Unintended Consequences

Hi Patrick,

CQI and root cause have a valuable place in this discussion and allow for an interesting thought experiment using a basic metaphor.  Root implies there is a seed and suggests there is an observable output (sprout) from the seed.  Roots connect the life cycle of the seed to the observable output (sprout).   To properly produce the desired output we have to look at the system, which includes the sprout, root, and the seed.  Without the seed there can be no root, without the root there can be no sprout.  Adversity is, statistically speaking, a common factor in health/social/and other detriments to quality-of-life.  Is adversity the root, the seed, or the sprouts?   Do you believe adversity is a root?  If so, what is the seed? 

For thorough systems analysis (and intervention), we have to dig deeper (no pun intended) and take a look at which seeds are finding fertile ground.  Which seeds do not find fertile ground?  What do the fertilized and unfertilized seeds produce?  I would submit that the extent to which we do or do not analyze the  observed output(s) in the preceding manner will predict the nature of consensus, influence the depth of understanding around "adversity," and will frame the solutions proffered and those given consideration or marginalized. 

In addition to the distribution of observations (outputs) as an indicator of system status, we also have to look at relative skew/clustering in relationship to the varied demographics and other variables under consideration.  Which gets us back to the preceding paragraph and its questions that would incorporate a mixed-methods approach to explain what the numbers show.  What should we be measuring in a prevention framework?  The presence of roots, the proliferation of seeds, the presence of spouts?  This is where I believe some of our discussion around "adversity" and "healing" needs more actionable depth and breadth, at this time. 

I, along with many others, do not believe it is the nature of man or human nature to inflict oppression and adversity on others.  Indeed, given incubating circumstances (fertile ground), we are all capable of embodying any number of depravities.  That is capability, not nature.   I happen to believe that barring some genetic or neuro/chemical/physiological malfunction, man is born whole, healthy, and fully capable (by nature) of receiving and transmitting peace.  What happens along the way?  The answer is not a mystery....epigenetics and socialization.  Are these roots, seeds, or sprouts?

Thank you Pamela and Pam for thoughtful comments that add a lot to the conversation. Your comment about systems decision thinkers is especially appealing to my thought processes, Pamela. As a CEO, I began to understand systems thinking and linkages through the management system I adopted, referred to in the U.S. as "Lean Management." The 2 major premises of Lean are "Respect for People" and "Continuous Improvement." Coupled with other management principles, I came a conclusion that we needed to identify a root cause for problems. The ACE Study results fit a root cause analysis for both driving behaviors and negative health outcomes. Then I began to understand Dr. W. Edwards Deming's concept of statistical analysis. Dr. Deming promoted the use of Control Charts to identify what, in a system, is common cause and what is special cause. He defines common cause as the normal outcome of a system and statistically measurable within a range of 3 standard deviations both above and below the mean. Special Cause is defined as being outside of that range.

Although this explanation is somewhat complicated by statistics, the basic point Dr. Deming made is that you cannot interfere by addressing Common Cause unless you are addressing systems problems. Otherwise, you actually increase "Variation" within the system. That only means that the range of a standard deviation increases and more defects and problems are created by the system. 

My conclusion is that we need to address a reduction in the infliction of ACE's as a public policy matter, and adopt a Problem Solving Healing solution that addresses what Toxic Stress does to our behaviors and our body. And I typically argue that until we get to a serious discussion by those who understand the problem very deeply, we will not reach the type of consensus that allows us to move forward with implementation and study of different proposed solutions.

So, Pamela and Pam, I guess what I am saying is that we, as different thinkers, have to continue to educate our politicians to consider a different response to negative behaviors than punitive ones. Thank you for sharing your thoughts.

Jane Stevens posted:

Hi Denise -- Do you have a reference for the "recent admissions by a Nixon aide..."

Thanks!

Cheers, Jane

Hi Jane,

I believe it is important to acknowledge both the work that is being done to ensure accountability and truth while acknowledging the truth of the work that still needs to be done and those who still need to be held accountable.  Following is a first hand account of Ehrlichman's admission.  An admission from 1994...twenty years (and millions of affected lives/families ago). There are multiple other sources analyzing the admission and its implications for admitted "intended" consequences, in this case, and, dare I suggest other "unadmitted" cases as well.   Patterns are not proof positive, yet we (everyone) use patterns as sufficient probability for universal precaution and prevention.  

First hand interview: http://harpers.org/archive/2016/04/legalize-it-all/

Plus: http://www.cnn.com/2016/03/23/...g-war-blacks-hippie/

Hi Denise -- Do you have a reference for the "recent admissions by a Nixon aide..."

Thanks!

Cheers, Jane

Thank you for this blog post about Unintended Consequences.   It is good to finally see serious policy action follow discussion about zero-tolerance/compliance-at-any-cost disciplinary policies in education.   The suspension practices feed the "school-to-prison pipeline" with out-of-school time being an opportunity for youth to get caught in unhealthy behaviors.   The delay in moving beyond conversations to corrective action took too long and cost too much-- both in $$ and in human life.  A cost highlighted in the articles you shared about education and addiction. 

It is no footnote to mention, recent admissions by a Nixon policy aide declare they knew exactly what they were doing and calculated the racial consequence of creating the perception of criminality ("welfare queens", "dead beats"), erecting a crime culture (crack, scapegoated Freeway Ricky) and then broken-windows policing (the Drug War declared during a record low drug use).  In a related point, I heard Bill Clinton recently defend the continued rise in imprisonment related to his (and Nixon's and Reagan's) criminal "justice" policies by saying folks in poor neighborhoods wanted the crime to stop.  Naturally, the lay citizen believed that getting the "criminal" out of their neighborhood would solve the problem...though typically only a few lay citizens are repeat violent offenders.  Thus, somehow Clinton felt he was answering their request by mass incarceration.  This suggests his analysis of the situation was only as wise and informed as the people in crisis.  Yikes and malarkey! 

The question is, do we agree that policy makers, thought leaders, public figures/newscasters should and must be AND demonstrate more ecological and cultural-historical knowledge than the average person?  Are we (who?) obligated to ensure our systems decision makers think deeper, have more nuanced (humane/historically accurate) beliefs, and act from a more informed perspective?  How do we define and measure "informed?"  And then, what professional, civic, and socialization/preparation is necessary to ensure decision makers and lay folks have a humane end-in-mind socialization and subsequent way of being in the world?  I welcome your thoughts.

Invitation to community?  Promote vulnerability, grow empathy, heal shame, create love and connectivity.  

Confirmation bias?  Probably. Important to always look at what happens before what happens happens.  As much as I appreciate the ACE study, let's cut to the chase and play in the deep end of the pool if we want to be TRULY effective.  Floaties optional.