos with inspiring examples of building resilience, along with a video from the Center for Disease Controls (CDC) that highlights how community protective factors can prevent ACEs.
This four-hour course will be set up so that participants can advance through the training in roughly one-hour blocks. It is designed not only for direct service professionals with advanced degrees, but for just about anyone in any sector. The introductory module is designed to provide attendees with a trauma informed lens to foster greater personal and community resilience. As a next step, the Curricular Team will be producing more advanced “sector specific” modules for educators, law enforcement officers, and healthcare providers so that attendees can add onto their introductory knowledge with specific practical training relevant to their professional settings.
Question: Are there any other activities the SBI has been engaged in?
Several members of the SBI have been recipients of Tennessee Building Strong Brains “Innovation Grants” over the past few years. These Innovation Grants have allowed faculty members to gain experience creating and implementing programming and data collection tools related to ACEs prevention and resilience promotion. We anticipate over time becoming a national research consultant who can provide the scientific evaluation piece for agencies implementing resilience programming.
As a team we applied for the CDC grant during summer 2020 that would have established an ACEs Surveillance System across the entire state of Tennessee. With a half dozen Strong BRAIN Trustees as Co-Investigators as well as strong letters of support from the Campaign for Trauma Informed Policy and Practice (CTIPP), the Tennessee Departments of Education and Public Health, the Tennessee Association of Chiefs of Police, the Tennessee Bureau of Investigation and the Tennessee Commission on Children and Youth, we submitted a strong application. However, we were not one of the four sites chosen for funding.
Recently, the SBI held a couple of “Town Hall” events to discuss virtual resilience, and specifically whether or not cameras should be on or off during Zoom meetings. These events yielded insightful discussion. Many factors go into our decision-making about when to turn them on, when to keep them off, and which to require when we are leading meetings or classes. With our camera on, we put ourselves out there. Zoom calls are not the same as face-to-face meetings. Being on camera in our homes during a pandemic is not the same as showing up well-prepared for an in-person professional meeting or class. Having children pop into the meeting unexpectedly is not something that used to happen, but it’s common now. Kittens mug for the camera, dogs bark at the FedEx delivery, and internet glitches freeze your face in expressions that are almost certainly unflattering. Beyond these obvious differences are more subtle ones, ones that can tap into our judgmental natures. Why is she broadcasting from her bedroom? Does he realize the paint is peeling on those pipes? Where is her make-up? Doesn’t he have anything better to wear than a stained T-shirt? Hearing observations expressed by Town Hall attendees helped many of the participants to understand others’ perspectives, promoted some deep thought on the subject, and probably fostered some flexibility and open-mindedness.
Beyond the “Town Hall” meetings, we are starting a newsletter and are in conversation about developing webinar and podcast series.
In the spring of 2021, the SBI is planning to launch a national “conversation” with other institutions of higher education who have an interest in or are currently engaged in work around resilience science in their postsecondary settings. By facilitating such a conversation there will be opportunities to learn from one another with the hopes of advancing this topic on university campuses across the nation.
If you would like to learn more about the Strong BRAIN Institute, visit our website (strongbraininstitute.org), subscribe to our newsletter, or join our “SBI External Friends” website. Please contact Benjamin Schonberg, MPH, Research Services Coordinator, ETSU Ballad Health Strong Brain Institute at firstname.lastname@example.org.