This meeting is now being recorded. All guests have been muted. I'm very briefly. I'm Caitlin Howley and I'm working enough to serve as the Associate Director of the Appalachia Regional Comprehensive Center or the ARC. ARC is one of 15 regional centers funded by the U.S. Department of Education to provide capacity building technical assistance to state departments of education. The ARC serves Kentucky, Tennessee, Virginia and West Virginia. And now I'm really delighted to introduce today's presenter, Kai Schaft. Kai is an Associate Professor of Education in the College of Education at Penn State University and the Director of Penn State Center on Rural Education and Communities. He's also the editor of the Journal on Research in Rural Education. He's trained as a rural sociologist and his work focuses kind of broadly on the intersection between social inequality and spatial inequality. He's interested in morality. His major areas of research include the interrelationship between rural poverty and student transancy, context for rural use development, farm to school program implementation and rural health outcomes. So you have a sense of where we're going today. I'm gonna talk about what our objectives are, which are pretty simple and straightforward on the surface anyway. To consider and discuss rural sociocultural dynamics, how they might arise and how they might show up in your work with rural school districts. And then second, to consider and discuss issues state departments of education might think about as they work with rural districts. So let's get rolling. I'm gonna turn things over to Kai now. Kai, it's all yours. Wonderful, thank you so much, Caitlin.  That was a great introduction. And yeah, so I guess what I'd like to do today is to talk about the context of rural schools and rural communities and how that context might affect the way that state and federal educational reforms might be received by rural communities. And what that in turn may imply for how state departments of education interact with and assist rural school districts. So I really do hope that this presentation will be of use to all of you. As Caitlin said, I do direct the center on rural education in communities at Penn State. And this is based within the College of Education. And what the center does is really sort of a combination of research and outreach, all of which focuses on the intersection of rural schools and rural communities with a specific focus on the relationship of between the well-being of each, how the well-being of rural schools translates to rural communities and vice versa. And I also there, as Caitlin mentioned, edit the Journal of Research in Rural Education, which is sort of the, probably the premier scholarly journal on rural education, both domestically and perhaps even internationally. So what I'd like to do is to break this talk into four parts. First of all, I'd like to talk about what is rural and building off that, talk about what is rural education. And I hope that you'll bear with me on this because I think that in order to talk about these broader issues of how state departments of education might interact with and assist rural school districts, it really is important for us to spend a little bit of time talking about how we might understand rural and how that affects the way that education and educational reforms are perceived. Then I'd like to talk about some key issue areas for rural schools and communities and finally wrap up with an example of local responsiveness to educational reforms and some concluding thoughts. So to begin a conversation about rural education, I think it's really important to simply ask, is rural? And the reason for this is that rural is one of those tricky concepts that seems so intuitively obvious, but it becomes less obvious the closer that you examine it. And to my mind, there are a few reasons why this is a tricky concept. First of all, there are multiple institutional ways in which we can define rural. Definitions that typically rely heavily on population size, concentration and density. For example, the metro non-metro distinction used by the Office of Management and Budget, the US Census definitions or the MCES metro-centric locale codes used in the Common Core data. So for example, with census definitions, rural refers to open country and settlements with less than 2,500 people. So by this definition, as of a couple of years ago, about 19% of the population could be considered rural by residents down from about 21% 10 years ago. Despite population concentrations in urban areas, the other side of the coin is that really geographically, the US remains a highly rural country in terms of the sheer landmass, as this map suggests that shows the urbanized areas and urban clusters and all the other geography that is not rural. So by contrast, the Office of Management and Budget designates counties as metropolitan or micro-pollutant depending on the size of the urbanized areas within them with all the remaining counties designated as non-metro. So using these criteria on metro territories, not as extensive as the rural territory, but still significant, about 75% of the US land areas non-metropolitan, about 16% of the population resides in non-metro areas. But this really has its operational limitations. So I live in Center County, Pennsylvania, which is where I'm speaking to you right now. And that is right in the middle of Pennsylvania, it's where Penn State is based, and it's a metropolitan county. But it also contains some recognizably rural places. And so the picture that I'm hoping that you're seeing with the Amish buggy right there is that could be taken a mile from my house. And yet in terms of its metropolitan status, Center County is indistinguishable from Philadelphia County or San Francisco County. And then there are the MCES Common Core of Data, Urban Centric Locale Codes, which are based on a place's proximity to centers to find urban areas and classifies territory into four major types, each with three subcategories allowing for greater precision in classifying areas. So there's lots of different ways of sort of officially defining what rural is, but one criticism of all of these approaches is that rural remains a residual category. That is, it's defined according to what is not rather than what it is. And in so doing, it tends to, this residual category tends to obscure significant within category variation. Now, I think perhaps more germane to our discussion today, we can think about rural as defined in symbolic terms. And with this, we begin to move away from the way that policy makers think about rural to the way that rural people themselves think about where they live and what that means to them, as well as the images that non-rural people have of rural America. So that is places are not only rural because of a particular structural or demographic or environmental characteristics, but because people who live there think of themselves as being rural with respect to a set of social, moral and cultural values. So a number of years ago, I heard Mike Arnold, who's a longtime figure in the rural education research world, he once said that when you lock your car on Sunday as a church to keep your neighbors from putting zucchinis on the seat, you know you're probably in a rural place. And I've heard other people talk about rural in terms of the distance one has to drive to go to a Walmart or a McDonald's or even a Starbucks. And it turns out that while about 82% of the US population lives within a census defined urbanized area, approximately the same population, proportion of the population lives within 20 miles of a Starbucks. I think though more to the point a few years ago, I was traveling around to different rural communities conducting focus groups as part of a larger study. And I frequently heard comments like the following. So this one focus group member says, a lot of times I think this type of community is somewhat bred into these kids. And I'm from experience in that you want to sometimes come back to where your roots were and raise your kids how you were raised. So even though they want to get away and go to college or go wherever, I think long term, some of those kids usually end up back in this community or in another one like it, like in my case.  Anyway, one of the facts that my middle son put down was that he was raised on dirt roads and that's where he wants to raise his kids. So there are strong positive symbolic associations with morality, linking it to family and community, neighborliness, closeness to nature, as well as associations with the American iconography of the frontier and individualism and self reliance and this kind of thing. But at the same time, it's also really important to acknowledge the equally persistent negative stereotypes of rural as backwards, second rate, pre-modern or even anti-modern stereotypes that may also affect how rural people see themselves and how others view them. And you know, it's really interesting. I don't have TV at home, but I spent last week at a series of meetings out in Idaho and when I travel and I stay in a hotel room, I watch TV and it's really interesting to me how it seems as though in the last couple of years it's just been this real explosion of these rural reality shows.  But, you know, when I was in my hotel room last week, I was watching the show about the Amish Mafia and Call of the Wild Man and of course you can think about like Buck Wilde and Duck Dynasty and Honey Boo Boo, it's quite interesting. And I think that these shows really tie into some of these more negative stereotypes about rurality. Now, you know, I can give you another example from the standpoint of educational administrators. When I first got to Penn State and started directing the center, one of my colleagues said, you know what you really should do is perhaps organize a set of courses around which we can form a rural specialization certificate for our educational administrators who are going through the educational leadership program. And so that seemed like a reasonable enough idea to me and I talked to a couple of different people about it and ultimately I went to the executive board meeting at the Pennsylvania Association for Rural and Small Schools and the board members were all made up of rural superintendents. And it was really interesting to float this idea by them because I could just, they sat there kind of stony-faced and they knew me and they liked me and they didn't want to let me down or anything like that. But finally one of them said, you know, Kai, we appreciate what you're doing here and we understand what you're doing but the reality is that this rural specialization certificate wouldn't help us. In fact, if anything, it would hurt us because as rural superintendents and rural educational leaders were already perceived as not being able to handle the larger school districts and the urban school districts even though arguably you need much more finely tuned management skills because of all the additional things that you have to do with fewer resources. And so this certificate would paint us into a corner and typecast us as rural and limit our mobility. So I found that very interesting. So how might these images and identities and associations translate into the ways in which local people react to educational reforms and or state assistance? And I think that we can reasonably imagine a couple of different possibilities including the implicit message that rural schools need to fix things somehow so that ties into the idea of rural as deficient or rural as backwards. The resistance to having local control and decision-making undermined. The belief and especially in historically working class communities that higher education credentials are not necessary to be self-sufficient. And in fact, maybe those credentials are even an indication of one's lack of ability to be successful in one's home community. And finally, the resistance to taking marching orders from outsiders who may have only limited understanding and a lack of responsiveness to rural needs and assets. And with this last point, I sort of think about the example of the investing in innovation or I3 grants which is a competitive federal grant program supporting innovation in public schools. And so to encourage projects focused on rural education in the first round of grants in 2010, the Department of Education offered two bonus points in the scoring system for projects that were somehow focused on the unique challenges of rural educational contexts. So among the 49 grant recipients, 19 or 39% made this claim that there was some sort of rural component to this. But most applicants did not propose using innovations that originated in rural schools and had had little or no prior use in rural schools. And only two proposals were designed to operate entirely in rural schools. And in one instance, there was actually no intent to engage in any rural school district whatsoever. And one of the winners was the Board of Education of the City of New York City, School of One proposal. So in short, underdeveloped municipal and administrative capacity tends to disadvantage rural districts left to compete with more densely populated areas for resources. And at the same time, the federal policy environment often demonstrates an inadequate understanding of rural needs and resources. So lastly, thinking about rural and nailing down what rural is, is the remarkable diversity of rural people and places. And this goes back really to the criticism of rural as a residual category. And it also has implications, I think, for educational reforms that are constructed or perceived to be constructed with urban areas in mind or as one science fits all approaches. So as an illustration, let's take a moment to look at some photographs from the part of the country I'm in, which is the Mid-Atlantic region and the background of these slides, you see a photograph of a barn in rural New Jersey and we can probably all agree that this looks rural. And yet, here's a photograph of Tidewater, Maryland, which I think we could also describe as rural. But we can leave the Mid-Atlantic region and encounter a whole range of rural contexts in terms of histories, economies, demography, landscapes and culture, including Appalachian, West Virginia, the Black Belt of the Deep South, the Great Plains, the Rocky Mountain West, on out to the West Coast, and here's a picture of Nia Bay, Washington home of the Maca Nation. And last, probably the most rural place I've ever been, Deep Springs, California, yet at the same time, located in one of the most urban and populated states in the nation. So what does this all mean for rural education? Well, rural schools and educational contexts obviously share a lot of characteristics and issues with non-rural contexts and we can do sort of a laundry list here and they include issues around academic achievement, English language learners, dropouts, turning around low-performing schools, parental engagement, but rural educational contexts are also associated with issues that if they're not unique to rural education certainly are disproportionately characteristic and I would argue that some of these include things like technology and distance education, school community connections, teacher and administrator recruitment and retention and again, I remind you of this whole notion of rural as a low status administrative appointment. Demographic change and institutional capacity and regarding the last point, the issues associated with institutional capacity and rural school settings don't just have to do with smaller school sizes, remoteness, and difficulties with teacher and administrator recruitment and retention, but with poverty. So we often think about poverty as an issue that principally affects cities and yet it often comes as a surprise to many people when they learn that in this country, non-metro poverty rates have always been higher than metro poverty rates. In fact, only central city poverty rates are higher than non-metro rates. So this is an issue not only for institutional capacity, but also in terms of the student populations enrolled in rural schools and the kinds of issues that they bring to the table. Among the 10 states with the highest incidence of poverty, 36% of students and 57% of school districts are located in rural areas. Over 26% of children in non-metro America currently live in poverty, an increase of about 4.5% from just five years ago. Title I of the Elementary and Secondary Education Act is the primary federal program designed to provide additional resources to schools serving economically disadvantaged students, as you know, with funds dedicated towards improving student academic achievement. But many rural education advocates have protested that the formula governing the disbursement of Title I funds is weighted in ways that significantly disadvantage rural school districts in addition to many small city high poverty. So Marty Strange, for example, notes that in Virginia, Fairfax County with a 6% poverty rate gets more Title I money for each disadvantaged student than rural Virginians, Lee County Public Schools with a 33% poverty rate. So this again, I think, speaks to the ways in which federal education policy can be interpreted as not being entirely responsive to rural needs and realities. And by extension, the ways in which rural stakeholders might respond to various federal and state level reforms and policies. So let's turn to a few key issues of rural education. And the first and one of my favorites is the rural school community connection. So rural schools have tremendous symbolic importance to rural communities and they function as a key site of civic interaction and intergenerational identity. And I think a really excellent example of this was once when I was visiting a school in rural Eastern Washington state and I was conducting some focus groups and I was between focus groups and I wandered out into the atrium of this high school and I looked up at the wall and there was a photograph, a portrait of the graduating class from the previous year. And I looked next to it and there was a class from the year before that and the year before that and the year before that and I walked along the wall of this atrium down one wall, down the next wall and down the third wall until I got back to 1916. And it was remarkable to me that here were all the photographs of the people who had graduated from this school and I went into the next focus group and I said, you know, I gotta tell you, I was just out there taking a look at the graduating class pictures and that was really cool. And I said, you know, I bet that some of you all were up in those photographs and this was a focus group of community members and they said, oh yeah, yeah, we're up there. Our parents are up there. Our uncles are up there. Our teachers are up there. And it just, it really gave me pause to think about what that experience must be like to grow up in that kind of a community and go to that kind of a school and see the pictures of your parents and your teachers on the wall and know that one day your picture will probably be on that wall as well. Well, rural schools are characterized by their relatively smaller size. So nearly 64% of schools in rural areas have 400 or fewer students, but the same is true for only 39% of city schools. And similarly, while only about 16% of students in cities attend schools with 400 or fewer students, in rural areas overall, nearly one third of students attend schools that size. Parents of rural students are more likely to attend school events or volunteer on school committees. Teachers in rural schools also report fewer problems with students in higher levels of job satisfaction. And in many rural places, the school is often an area's largest employer. So because of these characteristics, rural schools are often described as fostering especially strong social ties given their smaller size and the close linkages to the communities that they serve. And I think that it's really important, particularly in the light of some of the negative stereotypes of rural to seriously consider these characteristics and the way that they represent I think unique assets of rural schools. The presence of a school within a community can also be strongly related to elevated indicators of broader social and economic welfare, including housing values and local employment. So this means that those in positions of leadership within a rural school district, including the superintendent and school board members, they necessarily assume not only educational leadership roles, but local community development roles as well. So therefore those in leadership positions within rural schools, not only are the subjects of public scrutiny, but they're far more frequently required to assume community outreach roles and hone community relationship building skills in ways that are less common than within urban settings. So in other words, much more so than in many other places, the relationship between rural schools and the communities they serve is a deeply symbiotic relationship. Healthy schools beget healthy communities and vice versa. Alternately, this is one of the reasons why the threat of consolidation and school closure is so controversial and anxiety provoking in rural areas because of the ways in which schools play such critical local economic, symbolic and social roles. So how educational reforms have the potential to disrupt rural relationships? Well again, we can think about a couple of different ways in which this might take place. So we can ask things like what are the implications of accountability measures, teacher evaluations, performance incentives, critical friend professional development, and so forth in the context of communities where everyone knows everyone. How might accountability measures, especially in small schools, inadvertently create new kinds of exclusions? So performing children and their families, how are they gonna be treated if they're seen as liabilities to this school? And this brings to mind a conversation I had with a rural superintendent in New York State when I was doing my dissertation research and I was interviewing him about transient students coming in and out of his district. And I asked him, what kind of programs do you have in place set up for these students to help stabilize them? And his immediate response was stabilize them? Why would we wanna stabilize them? We don't even want them here. They're not our students. Finally, the threat of school closure or consolidation. Perhaps as a consequence of underperformance has real implications for rural people and communities. And I know that during the 90s, West Virginia went through a fairly massive process of school consolidation. So that has real impacts for how local people view these kinds of reforms and policy moves. So let's talk now briefly about student achievement and post-secondary transitions. So a body of scholarships suggests the social and academic benefits of smaller school environments. Although others have argued that rural schools, by virtue of their decreased size and capacity, are maybe less able to offer the breadth curricular options in comparison to their urban and suburban counterparts. I think this may be offset a bit by distance education and this kind of thing, but in any case, overall data suggests that rural schools tend to perform relatively well in academic assessments in comparison to their urban and their suburban counterparts. So in general, if we look to the national assessment of educational progress, reading and mathematics scores, only suburban schools really outperform rural schools. But the figures are not so promising when it comes to post-secondary transitions and college enrollment. And these barriers include things like cost, the physical proximity to higher education institutions, the mismatches between college degrees and local labor market needs. That is, can you use a college degree in your home community? And the potential for lowered expectations and aspirations in terms of post-secondary degrees among rural parents. And a recent study by Su Yong-byun and colleagues, presents some data about student achievement and post-secondary transition and lays out the achievements and the differences between rural suburban and urban places. So we see some of those data there. So how might we understand the relatively good secondary achievement and relatively lowered post-secondary achievement in the context of rural realities? Well, again, we can think about things like the ambivalence about post-secondary education in terms of both its costs and its opportunity costs. So for instance, debt, the distance from the family and the home community of the higher ed institution, rural brain drain. And the extent to which higher education means that your best and brightest are going to basically get a one-way ticket out of the rural community. And in the process, subsidize the development of other probably non-rural places. Again, from last week when I was out in Idaho, I was at a rural education meeting and I was speaking with the head of a foundation. And this person said, you know, we have some real problems in Idaho with kids, rural kids getting into college and then staying in college. And I would like to see even in the smallest community, you know, with a graduating class of 23 kids, I'd like to see all 23 of those kids feel like they can apply to Stanford and make that application and get into Stanford and go to Stanford. That's what I'd like to see. And my response to her was, well, you know, I think that's great and it's really important for, you know, for us to have high expectations for our kids, but I think that if we're concerned about the vitality of rural places and rural communities, we need to ask ourselves, do those kids have a place back in their rural communities with that degree from Stanford and with the student debt that they have racked up and all this. So this is not an argument to keep kids, you know, back on the farm or necessarily to keep them in their rural communities, but it's really about what options young people have and how those options or lack of options might affect how they develop their post-secondary aspirations. So, you know, connected to this is, you know, that you might think about the creation of internal conflict for youth who would like to remain local and or who don't necessarily aspire to a college degree. And lastly, you know, there may be a lack of parental support for post-secondary education if there's no family legacy or experience of college going. So where does this leave us? On the one hand, schools are fundamentally local institutions run by locally elected school boards and occupying the nexus of community, educational, social and economic activity and educators and educational leaders must therefore be responsive to local needs and issues. On the other hand, schools are institutions of the state and as such are beholden to state and national level interests, mandates and directives. And this is attention that's not new. It has deep roots in rural education in the US. So, you know, 100 years ago, school reformers in the US began to talk about what became known as the rural school problem. And these reformers argued that rural schools were just too inefficient for the demands of a rapidly changing urbanizing and globalizing society and people in rural communities were simply ill equipped to run their own schools and prepare students to be economically competitive and productive in a modernizing world. And, you know, I think this is one of those things where the more things change, the more they stay the same. And, you know, a pair of contemporary rural researchers Kanapel and DeYoung argued nearly a century later in 1999 that at the heart of the rural school problem is the conflict over the purpose of schooling with state and national reform leaders typically calling for schools to prepare students to contribute to national interests while rural education scholars and probably many rural parents believe rural schools should also serve local community interests. So this raises, I think, some really interesting and really difficult questions about the nature of education and also the nature of accountability. So to whom is education accountable? What purposes or whose purposes does it serve? So again, this is not to say that educational improvement and raising test scores is not desirable or that we don't want our students to be economically competitive in an increasingly volatile and global economy, but it is to suggest why educational researcher and sociologist Michael Corbett has referred to contemporary schooling within rural areas as the essential institution of disembedding. So that is a set of practices that privilege standardization and efficiency in business models of school management in the process severing attachment to place and producing mobile adaptable youth who can flexibly respond to changing labor market conditions on national and indeed global scale. So the critique is that standards require curricula and assessment that's purposefully decontextualized and because curricular standards are so expensive, little opportunity remains for teachers to engage students in curricula tied to location or tied to place. Students are geared towards competitiveness in a global marketplace rather than in a local arena and in a high stakes accountability environment, the opportunity costs for place-based education may simply be too high. Or as a rural administrator once told me, if it doesn't raise test scores, it's just not relevant to my job. So here's some further evidence that somehow schooling is becoming more distant from the local and lived realities of students. There's an annual survey of US high school seniors that's been conducted through the University of Michigan which found that 34.6% of students in 1983 reported that their courses were quite or very interesting while 19.8% found their courses slightly or very dull. By 2005, only 21.2% found their courses quite or very interesting and a third found their courses slightly or very dull. And in 1983, over 40% of seniors found their coursework often or always meaningful but by 2005 that figure dropped to 27.5%. And we see very similar changes regarding the percentage of seniors believing that their schooling would be quite or very important later in life. And so this is arguably a very different sort of educational outcome and one that raises different sorts of questions about how we think about accountability. So rural schools hold enormous symbolic, cultural and economic importance to the communities they serve but schools really can't survive long if the communities they serve are experiencing unchecked economic decline and social fragmentation. So again, I think it's really in the best interest of both school and community to work towards mutual enhancements and wellbeing. So enlightened educational leadership that takes seriously the 21st century needs of students as well as the communities in which they live in can't help but interpret academic and community betterment not as mutually exclusive but as fundamentally mutually reinforcing priorities. So now I'd like to turn to the practitioner end of things. What does an integrated approach to rural school and community development mean for educators and administrators? What in turn might state educational administrators learn from examples like this? Well, at the Center for Rural Education and Communities, one of the things that we do is we partner with the Pennsylvania Association for Rural and Small Schools to offer an annual award called the Building Community Award. And this is an award that recognizes a rural school or rural district that's shown innovative practices by improving education while strengthening the communities that they serve. And this is one of the winners of this program, the St. Mary's Area Middle School, which is located in the heavily forested and sparsely populated north-central part of Pennsylvania. The school has an enrollment of about 550 students and it's located on this multi-acre tract of land and much of it covered by forest. So there are strong traditions in the area of hunting and fishing. Forestry provides an important part of the area's economic base. And because of this, it's a little surprise that a significant share of the school's efforts and activities reflect this identity and contain a strong emphasis on natural sciences and environmental stewardship. So over the past several years, St. Mary's Middle School spearheaded a set of coordinated environmental education initiatives that draw from local context and at the same time dovetail with curricula in ways that speak directly to the live local experience. The centerpiece of which is the development of a regional environmental learning center funded through a series of grants, sponsorship and student-led fundraisers. So this originated initially from microbiology lessons that were conducted in a stream flowing through the school's campus. And it occurred to St. Mary's educators that there was an important untapped opportunity to adapt the science curriculum in ways that could take advantage of the natural environment literally at the school's doorstep. So raising funds from a variety of local and state-level sources and making use of student and community volunteer labor, the school designed and constructed what has become a student-managed trout nursery that currently raises and releases over 1,000 trout into local streams each year. So integrated into the local curriculum, as well as directly responsive to state academic standards, students are completely responsible for managing water quality, feeding, stocking, controlling for disease, and monitoring the production of effluent. So students record data on trout health, feeding habits, stress levels and appearance and they assist in maintaining tanks and fish raceways. So the aquaculture project has also been coupled with a building of an all-season outdoor classroom and an accompanying greenhouse complex. The construction of the complex was supported in part through a grant sponsoring a crew of local at-risk youth employed through the Pennsylvania Conservation Corps and the school has since created additional youth employment opportunities during the summer months at the site through the Regional Workforce Investment Board. So the greenhouse complex was developed as a natural extension of the aquaculture project and provides a hands-on opportunity for students to investigate hydroponics and aquaponics as a means of addressing water quality. Basically, they had all this waste water from the aquaculture and they needed to have something to do with it. So through the greenhouse complex, students discharged the nitrogen-rich waste water from the trout nursery and this water is then filtered through the soils that in turn supports the plants raised in the greenhouse. So the question then was, what are they gonna raise in the greenhouse? Well, they decided, students decided that they would use the water to grow niche plant species that could be used in the environmental remediation of acid drainage at local mining sites and effort coordinated with the elk conservation, elk county conservation district and a local campus of Penn State University. And so there are additional plans to expand the greenhouse effort in the form of an intergenerational gardening project linking middle school students with seniors from the community who have expertise in horticulture to create additional community mentoring opportunities. That the Environmental Learning Center also has a strong focus on alternative and renewable energy. So there's a grant funded a one and a half kilowatt wind turbine that helps to provide energy used in the outdoor classroom and the trout nursery. And this is coupled with three mobile solar labs for use in science instruction. So there are additional fixed solar panels are planned for the outdoor classroom with plans for students to monitor the output which will then be used to power the batteries for a green golf cart used for transportation across the school campus. Middle school is also pursuing plans to produce biodiesel from waste cooking oil. So in total it's difficult not to be struck by these efforts how they address community issues in a variety of practical applied ways, their thematic integration, how they link the school and students with the broader community, the ways in which social and institutional networks both formal and informal have developed through these efforts. And the way in which academic instruction has been seamlessly superimposed hands on student driven and locally relevant learning opportunities. And these are all efforts that are very much focused on academic achievement and in fact on student academic outcomes and test scores. So what might an enlightened rural educational leadership look like? Well, a starting point might be to consider the revised standards for preparing school administrators. Released in 1996 by the council of chief state school officers, the interstate school leaders licensure consortium or ISLIC standards were revised over a two year period and released in March, 2008. Adopted by the national policy board for educational administration, ISLIC standards are the first step towards creating comprehensive, locally tailored practice standards and other approaches for developing and retaining high quality school leaders. So the new policy standards are intended to shape and influence policy as well as provide guidance to education and policy leaders at all levels about the traits, goals and responsibilities of school and district leaders. So consequently, they have an inherent high value for preparing future leaders in rural school districts and schools. In an article that Hobart Harmon and I published in The Rural Educator a couple of years ago, we take these ISLIC standards and provide example questions for each standard to spur thinking regarding how to connect the standard and the role of the school to worthy community development efforts. Questions that reflect our belief again that good rural schools are only possible where community and school share a responsibility and take collaborative actions that strengthen positive results for all students to be successful and where community social capital serves the school and the school fosters a sense of place among the students. So for example, standard number one, setting a widely shared vision for learning. We might ask, how will the district or school leader gain the input and continuous support of key community leaders in setting and sharing the vision for student learning at the school? The second standard, developing a school culture and instructional program conducive to student learning staff professional growth. We might ask, how will the district or school leader encourage all school staff to become actively involved in the community as a means of professional growth for improving instructional effectiveness? Third standard, ensuring effective management of the organization, operation and resources for a safe, efficient and effective learning environment. How will the district or school leadership collaborate with community organizations to ensure a safe and effective learning environment for all students? Collaborating with faculty and community members, responding to diverse community interests and needs, mobilizing community resources. We might ask, what collaborative processes will the district or school leader use in identifying community development needs that mutually accomplish the goals of school and community? The fifth standard, acting with integrity, fairness and in an ethical manner, how will the district or school leader demonstrate integrity and fairness in collaborative community development activities that involve parents and multiple community organizations? And lastly, understanding, responding to and influencing the political, social, legal and cultural context. So we might ask, how will the district or school leader seek to understand the local rural culture in ways that influence positive school community collaboration? So given this information and these examples, I think there are a number of questions here and I apologize if I'm giving you more questions and more answers, but perhaps these questions will conspire to some answers that you might be able to come up with. But we can ask, what are the implications for how to proceed when working with rural districts? What are the possibilities for partnership opportunities? What are the possibilities for articulating the connection between the quality of rural education and the quality of rural communities? And I think that this in particular is often really overlooked in the current education policy environment. How do we re-establish that linkage between building academic quality and at the same time strengthening the communities where students live? And lastly, I guess this goes back to the theme I've been sort of reiterating throughout this presentation, how can we understand rural educational improvement and rural community improvement as complementary rather than competing priorities? So how can state educational agency leaders work with local school districts and local educational leaders so that local leaders don't feel compelled to say if it doesn't raise test scores, then it's just not relevant to my job. And so that's what I have to share with you and I'd be certainly interested in hearing any reactions or comments or questions that you may have. And if you have questions, I'll certainly do my best to answer them, I'd also be curious to hear whether some of you have answers to some of your questions. Thank you very much, Kim. My brain kind of hurts now, but anyway. I'm going to unmute everybody's phone line just a second. We'd like to invite you to make comments or ask questions or sort of explore with us how what you heard today relates to some of your own work with rural districts. So I'm going to unmute the phone lines now. All guests have been unmuted. So please feel free to speak up or if you'd prefer, you can type comments or questions in the chat box. Please don't be shy. I see that somebody is typing a message in the chat box. So I'll relay that to you, Kai, once it's completed. Sure, I guess one of the things I would just say is that going back to the theme of the diversity of rural contexts and the diversity of the context of rural communities and the diversity of needs and assets and resources that they may or may not have, it really is very difficult to sort of suggest blanket solutions to some of the challenges that rural schools and communities face. But I think that in the spirit of blanket solutions, one solution is really to sort of reestablish a focus on exactly what these contexts are and how those contexts may affect the ways in which rural school districts and educational leaders interact with their state level partners. I think that's a really well made point that there are no silver bullets but it's sort of the mindfulness that's required and that's work. And it's too bad that there's no silver bullets, right? I mean, that would be easy. Right, exactly. But that's not how it is. Yeah. We have a question here from Sarah Seiko. She has, what difference does this any, do you see between rural student achievement needs in general and that of American Indian or Native Alaskan students? Well, that's a really good question. You know, I think that, you know, while overall, as I said, academic achievement in rural areas tends to not be so bad at the secondary level in comparison to metropolitan areas. But of course, this is going to vary quite a bit with the economic status of both the students and of the community. And we know that poverty concentrates in rural areas and in areas where there's concentrations of poverty, there are going to be issues with student achievement. And some of the poorest areas in the country are in Indian country. And so that is, that's a particular concern. So this is something that certainly disproportionately affects American Indian students and Alaska Native students. At the same time, I think that at the post-secondary level, there are some really interesting models that are provided by the tribal colleges. And I'm not an expert in tribal colleges, but I know a little bit about them. And one of the main goals of these tribal colleges is to connect rural realities and local community realities and cultural realities with higher education outcomes. So that, you know, the transition to post-secondary education is not a severing of ties with the home community, but in fact, is both a reinforcing of those ties while at the same time building new connections not only nationally, but globally with other indigenous communities. But the academic achievement issues for Native American students are quite serious. Yeah, and I think there are issues as well of linguistic loss, loss of native languages, and also the lack of representation in curriculum. Although I know that there's some interesting stuff going on with the Yupik Indians in Alaska, refacing of math curriculum to reflect context better. Yeah. I've given another question, Kai. Many of the, well, we have two additional questions. Many of the rural districts in our region are among the persistently low-performing schools. I'm convinced we need innovative instructional approaches to increase the achievement of these schools. Are you aware of any studies currently being conducted around innovative approaches, particularly in rural schools? Well, that's not an area that I tend to do a lot of work in, actually. So there is nothing that I can point you to right off the top of my head, but I would throw that back on the group.  I can't think of anything. The only suggestion I might have is to direct you to the National Center for Research and Rural Education. Although I couldn't speak to what they're looking at exactly. I think they've been doing things on literacy and early childhood education. Right. But I don't know if I'm characterizing you what they're looking at as innovative. In the sense, it's a dramatic break from the conventional. Right, right. I would recommend looking to the Rural School and Community Trust. That might be a resource. And also possibly the Regional Educational Laboratories. Hi, we have one more question from Jessica. How do you see rural districts adapting to the adoption of the Common Core Standards and computer-based testing, whether it be PARC or the other ones, smarter or balanced? Well, I think that, you know, this is, I think probably rural districts are adapting in all kinds of different ways. I know that the conversation out in Idaho last week was about how to negotiate with different factions of the community that are very against the Common Core. And people within the community who see that as one more reason to pull their kids out of public education and into homeschool. So I think that there's that, you know, that aspect of dealing with that change. But you know, the Common Core Standards, I don't think this comes as a surprise to anyone. This is consistent with the kinds of educational reforms that we've seen over the last 10 or 15 years. And rural schools are, for the most part, doing the best job that they can to, you know, to essentially to serve two masters, right, to, on the one hand, ensure that, you know, their students are achieving in the ways that they're being told they should achieve and that they're following curricula that they're being told they should follow. But at the same time, you know, they're also trying to serve the needs of the communities in which they're based. And in some cases, that's easier than others. You know, again, from Idaho, one of the things that they were doing there was the State Education, the State Department of Education was with a state level business organization to work with local businesses in an effort to advocate for the ways in which, following these Common Core Standards would create graduates from rural high schools that would be well-qualified to take positions within local employment. So that was one way that they were dealing with that out there. Very, thank you, Kai. Well, unfortunately, we're about out of time, so thank you very much, Kai. I appreciate your insights and your thoughtfulness about these issues. As we prepare to draw to a close here, I'd like to sum up some of the major themes of what we've heard today from Kai. I think, first of all, an important point was that rurality is defined in a variety of ways, both institutionally in terms of how we measure it and work within it, and symbolically. What does it mean to people kind of on the ground and culturally and emotionally? And that those definitions have a variety of implications. Second, the importance of recognizing that rural schools and the communities that they serve are very interdependent for a host of reasons. A third point that I thought was especially interesting is that some of the rural resistance to education reform may stem from disparate views on the purposes of education. For whom are we educating? To what ends? And then finally, there's no silverable or clear prescriptions for easing rural skepticism, but there are some things that SEAs can do, such as linking state reform efforts to local goals and priorities, which of course means knowing the districts you serve. Secondly, by engaging multiple local partners and change efforts. Before we go, let's know how we did. Please complete our very brief survey. There's only three questions at the link on your screen, www.research.net backslash s, backslash arc space webinars, basically. All of the information you provide will be kept anonymous, but it's very helpful to us as we prepare for the future. And then finally, we invite you to connect with us, however you'd prefer. We offer a variety of services and they're all customized to your needs. You can connect with us on the web, on Twitter. We have a YouTube channel as well. But if you'd prefer, feel free to just mute the session way and give us a call. Thank you very much for joining us and Ty, thank you again very much. Take care everybody.


The first tactic is cognitive overload, but in a good way, also known as decision fatigue. I often recommend only having seven to nine food items, not to confuse and overload your customer so then that way they can actually make a decision. However, when your customers are home, things changes very drastically. Because of the abundance of time, it allows the customers to scroll through the leaflet to figure out what kind of options you may have. This is when decision fatigue kicks in. Because there are so many different options on the screen, I mentally get tired because of the overload of information. And because I don't have the time pressure to make a decision right away, I would oftentimes take a little bit longer and have this mental tiredness. Now our willpower to make the right decision completely tanks.


into let's say L2 of R with piecewise linear functions. So with EI, the first the I coordinate goes to the indicator function of the interval I over M. So M is N to the one third and say I minus one over M. So I minus one over an I over M. Let's make it half open or something. And then you have to, for this to be an L2 isomorphism, you have to multiply this by root M maybe. So this is a way of embedding Rn. And if you do this embedding, then of course with this embedding, you've also embedded the operator. So the operator will then act on these piecewise linear functions. So now at least these things live in the same space but there's still this problem that they act on completely different functions, okay? The same space but different functions. This guy acts on functions that are piecewise linear, right? In fact, piecewise constant, not piecewise linear. And this one acts on ones that have second derivatives. There's basically, the intersection is zero, I think. Constant functions, that's the intersection. But it turns out that this is not a problem for actual operator convergence because what you can do is, so these operators are both kind of nasty but both of them have, you can define for them inverses, okay? It's assumed that there is no zero eigenvalue. There's a zero eigenvalue, then you define the resolvent. So it subtracts some constant and you can subtract the complex constant. It doesn't matter. And you take the inverse. It turns out that the resolvent of this or the inverse of this is a compact operator. So actually it's defined on the whole L2 of R. The inverse of that you can also define as a compact operator, defined on the whole L2 of R. And those things are going to be, and the statement is that those things can couple in a way that their difference in norm is going to zero. Okay? So that's the precise statement. Okay, so let's call this Hn. I'm gonna call this H infinity. And I'm gonna say it's like this so this is gonna be kind of schematics. So Hn inverse minus H infinity inverse in norm. And this can be operator norm. So say two to two norm is going to zero. Okay? And this notion is called norm resolvent convergence for operators and it implies a lot of things. That's the nice thing about it. It implies that the eigenvalues converge. Not only the eigenvalues converge but the eigenvectors. If they're distinct eigenvectors in the limit then the eigenvectors of the approximating things converge in norm to the limiting eigenvectors. So everything beautiful that you want to know is in it. And it's a simple statement. And often this kind of statements can have simple proofs. So in this particular case, actually the proof is not that simple but in other cases the proof is very simple. And then you get a huge amount of interesting information out of some simple proof just by working at this slightly more abstract level. Two to two norm. So it's the maximum norm of what it takes in a L2 ball of radius one. Maximum L2 norm. This is also called the operator norm. So almost. But that's not how it works. So let me tell you, yeah, that's a good question. So the eigenvalues, so you can imagine what the eigenvalues of the area operator are gonna look like, because they're the limit of the eigenvalues of the random matrix. So those are the eigenvalues that turn here the boundary. Okay, so the tradition in this kind of, so these are like random Schrodinger operator. This is a kind of continuous random Schrodinger operator. The tradition here is, and that's why we took a minus sign here, is to make them almost positive definite in the sense that, well, they're bounded from below. So this is not positive definite. If you erase the noise, it is positive definite. That's just the area operator. But multiplication by x is positive and minus second derivative is the square of first derivative. Am I doing it right? Okay. Yeah, minus second derivative is the square of the first. Okay, you figure this out. So that's the precise statement. Okay. And let me see. So in the remaining time, I wanna tell you first about how we think about this. So you could say, well, okay, I have this operator, but when I have this convergence, it's very nice, but what is it good for? The point is that this is extremely useful. So it's a very nice representation of the top eigenvalue of which you can read off a lot of things in a very simple way, okay? And so let's start with the area operator, okay? One thing I didn't tell you is that I have to set the boundary condition here, okay? And the boundary condition is Dirichlet. Okay, so what is the area operator? There is just minus del two plus x, right? So what do we know about this operator? So you have seen the area function, right? So I'm sure if you, whenever you do any kind of random matrix, I think you always see the area function. So you probably have seen the Wikipedia page of the area function. So there's the area AI and BI functions. And the area BI function that blows up near infinity. So if you want to have a solution of this, right? So take this and apply some F and let's say that you just want it to be equal to zero. Well, you can solve it. There are gonna be two linearly independent solutions, right? And those are these things. The two linearly independent solutions, every solution is a linear combination of those two. But let's say that you put here lambda F, right? So you want to find some other eigenvalue of this operator. Well, you can put your lambda into the x. Move it over there, so x minus, whatever. So what you see is that all the solutions are gonna be just shifts. For all these lambdas, they're just gonna be the shifts of the AI and BI functions, okay? So if this guy has any eigenvalues whatsoever, they cannot have a BI component because that goes exponentially, well, it's actually super exponentially to infinity. So it just has to be a shift of the AI, okay? And the AI decays exponentially. So in fact, as long as the shift of the AI satisfies the boundary condition, it's gonna be an eigenfunction, okay? So the AI function, you've probably seen this thing, looks something like this, it decays, and then it does stuff like this here. Oscillates, oscillates faster and faster. It grows, I think, like fourth root or square root or something with oscillates faster. In fact, if you want to see the k zero is, okay? k zero is approximately, is approximately minus some constant times x to the, sorry, k, k to the two thirds, okay?  So what are gonna be the eigenfunction? So it's very simple. You just take this AI function and shift, okay? And the eigenvalue, because I erase this thing, but the eigenvalue is just gonna be the amount that you have shifted, okay? So the first eigenvalue is the first zero, the second eigenvalue is the second zero, and so on, okay? So we already know that lambda k is approximately c times k to the two thirds. Now there are general theorems that if you have a random Schrodinger operator which looks like this, this plus some potential, and it's in the half line, then if these things grows the right way, then it has a discrete spectrum, okay? So from that theorems, you can just say, well, this thing also, this guy has a discrete spectrum. These are the eigenvalues that they behave like this. It's not exactly, it's just approximately. In fact, the proper answer is that the eigenvalues are minus the airy ai zeros, and the eigenfunctions are just these ai's shifted and normalized, okay? So very simple. Now let's say that you want to have, you want to have asymptotics for not the airy eigenvalues, but for the airy beta eigenvalues. Okay? I shouldn't be doing this, but so, right? So you'd like to see that this disoperator also has a discrete spectrum and behave somehow similarly to the airy, okay? And here's what you can do. Okay, so here is a nice lemma that you can prove. We may do it today or tomorrow, which is the following. So you can look at the airy beta operator. Okay, let me just denote it like this. Okay? Then this can be upper bounded and lower bounded. Okay? So for every epsilon, the following is true. You can upper bounded by one plus epsilon times the airy operator plus the identity times some random constant. And lower bounded this by the same way. One minus epsilon times the airy operator minus the identity times some random constant. Airy beta is the stochastic airy operator, okay? So this is a random operator and you have this bound. Okay, so what does this mean? This means positive definite order, right? So if you take the difference of them as operators, then it will be positive definite. The constant C is dependent on the noise, exactly. That's the only place that the noise comes in. Okay, so this tells you everything you want to know. We'll prove this, it's not hard. In fact, it follows from the fact that these operators, B prime, okay, is less than or equal to epsilon times one plus epsilon A plus some random constant times I, okay? So multiplication by noise, it behaves nicely this way. Now we will prove this, right? If you use this, the difference between the airy beta and the airy is just B prime, okay? Just this multiplication by B prime. So as long as this is small, then you get automatically a domination of this kind. Well, that's exactly the question. So the answer is yes. So for example, it holds for the top eigenvalue. Why? Well, you just use, you can use the real equation formula, all right? So the top eigenvalue is a super overall functions of length one to length one of the quadratic form you make out of this, evaluated at that function, right? You can put that definition through these inequalities. And you get that. And if you use Courant-Fischer, which characterizes the second eigenvalue, you do the same, you get automatically that. So in fact, this implies that, right? So this implies that the same inequality applies for kth eigenvalue for every k. Exactly the same inequality as applies for the operator applies for the kth eigenvalue. So just this simple fact gives you these asymptotics. Okay? So for every beta, the, so this is some fact about the error process, which is, you know, you can prove it with determinants for beta equals two, you can prove it with faffians for beta equals one, or you can prove it like this. Well, I'll show you a proof and then we'll figure out. It's a, yeah. So, okay. So I have to tell you what functions you're gonna apply this operator for. And for what we did here, I will have to also tell you what the quadratic forms are, right? The quadratic forms have to be figured out. So we define the norm. I call L star norm. Okay, so F norm star. Okay, it's just let's just call this the L two norm of F. So we need an L two norm component plus the error norm of F, okay? So that's just F af, okay? And well, you know how to define this. And this one is just the integral of F prime squared. It is the L two norm of F prime. Okay, so maybe that's just by integration by parts from here, all right? So maybe write it like that. So this is the L two norm of F prime plus the L two norm of F times root X squared. Okay, so this is the L star norm of F. You can define it for every function unless the derivative doesn't exist. But if that's say, then let's say this L star norm is infinite. Okay, so that's this function space we're gonna work in. The ones that have L star norm, finite L star norm, okay? And already in order to work with this operator, we have to be able to say what is, so we need to compute F a beta F, right? How did I put it down? A beta F for beta, for F in L star. F comma AF, yeah. A is just the ordinary area operator. So you don't take the norm of AF, you take F comma AF. That's why you have this square root, right? Okay, so this is already not a trivial thing, right?  So where does L star live in the history of math? Okay, I can't tell you that now, but don't ask me. There are much better people to tell you that. Okay, so let me, so the only thing that we need to define, of course, is F B prime F, right? Because this thing is just, this is just equal to F AF plus F B prime F, okay? So, you know, at this point, you could just say that this is the paleo integral, okay? Of F with respect to Brownian motion. But you have to be, but you know, you should be able to define this also for F's that are depending on B prime, so. So there should be a way to do it without actually using any stochastic integration. Stochastic integration is messy, so there is a way to define it and here is how it goes, okay? So, so you want to understand this as integral of F squared B prime DX. That's what it should be equal to. So, you could try to do integration by parts. You could do this as F squared prime, so F prime to F prime F, all right? And B DX. So this now is a perfectly fine integral, excuse me? Minus sine, thanks. Okay, so this one is a perfectly fine integral except you may not, you know, because B is now just a function, F prime exists and F exists, so everything's nice, but it may not converge. Okay, so to control this, you would like to control this somehow, right? In particular, you'd like to control in terms of this A. Okay, so that's an exciting thing to do which we'll do next time. But the main idea, just before I stop, let me show you that is you write B as the average of B plus B tilde. Okay, so what is B? The average of B is the integral of T2, T plus one of B of SDS. So just average on an interval of length one. So this is gonna be a very nice function because it's, let me see, so the average is, it will have a derivative which is itself a function, okay? And this one on the other hand, which is the remaining of the average is gonna be small. So there is a smooth part and there is a small part. So we will be able to use this separation to actually give bounds in terms of, and growth of these things because we have some growth bounds on these to show this inequality over there. Okay, so that's what I'll do next. Thanks. Yeah, so basically if you, the simplest thing is if you, you can check that if you have an F which is an eigenfunction for the finite operator, then it will, has to be small in the beginning and it comes from the, how the boundary is at the finite operator. So you remember that actually it just comes from this very top entry here. So if you look at J, then you have this chi, and you have zero here, okay? So it comes from this zero, well not zero, you have this A, A but it's small, right? This is normal, which does is small. So this is big, big, big small. If you put here, if you put here a root n, then you'll have Neumann conditions. So in the discrete case, in this convergence, this is a general fact by the way about difference equation approximating differential equations. Is that in the discrete case, there you never have boundary conditions but the way you operate these entries at the boundary will actually give you boundary conditions in the limit.


So I myself am guilty of making this mistake in the Abloh4, but through my experience I hope to teach you guys about breakpoints with gear in the Abloh4 and how important they are when it comes to upgrading. Has it gone guys? My name is DPJ and if you do enjoy the video leaving a like really helps out and if you like what you see and want to see more be sure to subscribe. So you've probably heard the term breakpoints, item breakpoints, gear breakpoints, but today I hope to explain everything you need to know about them and exactly how they work for you. Okay so every piece of gear in this game has a power range. You can see said power range of gear under its item name. Now there are six breakpoint tiers. These are tied to power ranges on that gear and those you can see on the screen now. Breakpoint tier one is gear with a power range between 1 and 149. Breakpoint tier two is between 150 and 339. Breakpoint tier three is 340 to 459. Breakpoint tier four is 460 to 624. Breakpoint tier five is 625 to 724 and breakpoint tier six is 725 plus. So these are the gear breakpoints. Well what's the point of this information? Well guys when it comes to upgrading gear which you do at the blacksmith if you upgrade a gear piece which breaks tiers you gain a massive increase in stats. For instance if you have an item which is item power of 615 if you upgrade this enough it will break out of that breakpoint tier four and go into a tier five and in doing this you gain a massive jump in stats via the upgrade due to it breaking the point in which said gear is limited by the item power category it falls into. Now it's important to note when you upgrade an item via the blacksmith for each upgrade you only see five towards that item power score or level and item varieties are limited to how many times you can upgrade them. Rare as I believe is three upgrades. Legendaries are four. Sacres, Uniques and beyond are five. Another thing to pay attention to is the fact when a breakpoint is passed via upgrading that the chance of fixes can re-roll. So keep an eye on this when upgrading and make sure you check out that preview before spending materials. Now the mistakes not to make is wasting materials on items that won't break tiers or upgrade into a point and not paying attention and actually downgrading the fix which helps your build in a certain way. Breakpoints will make a big difference in regards to your build if you look out for gear leaning towards the top end of them. So only a few upgrades which won't cost your import materials if you don't plan on using say gear for a long time is a wise choice. I personally wouldn't upgrade more than three times on say gear and wouldn't upgrade past three until I'm out or around that breakpoint tier six but hey that is just me. But yes guys I hope this helps you out in some way or another. It's a complicated thing if you don't know about it and I'm confused about gear upgrading but yes these are basically breakpoint tiers how they work on gear the benefits and drawbacks to them. Guys if you enjoyed the video leaving a like really helps out if you feel like what you see and want to see more be sure to subscribe and hopefully guys I will see you on that next one


Our next speaker this morning is Naranjan Karnik. Naranjan is an associate professor of psychiatry and nursing and the medical director of the road home program, a program for veterans and their families run at Rush University Medical Center. And Naranjan is also a staff psychiatrist at Heartland Alliance for Human Needs and Human Rights and is a faculty member at the McLean Center. Naranjan earned his MD and his PhD in sociology at the University of Illinois. He completed his residency as well as his fellowship training in child and adolescent psychiatry at Stanford. Today, Naranjan Karnik will speak to us on the topic treating moral injuries of veterans and their families. Please join me in welcoming Naranjan Karnik. So Mark, thank you for the invitation to speak. Before I start my talk, I feel that I need to make note of yesterday's events in Paris, not only because of the tragedy that this represents for the city of light, which I know will recover from this, but I'm cognizant of the fact that the veterans that I work with and people like the veterans and families that I work with are often the ones who are called upon to respond to these types of events. And they do so willingly. They do so with a great deal of bravery. And it is one of the great privileges of my career to actually do this work. And it's an unusual path for a child psychiatrist to be in. So I just want to make note of that before I begin. These disclosures, none of these actually are material disclosures, I believe, that represent conflicts of interest. I am an unpaid research physician to drug studies that are going on at Rush for no other reason and they needed somebody to be there as a backup. And I serve on the board of directors of a not-for-profit corporation. Again, I will not be discussing anything in relation to these. The list of funders that you see here are the major list of funders that fund the Road Home Program. And the Road Home Program exists outside of the VA system. We benefit from close collaborations with our local VAs, but we're able to provide care to veterans and their families without any regard to their ability to pay, largely because of these funding agencies. These are the current estimates of the U.S. armed forces. They're about 1.4 million as of August of this year who are active in the armed forces and that includes all branches of the armed forces in including the Coast Guard. The current veteran population as of 2014 is estimated to be about 22 million veterans. And just for reference sake, the U.S. population as of that same year was estimated to be about 319 million. What you see among the veteran population among active military is increasingly female population. People may not be aware that in the post-911 era, almost 20% of the active duty military who were in that theater were female. Increasingly, there's a minority population. The military recruits significant numbers of African-American, Latino populations into the military. And so you see that shift. And about 25% of current veterans in the U.S. served during the Gulf War era. So this is post-911. And that has some significance for those of us who work in this area. So I feel before I go on, I need to address this question. How does somebody like me end up running a veteran center? So as a medical student at the University of Illinois in Urbana and then a resident at Stanford, I trained at VA hospitals. Some very good VA hospitals in fact. And I actually think it was one of the most important parts of my training as a physician. The veterans are a wonderful population to work with and I learned that very early on. In 2011, as a University of Chicago faculty member at the time, I was actually approached by a fourth year medical student to advisor on a research elective on military sexual trauma. Now, this was before military sexual trauma had any sort of public attention to it really. And this student asked me to supervisor and I said, look, I've seen a couple cases while I was at the VA, but you know, I'm not really an expert in this area, but I think I know a thing or two about trauma.  She and I actually worked rather closely and subsequently published a review paper in a family medicine journal because that was her projected career path. This has the aliens that I didn't know would be later on. In 2013, I moved from University of Chicago to Rush. And in March of the following year, I was tapped to oversee the children and families program within our veterans program. So this is really what distinguishes this program from what the VA can do. The VA by statute can't really provide the type of family based care that we do. And so I was asked to run the children families program and shortly thereafter, they sort of sprung this on me and asked me to run the whole program. I went on vacation at the end of June for two weeks and I came back in July and the chairman of the department surprised me and said, I need you to write a grant. The grant is for $15 million and you have two weeks to write it. So we wrote it and it subsequently got funded. So that's how I end up where I am. So what are moral injuries? So there's a substantial amount of writing in this area and I think my colleagues here who work in the VA system will be familiar with much of this. The index point in some ways of a great deal of conversation was Jonathan Shea's really excellent book called Achilles in Vietnam. And in that book, Dr. Shea describes basically three elements that he thinks are essential to understanding moral injuries. One, there's a betrayal of what is morally correct and I'll talk about some examples of this. The second part is there's action by someone who holds legitimate authority. And third, that this takes place within a high-stakes situation. It is generally accepted within the subfield of people who work on moral injuries and post-traumatic stress that these two experiences of moral injury and post-traumatic stress are not equivalent. They may be highly comorbid, but one is different from the other. And increasingly we're starting to have discussions that moral injuries likely require a different set of tools to address. And I'll get to some of that towards the end of my presentation. So here are some examples of what I have been told by veterans in the clinic. I went over there to protect my family and friends and now I wonder what it was all for. I lost buddies over there. I saw them die for their country and it turns out that our politicians lied to us about everything. And here this veteran was referring specifically to the findings of weapons of mass destruction and Baghdad and the controversies that emerged over how that information was discovered or not. I was asked one day very plainly, why did we do it? So as a psychiatrist who tries to stay back from these specific questions, these are very hard questions and in some ways they demand an answer. And another veteran said that betrayal is even worse when it comes from within your own group and your own leaders. Very much reflecting back to Dr. Shae's definition of that legitimate authority that's been used incorrectly. I haven't come up with good answers. Every time this has happened, I've now come to anticipate that it will happen. I haven't come up with good answer. The only answer I have been able to marshal up in response to these questions that I'm asked is that history may judge these events differently. And we have a discussion about that and I think our own personal political philosophies need not cloud the fact that in essence these individuals need care. So one of the things with moral injuries is like throwing a pebble into a pond, it reverberates. The injury actually goes beyond the individual and one of the things that we find at the Road Home Program is that it impacts everyone. It impacts the family. In fact, spouses and significant others. So the waves from this continue. And one of the things that has come up in the context of this is moral injury has classically been defined as something akin to doing acts in a time of war that run counter to their personal ethics. For example, killing enemy combatants.  At the time, they were told that they needed to do this. They were trained to do this and they come home and they reflect upon this and it's hard to reconcile their personal beliefs which generally run counter to this. They don't wanna hurt people. But yet that was their job and they were asked to do it at the time. And from this comes that Genesis point of moral injuries. And if you read through the moral injury literature you'll see many such examples. Interrogating individuals. Most people in here are probably aware enough or tied to the media enough that they know about many of the events that have happened about torture and victimization of enemy combatants that were held. And we've had individuals come into our center who have talked about this and having to be part of this or having to even be witness to it, being bystanders to it. That secondary impact of feeling like they can't act. But I wanna add to this a question that I ask myself and ask all of you and that I debate with my team that is military sexual trauma type of moral injury? Now I'll get into what military sexual trauma is but I will just point out that this is something that impacts the individual as an attack from within their unit. Trust being essential to military units to function. They all have different duties, different roles. They have to rely upon one another. This type of event goes to the heart of that. It has been likened in some of the writing on military sexual trauma to a type of incest injury because the military is such a close family system in some ways until recently people would talk about it as a brotherhood. Now it is a kinship that includes both genders and that if you view it in that family sense it is a type of incest injury. And it's part of a class of injuries that cannot occur outside of our zones. So in that sense moral injuries share this uniqueness that they take place there. Rape and sexual violence can certainly happen but this type of intra-unit or intrafamilial injury is somewhat unique in its nature when it happens within a war theater. So I would push and say that moral injuries are those injuries that emerge in the context of war actions that cannot easily be reconciled with civilian activities. So this is the definition of military sexual trauma that's in essence used by the Department of Defense. It's a physical assault of a sexual nature, battery of a sexual nature or sexual harassment which occurs while the veteran was serving on active duty or active duty for training. And it's characterized by some of these events. So these are some of the prevalence and projections and I think these should be very sobering to us. These are studies that come out of the VA. This is Nicole Ballrush's and I have the reference at the bottom here is the paper that we published where we synthesized all the available data at the time. There's some more current data that's come out of the RAND Corporation since then. But roughly one in five women serving in the military have had some instance of military sexual trauma in about 1% of the men. And you see that the numbers of survivors then total up to about 400,000 women and 200,000 men. Now when I took over leadership of the center I didn't anticipate that military sexual trauma would reemerge after this paper that I'd written so long ago even though it was published in 2013 the work was done in 2011. I didn't think it would reemerge. And what ended up happening is that people started showing up at our door. These show the first screen here on your left shows the frequency of females reporting military sexual trauma at our clinic. This is about the first 150 or so who come in we're at about 275 now veterans who've come to care. So about 70% of the women who come to our clinic report military sexual trauma and about 10% of the men. The men were somewhat the surprising number in this and unexpected to our team. And it turns out that a significant fraction of those men actually were from the Vietnam era who were coming to our clinic and hadn't discussed this. Actually didn't even have a term for it until the reporting had happened on sort of women and military sexual trauma occurring in recent years. And they were finally able to reconcile that with their experience that happened there. So they come to us and the VA has many good clinics and treatments for military sexual trauma. The attention in the VA system has come to this area. But what the veterans who come to the Road Home program tell us is that the reason that they come to us is that going to the VA hospital can be very activating for them. Being around a quasi military environment, seeing people in uniform at times can be very triggering and they prefer to come to our clinic because our clinic looks like a rather nondescript outpatient clinic and doesn't really match with that. This leads me to one other point in that my role in this was somewhat unusual. So the reason why I came to this, when I joined the Road Home program, it had already started to take shape. It was emotional already and it already discussed with the director of the Women's Mental Health Clinic at Rush that she would lead the military sexual trauma program. Shortly after I took over as medical director, my colleague went on maternity leave and I was the only other psychiatrist available. So the therapists who were working with these individuals in the transition plan said, look, Dr. Remnick's in a leave, are you okay seeing a male provider? And for the female victims and the male victims of military sexual trauma, it can be very difficult to talk to male providers. So they started this discussion with them and especially the women, there were a few for whom they preferred not to see a man.  Would does that make a difference? And it turned out that it made a difference. And so then they decided that they could come see me and despite my colleague's return, a few of them have actually stayed in my practice and I continue to follow them.  No, no, we'll continue with you, it's fine. So on almost every score, the victims of military sexual trauma versus individuals who present to our clinic more generally have higher rates of everything. So you will see higher rates of PTSD. This is on the PCL-5, which is a measure we use to assess PTSD. You see on depression, they're worse, anxiety, they're worse, it's almost the same graph it actually isn't. Now as a shout out to my colleagues here who trained with me here in the McLean Center Program who were in the NICU and did a lot of work on them, I pull this in because I think it's an interesting study out of the VA, looking at 16,000 deliveries at the Veterans Health Administration. And they studied active PTSD, so symptoms within the last year, historical PTSD, which is symptoms greater than a year, and no PTSD. They found that the odds of spontaneous preterm delivery were greater in active PTSD and even higher in MST with PTSD. And this is their data. And you see that the odds ratio for that first line, which is the active PTSD and military sexual trauma actually has the most impact. It's actually the only significant one on there. So this experience has repercussions. And as I said earlier, like pebbles in the pond, the reverberations go out and it impacts families. So here you see this kind of ongoing drama that is what we see. That the individuals with military sexual trauma have higher stress severity. They have a perception of their family functioning as being worse. They perceive their social support as being lower. They perceive their social support from significant others as being lower. They perceive their social support from family members as being lower. And social support from friends as being lower. Mark, I'm going through this as fast as I can, all right?   It's almost double what it would be in the individuals without military sexual trauma. So what do you do to treat moral injuries? What are we doing? So one of the things that we are in the process of doing right now is that we are assembling a moral injury treatment team. So who would be on this team? Well, we have psychologists who have particular experience and expertise in this area. We have LCSWs who are interested in this and working very hard on this. We are, for the first time, bringing a chaplain on board, which is somewhat unprecedented for our type of program to have that. Chaplains are very much a part of the VA hospital system. But in terms of a private university, hiring a chaplain specifically for one outpatient program, this stands somewhat alone at this point, as far as I know. We are continuing to treat military sexual trauma with PTSD methods. So the evidence-based methods that we use are drawn from the PTSD literature. We do so without knowing whether this is actually the right choice. Prolonged exposure is one technique that is used to treat PTSD. And we are using that in our clinic. We use cognitive processing therapy as well. There are others, a handful of others, such as EMDR that are used. But we haven't yet deployed those. The most interesting thing I think we are doing is doing this. We are using a model from UCLA called Families Overcoming Under Stress, Focus. Focus uses a family-based approach to treat military stress and trauma. And it doesn't get into the details of the trauma in great extent. It uses a system of family-based narratives where every individual in the family gets to tell their story. And then those stories are brought together. So the parents or the significant others talk, and then the children get to tell their stories. And here we use family actually according to what the individual veteran defines as their family. So we would take adult caregivers as family. We would take partners, significant others. We had one group of veterans come to us out of the Day Hospital at the Jesse Brown VA here in Chicago who came to our clinic together. The three of them had sort of formed a very close relationship during their time together in the Day Hospital. And they decided that they were a family. And we decided to treat them as such. And the flexibility that we have in doing this. Focus allows us to take their individual stories and weave those together. And to look at ways in which they had strength and resiliency in the face of stressors in their lives and build from that. And it actually has a strong evidence base. Our colleagues at UCLA have used this with the Navy SEALs. It has now become one of the major accepted modalities for the special forces within the military. And they are generalizing it across their entire system. So this is one thing that we are now working with UCLA to hone this technique for use with military sexual trauma. And they're working with us in a very collaborative way. It's a wonderful thing that we get to do. Finally, we're pursuing research on military sexual trauma and on moral injury. We have several active studies that are going on that are in progress. The MST research is largely being done by our team. We are joining ongoing studies at Duke and Urbana-Champaign that are looking at measurement of moral injury and trying to capture moral injury. So I want to thank my research team. All those graphs that I showed with the data, Randy Boley, who's my research coordinator, really put those together. Our MST team is a very gifted team. And now we have another psychiatrist on that team. I will make and see some of the patients. And I have a very good administrative team that works with me. So feel free to stay in touch if you have questions about this. Thank you. Yes, Robert, we'll do one question, please. So Dr. Karnak, as you know, I do counseling with combat veterans with PTSD, a lot of prolonged exposure in cognitive processing therapy. What I'm curious about is second wave therapies rooted in cognitive behavioral therapy look at challenging cognitions, automatic thoughts, intermediate beliefs, but not core beliefs or core values. And in third wave psychotherapy, like acceptance and commitment therapy, which Sharon Maduin who studied under LITS is looking at with moral injury, those look at cognitive diffusion of thoughts separating you from these ideas. What I'm curious about in my work with this is what's the moral authority for changing such a deeply held value of it's always wrong to kill a kid? It's a great question, Robert. My job offer to you still stands if you wanna come join my team. More than happy to bring you on board. I'm gonna go blush. Yes. I tried to recruit him a year ago, I will continue. But I think in some ways, I think the acceptance and commitment therapy is gonna be one of the ways that we will start to move. We are actually starting to do some research around that and also around self compassion. Not as a way of trying to undo those beliefs, right? But as a way to reintegrate them into their self in some ways. And these are really, we've stuck to the evidence based modalities for now and we will sort of basically trial these other second, third generation treatments against those as we move forward. And I'm hoping that we will find something better. Yeah. Norendra, thank you. Great, thanks. Thanks so much.