'A roadmap for how to respond to and provide funding for addressing collective traumas': A commentary by Stephanie Berkowitz

Twenty years after 9/11: Prioritizing trauma-informed mental health care

Twenty years after the September 11 attacks, lessons from that experience continue to inform the most effective ways to provide mental health support to individuals, families, and communities in crisis. At the same time, new lessons have emerged as a result of the COVID-19 pandemic and ongoing demand for racial justice. Together, these insights provide a roadmap for how to respond to and provide funding for addressing collective traumas for families as diverse as refugees arriving in this country from Afghanistan to those displaced by hurricanes. 

In 2001, the Greater Washington Community Foundation tapped Northern Virginia Family Service (NVFS) to provide trauma recovery services to survivors of the attack on the Pentagon. The September 11 Survivors' Fund was intentionally set up to be flexible and broadly focused. While we provided services to survivors most obviously impacted — those who were physically injured in the attack — we also supported a flight attendant who lost colleagues on the plane that flew into the Pentagon, a firefighter who saw the unimaginable and chose to change professions, and anguished family members who lost loved ones, among others. In all, the $25 million fund helped 1,051 people.

Years later, we learned of a group of construction workers from El Salvador who participated in clean-up efforts at the Pentagon but did not receive Survivors' Fund services. Only then did we recognize a significant shortcoming on our part. Since then, we have come to understand that targeted outreach to underserved populations in multiple languages by professionals with fluency in a variety of cultural traditions is the most effective way to reach neighbors who are frequently overlooked and disproportionately impacted by communitywide crises....

Read the full commentary by Stephanie Berkowitz, president and CEO of Northern Virginia Family Service.

'Systems change work is intrinsic to creative youth development': A commentary by Daniel R. Lewis

Supporting creative youth development as systems change work

In her recent blog post announcing $2.7 billion in commitments to equity-oriented nonprofits across the country, philanthropist MacKenzie Scott writes: "Arts and cultural institutions can strengthen communities by transforming spaces, fostering empathy, reflecting community identity, advancing economic mobility, improving academic outcomes, lowering crime rates, and improving mental health."

[...] As a longtime arts philanthropist, reading Ms. Scott's post, I couldn't help but recognize the work she was describing as systems change — a vision my organization, the Lewis Prize for Music, has set for itself [...] While the pandemic magnified the already apparent need for young people to develop artistic and employable media arts skills, calls for racial justice showed the imperative for adults to provide movement-building support and guidance to young people. The CYD field has simultaneously addressed both of these needs.

Systems change work is intrinsic to CYD, and the holistic approach of CYD is itself systems change....

Read the full commentary by Daniel R. Lewis, founder and chair of the Lewis Prize for Music.

'Now is the time for philanthropy to support today's brave movements for justice': A commentary by Jesenia A. Santana

Today's racial justice movements need protection — and funders must respond

Like so many others across the country, members of Black Lives Matter Phoenix Metro have organized and participated in numerous protests and public calls for racial justice in the past year. Their activism has kept a powerful spotlight on the harms and trauma caused by white supremacy and the need for healing and liberation for Black communities and other oppressed people. But that work has come at a great cost to the safety and security of people and organizations on the front lines.[...]

Across the country, activists and movement leaders are facing heightened levels of risk, trauma, and violence simply for speaking out for our collective rights and standing up for Black lives and communities of color. If it is not trumped-up charges and police violence, it is vicious harassment delivered both digitally and physically by people and groups spewing racism and hate. The problem has only gotten worse since the January 6 insurrection at the U.S. Capitol.

Now is the time for philanthropy to support today's brave movements for justice....

Read the full commentary by Jesenia A. Santana, senior resource strategist at Solidaire Network.

'We understood what it meant to be silenced, afraid, and vulnerable': A Q&A with Mónica Ramírez

Mónica Ramírez is an organizer, attorney, social entrepreneur, and founder and president of Justice for Migrant Women, whose work includes policy advocacy, civic and political engagement, public awareness and education campaigns, narrative shift initiatives, and multi-sector and multi-ethnic power-building collaborations. For two decades she has worked to protect the civil and human rights of women, children, workers, Latinos/as, and immigrants and to eliminate gender-based violence and secure gender equity, launching Esperanza: The Immigrant Women's Legal Initiative at the Southern Poverty Law Center in 2003. Ramírez also is co-founder of the Latinx House and Alianza Nacional de Campesinos, where she served as board president until 2018.

In our latest '5 Questions for...' feature, PND spoke with Ramírez about the intersectionality of women's, farmworkers', and immigrants' rights; the impact of COVID-19 on farmworkers; and the Healing Voices program. Here is an excerpt:

Philanthropy News Digest: You're credited with helping to galvanize the TIME'S UP movement against sexual harassment by publishing the "Dear Sisters" letter on behalf of farmworker women, addressed to women in the entertainment industry. What factors put migrant farmworkers at particularly high risk of sexual harassment, in both similar and disparate ways from women in Hollywood?

Mónica Ramírez: Women of color have historically been left out of the narratives featured in TV shows or movies, much less given the opportunities to feel safe and comfortable enough to bring to light their traumas and seek justice — and the same can be said for farmworker and migrant women. Most people don't realize that migrant women suffer from sexual harassment in the workplace at the hands of supervisors, recruiters, co-workers, and others. They are more vulnerable, as they're employed in small workplaces like private homes and small farms, sometimes with fewer than fifteen workers. And as these women are not covered by existing federal anti-sexual harassment law, they're particularly vulnerable to harm without any recourse to seek justice. To make matters worse, many are afraid to speak out about any incidents of sexual harassment that take place due to fear of deportation, being fired, or having their hard-earned wages taken away....We understood what it meant to be silenced, afraid, and vulnerable....

Read the full Q&A with Mónica Ramírez.

It's time to build a better behavioral health system

Our nation's collective mental health has been severely challenged since the start of the COVID-19 pandemic.

Now, as we begin to envision our post-pandemic future, it's important to take a step back and recognize that our behavioral health system needed improvements even before COVID-19, and that it's time for philanthropy to consider taking new approaches to funding and advocating in this area.

For more than a year, the isolation caused by the social and physical distancing necessitated by the pandemic and the ongoing stress created by the disruptions to our daily routines have impacted all of us — and those conditions have led to a massive spike in mental health issues. According to the Kaiser Family Foundation, an astonishing 41.1 percent of adults reported symptoms of anxiety disorder and/or depressive disorder in a January 2021 survey, nearly four times the average seen between January and June of 2019.

The toll has been especially heavy for our most vulnerable neighbors. Isolation has had a tremendous negative impact on the elderly and the young, while the daily stress of living through the pandemic has been especially intense for people of color, families living below the poverty line, the precariously housed, individuals with pre-existing physical or behavioral health problems, and single parents.

Foundations nationwide have recognized these risks and rallied to provide emergency funding to help support many of the urgent mental health needs created by COVID-19. The New York Community Trust (NYCT) — the community foundation where I oversee grantmaking in the areas of health, behavioral health, and biomedical research — has funded efforts to provide mental health counseling to frontline workers and technology to enable mental healthcare providers to connect with patients virtually and ensure that hard-to-reach populations receive the services they need.

These rapid-response efforts were, and remain, critical as we attempt to address the mental health crisis created by COVID-19. But we must now recognize that our system, as currently designed, is not built to accommodate the great need that already existed before the pandemic.

Prior to COVID-19, our systems for delivering mental health care were failing to help the majority of those in need of such support. In 2019, an estimated 51.5 million U.S. adults experienced a mental illness — roughly one in five people over the age of 18 — yet only 44.8 percent received mental health services.

This massive gap is largely the result of our healthcare system's lack of capacity to serve those who need help. Compounding the problem is the fact that even if there were enough trained providers to meet the need, many Americans do not have the means to afford it.

The human and economic cost of this failure is substantial. Each person with an untreated mental illness is a person who struggles to maintain steady employment and help support their family. Our criminal justice system is stretched beyond its limits, in large part because of the extraordinary number of incidents involving individuals who are experiencing behavioral health crises — the very challenges that also prevent millions of Americans from taking care of their physical health.

Imagine if we could rebuild our behavioral health system so it provided the ongoing care that's so clearly needed. Not only would we help those 51.5 million Americans with their mental health, we would create a better workforce, strengthen families, lessen the strain on our police departments and courts, incarcerate fewer people, reduce the number of people experiencing chronic physical health conditions, and increase lifespans. In other words, by putting a focus on mental health, we would be taking a critical step in addressing myriad social issues — and equipping our nation for a healthier and more prosperous future.

Yet for decades, despite our support for well-meaning interventions, both philanthropy and government have fallen short in addressing America's mental health crisis. Instead of improving mental healthcare systems, we've mostly invested in programs that address urgent needs and those in crisis — certainly an important aspect of care, but not the only one.

It's time to take a new approach. Philanthropy and government have an opportunity to join forces to make meaningful structural changes that will help millions of Americans who are not receiving the treatment they need to lead healthy, productive lives. And these changes are not as difficult, or as costly, as you might think.

For example, NYCT, along with Well Being Trust and the Sunflower Foundation, commissioned the Bipartisan Policy Center to study how to better integrate primary health care and behavioral health care. By taking steps to diagnose and treat behavioral and physical health in tandem, rather than separately, the center estimates that we can help improve outcomes for as many as a million Americans over the next ten years.

When I joined NYCT more than two decades ago, a mentor shared the adage “form follows finance.” A twist on the early twentieth-century architecture and industrial design principle of “form follows function,” it is perhaps more relevant than ever to the provision of behavioral health services.

The center's take on better coordination of care between behavioral and physical health is a clarion call for philanthropy to push for better coordination of delivery and financing systems. The federal government and several states have begun to advance models of care that prioritize outcomes over volume and pay for care that is delivered with this in mind.

This is a good start. But philanthropy must do more to ensure that its resources — modest as they are, compared with the country's healthcare spending, which by some estimates is almost 20 percent of our pre-pandemic GDP — ensure that financing aligns with a priority focus on coordinated care across all delivery systems, whether they be hospital- or clinic-based, or in community settings.

It behooves philanthropy to continue to pay attention to many of the root causes of mental and emotional distress that is so prevalent in communities across our country, often referred to as the social determinants of health — the conditions under which people live, work, and learn. Because historical inequities across the board — but especially within the context of race — have hampered such an approach, it is important that our funding address the complex challenges of inadequate insurance coverage, a stressed workforce, and the critical role of non-clinical providers in the delivery of services.

Finally, if America is to achieve a behavioral healthcare system that cares for those in crisis and enables them to manage chronic conditions, philanthropy has a critical role to play in advocating to ensure that financing actually supports such a system.

And for those of my colleagues who work at a community foundation or a grantmaking public charity that can legally engage in lobbying efforts, I entreat you to use that option. Let us imagine and work toward a healthcare system that covers the entire person — mind and body — and makes a healthier, more prosperous, and more equitable America possible.

Irfan Hasan is deputy vice president for grants at the New York Community Trust, where he oversees health, behavioral health, and biomedical research grants.

A case for self-support: serving ourselves in a time of great stress

"How are you doing?" I asked a donor on a phone call last summer. Her response stayed with me. "I'm doing pandemic fine," she said, before explaining that that was the kind of response one gives during a public health emergency instead of something like: "I'm doing okay. I have my job, and it's stressful, but at least I have work. And the family is fine. No one is sick. Virtual homeschooling is a struggle, but we're fine."

Her response was both amusing and perplexing, because when I ask someone how they're doing, I'm the type of person who wants and expects to hear all the details. In fact, I believe it helps explain why I enjoy working in philanthropy as much as I do, and is one of the main reasons so many of my meetings run longer than scheduled.

Organizational experts Paul Davis and Larry Spears would call my exchange with the donor a "fortuitous encounter — "[t]hose moments where a person, place, or thing causes our lives to change in a more positive direction." While I did not feel all that positive after the exchange, in the months since it has contributed to a transformation in the way I think about taking care of myself, my colleagues, and our philanthropic partners.

Of course, the donor's reply was informed by the unprecedented events of the past year — events for which our sector as a whole was largely unprepared. I live in Houston, where hurricanes and flooding events are commonplace, but once the water recedes, we jump back in our cars and check on our friends, neighbors, and even our donors. The coronavirus pandemic, by contrast, has been a "silent" storm during which we've been encouraged to care for others by literally keeping our distance from others.

What fundraising professionals are doing well…and not so well

From a fundraiser's perspective, the sector's collective response to the pandemic has been something of a mishmash. With respect to day-to-day operations, we're seeing good content related to engaging our supporters, innovating in our programming, and staying the course. I can't say enough about the creativity and resilience of the sector and the people who work in it. And without their advice and knowledge, I know I would have been less effective over the last twelve months in mapping out my own organization's fundraising strategies.

That said, nearly everything I've read over the last year has been focused on practical problems and challenges, things like how to strengthen a pandemic case for support, when to schedule a Zoom meeting with a new prospect, and retaining your supporters after you've made the decision to move your next fundraising event online. Yes, it's important to develop and strengthen our practice in normal times, and even more so during times of uncertainty. But what I'm not seeing are stories about self-care during one of the most challenging periods in recent memory, stories that remind us that if we want to do our best work, we need to make sure we’re well enough to fire on all cylinders. "[J]ust as they tell you on airplanes when the oxygen masks come down,” says Chris Mosunic, chief clinical officer at Vida Health, "we can't help others if we don’t take care of ourselves first."

I’m a realist who knows that a big part of my role as a fundraiser is to deliver maximum net revenue for my organization. I also know that many of us worry about cultivating donor relationships and meeting ambitious goals, but that we are not always honest about how we ourselves are holding up. Sure, I've found a reasonable groove during the pandemic and I'm doing the best I can. But let's face it, the current fundraising environment is different than the one many of us are used to. And, truth be told, it's different for our donors as well.

A practical reason for self-care

You may not know this, but the work of fundraisers is never "done." Between programs, events, and annual reports, the effort to steward and engage donors and prospects is a year-round affair, and at times it can feel like we’re laboring on our own little island, disconnected from the day-to-day work of the organization and with no sign of help on the horizon.

From a purely practical perspective, this has an impact on our work. Leadership guru Kevin Krause suggests that "[e]ngaged employees lead to better business outcomes." And a survey of more than five hundred business leaders by the Harvard Business Review found that 71 percent "rank employee engagement as very important to achieving overall organizational success."

Also relevant in this context is what Virgin Group founder Richard Branson has to say about an employee-first mentality: "If the person who works at your company is 100 percent proud of the job they're doing…they're gonna be happy and therefore the customer will have a nice experience."

But how can we expect our donors and supporters to have a "nice experience" if those tasked with engaging them in the work of the organization are struggling?

Doing the work of self-care

The events of the past year are likely to resonate for years to come, and work will continue to be challenging for many frontline and back-end fundraising staff. But there are things we can do for ourselves, and our team members, that will result in a happier, healthier workplace.

First, be mindful of your time. For many, working from home has morphed into living at work. Don't be that person. Instead, set real start and finish times for your workday — and stick to them. It'll be easier to do that if you make the effort to wear work clothes during the work day. And because your day-to-day tasks aren’t going anywhere, unless there's an emergency, don't check your email before 9:00 a.m. or after 5:00 p.m. (Managers, you can help by refraining from the super early/late email messages.) In addition, try to create a schedule for your meals and stick to it. Limiting food consumption to mealtimes can be great for your well-being, and equally beneficial to your waistline.

Second, be mindful of technology. These days, our big, medium, and little screens are where we spend a big chunk of our time. Indeed, Americans spend an average of 2.3 hours a day on social media — the equivalent of roughly thirty-one days a year. To combat screen-induced burnout, try to establish "no glow breaks" throughout the day — on a run, in the bathroom, while out doing errands — where you put the technology in your life on pause. Also, make an effort to incorporate some analog technology like paper into your life. For what it’s worth, Scientific American suggests that our screens "[p]revent people from navigating long texts in an intuitive and satisfying way. In turn, such navigational difficulties may subtly inhibit reading comprehension."

Finally, be mindful of your state of mind. One in six Americans sought counseling in 2020, joining the one-third of Americans who were already receiving some kind of counseling. Perhaps more than at any other time in recent history, we are willing to acknowledge the need for self-care. For those who are feeling stressed, reducing some of the distractions in your life, like  notifications on your phone/tablet, will go a long way to calming an overly busy mind. Similarly, when lodged in your home "spaceship," try to organize your space into discrete areas — a corner of one room for exercise, a certain chair for reading or chatting on the phone — and don’t use your sleep space for other tasks like work or social media.

The last year has been difficult for many. If you find yourself struggling with something more serious than time management or the distractions that come with being plugged in all the time, give yourself permission to talk to a professional or, at the least, a friend. And remember, you may have challenges; but you are not your challenges.

Our colleagues and donors rely on us, but more than anything we are responsible for ourselves.With that in mind, don’t be afraid to take the leading role in your own self-care.

(Photo credit: David Lusvardi via Unsplash)

Evan Wildstein has served on the fundraising team at the Kinder Institute for Urban Research at Rice University since 2017.

Challenging ableism through language justice

Social justice movements have long recognized the power of language. The idea of language justice — "the right everyone has to communicate in the language in which we feel most comfortable" — has helped bridge the equity gap when people who speak different languages work together. Multilingual spaces can connect movements across language barriers and build shared power across language differences. Below, we argue that the concept of language justice needs to be enlarged to other contexts and forms of communication — in particular, that by and about disabled people.

In 2017, we launched the Open Society Community Youth Fellowship Program, with a focus on engaging young people as individual grantees through a diversity, equity, and inclusion (DEI) lens. Through this experience, we learned that certain words can have unintended and damaging consequences and can reinforce stigmas related to oppression and ableism. We also learned what it means in practice to apply language justice to all stages of grantmaking, centering disabled people in these processes. Here we want to share these lessons, which both involve listening to and learning from disabled people, in accordance with the disability movement's key principle of "Nothing about us without us."

Shifting power through word use

Discriminatory and stigmatizing words are often used in everyday exchanges. Since the onset of the coronavirus pandemic and with the current political instability in the U.S., there has been widespread use — in emails, tweets, and mainstream media — of expressions such as "You're not nuts. This is a really crazy time!" or "I hope this finds you well during these crazy times," "falling on deaf ears," and "interrogating our blind spots." Politicians are referred to as "mad," "psycho," or "narcissistic." These everyday uses of language can reinforce stigma, implying, even when it is not the intention of the speaker or writer, that people with mental health conditions never make sound judgments, that being deaf means being stubborn, or that being blind means being unaware. Terms like "crazy," "nuts," and "insane" can be especially discriminatory and offensive, particularly when metaphorically used to mean "bad," "bizarre," or "very unusual" (as in "these crazy times").

In applying a language justice approach as funders, we also learned to be intentional in analyzing the words we use to talk about disability. In some parts of the world, disability rights activists tend to prefer "person with disability" to "disabled person," which, they argue, can suggest that one's identity is wholly defined by one's disability, perpetuating stigma and discrimination. In the United Kingdom, however, "disabled person" is widely used by activists due to the stronger prevalence of the social model of disability, according to which a person is disabled not by their sensory, motor, intellectual, or other impairments but by physical barriers, gaps in provision, and social attitudes that marginalize or exclude them. Adherents to the social model prefer "disabled person" because it emphasizes the disabling effects of society and they do not see such phrasing as discriminatory. It needs to be recognized that both of these naming conventions — "person-first" and "identity-first" — are widespread.

The example of autism highlights a different dimension of this debate. The term "neurodiversity" stresses that all people are different in terms of their expectations and identities, and moves us away from pathologization. It was once considered appropriate to say "people with autism," using person-first terminology. But some with lived experience have stated that autism is part of their identity, not an addition, and therefore prefer "autistic person." Disability activists often emphasize a point that Tom Shakespeare has succinctly stated: "[I]t is a good principle to call people by the names they themselves prefer."

Judgments about what terms are acceptable or discriminatory change over time. Many words referring to people with intellectual disabilities that are now regarded as highly stigmatizing were once used in scientific communities, as well as in official medical and educational policy documents, as legitimate descriptions of certain individuals and their genetic conditions. This does not mean that those words were not already problematic; it just means their connotations and the extent of their social acceptance changed over time until they eventually became unacceptable and taboo.

The word "cripple," and in particular its shortened form "crip," is a particular case. In the last two decades, disability activists have reclaimed "crip" and "cripple" as positive terms, as a badge of identity, flipping their connotations against their oppressive usage in much the same way "queer" was reclaimed by the LGBT movement. As an article written early in that process explained, "by reclaiming 'cripple', disabled activists take the image in their identity that scares outsiders and make it a source of militant pride." It remains problematic, however, for non-disabled people to use the term, even if their intention is to express solidarity with the disability rights movement. Here, too, people with disabilities must be in control of decisions about language that refers to them.

The point is not to "police" or "cancel" certain ways of talking, to ban certain words and elevate others, but to argue that we all need to be aware that expressions like these carry considerable power and can reinforce negative narratives, stereotypes, and discriminatory attitudes. Prejudiced language is endemic in society. As funders working through a language-justice approach, we need to recognize this and be guided by what disabled people themselves feel and say is discriminatory, stigmatizing, offensive, and/or hurtful. This is a basic principle of language justice in relation to disability.

Shifting power with language justice in grantmaking practices

In a grant-giving context, as elsewhere, a language-justice approach can help shift power and challenge ableism at each stage of a grant cycle. We learned that implementing these approaches meant rethinking timelines and systems based on notions of urgency and perfectionism. It does take longer to create the conditions and the spaces where people can exercise their power in their own language and in ways that are accessible for them. Looking, even inadvertently, for conventional kinds of "perfection" in applicants or our own operational processes can reinforce existing power relations and made us reflect on the intersections between ableism and other forms of discrimination, as highlighted by the Disability Justice movement. Based on our experience, we offer some suggestions on how language justice can be implemented through grantmaking practice.

First, reduce barriers and widen participation, calls for proposals must be accessible. This means application materials should be translated into the languages used by potential applicants' communities and also re-worked into Easy-to-Read, a format that conveys information in short sentences with widely used and easily understood words in combination with images, or Plain Language. Word, PDF, and Power Point documents should use accessible document formats. Informational webinars or events should be conducted in the languages used by applicants (with interpretation for the funder, if needed), as well as offered with sign language interpretation and Communication Access Real-Time Transcription to enable better information access.

Second, applicants should be given the choice to submit their materials in different communication formats (written, video, audio, etc.). No one method of communication should be imposed. For example, requiring only written submissions — even for only one part of the application — could exclude some signing Deaf people. If interviews are conducted, simultaneous or consecutive interpretation should be made available.

Third, once the successful applicants have been selected, welcome documents and other important information should be provided in Plain Language, and in the languages and formats used by the communities they represent. The same applies to reporting requirements, which are often daunting and technically complex. Grantees should have the option of submitting reports in their language or format of choice (video, audio, etc.). In our case, this then meant transcribing reports to meet the required formats of our institution. When grantees come together for virtual or in-person meetings, they must be asked well in advance what accessibility and accommodation supports they will need. The Autistic Self Advocacy Network and European Disability Forum offer excellent guidance for accessible meetings.

Final thoughts

Language justice is about challenging a widely accepted and internalized reality of exclusion and the dominance of institutionally powerful cultures and people. For us it has meant checking our own privilege as people holding particular kinds of institutional power. It has also meant acknowledging that we need to learn from the communities we want to support. Listening carefully is just as important as speaking.

Rachele Tardi is the director of and Zachary Turk is a program officer with the Youth Exchange at the Open Society Foundations.

Research and Analysis Best Practices in Behavioral Sciences

Behavioral and mental health conditions have long been misunderstood and exaggerated. Societal factors play a significant role in how those with behavioral or mental health problems are perceived. Behavioral science research can be used not only to educate the practicing professional but also to educate the public and help fight stigma. With heightened awareness and understanding, health disparities can be eliminated and better health policies developed.

However, before diving into research, there are some best practices we should take into consideration. Below, we will discuss the principles of ethical research, how to disclose funding sources, how to avoid funder bias, and the importance of using inclusive language.

Ethical Research

When it comes to the behavioral sciences studies, it is unethical to conduct research that converts public resources such as foundation funding into private gains. It is unprincipled to conduct biased work. Because research and analysis involve the participation of individuals or groups who have the relevant experience and background, there are also a number of ethical practices to take into account.

The research should not put participants at risk or seriously damage the environment. Informed consent is another one of the foundations of research ethics and is key to minimizing harm, distress, or discomfort for the participants. Participants in a study must not have been coerced or deceived into participating. They should understand the purpose of the research and, more importantly, recognize that they are participating in a study. It's also an ethical practice to discuss research methods and any potential inconveniences participants may experience.

Researchers also should explain how they intend to protect participants' anonymity and ensure their confidentiality. In many behavioral science studies, the subject matter is private or sensitive in nature. Participants want to feel safe when sharing information by knowing that identifiers that reveal who they are will be removed from any published work. If for any reason a study needs to disclose participants' identities, researchers have the legal responsibility to get their permission.

Memo to Foundation CEOs: Get a Youth Council

Seven years ago, we launched a President's Youth Council (PYC) at the California Endowment, and it seems like a good time to tell you that the young people who've served on the council over those seven years have significantly influenced our programming as a private foundation, been a source of reality-checking and ground-truthing on how our work "shows up" at the community level, and have substantially increased my own "woke-ness" as a foundation executive.

Before I get into the details, I'd like to briefly share why we decided we needed a President's Youth Council and how it works: In 2011, our foundation embarked on a ten-year, statewide Building Healthy Communities campaign that was designed to work in partnership with community leaders and advocates to improve wellness and health equity for young people in California. We had already been using a variation of a place-based approach in our work, and so we selected fourteen economically distressed communities to participate in the campaign — some urban, some rural, and all, taken together, representing the complex diversity of the state.

At the time, I was aware not only of the privileged position I occupied outside my organization, but also of how sheltered I was as a chief executive within my organization. More often than not, I received information about the effectiveness and impact of our work in the form of thoughtfully crafted memos from staff, PowerPoint presentations, and glossy evaluation reports filled with professionally designed charts and graphics. Even when feedback in the form of recommendations from consultants or comments from the community came my way, it was all carefully curated and edited. As I had learned — and this is especially true at large foundations — when members of the community get "face time" with the CEO, it is a carefully managed and considered process.

Being at least vaguely conscious of these issues early on in our Building Healthy Communities work, I wanted to ensure I would have some regularly calendared opportunities to meet face-to-face with young leaders from the communities we were serving. So, we solicited nominations from grantee-leaders in each of the fourteen program sites, and a President's Youth Council, featuring mostly young people of color between the ages of 17 and 21 and of varying sexual/gender orientations, was born.

Seven years later, here's what it looks like.

This Holiday Season, Don't Forget Families Mourning a Loss

December is the "season of giving" — a time when we're all made aware of the many ways we can give back to those less fortunate. On streets and in stores, on TV, and through our social networks, causes and organizations doing good work compete for our attention and year-end donations. But one group in need of support at this time of year often remains invisible: those who are grieving the loss of a loved one. It's time that philanthropy paid more attention.

The holidays are a difficult time of year for grieving children and families. For most, it is a season characterized by family traditions and poignant memories — memories that can trigger powerful emotions when someone significant is missing from the festivities, even when his or her loss is no longer fresh. In fact, a new nationwide survey conducted by the New York Life Foundation demonstrates the profound, enduring nature of loss. According to the survey, for those who lost a parent as a child, the pain was still raw years — and sometimes even decades — later, with 77 percent of respondents saying they would always feel like a part of them was missing and 78 percent saying they still thought about the departed parent every day. 

The survey also revealed a troubling "grief gap" — a disconnect between the length of time that grievers took to move forward after a loss and the time during which they received support. On average, those who lost a parent growing up said it took them six or more years to move forward, with a full 30 percent admitting that they'd never come to terms with their loss. Yet most reported that support from family and friends tapered off within the first three months after a loss, 21 percent reporting that support tapered off within a month of a loss, and 20 percent saying support from others tapered off after just a week.

To Close the Racial Health Gap, Philanthropy Must Itself Prioritize Wellness

In December 2009, the Campaign for Black Male Achievement (CBMA)  convened a cross-section of leaders working to improve life outcomes of black men and boys at a leadership retreat that included a session focused on strategies for healing and self-empowerment for leaders in the Black Male Achievement (BMA) field. At the time, the BMA field was still relatively new, having been launched by CBMA at the Open Society Foundations in June 2008. What the workshop revealed was both astounding and urgent: that the very leaders working vigilantly to support black men and boys in their communities were themselves in dire need of support and information with respect to how they addressed the myriad health and lifestyle challenges they, and an alarmingly large number of African Americans, face.

Then, in 2014, the BMA movement was dealt a tragic blow with the news that BMe Community leader Dr. Shawn White, a renowned academic working on public health matters, had died suddenly at the age of 42 of a stress-triggered seizure due to complications from severe hypertension, a preventable disease. There was and remains little doubt that the high levels of stress associated with doing racial equity work was a critical factor in the kinds of health issues faced by leaders such as Dr. White. There is also little doubt about how these issues are exacerbated by the insidious effects of interpersonal and institutional racism — psychological, physical, and emotional — on black people and communities.

The learnings that came out of that retreat nearly a decade ago have been given new life with the release of a report issued last week by National Public Radio, the Harvard T.H. Chan School of Public Health, and the Robert Wood Johnson Foundation. Titled Discrimination in America: Experiences and Views of African Americans, the report addresses the various types of individual and systemic discrimination that black Americans experience in a variety of arenas, including employment, buying a home, interactions with law enforcement, civic engagement, and access to health care. In each of these areas, African Americans reported frequent and consistent encounters with race-based discrimination — a finding that spans gender, education, political affiliation, geography, and socioeconomic status.

Beyond the Emergency Department: How We Can Improve Care for Patients With Complex Needs

As a physician, I have struggled with the question of how best to care for patients with complex needs since my early days of working in a hospital emergency department. Back then, my colleagues and I routinely encountered people in crisis who were battling medical, behavioral, and social difficulties all at once. And I realized over time that while we did our best to address their clinical problems, the issues they faced at home or in their communities were often what led them to the ED.

In recent years, my colleagues and I collectively have come to the realization that our patients — and others facing similar challenges — have, in many ways, been failed by society. Researchers have uncovered patterns of unstable, traumatic childhoods among patients with complex needs. They've also learned that many of these patients felt disrespected by the hospitals and clinicians who cared for them, which often resulted in patients skipping their medications or missing needed appointments. All too often, patients with complex needs are seen as statistics — just another person with diabetes or heart failure — when what those patients desperately want and need is to be acknowledged as individuals.

While the social implications of how we fail to fully care for these patients are deeply troubling, the economic cost is equally stark. We know that while people with complex needs represent only about 5 percent of the U.S. population, they represent about half of all healthcare spending.

Reframing Addiction: Removing Stigma, Saving Lives

Every parent worries about the harm his or her child might encounter in the world. As parents, we dedicate our time and energy to protecting our children from every preventable danger — accidents, violence, illness. Why, then, don't we take steps to stop the epidemic that is claiming more American lives than car crashes or gun violence — the devastating disease of addiction? Addiction is killing our children. Even worse, the stigma associated with addiction keeps many people who are affected from seeking treatment.

In 2011, I lost my son Brian to addiction. He didn't die of an overdose or as a result of a drug-related crime. In fact, he had been in recovery for more than a year. The undeniable reality is that it was not just addiction that claimed my son's life — it was the shame he felt every morning when he opened his eyes that led him that day to research suicide notes, light a candle, and take his own life.

Brian had struggled with the disease of addiction for nearly ten years, cycling through eight different treatment programs. He desperately wanted to lead a normal life. His substance-use disorder was not indicative of a lack of willpower on his part; rather, the chemistry of his brain continually worked against him. Brian wasn't irresponsible. He was always curious, cheerful, and consistently caring. A dear companion and a beloved child. Full of compassion.

I wish I could say my anguish has subsided over the years since his death. But it has only intensified with the knowledge that addiction is a disease that is preventable but that we don't prevent; that is treatable but that we don't treat; that is undeniable but that we continue to deny.

5 Questions for...Kenneth Fisher, Chairman and CEO, Fisher House Foundation

Since the early 1990s, the Fisher House Foundation has supported more than two hundred and seventy-seven thousand families of service members and veterans by providing lodging near VA hospitals and military medical centers where their loved ones are undergoing treatment. The foundation also awards scholarships to children and spouses of service members and veterans, administers the Hero Miles and Hotels for Heroes programs, which use donations of frequent flyer miles and hotel points to provide free airline tickets and hotel rooms to military families, and sponsors the Invictus Games.

Kenneth Fisher has served since 2003 as chairman and CEO of the Fisher House Foundation and is co-chair of the Intrepid Sea, Air & Space Museum, both of which were founded by his late great-uncle, Zachary Fisher. Ahead of Veterans Day, PND spoke with Fisher about the role of philanthropy in addressing the needs of service members and veterans.

Philanthropy News Digest: Providing support to the families of service members and veterans traveling for medical treatment is a very specific area within the broader scope of veterans issues. What made Zachary Fisher decide to focus on it?

Kenneth Fisher: Everything started with the Intrepid. After Zach completed the conversion of the USS Intrepid to the museum it is today, he wanted to do more. So he called the wife of the then-chief of naval operations, Pauline Trost, who told him a story about the day she was at the Bethesda Naval Hospital [now Walter Reed National Military Medical Center] and saw a family run in, drop their bags in the lobby, and run up to the room to see their loved one. They didn't even think about a hotel. There was no real low-cost alternative to a hotel, there was no real housing on the base for those families, and there was a clear need. And Zach said, "This is my skill set. I know an architect; I've been a developer. I can build a house." And so it was decided that what came to be known as Fisher Houses would be built, on two conditions: First, they had to be free of charge. Second, they had to be within walking distance of a VA or military hospital.

That essentially was the birth of the foundation — one phone call that made Zach aware of a need that wasn't being met. We have a saying in our family that has been passed down over the generations: "Don't be somebody who points out problems — we've got too many of them — be part of the solution." So the roots of the Fisher House Foundation can be traced to that story but also to that philosophy.

PND: Over the last twenty-six years, more than seventy Fisher Houses have opened across the United States and in Germany and the United Kingdom. Has the need for these types of facilities near VA hospitals and military medical centers been fully met over the years? And do you expect demand to grow?

KF: Before 9/11, obviously the needs were different. People in the military aren't only hospitalized when they're wounded in battle — they also get sick or are injured in training accidents. But the need for family lodging was so basic and underappreciated that no one really ever thought about it.

After 9/11, we knew that building one or two Fisher Houses a year was not going to be sufficient. In fact, the first house we built after 9/11 was in Germany, which is usually the first stop for many men and women who are wounded in battle overseas and is where they are stabilized before they're sent home to the United States. But back then I looked at the budget and said, "How the heck are we going to meet the need?" And my answer to that question was to apply a private-sector mindset to the running of the foundation. By that I mean, every dollar would be accounted for. I wanted to know how much of each dollar was going to administration, going to fundraising, and getting to the people who needed the program. I was very focused on running the foundation as efficiently as possible. And as we built more and more houses, we got on the radar of the American public, and people responded in ways that I'd never thought possible. At one point we were building nearly ten houses a year. The program still needs to be ramped up, but I don't want it to grow so fast that we can't keep up with it.

Today, some Fisher Houses are running at 100 percent occupancy rates, some at 80 percent, some a little lower. Will we ever fully meet the need? Who knows? It's a difficult question to answer. I can tell you that if a family can't get into a Fisher House because it's full, we put them up in a hotel through our Hotels for Heroes initiative until a room opens up. Any family that comes into the Fisher House program will be taken care of. And by virtue of the support of the American public and the way the foundation is run, I think we're making a very, very positive impact in meeting that need.

To Truly Reform Criminal Justice, Policy Makers Must Listen to Crime Survivors

The 2016 election campaign season has exposed the deep and bitter divides in our political system. Candidates have put forth vastly different views, and the list of what they agree on seems to be getting shorter by the day. Yet criminal justice reform has become that rare thing — an issue on which many Democrats and Republicans can agree.

State and federal policy makers are in the midst of an important conversation about how to reform the criminal justice system. After decades of growth in prison populations and prison spending, it is a conversation that is long overdue. Notably absent from this dialogue, however, are data or research on crime victims' experiences with the criminal justice system or their views on safety and justice policy. Given that politicized perceptions of the best way to protect victims has, in part, driven prison expansion, this absence is glaring. Now is the time to correct the misperceptions that drove the failed policies of the past in order to truly reform the system.

A primary goal of the justice system is to protect and help victims, so any reform effort must incorporate the voices of the victims themselves. That's why the Alliance for Safety and Justice decided to conduct a national survey of crime victims, including those who have suffered extreme violence such as rape or the murder of a family member.

While one might expect victims to overwhelmingly support the "lock 'em up and throw away the key" approach, we found something different. Victims were clear that rehabilitation and crime prevention, not more incarceration, is needed to ensure that fewer people become victims of crime.

Nearly three out of four victims we surveyed told us they believe that time in prison makes people more rather than less likely to commit another crime. Two out of three victims support shorter prison sentences and increased spending on prevention and rehabilitation over long sentences. And by a two-to-one margin, a majority of those surveyed were in favor of policies that emphasize rehabilitation over punishment. Crime survivors also overwhelmingly support investments in new safety priorities that can stop the cycle of crime, such as programs for at-risk youth, mental health treatment, drug treatment, and job training. These views cut across demographic groups, with wide support across race, age, gender, and political party affiliation.