positive medicine and its impact on health practice

Positive Medicine and its Impact on Health Practice

Leslie Rubin MDMorehouse School of MedicineSoutheast PEHSU at Emory University Break the Cycle of Health Disparities, Inc.The Rubin Center for Autism and Developmental Pediatrics

Disclaimer

“The views and opinions expressed on this presentation are my own based on the work of many people who went before me.

They do not reflect the views of any of the organizations and institutions that support my work.

I do not have financial connections with any financial entities who would benefit financially from anything I say in this conference

History of People with Developmental Disabilities

• Over the centuries attitudes towards people with developmental disabilities have changed and evolved

• By the 19th century scientific thinking along with philosophical, political, economic, and cultural changes converged to improve the understanding of, appreciation of, education of and rehabilitation of people with developmental disabilities

Dawn of 20th Century

Residential Care: A Promise

• 20th Century began with optimism

• Children with disabilities could be taught!

• Many Schools were opened around the country

• Usually out in the country

Residential Care: A Painful Reality

• Children were sent to the “schools” which had limited educational knowledge and resources

• By the mid 1960’s there were approximatively 200,000 people with disabilities in public institutions

Institutions became overcrowded and were seen as dehumanizing places of custodial care.

President John F KennedyOctober 11, 1961

• “It is important to integrate people with intellectual and developmental disabilities within our modern society and make full use of their abilities”

• and appointed "a panel of outstanding scientists, doctors, and others to prescribe a plan of action in the field“ of intellectual disabilities.

Developmental Disabilities History of Legislation

Maternal and Child Health and Mental Retardation Planning Act of 1963 (Public Law 88-156)

1963

Mental Retardation Facilities and Community Mental Health Centers Construction Act of 1963 (Public Law 88-164)

1963

Education for All Handicapped Children’s Act of 1975 (Public Law 94-142)

1975

Rehabilitation, Comprehensive Services, and Developmental Disabilities Amendments of 1978 (Public Law 95-602)

1978

The Developmental Disabilities Act of 1984 (Public Law 98-527)

1984

Individuals with Disabilities Education Act (IDEA) In 1990, (Public Law 99-457)

1990

Developmental Disabilities Assistance and Bill of Rights Act of 2000 (Public Law 106-402)

2000

In the early 1960’s, Eunice Kennedy Shriver saw that children with developmental disabilities especially those who were poor and did not even have a place to play, so she started a program in her back yard that grew into the Special Olympics.

Special Olympics

Special Olympics is the world's largest sports organization for children and adults with developmental disabilities, providing year-round training and competitions to more than 4.2 million athletes in 170 countries.

Citizen’s Actions and Advocacy

• The Association for Retarded Citizens was founded in 1950 by parents who believed their children with DD deserved more

• In 1969 the Youth-Chapter was formed consisting of 70,000 volunteers who met and made the following statement:

• Talk to him. Listen to him. Find out what he thinks, how he feels, what he wants to do. Help him be part of the bigger world ... encourage him to do everything he can for himself.

Paradigm Shifts Over the

Decades

• Institutions under Medical Supervision

•Deinstitutionalization

•Normalization

•Mainstream

• Integration

• Inclusion

WHO Definition of Health

• Not merely freedom from disease but.....

•The promotion of PhysicalEmotional &Social Well Being

Intellectual and Developmental Disabilities

.........are neurological conditions that have ▪ origins in early life▪ are identified by delays or significant

differences in an individual’s development▪ involve function across one or more

domains▪ require identification, intervention, and

support ▪ in order to assure optimal function for the

individual and the family in the community.

Rubin Definition 2021

Some Health Care Challenges

• Underlying Neurological Problems

• Associated Medical Conditions

• Syndrome Specific Conditions

• Mental Health

• Access to Quality Health Care

Management Plan

• Depends on diagnostic conclusions

• Manage general health concerns

• Appropriate referrals and therapies

• Support for families

• Long Term monitoring

• Coordination of Care – Medical Home

The Medical Home

• A medical home is an approach to providing care for children with special health care needs and their families:

• A system of delivery of primary care that is

• accessible,

• continuous,

• comprehensive,

• family centered,

• community based

• coordinated,

• compassionate, and

• culturally effective.

Health Care Infrastructure

Promoting Health: Physical and Physiological perspective

• Diet and eating patterns

• Personal hygiene

• Bowel patterns

• Sleep patterns

• Exercise patterns

Promoting Health: Medical perspective

• Responding to acute medical conditions

• Screening for at-risk conditions

• Monitoring of medications

• Management of existing chronic medical conditions

• Coordinating Care

Promoting Health: Psychosocial and Spiritual Perspective

• Daily activities

• Preferred activities

• Intellectual stimulation

• Personal relationships

• Social activities

• Personal time

Ultimately the practices and values of a

society are judged by how they treat

their most vulnerable citizens

For a view of history

Daniel J. Tomasulo, Ph.D., TEP, MFA, MAPPAcademic Director & Core Faculty MemberSpirituality Mind Body Institute, MA Program

Positive Medicine and the PERMA Modeltomasulo@tc.Columbia.edu

TEXT HOPEFUL

TO44222

PRIOR TOCOVID-19

• 80% Of People With Depression Relapse• 40% Of Americans Are Lonely• 10 Times More People Are Depressed Now Than In

1945.• In The Last 3 Decades, 15-26 Year Olds Report Twice As

Much Anxiety, Depression, And Behavioral Problems As Their Predecessors.

• Suicide Is The Leading Cause Of Death In This Age Group.

• Depression, loneliness, anxiety and suicide have gotten worse since COVID.

The data points to a sharp rise in society’s

symptoms in a relatively short time, which

indicates the root cause of most depression

isn’t a chemical imbalance—human genes do

not change that fast. Something else accounts

for this. People are losing hope and meaning—

and they are losing it faster than at any time in

history.

George Bonanno is a clinical psychologist at Columbia University’s Teachers College; he heads the Loss, Trauma, and Emotion Lab

Living through adversity doesn’t guarantee that you’ll suffer going forward. What matters is whether that adversity becomes traumatizing.

• Why do some people use the system so much more frequently or effectively than others?

• Do you conceptualize an event as traumatic, or as an opportunity to learn and grow?

• “Events are not traumatic until we experience them as traumatic,”

• Coined term: PTE, or potentially traumatic event.

• Every frightening event has the potential to be traumatic or not to the person experiencing it.

1280 × 720

In research at Columbia, the neuroscientist Kevin Ochsner teaches people to reframe an initially negative event in positive terms, or in a less emotional way when the initial response is emotionally “hot,” changing their experience and reaction.

You can train people to better regulate their emotions, and the training seems to have lasting effects.

Resilience skills can be learned over time.

Martin Seligman

Zellerbach Family Professor

of Psychology

Director of the Positive

Psychology Center Trained people to change their explanatory styles from internal to external (“Bad events aren’t my fault”), from global to specific (“This is one narrow thing rather than a massive indication that something is wrong with my life”), and from permanent to impermanent (“I can change the situation, rather than assuming it’s fixed”) generated

higher well-being and l less depression.

Children with spirituality are 60 percent less likely to be depressed as teens, 40 percent less likely to engage in drug use and 80 percent less likely to engage in some risky behaviors. Cortical thickness was observed in study participants who said “spirituality is personally important,” regardless of their specific religious traditions.

Spirituality is an inner sense of relationship to a higher power that is loving and guiding. LISA MILLER is Professor of Psychology and Education at Columbia University, Teachers College and is Founder of the Spirituality Mind Body Institute, the first Ivy League graduate program in spirituality and psychology.

Coping and Resilience Strategies

• Regressive Coping (Avoidance)

• Transformational Coping (TRANSFORMATIONAL MINDSET)

• Proactive Coping (Planning to reduce the likelihood of future stress)

Regressive Coping Crisis

Avoidance

Depression

Anger

Guilt

Resentment

Lower Self Esteem

Move Toward

Conflict

Emotionally Depleted

from Giving

Without Feeling You Are

Getting Support

A Need to Help Others

(Neglecting Self)

Feelings of Depression,

Resentment, and Guilt

Keep You Focused

Outward, Not Inward

CAREGIVER’S FATIGUE SYNDROME

Transformational Coping: The Science of Hope

TRANSFORMATION MINDSET

Proactive Coping

Be Mindful of the Moment,But Not at the Expense of the Future

ABCs of Resilience

Positivity can enter the cycle through any part of it.

Hopefulness Strengths

Narrative

®Dr. Dan Tomasulo

Academic Director, Spirituality Mind Body InstituteTeachers College, Columbia University

Teaching Staff, Master of Applied Positive Psychology ProgramUniversity of Pennsylvania

Tomasulo@tc.Columbia.edu

@Dr.DanTomasulo

@Dr.DanTomasulo

@Dr.DanTomasulo

Dr.Dan Tomasulo

TEXT HOPEFUL

TO44222