Saturday, September 15, 2018

Message from Thomas P. Royer, President CEO

Presented at Beech Brook’s 166th Annual Meeting September 13, 2018

Moving upstream and adaptation have been the themes for Beech Brook this year and will be for the foreseeable future. Both CMSD and Julius Simmons are pioneers who offer tangible examples of how moving upstream can be so effective, catching children and families before they are washed away.

Beech Brook’s School-Based program is just one example trying to get out in front, before children fail to thrive, whether that be in school, in the community or at home. I have talked several times about violence in our schools and communities. But we have another problem that needs to be addressed through better prevention and early intervention initiatives. According to the National Institute of Mental Health, there were more than twice as many suicides in the United States as there were homicides in 2016. The Center for Disease Control reported a 28 percent rise in suicide-related deaths between 1999-2016.

And as you may know, September is Suicide Prevention Awareness Month. But did you also know that suicide is the second leading cause of death for people ages 10-24? More teenagers and young adults die from suicide than from cancer, heart disease, AIDS, birth defects, stroke, pneumonia, influenza, and chronic lung disease, combined.

Reports show that nearly nine percent of high school youth reported that they had made at least one suicide attempt in the past 12 months; girls twice as often as boys. These are alarming statistics. But there is something that we can do about it. In fact, four out of five teens who attempt suicide have given clear warning signs.

The only effective way to prevent suicide is to identify the people who need help.

Because of this, Beech Brook has recently adopted a new risk assessment tool, the Columbia-Suicide Severity Rating Scale, which uses simple questions to identify clients who are at risk of suicide and measures the severity and immediacy of that risk. This new tool is now used with all our behavioral health clients.

Preventable, violent deaths among young Americans are at epidemic levels. Whether these deaths are caused by violence in our schools, violence in our communities or by suicide, we must do more to protect our young people.

As a community we need to get better at identifying people in pain, people who are suffering from trauma, and those experiencing the toxic stress of poverty beyond their ability to cope. We must encourage our local, state and federal representatives to make prevention a priority in our schools, workplaces and communities.

Rather than rescuing just a few children in grave peril, we must focus our energy and resources upstream to stop them from falling into dangerous currents in the first place.

To illustrate my point, I want to tell you a story about a child and a family. The kind of family that I wanted to jump in the river and save when I started at Beech Brook. The type of family that was not likely to survive, let alone thrive, without people to rescue them. Thankfully, Michelle Flynn, one of Beech Brook’s therapists was there to help, and so were many others.

Bobby came to school one day with a black eye. After asking about the injury, the school intervened and called the 696-KIDS hotline to report suspected physical abuse. When the county social worker went to visit Bobby and his family, Bobby confirmed that his father had, in fact, hit him.

So, just like hundreds of cases each year, a referral was made to Beech Brook for family preservation services. The initial goal was to keep the family intact, safely. But when Bobby started working with his Beech Brook therapist, he reported that he no longer wanted to live at home because he feared his father. He experienced daily beatings. Subsequently, the county removed Bobby from his home and placed him in a group home.

But before you pass judgement, I want to give you a little bit of history on this family. Things are not always as clear as they seem. And then I want to tell you how this story ends.

Bobby’s mother had died a few years before this case came to Beech Brook’s attention. But while she was alive, she was also very hard on Bobby…constantly putting him down and using physical discipline to parent him. But then, she died of cancer and of course, this did not make anything better. Even though she too was hard on Bobby, it was a traumatic experience for her children. And it was tough for the father, too. The father eventually remarried but struggled to manage his relationship with his new wife and blended family, to hold down a construction job, and to raise Bobby and his older sister.

After Bobby’s removal, the county mandated that the father participate in parenting and anger management classes. The father was furious! He fought tooth and nail against these requirements stating that he already knew how to parent and that Bobby was the problem. He was working so hard to hold everything together! How could he handle more? Eventually, the meetings at county became so volatile that security would be called when the father came into the building.

The father’s relationship with his new wife and his blended family was also crumbling. Bobby’s stepmother decided to leave. This left the father to raise Bobby’s older sister by himself. He was in disbelief at what was happening to his life. He loved Bobby, Bobby’s sister, and his wife and her family as well, but it was all falling apart. Finally, he decided that he needed to do something different or he would lose everything for good.

He decided that he would start complying with what county was asking him to do. He went to his parenting classes. He went to his anger management meetings and, over time, started to see the benefit of his participation. The father reported to the Beech Brook therapist that he never realized how angry he was or how devastating his behavior was to his family and even to himself. The father eventually gained insight into his own past, gaining an understanding of how he was raised. He was able to see how the abuse and trauma that he suffered as a child led to his current behavior and how it impacted his relationships and his parenting style.

The father frequently visited Bobby in the group home and tried to work on improving communication and bettering his relationship with his son. He often thought it might be too late. But he persisted and continued to show up for every single visitation and every single meeting. He successfully completed his parenting and anger management classes as well.

The father grinned as he recalled the instructors in his class making a cake for his last day. And he began to cry as he recalled that this was the only time anyone in his life celebrated his accomplishments and made him feel good about himself.

In the beginning, when the therapist began working with this family, it was evident that they’d to scratch and fight, tooth and nail, for everything they had in life. They were tired of fighting all the time, and they were wearing down from the stress of their everyday life.

Everyone has difficulties in life. But this was different. The weight of traumatic experiences suffered over generations makes everyday life and their troubles much more difficult to survive. But despite all this, it was also clear that these were good people who desperately needed someone to help them, someone to believe in them, and someone to grab their hand and start pulling them out of the river and to tell them, in the therapist’s words, “It’s going to be ok; you got this!”

Bobby’s father worked hard and regained full custody of Bobby. Bobby transitioned smoothly back into his family’s home. The father and his blended family are back together, too. This summer, Bobby has been going to work with his father. In fact, they have been spending a lot of time together really getting to know each other. The therapist even witnessed Bobby and his father laughing, joking, and smiling with one another during a recent visit. This is something that had never happened in the past.

The father reported, “I’m a completely different man, I’m a man that I can be proud of, and my kids can look up to me now instead of being afraid of me.”

But not all stories have a happy ending. In fact, many of them don’t. Adverse childhood experiences (ACEs), as they are known in our field, are stressful or traumatic events, including abuse and neglect. They may also include household dysfunction, such as witnessing domestic violence or growing up with family members who have substance use disorders. We know that adverse childhood experiences lead to negative physical and mental health outcomes such as fetal death, low birth weight, and lifelong sleep disorders. ACEs increase the risk of attempted suicide by two to five times throughout a person’s lifespan. Individuals who reported six or more ACEs have increased odds of attempting suicide by more than 24 times.

Right now, just in Cuyahoga County, there are more than 2,500 children who have been removed from their families due to abuse and/or neglect. In 2016, the Cuyahoga County Juvenile Court filed 15,479 delinquency and unruly charges, and there were 172 child deaths during that same period. I could go on. How many of these cases are linked to adverse childhood events? How many of these kids will grow up and pass trauma down to the next generation? How many more years will Beech Brook receive hundreds of referrals just like this one? How many more kids and families will we have to pull out of the river? How many of them won’t make it out of the river at all?

We need to move upstream. Luckily, this family and this child were caught before they got too far down the river. This story has a happy ending because of the heroic work of a Beech Brook therapist and many others who jumped in the river to help this family. This work is so hard. And it is so important. It literally saves lives.

But. But what if we had caught this family further upstream? What if someone would have referred Bobby for help when he lost his mother? Would that someone have seen what Bobby was going through and intervened? Could Bobby have avoided several years of abuse? Would things have not been so bad that Bobby could have stayed home while the family worked on their issues?

Could someone have noticed that something was wrong in Bobby’s life even earlier? In daycare? In kindergarten maybe?

What if Bobby’s parents had enrolled in an early parenting program, like Beech Brook’s program, when Bobby was born? What if they had enrolled even further upstream when Bobby’s older sister was born? Would things have ever gotten this far?

What if somehow would have caught Bobby’s father when he was young? What if someone would have noticed the trauma of abuse he was experiencing as a child and intervened then?

What if we caught this case further upstream?

Maybe it would have had an even happier ending.

Or maybe I wouldn’t have had a story to tell you tonight.

And that would be just fine with me.