Tag: Trauma

Trauma 4.0: 30-Day Landscape of the Post-Roe v. Wade Era

Providers, practitioners, patients, and their supports have long dealt with public scrutiny over the decision to terminate an unintended, unviable, if not potentially life-threatening pregnancy. Yet, amid the post-Roe v. Wade era, it has become tougher to receive and render necessary care; a new dimension of trauma is being unleashed for all involved.

Roe v. Wade was overturned one month ago. The flagrant assault on women’s health and their reproductive rights is now at full throttle. My blog post, Trauma Amid Roe v. Wade Despair, addressed the historical, manifesting, and enduring trauma experienced across society from this new norm. Providers, practitioners, patients, and their supports have long dealt with public scrutiny over the decision to terminate an unintended, unviable, if not potentially life-threatening pregnancy. Yet, this intimate choice was a guaranteed right under the law for almost 50 years, that is until June 24th, 2022. 

I introduced the hashtag, #Therewillbetrauma, which has resonated loudly across the globe. It has joined other entries on social media related to this topic, including:

#abortionishealthcare

#freedomofchoice

#mybodymychoice 

#reclaimRoe

#reproductiverights

#righttochoose 

#Roe43

There has been an outpouring of mobilization this last month to counter the Dobbs v. Jackson decision that overturned Roe v. Wade. Struggles to ensure necessary care for women in need have been fierce with ongoing efforts to craft new abortion and reproductive rights legislation. More vulnerable populations, such as women of color, transgender men, nonbinary, and gender-nonconforming persons. and those living in poverty were disproportionally impacted prior to Dobbs v. Jackson; their access to appropriate healthcare often limited. A recent Kaiser Family Foundation analysis identifies these populations are more likely to obtain abortions, yet have limited access to health care, and face systemic inequities that make out of state travel for abortions more difficult compared to White counterparts.

Recent events have occurred amid these struggles that reinforce the impact of trauma’s wrath. Each packs a fierce intensity to challenge ethical tenets across health and behavioral health care. Patient autonomy is compromised, as is beneficence, fidelity, justice, and non-maleficence. What happens when “do no harm” is the antithesis of reality for those reconciling their intimate right to choose, and the inability to do so?


Ethics Matter

#Ethicsmatter is another of my popular hashtags. The following news stories demonstrate how little ethics matter to far too many. Each event activates a trauma response that sends my cortisol levels into overdrive. I am a seasoned clinical professional, but also a woman working hard to maintain balance amid a range of emotions, from anger and frustration, to sheer rage:

  1. Within weeks of Roe v. Wade being overturned, a horrific story surfaced. A 10 year old in Ohio, had been sexually assaulted and raped by a 27 year old man, resulting in a pregnancy. At 6 weeks and 3 days of gestation, the child was denied an abortion in her home state due to the Dobbs v. Jackson decision; she was forced to travel across state lines to receive appropriate health care. The physical and psychological trauma from rape is unthinkable. The thought of a rape victim being forced to carry a resulting pregnancy to full-term against her choice is reprehensible; for a 10 year old child, it is unconscionable. This is trauma.
  2. The 10 year old discussed above was referred by her physician to an OB/GYN in Indiana to terminate her pregnancy. The treating physician, Dr. Caitlin Bernard, has subsequently been harassed and threatened by the public, as well as Indiana’s attorney general; her medical license is now under scrutiny. Reports validate Dr. Bernard complied with state and local laws, such as existing HIPAA privacy rights laws for treating a minor, reporting the case to child protective services, and other regulations. Despite acting with beneficence, fidelity, non-maleficence, and egal due diligence, Dr. Bernard faces “reputational harm and emotional distress”. This is trauma.
  3. Marlena Still and her husband, Abie DeSilva live in Texas and were excited about their pregnancy; the couple have a toddler and had tried conceive a second child for some time. During a routine office visit at 9 weeks, doctors informed the couple that there was no heartbeat, and thus, no viable pregnancy; a fetal demise was their new norm. The emotional intensity of their baby dying in utero was unthinkable and traumatic enough. Yet, this tragic situation took an even, more tragic turn. The events that followed were antithetical to “do not harm”:
  4. Marlena was forced to carry a dead fetus for 2 weeks: This is trauma.
  5. Marlena requested a Dilation and Curettage, also known as a D and C and the traditional care following a miscarriage. Her physician refused to do the procedure, citing the new Texas anti-abortion law as the reason. She noted the patient must have a transvaginal ultrasound before further consideration of the procedure. This is trauma.
  6. Marlena endured this invasive diagnostic procedure, plus, then was forced to hear the words no parent experience, and more than once: “your baby is dead”: This is trauma.
  7. After the second ultrasound, Marlena’s OB/GYN still refused to provide clinically indicated care putting her at grave clinical and emotional risk. The patient endured, yet another, ultrasound: This is trauma.
  8. The literature notes profound risks associated with fetal demise and from carrying a dead fetus for an extended period of time: hemorrhage, infection, infertility, organ failure, mortality. The psychological impact of being forced to experience this reality is unacceptable: This is trauma.
  9. Marlena found another physician to do the D and C procedure. This denial of clinically appropriate miscarriage care and treatment is unethical and immoral. This is trauma.
  10. The couple are considering leaving their home state of Texas, their family and support system. They have also opted to not try and conceive another child. Marlena is fearful of being unable to access appropriate care should she have another fetal demise. She is not prepared to put her life in jeopardy and risk leaving her daughter without a mother and husband without a life partner. This is trauma.
  11. The reality for Elizabeth and James Weller of Texas is gut wrenching and almost too much for, even, this author to fathom. At 18 weeks pregnant, her water broke. Given the length of this blog post, those interested can review the heartbreaking events in an article on NPR. They tell a horrific story no person should have to endure: traditional obstetric care amid a medical emergency obstructed due to state law, a patient’s life at risk as she is forced to endure medical and emotional trauma while awaiting “fetal death”, a physician caught in a legal quagmire and unable to practice medicine in a way that prioritizes, “Do not harm”. This is the grim reality which has been created; THIS IS TRAUMA.

The Current State of Trigger Laws

 The emergence of trigger laws banning abortion has been swift. An interactive map of current laws across the nation appears on Governing.com. As of this writing, abortion is illegal in 10 states, though 13 others limit access. Idaho, Tennessee, and Texas will join the state bans in place as this article is published, on July 24th, 2022; Arizona and Georgia will follow in the coming months with a growing number of states curbing women’s reproductive rights. Providers may refuse to participate in an abortion procedures in 45 states. Those practitioners supporting reproductive rights are being threatened at every turn. They are becoming more reluctant to provide necessary care and treatment to women experiencing fetal demise, or where the termination of a pregnancy is clinical indicated; fear of legal reprimand and sanction may supersede patient care. Waiting periods for abortions are advancing, as are efforts restricting all types of abortions: those received across state lines, telehealth procedures, and mail access to medications that induce miscarriages. The reproductive rights scene for women, their families, and all providers who care for them, is becoming scarier by the minute. This is trauma.

Advocacy Matters

As the first 30 days of our post-Roe v. Wade era draws to a close, advocacy continues to be the antidote. The resource listing from my initial blog post on this topic is posted below for ease of access. Engage in action as you can and vote:

It is unclear what the next 30 days will bring, though there is one certainty. Trauma is now its own epidemic, and will only intensify. Amid the battle to fight for reproductive and women’s health rights, there is, and will continue to be, trauma. How much will be determined by ongoing advocacy toward action.

Trauma Amid Roe v. Wade Despair 

Amid my concern of the massive societal impact from overturning Roe v. Wade, lies the intersection of this decision’s havoc with every iteration of trauma.

Roe v. Wade has been overturned, and like many, I’m devastated. There will be mass impact of this decision across systems and sectors for generations to come. As I pondered a unique way to approach this blog post, one chronic theme came to mind. Amid my concern for all populations, lies the intersection of this decision’s havoc with every iteration of trauma.

Here are the facts: There is Pervasive Trauma

  • Vulnerable and marginalized populations live with rampant access to care obstacles; historical, experiential, and medical trauma are embedded within in the DNA of each person. 
  • The Turnaway Study released last Spring revealed stark facts of trauma’s wrath for women denied an abortion.
    • They are 4X as likely to end up living in poverty, stay with abusive partners, suffer from poor physical and mental health, plus have decreased aspirations. 
  • Collective Occupational Trauma for practitioners will further escalate as they reconcile:

There Will be More Trauma to Come

We can also expect:

  • Thousands of unplanned births and the potential for increased maternal morbidity and mortality; There will be trauma.
  • Increased mental health challenges for persons dealing with unwanted pregnancies; There will be trauma.
  • High rates of suicidal ideation, gestures, and action for victims of rape, sexual assault, and interpersonal violence who are forced to carry a pregnancy to full-term; There will be trauma.
  • A ripple effect for college-aged students facing an unwanted pregnancy, and forced to raise children on college campuses, delay, or give up hopes of earning a degree; There will be trauma.
  • Persons with chronic conditions, medical, psychiatric, and intellectual disabilities often face often life-threatening conditions when forced to maintain a pregnancy. “Abortion restrictions do not only endanger people who don’t wish to be pregnant. Many people who want biological children have conditions that put them at higher risk of adverse outcomes and miscarriages…this poses clear psychological risks, as well as physical ones”; There will be trauma
  • A rise in adverse childhood experiences scores for children born of unintended pregnancies, and for persons exposed to adverse life experiences; There will be trauma.
  • Threats to other rights and freedoms of ALL vulnerable and marginalized populations across the diversity, equity and cultural inclusion landscape; There will be trauma.

Moving Forward

Many associations and entities have already published position statements opposing the overturning of Roe V. Wade. This list of resources will fuel your advocacy energies:

ACLU

Center for Reproductive Rights

Center for Trauma-informed Policy and Practice

Guttmacher Institute

Human Rights Campaign

International Partners for Reproductive Justice (Ipas)

Keep Our Clinics

NARAL Pro-Choice America

National Abortion Federation

National Black Women’s Reproductive Agenda

National Latina Institute for Reproductive Justice

National Network of Abortion Funds

PACEs Connection

Planned Parenthood

Rape, Abuse, Incest National Network (RAINN)

Women Have Options

There are other countless other resources, and I invite all to add resources to this list. In the meantime, seek support by reaching out to each other: family, friends, colleagues, and counseling. Stay fierce, advocate, and ensure appropriate care for those in need. There will be ongoing emotions to reconcile as society contends with the new reality. We must be ready to ensure necessary health and mental health intervention, and for every person. After all, There will be trauma.

The Dismal State of Maternal Wholistic Health for Women of Color

Change is long overdue for this massive maternal health chasm of wholistic health disparities, transcending physical, behavioral, and psychosocial health, and particularly for women of color (WOC)

April 11-17th marks annual Black Maternal Health Week. There will most likely be a flurry of well-intended articles, blog posts and announcements focused on legislation, funding of initiatives and programs, and advocacy. But here’s the lowdown: Black mothers have had higher mortality than White mothers for well over 100 years. They are > 3X more likely to die from pregnancy-related complications and 2X as likely to suffer from mental health issues than their White counterparts. The impact of historical, intergenerational, medical, racial trauma is invasive and enduring. Change is long overdue for this massive maternal health chasm of wholistic health disparities, transcending physical, behavioral, and psychosocial health, and particularly for women of color (WOC)

The recent Commonwealth Fund report on women’s reproductive health reveals how severe the issue remains:

  • U.S. women have the highest rate of maternal deaths among high-income countries. The current maternal mortality ratio of 17.4 per 100,000 pregnancies, equals roughly 660 maternal deaths. This earns the U.S. last place standing overall among all industrialized countries.
  • A woman’s chance of dying in southern states is 2X greater than those in the north:
    • Alabama, Arkansas, Kentucky, and Oklahoma report death ratios of greater than 30:100,000 live births 
    • California, Illinois, Ohio, and Pennsylvania reported death ratios less than half the figures in those states, <15 deaths: 100,000 live births

Data for WOC is beyond alarming: 

  • The maternal death ratio for Black women is 37.1:100,000 pregnancies. The number is 2.5X the ratio for white women (14.7) and three times the ratio for Hispanic women (11.8).
  • Hispanic mothers were 80% as likely to receive late or no prenatal care as compared to non-Hispanic white mothers.
  • A Black mother with a college education is at 60% greater risk for a maternal death than a White or Hispanic woman with less than a high school education.
  • Even when WOC verbalize health and mental health concerns to providers, their voice is disregarded:
    • WOC are more likely than White women to express their concerns and preferences regarding births though more frequently ignored
    • Women with Medicaid report inadequate postpartum care and support, where they are:
      • Pressured to have C-sections
      • Not scheduled for postpartum visits
      • Disrespected by providers due to insurance
  • Pregnancy-related mortality rates vary across ethnic groups, yet show a constant disturbing trend:
    • Black (40.8%), American Indian/Alaska Native (29.7%), Asian Pacific Islander (13.5%), and Hispanic (11.5%) compared to Whites (12.7%).
    • Upwards of 60% of these deaths are preventable. A CDC report, reveals the often avoidable causes:
      • Infection (13%)
      • Postpartum bleeding (11%)
      • Cardiovascular conditions such as Cardiomyopathy (11%), 
      • Blood clots (9%), 
      • High blood pressure (8%), 
      • Stroke (7%), and a category combining other cardiac conditions (15%). 

Maternal Mental Health Awareness Week is scheduled annually for the first week in May, though bears mention. Not treating maternal mental health conditions costs $32,000 per mother-infant pair, totaling $14.2 billion nationally

  • Black women are twice as likely as Whites to suffer from perinatal mood and anxiety disorders, and less likely to receive treatment: 40% compared to 20-25%  
  • Indigenous women have a higher incidence of depression, anxiety, and substance misuse during the perinatal period from 17-47%; Indigenous identity increased the likelihood by 62%
  • Migrant WOC are at greater risk for behavioral health issues during pregnancies (e.g., depression, schizophrenia, post-traumatic stress) from the interaction of psychosocial determinants as forced migration plus generalized insecurity associated with experiences as refugees, asylum seekers, and human trafficking victims

Endless data validates WOC’s maternal health mandates. Recent years have witnessed robust action courtesy of fierce voices and tireless work of many entities in the US and around the globe. Their agendas serve as a clearinghouse of efforts. The list below is a starting point of resources:

The “honorary” annual week is valued, but a wholistic health crisis of this magnitude mandates far more than 7 days of attention. Distinct legislation, dedicated and substantial funding at federal, state and local levels is vital. Yet, these efforts are for naught unless the systemic racism and implicit bias that perpetuate this reality are equally addressed. We must:

  • Identify, call out, and dismantle systemic racism across macro, meso, and micro spaces
  • Develop and implement population-inclusive clinical predictive analytics and algorithms
  • Ensure dedicated quality metrics that report the necessary outcomes to drive clinical programming, treatment, and concordant practices
  • Shift the academic curriculum to better prepare the interprofessional workforce to provide population-specific care without bias
  • Continue to advance the concordant provider-base
  • Expand ethnic, racial, and cultural programming, such as reimbursement of community-based Doulas, especially in medically underserved areas.
  • Expand access to fertility treatments and address racial disparities in outcomes for IVF. Black women are more likely to have infertility compared to other races, yet the access to treatment is minimal

Data has long validated this epidemic’s emergent state, which has continued to escalate. Maternal wholistic health is a public health emergency of the highest priority. This article is just the tip of the iceberg. I invite those in this care space to post additional resources and information.

Managing the Doomscrolling Dichotomy

Doomscrolling (or doomsurfing) is a recent addition to Merriam-Webster and other dictionaries: addictive surfing or scrolling through bad news, even though negative in scope. The dynamic is impacting rising numbers of persons across the globe, along with their physical and behavioral health; this includes the professional workforce. Here are 5 ways to manage the doom scrolling dilemma.

A versions of this article was initially published by the CGI Newsletter, and appears with permission.

You have a break in the day and decide to catch up on your favorite social media feeds;  suddenly it’s 30 minutes later. What began as a look at your BFFs Facebook feed spiraled to viewing headlines, graphics, and disturbing images of recent events. You are sucked into a vortex of posts across platforms and apps, distracted from everything on your calendar: social, occupational, or education activities. Emotions bubble up: anger, bewilderment, frustration, rage, sadness. You become unable to focus, sleep, and feel crispy around the edges. Welcome to the world of doomscrolling: a dynamic impacting rising numbers of persons across the globe.

What it Means

Doomscrolling (or doomsurfing) is a recent addition to Merriam-Webster and other dictionaries: addictive surfing or scrolling through bad news, even though negative in scope.  Society has been exposed to a pervasive cycle of negative news these past two years including the pandemic, cultural, racial, and ethnic disparities, and the recent Ukraine crisis. It becomes easy to get caught up consuming mass quantities of online news in a single sitting.

The impact of these events on our wholistic health is telling. Growing studies speak to rising incidence of severe anxiety, depression, and psychological distress from over-consumption of pandemic-related media (Bendau et al., 2021). Daily social and traditional (e.g., new portals, magazines) media use exacerbates onset and exacerbation of depression and post-traumatic stress disorder (Price et al., 2022). Poor mental health negatively impacts sleep, putting further stress on the immune system; the interconnection between psychopathology and chronic illness is well-documented in the literature (Isvoranu et al., 2021).

The professional workforce walks a slippery slope with the doomscrolling dilemma, particularly those in behavioral health, integrated care, and related roles. Practitioners are faced with increasing numbers of patients seeking treatment for anxiety, depression, insomnia, and other symptoms related to the negative news cycle. Yet, each practitioner, is also a human being, striving to set limits on their own over-exposure to the media. Balancing professional self-care with respect for patient autonomy and rendering of effective treatment becomes the sharpest of double-edged swords. Professionals must limit their (over) exposure and potential collective occupational trauma, while intervening effectively with patients: an ethical dilemma of its own!

Why We Do It

            One quick answer is, misery loves company. Reading about negative events validates negative feelings felt by individuals. The more one seeks to satisfy this need, the more doomscrolling advances to addictive habit. Striving to stay informed about current events devolves into a vicious cycle where stress increases and cortisol levels rise. A myriad of health issues can result: increased blood pressure and glucose levels, migraine headaches, insomnia, or autoimmune disorders (e.g., lupus, multiple sclerosis, rheumatoid arthritis, Sjögren’s syndrome).  


What to Do About It

Here are 5 strategies to inform your efforts:

  1. Limit Social Media Bandwidth: Read one article in the morning, listen to a podcast from that favorite platform (or news outlet) you trust. 
  2. Take Social Media Breaks: Don’t get sucked in or your energy will be sucked out. You may stay off social media certain times of the day, or for longer periods of time (e.g., during the workday, weekends, or for several months).
  3. Use Body Scanning, Breathing, and Other Trauma-informed Tactics: Doomscrolling can trigger prior traumas. A colleague recently shared how use of trauma-informed interventions made the difference, for both clinician and patient. Regular body scans are an asset: take that nice deep breath, then start at the top of your head and move down your body. Note any sensations that appear: ringing in your ears, pressure around or behind your eyes, a tight neck or back, tingling in your chest or gut. 4-7-8 breathing is an asset as well. 
  4. Sleep Hygiene Strategies: Doomscrolling and insomnia are a dyad. Sound strategies that address both disruptors include:
    • Declare a screen-free sleep space.
    • Keep traditional items nearby, such as a notepad or book. Jot down thoughts that wake you up or read to tire your eyes without using a digital screen.
    • Detox devices by turning off notifications and removing apps; block apps and distracting websites using Freedom or other like-platforms. 
    • Avoid heated or emotional posts within an hour of bedtime
    • Keep screen-free hours one hour prior to bedtime and over the sleep cycle.
  5. Stay Proactive and Consistent: It is easy to fall off the Doomscrolling wagon. Stay vigilant; like any addiction, it won’t take much to fall down the rabbit hole and re-engage. Take control of doomscrolling before it takes control of you!

Have other thoughts? Feel free to add them below!

Workforce Trauma, Shortages, and Retention are Interprofessional Challenges: Resolution Tactics

Disregard for the health, mental health, and well-being of all members of the workforce is a grave concern. What tactics can be implemented?

The full scope of professionals must be recognized for their sacrifices and dedication to patient wellness; anything less is unacceptable.

 One year ago, I wrote how the pandemic, and other societal narratives prompted a new dimension of collective occupational trauma; an already worn workforce was forced to wrestle with constant and intense levels of suffering. As we enter 2022, and year 3 of COVID’s wrath, this trauma remains unrelenting. Pervasive burnout, retention issues, and staff shortages are ravaging disciplines and settings, cumulative costs into the billions. These realities put quality patient care at severe risk.

     Global data emphasizes the impact of chronic and recurrent COVID-waves for front-line physicians and nurses; no doubt these disciplines have endured, and continue to take a powerful hit; >80% ready to leave the industry. The ‘Great Resignation’ is decimating healthcare, the sector experiencing the largest job transition rates and among the highest number of job openings. Concern exists whether there will be enough practitioners to render care. However, what of other disciplines? Disregard for the health, mental health, and well-being of all members of the workforce is a grave concern.

The Entire Workforce Mandates Attention

     The health and behavioral health workforce is vast and comprises many professional disciplines: behavioral health professionals (behavioral analysts, counselors, social workers, psychologists), case managers, community health workers, medical assistants, nutritionists, pharmacists, phlebotomists, psychiatrists, public health workers, rehabilitation professionals, and respiratory therapists, etc. Valued personnel are also employed by other sectors (e.g., schools, businesses, prisons), such as teachers, occupational health, and school nurses, to name a few. Each of these groups have suffered more than their share of deaths, illness, and long-haul syndrome disability; the mental and emotional toll of their work yielding intense emotional trauma across:

Despite these graphic realities, too many personnel are excluded from industry/employer recognition for their contributions to the pandemic, whether awards or merit raises. Even media focus on these individuals is limited. A recent article discussing, hazard pay, focused on nurses and doctors alone; why are others not deserving?

     A vicious cycle unfolds where stressed, underappreciated team members experience a higher incidence of negative mood, emotional exhaustion, and thus, increased medical errors. More than 250,000 medical errors and 100,000 deaths annually were attributed to workforce frustration pre-pandemic; poor team member communication and fragmented care ensued with a ripple effect of order entry mistakes, medication, and treatment missteps, among other occurrences. Considering all the disciplines to interact with patients, at what point does the risk to patient care become too great?

Professional Advocacy is a Mandate

     There must be greater advocacy and action to acknowledge the vital interprofessional contributions rendered by entire workforce. Professional associations, their leadership, and those in positions to do so, must assert influence to promote the value of their requisite members. Language promoting self-care and professional advocacy has started to appear in standards of practice and ethical codes. However, these efforts must continue to amplify. Many colleagues actively use their social media presence to write articles, blogs, and other messaging to lead this charge; more must join the discussion and advocate for action through employers, and the industry overall. Media attention to this cause must be swift, fierce, and consistent.

There must be collective accountability across the professional landscape to acknowledge, and reconcile this issue, spanning academia, credentialing and regulatory entities, professional associations, and of course, employers. Workforce sustainability directly impacts quality health and behavioral healthcare, ultimately saving lives and dollars. Reaching this goal takes the expertise and contribution of each interprofessional team member.

How this goal is accomplished varies across each setting and far from a cookie-cutter approach, spanning:

  • tangible acknowledgements and recognition (e.g., free staff meals, merit raises or other benefit enhancements, staff appreciation awards, weekly formal and informal “shout-outs” of workforce contributions)
  • investment in staff professional development, as in payment for professional association dues, credentialing, continuing education
  • implementation of on-site mental health programming
  • scheduling teamwork celebrations
  • flexible scheduling as possible
  • plan departmental/organizational townhall meetings with actionable items and follow-up on deliverables
  • ensure staff mentoring and support programs
  • have informal staff-check ins
  • effective communication by leadership with staff (include the why of each action)
  • provide a culture where all persons, and their input are valued and respected
  • deliver and demonstrate consistent verbal appreciation
  • ensure professional regulations, credentialing entities, and associations highlight professional self-care and advocacy in all standards, and hold requisite workforce members and employers accountable to uphold the language
  • set a tone of mutual respect in academia and education programs through collaborative programs, events, and classroom activities (e.g., co-teaching across disciplines and programs) that empower interprofessional learning
  • implementation of Trauma-informed Leadership models and strategies (PS: my last blog post will jump-start this action)
  • Have other ideas? Add them below in the comments section

The full scope of professionals must be recognized for their sacrifices and dedication to patient wellness; anything less is unacceptable.

This blog post originally appeared on PACEsConnection

Bio: Ellen Fink-Samnick is an award-winning industry subject matter expert on interprofessional ethics, wholistic health equity, trauma-informed leadership, and supervision. She is an esteemed professional speaker, author, and knowledge developer with academic appointments at George Mason University and the University of Buffalo. Ellen is a clinical supervision trainer for NASW of Virginia, and serves in national leadership and consultant roles. She is also a Doctoral in Behavioral Health Candidate at Cummings Graduate Institute of Behavioral Health Studies. Further information is available on her LinkedIn Bio and website

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