Health Equity: A Systemic Approach to Social Determinants and Trauma

This is Part 2 of a 2-part series. You can access Part 1 here.

How To Gain Positive Outcomes?

As we all continue to be impacted by the worldwide pandemic and other world events, I was thinking about Direct Support Professionals (DSPs) and their supervisors. I was pondering ways to assist therapists, clinicians, and other DSPs in gaining a better understanding for utilizing the communimetric tools (see Part 1), such as the Child Adolescent Needs & Strengths or CANS, directly in the work. So, I began to jot down some ideas and framed them around the conceptual framework of Transformational Collaborative Outcomes Management or TCOM. The goal of TCOM is to assist the human-services field to center the work around managing systems, organizations, as well as programs whose ‘shared-vision’ is support meaningful changes in the lives of those we serve.

Then I found myself connecting my own with experiences using CANS and my systemic training as a marriage & family therapist. What I was doing was melding my MFT world with my CAN-TCOM world and suddenly a real clarity came upon me. CANS, TCOM and Family Systems became the perfect trio.

My formal clinical training began at Seton Hall University back in the early 1990s, with my studies in marriage and family therapy. I read the theoretical work of Virginia Satir, Jay Haley, Salvador Minuchin and Murray Bowen. These systems theorists offer elegant theories on the development or causes of concerns as well as the solutions to elevate pain and suffering with regards to the human experience. It was then that I began to truly see the world and the people in it, including myself, through a systems or systemic lens.

What Role Does Early Trauma & Social Determinants Play In Health?

Fast forward to today and these theories are more applicable in understanding or framing the context of the challenges individuals are experiencing.

What is the Impact of Social Determinants and Trauma?

So, what is different today? There are systems and systemic impacts which have not been included within these packaged theoretical orientations. Some examples of what we know have impacts on our physical, psychological, and emotional/social wellness are Adverse Childhood Experiences or ACEs and Social Determinants of Health (SDoH, see Part 1 for descriptions).


Steps Towards Achieving Health Equity through Social Determinants of Health

Social Determinants of Health (SDoH) are factors which influence the quality of health of a specific population. In another way to look at this is from a societal influence and impacts of restrictions on groups, especially Black, Indigenous, People of Color (BIPOC). These restrictions lead to lack of freedoms which lead to social determinants of health outcomes. For example, the freedom not to die from a preventable disease, the freedom to eat properly, the freedom to find adequate housing, the freedom to read and write, the freedom to achieve Abraham Maslow’s highest level on the hierarchy of needs pyramid or self-actualization. The top level relates to that individual having the opportunity to use their talent, and a chance to go where those talents might lead.

What is family system therapy?

When we really think about the goal of any therapy, but especially family system therapy, it is the ability to assist in transforming the lives of those we serve. Psychotherapy is a general term for treating mental health problems by talking with a trained mental health professional. It is during psychotherapy the individuals learn about their condition as well as their moods, feelings, thoughts and behaviors. Psychotherapy helps people learn how to take control of their lives and respond to challenging situations with healthy coping skills. There are many ‘types’ of psychotherapy, each with its own approach. The type of psychotherapy that’s right for someone depends on their individual situation. Psychotherapy is also known as talk therapy, counseling, psychosocial therapy or, simply, therapy.

How do we demystify therapy?

As a practicing Marriage & Family Therapist for two-decades being trained and supervised from a Multi-Cultural Family or Bowenian Family Therapy perspective, it is essential to gain a full understanding of the person in treatment. Information gathering becomes a collaboration in communication where rapport building can be accomplished. The CANS and TCOM can immediately assist in the development of ‘partnership’ with those being served. Often I was being told by those being served, that by collaborating with them, defining and monitoring improvements or outcomes, it ‘demystified’ therapy and ‘normalizing’ the processes. Positive outcomes in treatment resulted but just as important was an empowerment back to those who often felt helpless and hopeless.

Health Equity Determinants


Systems-Regularly Interacting or Interdependent Items Forming Unified Whole

A system is said to consist of four things:

  • First are objects – the parts, elements, or variables within the system. These may be physical or abstract or both, depending on the nature of the system.
  • Second, a system consists of attributes – the qualities or properties of the system and its objects.
  • Third, a system had internal relationships among its objects.
  • Fourth, systems exist in an environment. A system, then, is a set of things that affect one another within an environment and form a larger pattern that is different from any of the parts.

What is Family Therapy?

A family’s patterns of behavior influences the individual and therefore may need to be a part of the treatment plan. In marriage and family therapy, the unit of treatment isn’t just the person – even if only a single person is interviewed – it is the set of relationships in which the person is imbedded.

 Family therapy is:

  • § brief.
  • § solution-focused.
  • § specific, with attainable therapeutic goals.
  • § designed with the “end in mind.”

Who are Marriage and Family Therapists?

Marriage and Family Therapists (MFTs) are mental health professionals trained in psychotherapy and family systems, and licensed to diagnose and treat mental and emotional disorders within the context of marriage, couples and family systems.

Marriage and Family Therapists broaden the traditional emphasis on the individual to attend to the nature and role of individuals in primary relationship networks such as marriage and the family. MFTs take a holistic perspective to health care; they are concerned with the overall, long-term well-being of individuals and their families.

What is Bowenian or Multigenerational Family Therapy?

Murray Bowen, a psychiatrist, originated this theory and its eight interlocking concepts. He formulated the theory by using systems thinking to integrate knowledge of the human species as a product of evolution with knowledge from family research.

A core assumption is that an emotional system that evolved over several billion years governs human relationship systems. People have a “thinking brain,” language, a complex psychology and culture, but people still do all the ordinary things other forms of life do. The emotional system affects most human activity and is the principal driving force in the development of clinical problems. Knowledge of how the emotional system operates in one’s family, work, and social systems reveals new and more effective options for solving problems in each of these areas.

How Do We Connect All the Pieces Together?

So how does this all connect the CANS and goal of TCOM with family systems therapy? I see it as a perfect continuum of connecting the work that we do as therapists/clinicians. We begin first to define what it is we are attempting to accomplish. We define the parameters from which are work is to be done. All this is being done with a full understanding from everyone’s perspective. As outlined on the, using the communimetrics tool or CANS:

Child and Adolescent Needs and Strengths (CANS) is an assessment strategy that is designed to be used for decision support and outcomes management. Its primary purpose is to allow a system to remain focused on the shared vision of serving children and families, by representing children at all levels of the system.

The ‘system’ in this definition is the ‘child-serving system’ which to maintain a shared vision must partner with the youth and family throughout the process. The CANS is a communication tool that is the conduit for getting at a comprehensive shared vision. It helps define the necessary steps to meet the outlined goals of treatment. TCOM is the framework for which this work is being done.

Is this the essence of systems theory?

The view of an individual within the context of their family, living within a community, internalizing life through cultural lenses and all this connected to a larger societal influence (bio-ethno-gender-socio-economic status). All of this provides, the most plural, ‘US’ with the information needed to effectively do our work while transformationally empowering those we serve.

Ken McGill EdS, LMFT- Opeeka’s Solution-Focused Care Senior Scientist. Served within New Jersey Children’s System of Care (NJCSOC) 17 years out of the 20 years statewide implementation. He came to Opeeka from Rutgers University-University Behavioral Health Care-Behavioral Research Training Institute serving as the statewide trainer on Wraparound, the fundamental evidence-based practice offered throughout the NJCSOC, and the Child and Adolescent Needs and Strengths (CANS) curriculum. Ken was the 2013 recipient of the Praed Foundation’s Outcomes Champion (TCOM/CANS) Award for his work in children’s systems of care and outcomes management. He has more than 20 years of experience in marriage and family therapy, education & research and was the longest serving President of the New Jersey Association for Marriage and Family Therapy (NJAMFT). [email protected]