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​The Community Academic Partnership on Addiction (CAPA) Clinic, a partnership between the Brown School and Preferred Family Healthcare (PFH), was able to increase treatment completion rates by 11% over a six-month time period.

“This is excellent work and very strong findings,” said Mary McKay, the Neidorff Family and Centene Corporation Dean of the Brown School at Washington University in St. Louis. “This is great news for all the people involved in this important work and especially for individuals seeking substance use disorder treatment with our partner organization, Preferred Family Healthcare.”

CAPA is embedded in a PFH facility that offers medical detoxification along with residential and outpatient behavioral health services. It has a full clinical staff of therapists, counselors, community support and peer specialists along with a medical doctor, two nurse practitioners and about a dozen nurses.

The partnership added social work student interns working toward their master’s and doctoral degrees with an interest in careers in addiction-related services.

“Because successful addiction treatment completion is such an important health outcome, we at the clinic began focusing our attention toward improving the clinic’s treatment completion rates,” said David Patterson Silver Wolf, associate professor at the Brown School and director of CAPA.

This first-of-its-kind addiction-focused community-academic collaboration offers many opportunities for teaching, learning and research, Patterson Silver Wolf said.

“It is well-known that while there is a science of addiction, there is virtually no science of recovery,” he said. “Developing and transferring this new science throughout the addiction treatment industry is vital especially during the current opioid epidemic facing our country and the next one that is certain to come.”

“This is very promising,” said Cori Putz, executive vice president of Preferred Family Healthcare. “The CAPA Clinic serves a very high-need population. These outcome data show we can use innovative ideas to improve outcomes for individuals presenting with multifaceted health conditions.”

CAPA uses an addiction treatment platform called Takoda, which was co-founded by Patterson Silver Wolf.

“The goal of the clinical dashboard and soon-to-be-released suite of mobile applications developed by Takoda is to bring usable recovery performance data to front-line professionals so that they are able to leverage their clinical services more effectively,” Patterson Silver Wolf said.

In St. Louis area schools, some students are far more likely to be suspended than those least at risk — 20, 30 or even 60 times more likely, finds a new study from the Brown School at Washington University in St. Louis and Forward Through Ferguson.

The study found that being black, male or having a disability places students at greater risk of out-of-school suspension (OSS). When all three factors — race, sex and disability — were taken together, the numbers increased dramatically.

“Every time we suspend a student, we risk harming their sense of self-worth, their sense of belonging in school, and ultimately their lifelong well-being,” said study co-author Karishma Furtado, doctoral candidate at the Brown School, and research and data catalyst at Forward Through Ferguson. “Our students pay a horrible price because of our broken system of school discipline, and ultimately so do we all.”

The report, “Falling Through the Cracks: Disparities in Out of School Suspension in St. Louis at the Intersection of Race, Disability, and Gender,” was published online Aug. 29 via the Forward Through Ferguson website.

Using publicly available data from the 2015-16 school year, Furtado and Alexis Duncan, associate professor at the Brown School, along with co-authors Jennifer Kocher, parent advocate, and Pranav Nandan, Brown School master of public health candidate, investigated how race, sex and disability came together to affect risk of OSS for kindergartners through 12th graders in the St. Louis region.

They focused on the 30 public school districts located primarily in the City of St. Louis, St. Louis County and St. Charles County to align with previous work by the Keep Kids in Class Coalition.

The findings showed that while white girls with a disability were only 1.4 times as likely to receive an OSS than the least at-risk students (white girls with no disabilities), white boys without a disability were 2.7 times more likely to receive an OSS.

White boys with a disability were 9.1 times more likely. Black girls without a disability were 11.0 times more likely. Black girls with a disability were 18.1 times more likely. Black boys without a disability were 18.3 times more likely. The most at-risk students, black boys with disabilities, were 24.6 times more likely than white girls with no disability.

“The magnitude of the combined effect of race, sex and disability on risk of out-of-school suspension in the St. Louis region is astronomically high and nearly unheard of in public health,” Furtado said. “A person could smoke a pack of cigarettes every day for 30 years and face a lower risk of getting lung cancer than the risk of OSS for a black boy with a disability. In some districts, black boys with disabilities are 40, 50, even 60 times more likely to get an OSS than a white girl without a disability.”

While the report used St. Louis area data, the findings almost certainly apply beyond the region, Duncan said. “Decades of research show that being male, black and having a disability are well-established risk factors for suspension due to systemic barriers like inadequate supports in schools, bias and institutionalized racism,” she said. “Recent national studies have looked at disability status combined with race and found that the risks grow when you examine them intersectionally. We simply extended this to look at sex, in addition to disability and race.”

However, the St. Louis region and Missouri have historically had especially high racial disparities when it comes to school discipline, she said.

The authors suggest that OSS is not an effective deterrent to perceived bad behavior, particularly when the child’s behavior is only a signal of an underlying need or issue.

“The scientific evidence shows that OSS doesn’t prevent kids from misbehaving in the future, and it is related to all sorts of negative outcomes that we are trying hard to prevent, like dropping out of school and involvement with the criminal justice system,” Duncan said. “Time off of school may feel more like a reward than a punishment to many kids, so OSS may actually increase the likelihood of future misbehavior. In fact, the majority of kids who are suspended once go on to be suspended again.”

Few investigations of the school discipline gap have taken into account the many identities that children hold simultaneously, including disability status.

“When children with disabilities are suspended, it is often due to behavior related to their disability,” Duncan said. “OSS does nothing to help in these cases and has a lot of potential for harm. Students with disabilities don’t get the in-school services that they need and are already excluded from their typically developing peers in many ways — OSS just makes the problem worse.”

The report also discusses evidence-based strategies for closing the discipline gap and calls on parents, teachers and district leaders to redouble their efforts to implement them.

“In addition to restorative practices that take the place of exclusionary measures like OSS, we also know that schools can work to prevent problem behaviors altogether,” Duncan said.

Effective preventative measures include trauma-informed practices, positive behavior interventions and supports, social emotional learning approaches, and better using Individualized Education Programs to support children with disabilities.

The report suggests that school districts should work to promote​ restorative alternatives to suspension, reduce disparities and prevent challenging behaviors.

“We also have to seriously look into how we can ensure disparities in the way we discipline students aren’t driven by biases on the part of educators and administrators,” Furtado said.

International social work students recently completed work in a first-of-its-kind intensive summer seminar focused on advanced research methods. The 11-day event was presented thanks to an ongoing partnership between Washington University in St. Louis and its McDonnell International Scholars Academy partner Xi’an Jiaotong University (XJTU). The workshop’s goal was to provide important tools for social work practitioners and researchers working in other countries, including China.

“The social work profession in China is still relatively new,” said Shenyang Guo, the Frank J. Bruno Distinguished Professor of Social Work Research at the Brown School. Guo is also assistant vice chancellor for international affairs-Greater China and a Yangtze River Scholar.

“Over the past couple of decades, many new ideas have been implemented by social work practitioners there,” Guo said. “However, there still needs to be a sharper focus on research methods, particularly as they become ready to share what they’ve learned in the field.”

More than 150 faculty members, graduate students and practitioners took part in the special advanced workshop, which began July 19 at XJTU’s campus in Xi’an, China. Students from six universities in the United Kingdom and the U.S. —  the Brown School among them — took part. The Brown School, in collaboration with XJTU, hosted the event.

Students learned from Washington University senior faculty, including Enola Proctor, the former Shanti K. Khinduka Distinguished Professor at the Brown School, who presented sessions on implementation science; Carolyn Lesorogol, professor and associate dean for global strategy and programs, who taught qualitative research methods; and Guo, who focused on quantitative research methods. Linyun Fu, manager of global programs at the Brown School, led the Teaching Assistant team comprised of Washington University alumni Jiamin Chen and Qi Chen.

“Some of the students told us this was the best workshop they’d ever had, and practitioners told us they were impressed by the amount of information we were able to impart in such a short time,” said Jin Peng, deputy director of XJTU’s Department of Sociology and a Washington University alumna.

The workshop was first discussed in October during “Washington University Day” held at XJTU. Guo said that the event served as a catalyst, which set the wheels in motion for the summer workshop, with support from Mary McKay, the Neidorff Family and Centene Corporation Dean of the Brown School, and Chancellor Emeritus Mark S. Wrighton. Wrighton, along with XJTU’s President Shuguo Wang, attended the workshop’s opening ceremony and gave remarks.

​An Oklahoma judge ordered Johnson & Johnson to pay $572 million for its role in the opioid crisis in a historic ruling on Aug. 26 of this year. A federal case in Ohio involves at least 1,600  lawsuits from cities and counties throughout the country. Oxycontin maker Purdue Pharma has offered to settle more than 2,000 lawsuits from states and cities for between $10 billion and $12 billion.

All of this legal action represents a major tipping point in the fight against the opioid crisis, said an addiction expert at Washington University in St. Louis.

“It is not the $572 million judgment in this single state that is significant, but the likelihood that pharmaceutical companies will end up paying billions of dollars for the harms they have caused in our nation,” said David Patterson Silver Wolf, associate professor at the Brown School and an expert on substance use disorder treatment.

“The Oklahoma case is why Purdue is already in talks to settle their own liabilities, and I imagine other pharmaceutical companies, as well as pill distribution companies, are already in discussions to settle,” he said.

It is possible these American corporations, “who  were motivated by profit as their products devastated American families, will end up paying about $100 billion,” Patterson Silver Wolf said.

“However, the suffering that families experience from this kind of corporate greed will continue, regardless of the final dollar amount reached in these settlements. No amount of money can bring loved ones back.”

Patterson Silver Wolf said he is concerned how states will use the funds gained in these suits.

“When the tobacco settlements happened, some states placed those dollars into their general funds,” he said.

“States seem obligated to use any opioid settlement funds for prevention and treatment, two important services that have been historically under-funded. To use opioid settlement funds in any other way than for the prevention and treatment of addiction, would be another act of dishonor to American families.”

Illinois became the most recent state in the U.S. to adopt universal Child Development Accounts on August 23, when Gov. J.B. Pritzker signed legislation to open a 529 college savings plan account with deposits for every child born or adopted in Illinois after Dec. 31, 2020.

“We are excited to provide this opportunity for children in Illinois,” said Illinois Treasurer Michael Frerichs. “Every child should have an opportunity to afford to attend college. We think starting a college savings account will set the expectation that college is achievable and will put our children on the road to success.”

The gubernatorial signing is the third in a little over a year for statewide Child Development Accounts (CDAs), joining Nebraska and Pennsylvania. It signals encouraging momentum for child accounts, according to Margaret Clancy, policy director for the Center for Social Development (CSD) at Washington University in St. Louis. Also noteworthy, these three examples represent red, purple, and blue states. During a very partisan political era, CDAs find support across political parties.

“This marks three statewide CDA legislative victories within just over 12 months, and more states are considering this asset-building policy for children,” Clancy said. “Using the 529 college savings plan as a platform to implement statewide CDAs has been very successful, both economically and politically.”

CSD has been a national leader in CDA research and CDA policy innovation around the world. Research in a CDA policy model in Oklahoma has shown that mothers’ outlook and parenting improved, as did their education expectations for their children. Children’s social–emotional development also improved, regardless of whether or not the families saved additional amounts. Other research finds that children with an account in their name are likely to have higher educational attainment.

In Illinois, the Sargent Shriver National Center on Poverty Law, based in Chicago, was one of twelve partners in the SEED demonstration of CDAs in the early 2000s. Careful research in SEED has laid the groundwork for CDA policy in Illinois and elsewhere. Clancy has worked with the Illinois Asset Building Group, the Woodstock Institute, the Heartland Alliance, and Bright Start Direct, as well as the state treasurer’s office, to develop the CDA policy concept in Illinois.

When it is implemented in 2021, the Illinois program will have the largest annual cohort of CDA participants in the nation, with about 160,000 newborns each year. The largest amount of CDA assets is currently in the state of Maine, at more than $134 million.

The Illinois House passed the Child Development Account legislation on April 3, and the Senate passed it on May 31. It uses the Illinois Higher Education Savings Program for the purpose of “expanding access to higher education through savings.” Among its provisions:

CSD Director Michael Sherraden—who in 1991 first proposed universal asset building beginning at birth—said research testing CDA policy, and documented success in statewide CDAs have been key steps in moving toward a national policy. “Since 529 college savings plans already exist and are very stable, these can become the backbone of a national CDA policy that reaches all U.S. children,” he said. “A nationwide CDA policy could eventually develop into a lifelong asset-building policy for the nation. This policy vision would emphasize asset accumulation and achieving life goals.”

​Leaders of the Missouri Botanical Garden Outdoor Youth Corps felt strongly that their program was making a difference in the lives of the youths it employed, but they wanted proof of its impact.

Enter the Brown School Evaluation Center, founded in 2015 to help organizations figure out what is working, what is not, and changes that might improve outcomes. The Center’s analysis and report not only bolstered the Outdoor Youth Corps’ (OYC) work, but helped make the case for additional funding that enabled the Corps to expand.

“That evaluation helped us greatly,” said Betsy Crites, Manager of Youth and Community Programs at the Garden. “It gave us proof of our effectiveness from a third party, and that was very valuable.”

The Corps is a youth employment program that provides hands-on, outdoor work, with partners like the City of St. Louis Forestry Division, Missouri of Department of Conservation, Bellefontaine Cemetery, and the Great Rivers Greenway. It is part of the St. Louis Green Teen Alliance, a growing consortium of organizations who collectively employ teens in outdoor environmental stewardship jobs across the region.  

The Corps helps participants build career skills like job interviewing and preparing resumes, an effort aided by job coaching from Brown School practicum students. Most of the participants are teens recruited from St. Louis city high schools, and the program aims to prepare them for jobs ranging from bioscience to horticulture research to working on the city parks crew.

Heather Jacobsen, a manager at the Evaluation Center, led the inquiry into the OYC program, which involved visiting the youths at work and interviewing each of them. Talking with students in the August heat at a park in North St. Louis under the airport flight path was sometimes challenging, she said, but ultimately rewarding.

“They were all very passionate about their work,” she said. “All spoke to the confidence they had gained, and their leadership skills. As an evaluator, you always hope for an outcome like this.”

Based on the youth’s input, the Evaluation Center recommended including using past participants to help lead the Corps, giving participants more hours and extending activities into the school year.

The suggestion to add more time to the program helped strengthen a successful OYC grant application to extend the program. Crites said the evaluation also helped the OYC partners to think about how they can better work with teens on their own.

Nelson Curran, the Youth Garden Instructor who leads the youth crew, said the evaluation captured the many benefits of the program, which acquaints many of the teens with their first real “green” experience.

 “We get to work outside in such a diverse range of activities,” he said. “They go home with stories to tell. It’s an introduction to the benefits of nature.” Field trips included canoeing on the Mississippi River and visits to the Shaw Nature Reserve. “I love the energy and enthusiasm that comes from the crew,” he said.

Curran said support from the Evaluation Center and others in the community “has been a huge plus” and offered positive reinforcement for the teens.

“It empowers them to see value in the work they are doing, and value in their future,” he said.

One of the Evaluation Center’s objectives with the project was to provide the Botanical Garden with the tools to evaluate their processes and the impact they have with youth and in communities.

“It can be difficult for organizations to know what questions to ask, what data to collect, and how to analyze data to obtain evidence-based conclusions that are not skewed by the organization’s beliefs or perspective,” Jacobsen noted.

 “We worked with the Garden staff on evaluation best practices, so they could accurately collect data from future participants in the program,” she said. “This is an invaluable skillset for organizations who want to ensure, on an ongoing basis, their programs are having the desired effect.”

Evaluation Center Director Nancy Mueller agrees. “This is key to our Center’s mission. Along with offering our evaluation services, analysis and expertise, we want to help organizations develop their own customized toolbox for growth and impact.”

To learn more about the Evaluation Center’s Services, visit evaluationcenter.wustl.edu.