January 25, 2017

A Tribute to Tom Seekins

This tribute to RTC:Rural Co-Director Dr. Tom Seekins was originally published in the December 2016 issue of the Montana Psychologist, the newsletter of the Montana Psychological Association.  It is reproduced here with their kind permission. 


Dr. Tom Seekins(1)The following is a tribute to Dr. Tom Seekins, who is retiring from the University of Montana at the end of the academic year. Dr. Seekins, a Professor of Psychology, has served as the Director of the Research and Training Center on Disability in Rural Communities at the University of Montana since 1993. His research involves rural policy, issues surrounding rural health and disability, and disability within Native American tribes and reservations, among other topics. He is a past recipient of the Earl Walden Award for Outstanding Achievement in Rural Advocacy in 2001, the Allan Myers award from the Disability Forum of the American Public Health Association in 2006, and the Americans with Disability Act Award from the University of Montana in 2014.

Like so many of the fine faculty in the Montana University System, Tom’s entire corpus of professional work is impossible to capture within the scope of this newsletter. Following, Dr. Seekins speaks of his early experiences working with people with disabilities in Montana and how these early experiences dictated Dr. Seekins’ educational and career path, which subsequently affected the quality and even course of residential treatment for individuals with disabilities in Montana and beyond. It is followed by reflections from two colleagues who have worked with Tom the longest at the University of Montana: Dr. Meg Traci and Dr. Craig Ravesloot.

—Greg R. Machek, Ph.D. | Academic/Scientific Coordinator, Montana Psychological Association


Tom Seekins, Ph.D.Tom Seekins, Ph.D.

Professor of Psychology, Director of the Research and Training Center on Disability in Rural Communities at the University of Montana

As I recall, I gave my first professional presentation at the Montana Psychological Association meeting held in Billings about 1975. I had graduated from the University of Montana (UM) with a bachelor’s degree in Psychology in 1973. I had applied to graduate school but (fortunately) was not accepted. Subsequent events proved that to be one of my best setbacks.

Untethered from school and with no direction, I found myself looking for a job. The Sunday Missoulian provided the solution. I applied for a job as a Behavior Modification Therapist at the State institution for the “mentally retarded” in Boulder, Montana. The advertisement said that they were looking for people with a degree in psychology or a related field. I hadn’t been exposed to behavior modification as an undergraduate but still it seemed like there might be a fit.

When I arrived for the interview, I learned that Dick Swenson, a psychologist who had been a faculty member at UM, was directing an experimental program trying to demonstrate the utility of applied behavior analysis to the treatment of the residents of the institution. The project was funded by a grant from the Elementary and Secondary Education Act (ESEA Title I). The Superintendent of the institution was Keith McCarty, who had completed a Master’s degree at UM. The 14 or so staff of the program were all young, idealistic, and energetic. For most, it was their first professional job. Those who had been there for the first year of the program had taken leadership positions and they were looking to expand.

George Siverts, one of the old-timers, gave me a tour of the campus. One building he took me to was euphemistically called Cottage 6. It took a key to open the first, outer door. This led to a foyer with two offices, one on either side. A disheveled, thin man dressed in a white orderly’s uniform sat sprawled in a chair smoking a cigarette. George announced our presence and asked if we could go through the building. He stared back at George with hollowed eyes. “Sure. What do I care? You can go in there if you want. Me? I am starting my third shift. I’ve been the only one here for two days. Go on. Just lock up behind yourselves.”

George used his key to open the inner door. A wave of stale air and echoes came out of the inner hallway. Two large day halls were at each end of a long hallway. The first was crowded with men of all ages. Some rocked back and forth while standing in place. Others sat on the floor peeling paint from the walls or playing with shoestrings. One smaller young man was trying to avoid a larger, older man who was following him around the room. One man sat naked on the floor in the sun. Another stood with his hands over his ears, screaming. There was not one stick of furniture in the “day hall”—not a picture on a wall nor a rug on the floor. There were no curtains on the windows. Of course, the only staff was napping in the office. Except for these residents, it was an empty warehouse.

The other three rooms were the same. Then we went into one of the dormitories, an open room some 60 by 35 feet. Identical beds lined the walls on both sides and two rows of beds stretched down the middle. George explained that this building was designed to house 16040 in each dorm. There were more than 40 beds in each dorm.

Outside, George told me that the mission of the ESEA project was to demonstrate methods for improving the treatment of the residents. “How do you do that?” I asked. “That’s what we’re working on,” he replied.

I started work at the institution in October of 1973. Early in my first year there, I discovered the Journal of Applied Behavior Analysis (published in Lawrence, Kansas) and read each issue from cover to cover as soon as it came out. Then, I applied every procedure and technique I could. In one article, Todd Risley and his team at the University of Kansas argued that institutional environments affected the behavior of institutional residents directly and reported a method for directly observing the quality of institutional environments, the Manifest. In that article, they cited the work on Ecological Psychology by Roger Barker. I got a copy of the book and read it. I noted that Barker was at the Department of Psychology at University of Kansas.

Over the next four years, the ESEA Title I Behavior Modification program made significant progress in demonstrating the effectiveness of a structured treatment program based on behavioral principles compared to custodial care. Our successes included the demonstration of behavioral procedures in a classroom setting to establish both daily living skills and more academic skills, such as reading. Others demonstrated the utility of the behavioral approach in promoting development among children who were living in the institution. We also helped manage significant aggression among the residents. Each effort was driven by careful observation of antecedent events, behavior, and consequences, and rigorous data collection and analysis. Dr. Swenson was studious in building the capacity and credentials of his young army of behavior analysts. He organized a local chapter of the Association for the Advancement of Behavior Therapy. We met regularly to talk about our work, from both a technical and ethical perspective, and to socialize. Dick also arranged opportunities for us to participate in the Montana Psychological Association, where I gave my presentation.

In my spare time at work, I tried out some of the ideas suggested by Risley and others in the literature, and developed a program of environmental enrichment. This involved getting furniture, rugs, exercise equipment, toys, and other elements into the environment. At night, I worked with others to advocate for institutional reform. There was a sense of optimism for the future.

Then the years of neglect of the institution finally came crashing down. Nine residents died from neglect or abuse over a relatively short period. Still, there was little action to address the underlying problems of the institution. Many of us openly wondered, did using sophisticated behavioral technology to establish more functional skills among the residents have any value, if the residents were trapped in the institution?

Eventually, Keith McCarty, the Superintendent, called the U.S. Department of Justice, which had recently begun to file right to treatment suits against institutions, and invited them to visit. Their subsequent assessments focused significant public attention on the institution, led the State Legislature to increase funding for the institution substantially and to expand dramatically the system of community-based service providers.

I followed the deinstitutionalization movement and left Boulder in 1977 for a job in Billings doing similar work—training staff of sheltered workshops and group homes the skills of behavior analysis they needed to serve their clients, many of whom had come from the institution at Boulder. Those individuals now lived in a variety of arrangements – from group homes of no more than eight to independent apartments. Many worked at jobs that ranged from sheltered employment to standard jobs like mine. But despite their presence in the community, they did not seem to be of the community. They seemed to be isolated in the community. Segregated. My interests in the nature of community began to simmer. I could understand the workings of the institution. I could see how community service organizations worked. But what about communities themselves? How did they work? If we understood behavior within communities, could we design better communities?

Those questions led me to graduate school at the Department of Human Development and Family Life (now the Department of Applied Behavioral Science) at the University of Kansas. For the next several years, I conducted research in applied community psychology. This work included developing programs to build community leadership skills among residents of low-income neighborhoods, to establish and improve the effectiveness of citizen advocacy groups, to promote and evaluate public health initiatives such as the child passenger safety movement (i.e., laws mandating the use of car seats), to create life line utility rates, to organize community service agencies, to register voters, and to set local development agendas.

Meanwhile, the community service network continued to expand in Montana. Residents of the institution continued to be released; finding homes, work, friends, and meaning in the community. Montana advocates worked with Representative Pat Williams to create Public Law 99-457, the Early Intervention Act that provided incentives for all states and territories to establish preschool programs for children 3-5 years of age who experience developmental delays and early intervention programs for those less than 3 years of age. This program established services that helped families better raise their children and virtually eliminated the institutionalization of children with significant developmental problems.

My family and I returned to Montana in 1988. Our first stop was in Helena where I was fortunate to direct Family Outreach, one of the five regional early intervention programs funded, in part, by P.L. 99-457. We served families in the 12 counties of central Montana. Then, in 1988, we returned to Missoula where I directed the Research and Training Center on Disability in Rural Communities (RTC:Rural) at the University of Montana. This research center has developed several evidence-based programs in use in rural communities throughout the nation, has influenced national and state polices, and has provided professional training and research opportunities to numerous undergraduate and graduate students.

Today, the institution at Boulder that once housed over a thousand residents is on its way to closure. The nation’s laws and our State provide a wide range of resources that support a policy of community living for people who experience disability. Psychology and psychologists have played a role in these changes and thousands of Montanan’s have benefited from them.

 


Craig Ravesloot, Ph.D.Craig Ravesloot, Ph.D.

Co-Director, Research and Training Center on Disability in Rural Communities at the University of Montana

I met Tom Seekins 28 years ago. I was a first-year graduate student in Clinical Psychology at the University of Montana looking for work. Tom had recently been hired as the Director of Research for the newly funded Research and Training Center on Rural Rehabilitation. While my goal at that time was to get my Ph.D. and move away for an academic teaching job, when I saw the impact and promise of Tom’s career I decided to work with him instead.  Over these 28 years, I have had the unique perspective of a student, mentee and colleague as I’ve watched his career develop and influence so many.

First, the policy and practice of tomorrow is based in large part on today’s science. Dr. Seekins has published over 120 journal articles and book chapters that have helped shaped the science of disability and community living. He has been a leader in the development of community based participatory research methods that are now commonly used in social and health research. This unique approach to research has led to the development of social programs that have been applied across the United States including the Living Well with a Disability Program, which was cited by President Bush as a model program in the New Freedom Initiative (2001). Additionally, his work on rural transportation and self employment has influenced the policy and practice of entire services systems, such as Vocational Rehabilitation and Independent Living.

Second, in research and program development, what gets done is what gets funded. Dr. Seekins’ work has influenced major US disability research programs including the National Institute on Disability, Independent Living and Rehabilitation Research in the Administration on Community Living (formerly at the US Department of Education) and the National Center on Birth Defects, and Developmental Disabilities at the Center for Disease Control to reflect the voice of rural Americans with disabilities. His work has been instrumental in policy development that recognizes the need for better self employment support and transportation for rural workers. In Montana, he has been instrumental in the integration of disability issues into the Public Health agenda including cancer, chronic disease, and health promotion. Where Montanans with disabilities had very few opportunities for health promotion before his career, they now have regular access to services to avoid additional disease and disability.

Dr. Tom SeekinsThird, the impact of Dr. Seekins’ career has been felt by many, most of whom do not know his name. Over the past four decades, people who would have been homebound and isolated have gotten out using a Transportation Voucher developed by Dr. Seekins. They have started small businesses based on vocational rehabilitation policy and training programs developed by Dr. Seekins and they have avoided serious illness due to health promotion they learned from programs he developed. Every day, thousands of rural adults with disabilities receive services from agencies that recognize the importance and uniqueness of rural environments thanks to their membership in the Association of Programs for Rural Independent Living, an organization Dr. Seekins was instrumental in developing. The lives of these people would be very different were it not for the career of Dr. Tom Seekins. Few people have the opportunity to see science in action making the world a better place as I have over these past 28 years.

Finally, accomplishments aside, it has been my pleasure to work alongside Dr. Seekins over these many years. In the early days, we debated the relative merits of the cognitive revolution for health behavior change. Later, we pulled “all nighters” to make grant deadlines, not because of procrastination, but because we had two great ideas that each deserved a proposal—both were funded. We travelled across the US on many occasions to present and discuss our past, present and future work with colleagues that became friends. Some of those friends became partners. Tom is good at expanding circles and creating partnerships. It is one secret of his success. I have treasured our partnership and am saddened to see it come to an end. I endeavor to keep the tradition alive and hope to create partnerships that are as valued by others as I have valued my partnership with Dr. Seekins.

 


 

Meg Traci, Ph.D.Meg Traci, Ph.D.

Research and Training Center on Disability in Rural Communities at the University of Montana

I introduced myself to Tom Seekins several years after his propitious collaborations with Craig had begun (described above). My entrée into the Research Unit that Tom directed at the Rural Institute for nearly three decades was predicated by two new programs. The first was a program that Tom fostered with Lynne Koester and Paul Silverman, namely the developmental psychology minor within the University of Montana’s Experimental Psychology Doctoral Program, of which I was the first graduate, and for which Tom’s grants have provided over twenty years of graduate research assistantships. The second was a program of participatory action research (PAR) that as Tom recalls, was demanded by a family advocate after she heard him report on the productive line of research to improve the health of adults with physical disabilities, begun in 1988. “She literally grabbed me by the lapels of my coat and shook me saying ‘you need to do this with my kids’.” These ‘kids’ were adult children with intellectual and developmental disabilities of members of the Montana Developmental Disabilities Council, and the program of research she expected was to improve the health and participation of adults with I/DD.

This program of work, with Tom’s consistent direction, has defined much of my career, has informed two U.S. Surgeon General Reports, Institute of Medicines Reports on health and disability, and contributed to the current focus on health equity for adults with I/DD in local, state and national organizations like county and state health departments, Easter Seals, State Developmental Disabilities Councils, the Arc, and Special Olympics. Notable outcomes of the work were participatory methods to measure health and related risk factors of adults with I/DD, an economic study of the contributions of direct care worker stability to the health of adults with I/DD living in community-based settings, environmental designs to improve oral health and nutrition behaviors in supported living arrangements, and a program to integrate health objectives into person centered plans that coordinate services and supports for adults with I/DD.

It has been to my amazement that in addition to the productive research projects he has led over the years, Tom has simultaneously worked with colleagues to translate observations from those projects into coordinated responses to increase the involvement of people with disabilities in policy, programs, systems, and environmental improvement efforts overall. Examples include helping to found the Association of Programs for Rural Independent Living, fostering the growth of the Disability Special Primary Interest Group (SPIG) into a Caucus then a Disability Section within the American Public Health Association, and contributing tremendous leadership, as an inaugural grantee, to a constituency-driven Disability and Health Program within the Centers for Disease Control and Prevention.

In recent years, he coordinated with his peers nationally to develop selection criteria for several important systematic reviews to analyze the literature to identify evidence-based strategies to advance the equitable participation of persons with disabilities in society (e.g., identify evidence-based health promotion interventions for persons with disabilities). These selection criteria would provide language reflecting and furthering a shared understanding of the characteristics of policy, programs and practice that effectively include people with disabilities. Tom worked with a national Task Force to integrate this understanding into the American Psychological Association’s Guidelines for the Assessment of and Intervention with Persons with Disability. He and I worked with state partners to apply this language to the Montana Chronic Disease Prevention and Health Promotion Plan as cross-cutting issues to improve outcomes for all Montanans, including those with disabilities. Other sets of guiding principles that reflect this understanding include the core components of the U.S. Fitness Council’s Nine Guidelines to Commit to Inclusion and the CDC/AUCD Including People with Disabilities Public Health Workforce Competencies.

Dr. Tom Seekins(2)Tom has noted that the long term and ubiquitous application of participatory action research within the field of disability research and practice means that the emerging guidelines or design criteria reflect the experience of the disability community in advocating for lead roles in research, policy and practice. Tom has led the field committed to a core principle that there is nothing about us without us—“us” being the disability community. Most recently, he has placed the disability community’s experience squarely within the work of the Patient Centered Outcome Research Institute (PCORI) and its evaluation framework. This has informed and advanced PCORI initiatives and investments to be more inclusive, successful, and equitable.

Tom Seekins’ work has produced tools and supports to continue his work—methods, guidelines, and principles to assist psychologists and social scientists to define their work with the values of social justice, equity and fairness—the values that have guided his work and his life. To learn more, see the Community Tool Box developed by the University of Kansas Work Group for Community Health and Development.