Child Mental Health Series - Episode 2

Transcript

• 00:04And I just wanted to let everybody
• 00:06know the Pros for Peers webinar
• 00:08series is is a collaboration between
• 00:09the Yale School of Medicine and
• 00:11the Yale New Haven Health System.
• 00:14And it's brought to you by the
• 00:15Office of Academic and Professional
• 00:17Development and the Office of Chief and
• 00:19the Office of Chief Wellness Officer.
• 00:23So I'd like to really turn it over
• 00:25to Doctor Robert Rohrbach who can who
• 00:28serves as the Deputy Dean for for
• 00:30Professionalism and Leadership Development
• 00:31with the Yale School of Medicine.
• 00:34Doctor Werbach, please turn it over to you.
• 00:37Thanks so much, Peggy. One
• 00:39of OAP DS missions is to elevate well-being
• 00:41for for faculty and we're delighted to
• 00:44to welcome you today.
• 00:47As faculty and staff
• 00:48indicated in Wellness surveys,
• 00:49child mental health is a critical issue
• 00:51for members of both of our communities.
• 00:54We serve as caregivers at home
• 00:56and in the healthcare setting.
• 00:59We're really fortunate to
• 01:00have world renowned faculty
• 01:01at the Yale Child Study Center who
• 01:03can help us address this issue.
• 01:05I'm going to turn it over
• 01:06to Doctor Christine Olson,
• 01:08the Chief Wellness Officer for
• 01:10Medical Staff across the aligned
• 01:12clinical enterprise to introduce
• 01:13the Pros for Peers program and to
• 01:16introduce our host for this program,
• 01:18Doctor Linda Mays.
• 01:20Christine, thank you,
• 01:22Doctor Urbah Pros for Peers
• 01:24recognizes that we are surrounded
• 01:26by renowned experts in Wellness
• 01:28here at Yale all the time,
• 01:30every day.
• 01:30And we all have something to offer
• 01:32one another while fostering a
• 01:35culture of care and connectedness
• 01:37and strengthening pride and sense
• 01:40of belonging in our community.
• 01:42When our community identifies the need,
• 01:44as on the Wellness survey,
• 01:46we seek those experts to meet those needs.
• 01:49Previously,
• 01:50Pros for Peers brought you Sleep Week
• 01:53from the Yale section of Sleep Medicine,
• 01:56and you've indicated that your
• 01:58well-being would be improved by
• 02:00better knowing how to care and
• 02:02support the young people in your life.
• 02:04And so today for Mental Health Month,
• 02:07we are so grateful for the
• 02:09experts that we have here today.
• 02:10We look forward to this time
• 02:12together and it's a privilege
• 02:14to introduce Doctor Mays,
• 02:15chair of the Yale Child Study Center and
• 02:19our host for this program this month.
• 02:21Thank you so much.
• 02:24Thank you so much, Doctor.
• 02:25Really appreciate being here.
• 02:27And to add my welcome to all of
• 02:29you for joining for this second
• 02:31of the pros for peers webinars.
• 02:33And it's very appropriate,
• 02:34as Christine just said,
• 02:35to be doing this in Mental Health Month,
• 02:38but appropriate to do it actually
• 02:40anytime through the year.
• 02:41I'm going to introduce you to
• 02:43my colleagues very shortly,
• 02:44but I want to just tell you very
• 02:46briefly about the Child Study
• 02:48Center that we are a department
• 02:49in the Yale School of Medicine.
• 02:51We're focused on providing
• 02:52clinical care for children,
• 02:54adolescents and their families
• 02:56and and also on developmental
• 02:58science where we ask how children
• 03:00truly grow in their understanding
• 03:02of the world and the skills that
• 03:04they need to navigate that world.
• 03:06We have a very large educational
• 03:08program where we train the next
• 03:10generation of clinicians who will
• 03:11move our field field forward
• 03:13and we are multidisciplinary,
• 03:15have over 20 perspectives or
• 03:17trainings represented and our
• 03:19community is just over 500 people.
• 03:21You'll be hearing a lot about
• 03:23our clinical work today.
• 03:24And just to give you a sense,
• 03:25we serve over 3000 children and
• 03:28families annually through about
• 03:30over 60,000 scheduled visits.
• 03:33We've seen a tremendous increase in
• 03:35the need for our clinical services
• 03:37as has been true across the country.
• 03:40And it is also indeed true that
• 03:43children and adolescents are not
• 03:45only needing services younger,
• 03:46but also presenting with more challenges
• 03:50that require more intensive work.
• 03:53We provide our services much continuum
• 03:55from working in the home and community.
• 03:57You'll hear a lot about that today,
• 04:00consulting with pediatricians, seeing
• 04:02children in the hospital emergency room.
• 04:05Our outpatient services are inpatient
• 04:08units and we deliver care virtually as well.
• 04:11We're seeing about 1/3 of
• 04:13families now coming to us.
• 04:15As I mentioned, this is a national,
• 04:17a national concern.
• 04:19But what's most important that I hope
• 04:21you'll hear today was I introduce you
• 04:24to my colleagues is how we're really,
• 04:26truly trying to help children reach
• 04:28their fullest potential in our
• 04:30communities and how to help them
• 04:33again gain the skills they need.
• 04:35So my colleagues are going to speak
• 04:38about effective collaboration
• 04:39with our community providers,
• 04:41perhaps some barriers to clinical care
• 04:44that may impact getting to services.
• 04:46Indeed access is one of the things
• 04:49we think a lot about because it's
• 04:50it is quoted that 80% of children
• 04:53with mental health needs don't
• 04:55have access to care.
• 04:56And then we'll also talk about
• 04:58the impact of school based mental
• 05:01health services on children's
• 05:03education and and health.
• 05:05First you'll be hearing
• 05:06from Heather Maurizio.
• 05:07Heather is an assistant clinical
• 05:09professor in of social work followed
• 05:11by Taylor Collins who works in
• 05:13our in Home services,
• 05:15Roshani Treadwell who is also an assistant
• 05:18clinical professor in social work,
• 05:20Bridget Torres another
• 05:22assistant clinical professor.
• 05:24All will be talking really about
• 05:26the most sophisticated clinical
• 05:28work with children and families.
• 05:30And then to bring us home will
• 05:32be doctor Amanda Dettmer,
• 05:34research scientist is who is also
• 05:36working in schools and in school
• 05:38based mental health. So Heather,
• 05:40may I turn it to you to get us started?
• 05:43Yes, of course. Thank you Doctor
• 05:45Mays for the introduction and thank
• 05:47you all for having me here today.
• 05:49My name is Heather Morizio and I'm an LCSW.
• 05:52I've had the pleasure of being an ICAPS
• 05:54clinician for the past 7 1/2 years.
• 05:56Before I get going,
• 05:58I just wanted to acknowledge that
• 05:59the Yale Child Study Center has
• 06:01many in home programs that aren't
• 06:03necessarily focused upon today,
• 06:05but are too valued for their dedication
• 06:08serving families in their communities.
• 06:10The ICAPS program stands
• 06:11for Intensive in Home,
• 06:13Child and Adolescent Psychiatric Services
• 06:16that serves families and children 5 to 18
• 06:20years of age with acute psychiatric beads,
• 06:23our clients can be discharging from the
• 06:25hospital from intensive outpatient care,
• 06:28referred from a lower level of care
• 06:30like outpatient from a provider who
• 06:32has had ongoing concerns that place
• 06:35a child at risk for hospitalization.
• 06:37We focus our work really in four areas,
• 06:39so there's youth, family, school,
• 06:42physical environment and community.
• 06:43There are three phases of our work
• 06:46and three types of sessions a week.
• 06:49So there's family,
• 06:50individual and parent.
• 06:52These phases are clinically influenced
• 06:54by the therapeutic relationship
• 06:56which is really essential.
• 06:58It's essential in our model.
• 07:00We think relationships and we are relatable.
• 07:03Most of the children and teenagers and
• 07:05even a lot of the parents that we work
• 07:08with have significant life experiences.
• 07:10And with these experiences or layers of
• 07:13a person come the very real emotional
• 07:15responses that can then influence building
• 07:18relationships with others moving forward,
• 07:20whether it's with family,
• 07:22whether it's with providers,
• 07:24systems, schools,
• 07:25life experiences,
• 07:26shape how people and our
• 07:28families perceive the world.
• 07:30Ensuring today myself and some of
• 07:32the other colleagues and clinicians
• 07:34will be emphasizing upon the layers
• 07:37of trust needed to facilitate the
• 07:39work and to highlight the complexity
• 07:42of the work for me right now.
• 07:45Really focusing on this idea of
• 07:47like the in home piece to our work
• 07:49and inviting you to think and
• 07:51rethink this idea of community.
• 07:53Really existing solely as a place
• 07:55but really embracing the idea of
• 07:57the dimensions surrounding a person
• 07:59surrounding a family in motion as
• 08:02they are in motion with different
• 08:04aspects within their day.
• 08:05I have come to learn.
• 08:07Definitely realize as an in home clinician,
• 08:11I don't always like arrive at
• 08:13your home right.
• 08:14Not always knocking at your door,
• 08:15but rather I'm arriving where,
• 08:18when and how you are to
• 08:20meet you where you are.
• 08:21So this can be at anywhere,
• 08:23right?
• 08:23So having therapeutic sessions anywhere
• 08:25and some of my most recent endeavors
• 08:28target in a baseball baseball field,
• 08:30right.
• 08:32And then there's times too where I'm
• 08:34on the other side of a door with a
• 08:36teenager who has the door closed and
• 08:38they don't feel like coming out here.
• 08:41We we really meet families where they
• 08:43are within the lives that they live,
• 08:46how they authentically are.
• 08:48We are offered opportunities to
• 08:51physically be and access people places,
• 08:54the the people surrounding the family,
• 08:56the neighborhood in which they
• 08:58live and at times working towards
• 09:01in relationship with. Right.
• 09:03So we're building community with
• 09:05this can look like even a child
• 09:08like our work really finding an art
• 09:10class or a parent really working
• 09:12to find like his or her own job.
• 09:15This too creates other connections
• 09:17and connections that then impact this
• 09:19idea of what community is and how
• 09:22this person feels and interacts with
• 09:24in community within our model, right?
• 09:27So we have those three sessions,
• 09:28so we meet with a child,
• 09:30we meet with a parent and then the family.
• 09:32While these children go to schools,
• 09:34they have doctors, they have coaches,
• 09:36they have providers and just like parents do.
• 09:40So with building the relationship
• 09:43comes access to parents,
• 09:45providers with permission,
• 09:47meetings with other providers
• 09:48and that those are pieces of the
• 09:51family and the parents community.
• 09:53And with trust we really work with
• 09:57and connect to these different
• 09:59pieces of individual's lives
• 10:01to support the entire family.
• 10:03The trust piece cannot emphasize enough
• 10:06like but true true core trust by bearing
• 10:10witness with muddling through treatment,
• 10:13with moments that become
• 10:14even the bigger moments.
• 10:17Trust with like in which the family
• 10:19like lends to us then allows us as in
• 10:22home workers to really sit on their
• 10:24their on their floors and their homes
• 10:27and become acquainted with our communities.
• 10:30And I would love to pass it
• 10:32along to Taylor Collins,
• 10:33my colleague who will share more about
• 10:35the importance of treatment through the
• 10:37lens of the family systems approach.
• 10:41Thanks, Heather, and thank you
• 10:43everyone for giving us this space
• 10:45to share our clinical experience.
• 10:47My name is Taylor Collins,
• 10:49working as an LCSW with families
• 10:51and ICAPS for the past five years.
• 10:53One of my most salient takeaways
• 10:55is that child mental health
• 10:57problems don't operate in a vacuum.
• 10:59School systems, community groups,
• 11:01technology, peers and families all
• 11:03service contacts that ebb and flow in
• 11:06their influence on child mental health.
• 11:09ICAPS focuses on the convergence
• 11:11of these systems and particularly
• 11:13family patterns with a highlight on
• 11:16attachment and trauma informed care.
• 11:19Our family systems are one of the first
• 11:22micro environments we really experience.
• 11:24They serve as a foundational lens in
• 11:26which we begin to understand our world,
• 11:29how we communicate, behave,
• 11:31trust and we then take this lens and
• 11:34carry it with us throughout our life.
• 11:36Our work is to build a more complete
• 11:39picture of that family context with
• 11:42a multi generational perspective.
• 11:44We really zero in on the family patterns
• 11:48and parenting influences that might be
• 11:50overlooked if we just examine a child's
• 11:53mental health needs in isolation.
• 11:56For this reason,
• 11:57our practice aims to increase parental
• 12:01curiosity about their own experiences
• 12:03and as well as their child's.
• 12:06So this presenting problem that parents
• 12:09typically tend to notice in their
• 12:11children and then come to treatment to
• 12:13address those can be things like outbursts,
• 12:16conflict,
• 12:16impulsivity, defiance,
• 12:18really any types of mental health symptoms.
• 12:22And so with this in mind,
• 12:24we come in to treatment with them with
• 12:26a non judgmental presence to observe,
• 12:29build, trust and join with the family.
• 12:32Really learn and get to know them.
• 12:35Then through careful observation and
• 12:38built understanding help the families
• 12:41become attuned to underlying emotional
• 12:43needs and maladaptive family dynamics
• 12:46that might be hidden below these more
• 12:49observable surface level problems.
• 12:52Our parenting work uses therapeutic
• 12:54tools to aim a spotlight into
• 12:57unacknowledged trauma and family norms.
• 12:59Growing up, So what was your home like?
• 13:03What was normalized?
• 13:05What lessons about yourself and
• 13:07the world did you learn and then
• 13:10translate that knowledge into now?
• 13:12How are these patterns serving
• 13:14you and disserving you both as
• 13:16a person and a parent today?
• 13:17How are they impacting your child's
• 13:20mental health when there hasn't been space
• 13:23for introspection or self reflection?
• 13:25It can result in the meeting of our defenses,
• 13:28our coping mechanisms,
• 13:30and our socially learned habits,
• 13:31all forming this default way of responding
• 13:34to the world and responding to our children.
• 13:38While exploration of ourselves,
• 13:40our tendencies and their origins
• 13:43allows us to see alternatives and
• 13:45to expand our ability to respond
• 13:48differently to our world and interrupt
• 13:51any of these problematic patterns.
• 13:53So really we we want to
• 13:56encourage parents to say,
• 13:58hey wait,
• 13:59why am I responding to my child this way?
• 14:02Is this the only way to handle this?
• 14:05What's happening for my child
• 14:07emotionally when I do this?
• 14:09And what are my other options?
• 14:12As we understand patterns across generations,
• 14:15we then work to highlight
• 14:17with parents how this shift
• 14:19impacts their child and how
• 14:21they can work to create change.
• 14:23The gravity of this ask to shift the
• 14:25focus to the parent's self is really heavy
• 14:28as so many parents are already working
• 14:30their hardest to do the best they can.
• 14:33And at times we might be asking
• 14:35parents to practice labeling,
• 14:37organizing and being with their
• 14:40child's underlying emotions or
• 14:42taking space when heated to model
• 14:45regulation and to reduce conflict.
• 14:47And This is why meeting parents where they
• 14:50are in their process of self-awareness
• 14:52is a key part of our clinical process.
• 14:55At times, parents present with complex
• 14:58trauma histories or limited prior mental
• 15:01health care for their own unaddressed needs.
• 15:04Parents may not have had a felt
• 15:07experience of having an emotionally
• 15:09attuned response from a safe caregiver,
• 15:11and so this can mean asking parents to
• 15:13meet this seemingly impossible challenge
• 15:15of showing up for their children in a
• 15:18way that was never modeled for them.
• 15:20The therapeutic relationship
• 15:21can then serve as a reparative,
• 15:24secure attachment experience,
• 15:25acknowledging a parent's inner
• 15:27child by sharing the same warmth,
• 15:30safety and validation we want
• 15:32them to have with their children.
• 15:34Our objective is to improve child
• 15:37and adolescent mental health
• 15:39by encouraging curiosity,
• 15:41increasing self reflection,
• 15:43reducing conflict and supporting
• 15:45connection within the family.
• 15:47All of which helps to build trust,
• 15:48allow vulnerability and promote healing.
• 15:51And with that I want to pass it
• 15:53along to our our another one of
• 15:55our in home clinicians.
• 15:56Roshani.
• 15:59Thank you Taylor. Thank you.
• 16:00Thank you also for giving me this
• 16:03opportunity to share my experiences today.
• 16:06I'm Roshani Treadwell and I'm a
• 16:07licensed marriage and family therapist.
• 16:09I have been working at Yale Child Studies
• 16:13Center a little over 7 years and I I really
• 16:15enjoy working as an in home therapist,
• 16:18especially because I get to work in the
• 16:20community as a as a part of our work we
• 16:23build an understanding of our clients
• 16:25experience in a way that incorporates
• 16:27their characters including gender,
• 16:30sexuality, race,
• 16:31culture, and religion.
• 16:33All of what comes together to form
• 16:36each client's unique identity.
• 16:38We often collaborate with other providers
• 16:42as a part of the care we provide.
• 16:44The severity of the cases we treat
• 16:47cannot be effectively managed
• 16:49by anyone service provider.
• 16:52So we do need the support of all
• 16:54the providers to address multiple
• 16:57aspect of our client's life.
• 16:59Our family's life could be mental health,
• 17:01physical health,
• 17:03Daily living needs social support.
• 17:05So the moment we receive the referral,
• 17:08we begin connecting with other providers.
• 17:12Personally,
• 17:12I do believe that entire community
• 17:14play a big role in shaping each child's
• 17:17future and I I find collaboration
• 17:19helps me advocating for children
• 17:22families within their own unique
• 17:24community because they're not always
• 17:27able to advocate for themselves.
• 17:30This could be due to a negative
• 17:33experience in their life as well
• 17:35as the past and ongoing trauma.
• 17:38It is really essential to build meaningful
• 17:42trust and rapport with the whole family,
• 17:46but especially important when working with
• 17:49parents in the beginning of treatment.
• 17:51Building trust with families at this
• 17:54stage allow us to demonstrate our ongoing
• 17:57commitment to them throughout the treatment.
• 18:00We usually initial collaboration by
• 18:03collaboration by getting consent from
• 18:06the family and we seek to clarify
• 18:09our role as a liaison to all parties,
• 18:12especially maintaining confidential between
• 18:14parent and other providers such as schools,
• 18:19DCF, hospital, lawyers,
• 18:20food banks and even landlord.
• 18:23At times,
• 18:24we really need to learn about
• 18:26each family's history and the way
• 18:29that each family and how they fit
• 18:31in within their own community.
• 18:34We really ask about families
• 18:36experiences with other care providers,
• 18:38carefully noting both negative and
• 18:41positive responses to individualize our
• 18:44individualize our care for our families.
• 18:47This really fascinated the creation of a
• 18:50safe and supportive therapeutic environment,
• 18:52making family members more likely to
• 18:55open communication and build positive
• 18:57partnership with other providers.
• 19:02Most of our families comes
• 19:04with a deep rooted trauma.
• 19:05Acknowledging each family's unique
• 19:07trauma as part of our treatment
• 19:10increases the likelihood that the
• 19:12family will trust in our care
• 19:15and value our clinical support.
• 19:17One of the goal is to empower
• 19:20families to advocate for themselves
• 19:22within their providers and
• 19:25manage ongoing communication.
• 19:27However, at times we do face
• 19:30challenges working with providers
• 19:32who may not have a complete with
• 19:35both the families need or may not,
• 19:37may have their own biases or may not be
• 19:41aware of how the role that past drama
• 19:44plays in families reaction in treatment.
• 19:47As in home therapist ours,
• 19:50our role is so comprehensive that
• 19:52it gives us a big picture that most
• 19:56individual service providers may not have.
• 19:59I want you to imagine a parent to
• 20:02experience a significant amount of trauma.
• 20:06This parent will feel so vulnerable and
• 20:09not not feel that they can trust anyone.
• 20:14They will feel that no one can help them.
• 20:16Their responses and reactions are
• 20:19not always understood by others,
• 20:21which create challenges for families
• 20:24who receive multiple services
• 20:26in the in their community.
• 20:28Our most marginalized groups can
• 20:30feel negatively labeled and they may
• 20:32interpret experiences as rejection
• 20:34or rejecting or hostile which tend
• 20:37to minimize their trust in providers
• 20:40who are trying to support them.
• 20:43So it is really important and we
• 20:45actually model and roll favor
• 20:48effective communication looks like
• 20:50between clients and providers.
• 20:52We reinforces use of trauma,
• 20:54sensitive language that acknowledges
• 20:56and validate experiences which
• 20:58help families feel safer.
• 21:00We avoid blaming,
• 21:01shaming and anything that could
• 21:03be triggering or retraumatizing.
• 21:05Most importantly,
• 21:06we focus on our clients strength and
• 21:10encourage them to rely on their resilience,
• 21:13our focus in communication
• 21:16build improved understanding.
• 21:19Thank you for your time and you will
• 21:21be hearing from my colleague Bridget.
• 21:23Thanks,
• 21:23Rashawn.
• 21:25Hi, my name is Bridget Torres.
• 21:28I'm a licensed clinical social worker
• 21:29and have been a clinician and supervisor
• 21:32in the ICAPS program for nine years.
• 21:34I'm really, really excited to get
• 21:35the chance to talk to you all today.
• 21:39As my colleagues have already highlighted,
• 21:40community based services work to meet
• 21:42the needs of children and their families
• 21:45wherever they are with compassion, humility,
• 21:47collaboration and authentic connection.
• 21:51Many of the youth that access
• 21:53community based services like ICAPS
• 21:55have experiences that fall under the
• 21:57umbrella of complex trauma or repeated,
• 21:59pervasive interpersonal traumatic
• 22:00events that can impact their sense of
• 22:03safety both within their communities,
• 22:05their homes, and their caregivers.
• 22:08Many of these youth develop ways
• 22:10of coping and surviving,
• 22:11which makes sense at the time but
• 22:14become maladaptive over the years,
• 22:15including dissociation,
• 22:16self harm, suicidal ideation,
• 22:19and physical and verbal aggression.
• 22:21And as Taylor addressed,
• 22:23many of their caregivers have had
• 22:25similar experiences and developed
• 22:26their own ways of coping and surviving.
• 22:29And when we first meet many of our clients,
• 22:32they already have had experiences
• 22:34of inpatient hospitalization,
• 22:35outpatient therapy,
• 22:36and invalidating experiences
• 22:38with larger institutions,
• 22:40sometimes including our own.
• 22:42And again, so have so many of their parents.
• 22:47Making the extra effort to join with and
• 22:50understand is extra valuable when others
• 22:52have not attempted to build trust before.
• 22:55Building a strong,
• 22:56authentic relationship is key to creating
• 22:59a space where youth can do the difficult
• 23:02work of working through their emotions,
• 23:04finding ways to express them,
• 23:06making sense of their experiences,
• 23:08and then sharing this story and their
• 23:11narrative with their caregivers with
• 23:13the hopes that their caregivers
• 23:15can better understand them and
• 23:16begin to be a steady guide.
• 23:18As clinicians,
• 23:19we work to build epistemic trust
• 23:21with our clients and their families.
• 23:24This refers to the capacity for
• 23:26someone to trust in the knowledge
• 23:27that somebody else is imparting.
• 23:29When youth and their families have
• 23:31experiences of complex trauma,
• 23:33epistemic trust with anyone
• 23:35is difficult to build.
• 23:36Those who were supposed to protect them
• 23:39could not or were actively harmful.
• 23:41As clinicians, we have to be present,
• 23:43actively engaged,
• 23:44non judgmental and align our
• 23:46pace with our clients.
• 23:48And it is this trust that can help clients
• 23:50to continue to access care as they need
• 23:53it throughout the course of their lives.
• 23:55You've likely heard of the
• 23:57concept of a continuing of care,
• 23:58which includes preventative care,
• 24:00treatment, rehab, and maintenance.
• 24:02The needs of youths and their
• 24:04families are rarely as linear,
• 24:06especially as stressors can
• 24:08compound over time and generations.
• 24:11The intensity of support needed may
• 24:13wax and wane as youth transition
• 24:15through different developmental stages.
• 24:17And I know this isn't like big news,
• 24:20but growing up is very difficult develop.
• 24:22The task of becoming a person is hard,
• 24:26and the task of helping somebody grow
• 24:28up into a person is really hard.
• 24:30And for almost everyone.
• 24:32Life gets more complicated with time.
• 24:34The special kind of trust that
• 24:37families may develop with us,
• 24:39as in home clinicians and is actually an
• 24:42extended part of their communities can
• 24:45act as a long term stabilizing force.
• 24:48I and many of my colleagues have had
• 24:50the experience where we've worked with
• 24:52families and I caps, maybe worked
• 24:53with them in an outpatient setting.
• 24:55And then as needs change,
• 24:56something happens.
• 24:57They come back to us in I CAPS.
• 24:59And where there is that extra boost
• 25:02and support for the whole family until
• 25:05things have kind of gotten back to
• 25:07a point where they're regulated and
• 25:09maybe they come back to outpatient or
• 25:12move on for another community support.
• 25:19This connection, long term connection
• 25:20and understanding can help to build
• 25:23resiliency and youth who then have
• 25:25another stable figure to go to as needed,
• 25:27who can understand their home life
• 25:29in a different way and can serve as
• 25:32a bridge between themselves and their
• 25:34caregivers when they're at an impasse.
• 25:36There is so much power in human connection,
• 25:40in just being with each other and in being
• 25:43seen working in community with each other.
• 25:46That includes the providers,
• 25:48schools, caregivers,
• 25:49everybody that's around helps us all
• 25:52to access these essentials more fully.
• 25:54And thank you so much for your time.
• 25:57I'm going to pass it over to
• 26:00Doctor Amanda Demmer now.
• 26:01Thank
• 26:02you, Bridget. And wow,
• 26:03I'm just so honored to be included in
• 26:06this panel of my expert colleagues.
• 26:08I've already learned so much
• 26:10just by listening to you all.
• 26:13I'm thrilled today to build on what my
• 26:16colleagues have shared by discussing
• 26:18some of the research that we've done
• 26:20looking at the impact of school
• 26:23based mental health on students,
• 26:25educational and behavioral health outcomes.
• 26:28And as we've already heard,
• 26:30it really takes a village to raise children,
• 26:33and not just to raise them but as
• 26:35Doctor Mays mentioned at the beginning,
• 26:37to teach them the skills to
• 26:40thrive in their environment.
• 26:41And when we think about it, right,
• 26:43school is the place where our kids spend
• 26:46the majority of their waking hours.
• 26:49So this is really a prime opportunity
• 26:53to act on behalf of our kids.
• 26:57Now, I am not a clinician,
• 26:58so I I can't speak to personal experience
• 27:02in treating children in schools.
• 27:04But why I'm excited to share a
• 27:06little bit about today is the work
• 27:09that we've been partnering with,
• 27:11doing and partnering with a provider
• 27:14of in school mental health services.
• 27:18So in 2022, just a few years ago,
• 27:22we began this formal partnership
• 27:24with an organization called
• 27:26Effective School Solutions.
• 27:27Now this is an organization based in
• 27:30New Jersey and they began in 2009
• 27:33as a private therapeutic day school.
• 27:36So this was an out of district placement,
• 27:38right,
• 27:38for students who couldn't be
• 27:40served in their home district.
• 27:42And out of the services grew
• 27:44an idea from ESS.
• 27:45You know,
• 27:46why can't we take the same type
• 27:47of clinical programming that
• 27:49we offer out of district?
• 27:50Why can't we adapt it and offer
• 27:52it within the school walls so that
• 27:54students can stay in their district?
• 27:56That's really the ultimate goal.
• 27:58And thus thus was born ESS as
• 28:02it stands today.
• 28:04And ESS now serves over 6000
• 28:07students nationwide each day in
• 28:10over 120 districts in 12 states.
• 28:13And that includes Connecticut.
• 28:14In fact in Connecticut at our
• 28:17most recent analysis,
• 28:18ESS is serving over 600 students
• 28:21which is second only behind
• 28:23its home state of New Jersey.
• 28:26And So what we wanted to do in
• 28:28partnership with ESS that they
• 28:29hadn't been able to do yet was
• 28:32really start looking at the impact
• 28:34of their in school services.
• 28:35So what kind of services do they provide?
• 28:39Well ES S s mission is to provide
• 28:42high quality and cost effective
• 28:44clinical programming for youth K
• 28:47through 12 in district and this
• 28:49is for students with really the
• 28:51most significant emotional and
• 28:53behavioral challenges.
• 28:54So ESS follows a multi tiered
• 28:58systems of support and what this
• 29:01means in practice is that ESS
• 29:04provides in the school building
• 29:06both Tier 2 and Tier 3 services.
• 29:09So these would be programming that
• 29:13either offer moderate intensity care
• 29:16and crisis response for students
• 29:19at kind of the Tier 2 level or for
• 29:22really the most in need students.
• 29:24This would be intensive in school
• 29:27clinical support during the school day
• 29:30and these are really comprehensive
• 29:32wrap around services.
• 29:33So it includes on site clinical
• 29:35care from a a licensed clinician,
• 29:38behavioral programming both individually
• 29:40and in groups with other with peers.
• 29:44It also includes other services we that
• 29:46may not come to top of mind immediately
• 29:50like school avoidance interventions,
• 29:51family support.
• 29:52So families are brought into the schools
• 29:55as well to engage in therapeutic sessions,
• 29:58multiple layers of supervision
• 30:00across the school setting,
• 30:02clinical documentation and then
• 30:05crucially it also includes professional
• 30:08development and psychoeducation for
• 30:10the educators in the school building.
• 30:13And So what we found in our just the
• 30:16past couple years of working with ESS
• 30:18is that this type of programming and
• 30:21meeting students where they are during the
• 30:24day really has potential to benefit students.
• 30:29And we found this is true not only
• 30:32behaviorally but academically.
• 30:34And that's where I'm gonna start first.
• 30:35So we found that compared to baseline,
• 30:38which is the period of time,
• 30:39the marking period in schools before students
• 30:43were officially enrolled in ESS services,
• 30:45right.
• 30:46So compared to baseline,
• 30:48students saw a a significant
• 30:51increase in their GPA.
• 30:54And so for 65% of those
• 30:56students who enrolled in ESS,
• 30:57they either maintained or increased
• 31:00their GPA compared to baseline.
• 31:02And we followed this up with a
• 31:04sort of a fidelity analysis.
• 31:06So what we mean by fidelity analysis
• 31:09is we we recognize that school
• 31:11districts are not going to be able
• 31:14to uniformly implement ESS services
• 31:16for a variety of reasons, right?
• 31:19But in order to maybe try to
• 31:22prompt districts to adhere to ES
• 31:24s s highest standard of care,
• 31:26we conducted this fidelity analysis
• 31:29where we divided students who
• 31:31received in school mental health
• 31:34services to two groups.
• 31:35So the first of those was what we
• 31:38called a high fidelity group and
• 31:40this is where students were received
• 31:453 therapeutic sessions in the past
• 31:48two weeks plus one family session
• 31:52and that occurred for at least
• 31:53half the school year.
• 31:55Low fidelity were those students
• 31:56that received less than that and
• 31:58we found that for those students
• 32:00engaged in high fidelity programming,
• 32:02they they realized a greater
• 32:04than 30% increase in their GPA.
• 32:07We saw reductions in absences and
• 32:10disciplinary incidents as well.
• 32:12Crucially though,
• 32:13we also wanted to look at mental
• 32:17and behavioral health outcomes.
• 32:19And so post ESS enrollment in
• 32:21the 12 months following the start
• 32:23of these therapeutic services,
• 32:25we found that inpatient hospitalizations
• 32:28for these students is decreased by 56%,
• 32:30which is I think a staggering number.
• 32:33And the number of weeks these students
• 32:35needed to spend in higher levels of care,
• 32:38which is intensive outpatient
• 32:40referrals or partial hospitalizations,
• 32:43those were reduced by 35%.
• 32:46So this is really promising type
• 32:48of intervention that I think
• 32:50can work really strongly,
• 32:51really well in conjunction with
• 32:53the types of services that we've
• 32:55heard about already to provide the
• 32:57optimal care for our students by,
• 32:59as we've already heard,
• 33:01meeting them where they are.
• 33:02So thank you very much and
• 33:04I'm really looking forward
• 33:05to our Q&A. Thank
• 33:06you so much, Amanda.
• 33:08Really appreciate everyone bringing
• 33:10us into such a rich discussion.
• 33:13There's some questions coming in,
• 33:14but I want to actually begin with,
• 33:17with one question that I suspect
• 33:20might be on everyone's mind and
• 33:24maybe well why don't I put the
• 33:27question out and and let any one
• 33:28of you begin to to think about it.
• 33:31So just thinking really practically,
• 33:33I know you work with many children
• 33:35who have a number of needs,
• 33:37but often times can be very, very upset.
• 33:40Could you just talk about what you've
• 33:42learned in your work that you would
• 33:44do if you're if a child was having a a
• 33:47meltdown and the adults around them,
• 33:49We're also feeling really overwhelmed.
• 33:52What are some of the strategies that you
• 33:54could give people to to think about?
• 33:57And Taylor, would you like to start?
• 34:00Yeah, sure. I I'd be happy to.
• 34:02I think this is a really human thing that
• 34:05occurs in our relationships and having
• 34:07things come up for us when we are the
• 34:11protectors and caregivers for children,
• 34:13one of the best things that we can
• 34:14do first is to practice, look inward
• 34:17and practice our own self regulation.
• 34:19Because if we bring our frustration or
• 34:23our intensity, our overwhelm into that,
• 34:25we are now taking that child's emotions
• 34:28and adding ours into that pot.
• 34:30And so the best thing we can do
• 34:32is to to do something to regulate
• 34:34ourselves and work on our regulation
• 34:36and then we can sit with them in
• 34:39that overwhelm that they're having.
• 34:40So that can be really just naming
• 34:43what we see and just being with,
• 34:46not trying to change it,
• 34:49not trying to minimize or shift,
• 34:51but just staying with.
• 34:52And that's a it's a really hard task
• 34:54to do I think when when everything is
• 34:57chaotic you might have multiple kids
• 34:59whether that's in the classroom and
• 35:00you're you're a teacher or whether
• 35:02you're in the hospital and you're
• 35:03with a family that's struggling
• 35:04or whether you are a parent and
• 35:07you're in the thick of things So.
• 35:09So looking in naming emotions
• 35:11and just being with is is really
• 35:14the best way to start.
• 35:17Great thanks. Any other
• 35:18anybody else want to add
• 35:24another question has come across
• 35:26the question answers about can
• 35:29we discuss the availability of
• 35:31services for non-english non Spanish
• 35:33speakers anyone like to take that
• 35:40just looking Bridget do you want to
• 35:43go I think it's a it's a everybody
• 35:47paused because I think it's a
• 35:48challenging question to the answer
• 35:50because they're the resources feel
• 35:53very limited a lot of the time.
• 35:55I know that for non-english,
• 35:58non Spanish speaking folks, which we have,
• 36:01we've worked with people in the community
• 36:04with different levels of English language
• 36:07ability and whose first language varies.
• 36:10And we do have access to translation and
• 36:14interpretation services and we've been
• 36:17able to provide services in that way.
• 36:21And I believe more recently we're now
• 36:23able to actually have an interpreter
• 36:26that can come to the homes with us.
• 36:28When we do do visits with families
• 36:31that need interpretation services,
• 36:33which I've used before and has been helpful,
• 36:38especially because often we're able
• 36:41to have the same person come as an
• 36:45interpreter and so they kind of get
• 36:47to know the family.
• 36:48But it it can,
• 36:49it can be a huge barrier,
• 36:51I think.
• 36:52And we do,
• 36:53we definitely need more people that
• 36:57are bilingual and in Spanish and
• 37:01and every other language because it
• 37:03would really be beneficial for us to
• 37:05sort of be able to help more people.
• 37:08I certainly agree. Anyone else want to add?
• 37:13Hi there. I think you're on mute. Yeah,
• 37:16I was just agreeing with Bridget
• 37:18and shaking my head very,
• 37:19very much so because it, yeah,
• 37:21I think it speaks to the need in
• 37:23the populations like our catchment
• 37:25area specifically serves too, right.
• 37:27So we're, yeah, it's Shoreline
• 37:29towns but we're in New Haven, right.
• 37:32And our catchment area really extends
• 37:34different ways and Spanish speaking
• 37:36communities and like Bridget you
• 37:37named as well it's not just Spanish
• 37:40speaking but yeah resources are
• 37:42are always needed in addition to
• 37:44clinicians who really can sit with
• 37:46and and and language that clients
• 37:48and families and and children feel
• 37:50best comfortable in speaking in.
• 37:53Thank you. I know that we also have
• 37:55partnered very effectively with
• 37:57our health system colleagues on
• 37:59increasing interpreter resources
• 38:00certainly for your in home,
• 38:02for all of our in home services but
• 38:05also for when children come or in the
• 38:07hospital or come to our outpatient clinic.
• 38:11So but it's absolutely a tremendous
• 38:13need and it's important that we
• 38:15also attend to the culture that
• 38:18families bring to us as well.
• 38:22Amanda, could I,
• 38:23could I give a question to you?
• 38:25Sure. Could you also talk about the,
• 38:29besides the obviously the
• 38:31information that you provided
• 38:33about the benefits to students,
• 38:35behavioral how,
• 38:36what are some other benefits
• 38:38that might be accrue from having
• 38:40mental health embedded in schools?
• 38:43Absolutely. What a couple of other findings
• 38:47that I didn't have time to delve into
• 38:50were those for a marginalized students.
• 38:53And so in our analysis we found
• 38:56that in those in that reduction
• 38:59of inpatient hospitalizations
• 39:01following ESS services that was even
• 39:04higher for LGBTQ plus students,
• 39:06it was a 62% reduction.
• 39:08And when we looked at weeks and
• 39:11higher level of care that ranged from
• 39:1451 to 68% for non white students.
• 39:16So when we're talking about equitable
• 39:19access especially for students who
• 39:21may be having difficulty for various
• 39:24reasons and getting the mental
• 39:25health services that they need,
• 39:27I think this is has really
• 39:29strong potential getting to meet
• 39:30these students where they are.
• 39:32Thank
• 39:34you. Well, what are the policy
• 39:37implications that you see for the.
• 39:40Yeah, so especially for other for
• 39:44providers or maybe primary care providers.
• 39:47You know, I think this is really a
• 39:50unique opportunity to strengthen advocacy
• 39:54efforts and really coalesce around
• 39:57this notion of it taking a village.
• 40:00And we really think that these
• 40:03data especially looking at the
• 40:05inpatient hospitalizations,
• 40:06higher level of care and how those
• 40:09were reduced following school
• 40:10based mental health services,
• 40:12we really think this has strong
• 40:14policy implication for you know,
• 40:16changing the way that health
• 40:19insurance providers will decide
• 40:21to reimburse services, right.
• 40:23And so right now as it stands,
• 40:26these same services could be provided in
• 40:28a building right next door to the school
• 40:31and be covered by health insurance,
• 40:34but they're not covered in the school.
• 40:36And we're really hoping that data like
• 40:37these might help change that eventually.
• 40:39And this is where we can really use
• 40:42strong vocal support for these kinds
• 40:43of services from our colleagues.
• 40:46Absolutely. Thank you.
• 40:47Another question has come in and
• 40:50maybe Rashani, this would be maybe
• 40:53you could address it or anyone,
• 40:56but can you talk about situations where
• 40:59other clinical clinicians biases might
• 41:02impact their support for families,
• 41:05especially as we're trying to
• 41:06think so much about culturally
• 41:08sensitive care and then doing that.
• 41:13Thank you. Yeah, I think most of
• 41:16the time our work is really try
• 41:19to help other providers to see
• 41:21the family in a broader view.
• 41:24Of course we need family's permission
• 41:27to especially get consent to see if
• 41:31like if we can support the providers
• 41:33to recognize the impact of trauma in
• 41:37families life and also like learn
• 41:39about what difficulties the the the
• 41:42client or the family or the child
• 41:44had in the past with the providers or
• 41:48just in general accessing services.
• 41:50It is really,
• 41:52really important providers take
• 41:55client as the expert on their life,
• 41:58just listen to them.
• 42:00I had AI had an example,
• 42:02a parent who was with the provider
• 42:05felt really invalidated because the
• 42:08provider looked in the computer
• 42:11and kind of like to took that as an
• 42:14expert on client's life trying to
• 42:16tell her you have this diagnosis
• 42:18you have to do this because of
• 42:20that and really didn't have.
• 42:22He didn't take the client view
• 42:24and she actually told me that
• 42:27I thought very powerful,
• 42:28no one can tell my story like I do.
• 42:31I have to tell the I had to tell
• 42:34the provider what actually went on.
• 42:38So I think it's really important to
• 42:39take the client centered approach,
• 42:41empower the client,
• 42:43focus on clients strength needs and let
• 42:47them make choices and support the growth.
• 42:51Also taking a holistic approach
• 42:53client to receive services with
• 42:55physical health and mental health
• 42:57other services and one of the most
• 43:00important thing that I also see
• 43:02providers can hold cultural biases on
• 43:05assuming that may things that impact
• 43:08the interaction with the clients.
• 43:10Some providers comfort level can be
• 43:14difficult for them to stay with the
• 43:17client when the client coming with the
• 43:20high anxiety or intense and become defense.
• 43:23I think those are the some of the
• 43:25things that we can address and
• 43:27support providers to understand
• 43:29so families can get the support.
• 43:33Thank you for that. Anyone else want to add?
• 43:36Yeah, thanks Rashawni.
• 43:37I think you did a a great job summing,
• 43:39summarizing that all.
• 43:40And I just kind of going on to
• 43:43what you said about providers.
• 43:44I think almost what we can do on our
• 43:47provider side is like the language
• 43:49that we use in describing and talking
• 43:52about our clients and the people
• 43:54we serve is incredibly important
• 43:55because you can set up someone when
• 43:57you're transitioning them to care
• 43:59a very different way by what you
• 44:01highlight and what you're showing
• 44:03about the case and what you're how
• 44:05you're thinking about another person.
• 44:07And so there's like stigma about diagnosis
• 44:10and and how things might present.
• 44:12And sometimes like you can look at a
• 44:15child in the referral we get of what
• 44:17they're described behaviorally as being
• 44:19like and and what their diagnosis are
• 44:21and their their level of medication.
• 44:23And then you meet this really sweet
• 44:26kid that's just has so many strengths.
• 44:28And I think what language we
• 44:29use in sharing and telling about
• 44:31things like our our clients to each
• 44:33other is really important.
• 44:35Absolutely appreciate that.
• 44:38We have another really practical
• 44:40question that if the student needs
• 44:42help at school how is that referral
• 44:45initiated is does it come by the school,
• 44:47by the primary care pediatrician,
• 44:49by the family?
• 44:51Amanda do you want to take that or
• 44:55I think I I may need a little more clarity
• 44:58by what they mean by help at school.
• 45:01I'm I'm gonna go on an assumption
• 45:03that this may mean they need
• 45:06therapeutic help at school. Yeah.
• 45:09So to the best of my knowledge,
• 45:13this is generally begun by, well,
• 45:19in the schools where these services exist.
• 45:23This is generally begun through consultation
• 45:26with I think all all parties, the family,
• 45:30the student themselves, of course.
• 45:32And then the maybe the school psychologist
• 45:35who would then refer them for an initial
• 45:39evaluation like an intake and then
• 45:41determine their eligibility for the in
• 45:44school intensive mental health services.
• 45:46So I hope that answers the question
• 45:49and if not please follow up. OK,
• 45:52so so usually by a person in
• 45:56the school in college, that's
• 45:57my understanding. Typically yes.
• 46:00But in in the schools in which
• 46:02the ESS services are embedded,
• 46:04the request may come for example
• 46:06from a parent, have the student
• 46:08be evaluated for eligibility.
• 46:13You know, for
• 46:13all of you, I think mental health and
• 46:16advocating for more what children
• 46:18need and more services on how you get
• 46:21better access to services is a is a
• 46:24is a challenge that we all share.
• 46:26And I guess I would ask you maybe
• 46:28to to talk of a little bit about
• 46:31how can families be involved and
• 46:34advocating for children broadly,
• 46:37but in advocating for the services that
• 46:39they want and need for their child.
• 46:49Yeah, I didn't mind getting going.
• 46:51And then I'd love to hear others,
• 46:53too, 'cause I think it,
• 46:54everyone brings in such like
• 46:57great perspective, you know,
• 46:58like everyone's kind of talking about,
• 47:00I know and like our model,
• 47:01like the first month or so,
• 47:03we're really working to gather
• 47:04a lot of information.
• 47:05We're making those calls.
• 47:07We're talking to pediatricians,
• 47:09we're talking to schools.
• 47:10But I think the most important people we
• 47:12need to be talking to are the families
• 47:14that we're sitting in the room with.
• 47:15You know and I think like we've
• 47:17all talked about parents are doing
• 47:19their best and figuring out also
• 47:22what needs they would like to have
• 47:24addressed are are always in the
• 47:25forefront and really pairing with them,
• 47:27joining with them if you will of you
• 47:30know for example like I'm thinking about
• 47:32school services from the lens of our work,
• 47:34right.
• 47:34So we might step into a the picture
• 47:37where kids really struggling in
• 47:39school you know academically,
• 47:40socially, etcetera and their
• 47:42classified maybe as regular education.
• 47:45So it's really sitting down with a kid,
• 47:46it's sitting down with a parent
• 47:48and it's like, hey,
• 47:49what has been your experience
• 47:51with working with schools,
• 47:52fostering relationships with schools
• 47:54and then working with parents too,
• 47:57to write a letter to have a school meeting?
• 47:59Hey, let's chat,
• 48:00let's see what's going on,
• 48:01what's working, what's not.
• 48:04And usually parents,
• 48:05parents know what's best and and we
• 48:08let them be in that seat, that's,
• 48:10that's the seat for them.
• 48:16I think I
• 48:17would. I would like to add sometimes our
• 48:21parents are not aware of the services
• 48:25and resources that are available.
• 48:28Especially thinking about the school when
• 48:30a child is refusing to go to school or
• 48:34child is having difficulties in the school.
• 48:36There are different services
• 48:38that available for parent,
• 48:39but parents get really anxious or parent
• 48:42get really frustrated because it might
• 48:44be because they don't have the trust in
• 48:47the system or trust with the providers
• 48:49or care that they may have received.
• 48:51In the past.
• 48:52Sometimes we had situations that
• 48:55parent actually decided to home school.
• 48:57I think educating them and supporting
• 49:00them to understand what services
• 49:02available for them is also very important.
• 49:07I think a very practical question
• 49:10for all of you working in homes
• 49:13you you well one thing is I it's
• 49:15would like you and in many ways
• 49:17to talk about you you see so much
• 49:19more in homes and you you've talked
• 49:21about that that kind of advantage.
• 49:23But I'm I'm really sure that you
• 49:25have to see a lot of children there
• 49:26who they don't want to go to school.
• 49:28They they prefer the safety of home or
• 49:31whole whole post of reasons and I think
• 49:35that that is sometimes a universal issue.
• 49:38So do you have some practical ideas for
• 49:41parents on how to address where their
• 49:43child does not want to go to school?
• 49:46Oh, what a challenge I think it's yeah,
• 49:54I'm, I, I welcome anybody to
• 49:56jump in here because this is,
• 49:58it's really tough right now.
• 50:00I feel like it's it's something
• 50:02that has been happening and is
• 50:04is like a perpetual challenge.
• 50:05But also since the pandemic started
• 50:09and students started school from
• 50:12home and then maybe never really
• 50:14fully transitioned in new schools
• 50:15gotten much more difficult.
• 50:18I think from a very big in like the
• 50:21most basic sense if the if your child
• 50:24doesn't want to go to school and
• 50:27they are spending a lot of time then
• 50:29on the computer or on video games
• 50:31or like how are they spending the
• 50:34time when they would normally be in
• 50:36school and kind of removing access
• 50:40to those things at the time when
• 50:44they would normally be at school.
• 50:47Because if if the difficulty is
• 50:48that it's preferable to do that.
• 50:50But I think often there's something
• 50:55going on under the surface of the
• 50:57school refusal and so I would I would
• 51:01also recommend working with a clinician
• 51:04either in you know an eye caps level
• 51:07of care and outpatient level to try to
• 51:10understand what is going on and what
• 51:12is kind of fueling the school refusal.
• 51:14Is it is it around bullying?
• 51:16Is it because they don't understand the
• 51:19work and it feels uncomfortable to do.
• 51:22Is it that school's over stimulating?
• 51:25There are so many different reasons that
• 51:28kids are not going to school right now.
• 51:31And
• 51:34it takes, it takes like the whole
• 51:36community to be able to help get them back.
• 51:39And including a clinician,
• 51:41including the school.
• 51:42There's a lot that you can do when
• 51:47there's some that you can do in terms
• 51:49of working with the school to help get
• 51:51the get your child kind of back in if
• 51:55they don't have any kind of services yet.
• 51:59You can advocate for something
• 52:01called a five O 4 plan,
• 52:03which is if your child has any
• 52:05kind of psychiatric diagnosis,
• 52:06they do qualify for a five O 4 plan.
• 52:09Parent can request this via writing
• 52:12and have a meeting with the school,
• 52:13and this is a kind of less formal
• 52:18way of getting additional services
• 52:21in place for your for your child.
• 52:23And that can include maybe like different
• 52:26ways that their work gets presented to them.
• 52:29It can include having 1/2 day or
• 52:32moving their schedule around in a
• 52:34way so that they're able to attend
• 52:37a class that's preferable in the
• 52:40morning and keep them there longer,
• 52:43spend more time with friends or
• 52:45be in classes with peers.
• 52:47And that's like that's an early step.
• 52:51I know everybody here has also
• 52:53worked with folks that are having
• 52:56trouble going to school,
• 52:57so if you had anything else you
• 52:59wanted to add, that would be great.
• 53:04Yeah. Bridget, you summarized it really,
• 53:06really wonderfully that there's so many
• 53:08things and the first thing we need
• 53:11to do really is understand what is
• 53:13that reason for the school avoidance,
• 53:16because it can come from all these
• 53:19different things going on at school
• 53:21that makes school stressful.
• 53:23It can also be things that are at
• 53:25home that might be driving it.
• 53:26So that can be a caregiver that the
• 53:29child's really worried about or has
• 53:31a really strong attachment to and
• 53:33has a hard time separating from.
• 53:34It can be a peer that also is not
• 53:37engaging in school somewhere else
• 53:39and they're communicating with and
• 53:41kind of there's a a cohort thing
• 53:43occurring there's it can be really
• 53:47really strong depression and and
• 53:49maybe needing medication support to
• 53:50get out of that because it's it's
• 53:53at a really strong level.
• 53:54So there's so many different reasons
• 53:56and the the best way to start is to be
• 53:59curious and create an open and safe
• 54:01space for that child to really share
• 54:03with you what's going on in their world.
• 54:06So you can kind of figure out
• 54:07OK now how do we tackle it.
• 54:08It's
• 54:11a fun work to
• 54:12ask you because you've all again
• 54:14been homes for with many children.
• 54:17Have you had a sense of the impact
• 54:19of the pandemic when children were
• 54:21off of spending more time at home
• 54:24or or school was very different.
• 54:26Would you would you have
• 54:28any comments about that?
• 54:34We can, I can jump, But unless OK,
• 54:39there's definitely been a
• 54:40large impact of the pandemic.
• 54:42And I think not only on
• 54:44kids but also on caregivers.
• 54:46It's kind of everybody from
• 54:48what I've seen going in
• 54:53in that and and Taylor references
• 54:56too of like for kids to be OK,
• 54:59parents also need to be OK,
• 55:02need to be working on
• 55:04understanding themselves,
• 55:05what's triggering them.
• 55:05And I think the pandemic was
• 55:07just an intensely stressful,
• 55:09scary time for everybody.
• 55:11And we were all trying to get
• 55:14by and for a lot of us and felt
• 55:18the lingering effects of that,
• 55:19like this mass deeply scary event are still,
• 55:26they're still present.
• 55:28So we've seen that parental
• 55:29stress has been up and that's
• 55:32impacted kids and vice versa.
• 55:34And even I think still there's the
• 55:41ongoing work of trusting the world again.
• 55:45For some people like it was very
• 55:50scary time and not to discount
• 55:53at the same time kind of all of
• 55:56the social movements that came to
• 55:59afford during the pandemic and that,
• 56:02I mean that's active.
• 56:04That's an active part of our work
• 56:05too of of thinking through the ways
• 56:07that identity and everything impacts,
• 56:12impacts a person's sense of safety.
• 56:14And yeah, so there's been pretty
• 56:18significant impacts. Yeah, Taylor,
• 56:20well, yeah, I think I think the pandemic
• 56:23also normalized disconnection, right.
• 56:25That was like actually called for.
• 56:27And so especially for children in this
• 56:30foundational time where you're working
• 56:32on building relationships and where
• 56:33like if you if you I guess just even
• 56:36thinking about like the world around us,
• 56:38what gives us like the lifeblood and
• 56:40feeds us and what gives us energy is,
• 56:42is community is like outside
• 56:44connections or hobbies or communities
• 56:47that like bring groups together.
• 56:50And when not having those was
• 56:53just this foundation for so long,
• 56:56I think it's really hard for people
• 56:58to transition back into that.
• 56:59So like one of the best things we can
• 57:01do is get involved, get connected,
• 57:03kind of shake some of that disconnection
• 57:06up because that's been something people
• 57:09have been suffering for a while now.
• 57:12Yeah,
• 57:12really, really agree.
• 57:13So we're just, we're at our time,
• 57:15want to thank all the presenters
• 57:17for joining and then doing this.
• 57:19Really appreciate it.
• 57:21And to remind everyone that we
• 57:22will have another one coming
• 57:24up next week where we will talk
• 57:26about parenting and transition,
• 57:28adults transitioning to parenthood.
• 57:31Look forward to your questions.
• 57:32Look forward to joining again.
• 57:34Thank you so much for coming
• 57:36together to think about children
• 57:38and families and to my colleagues
• 57:40for such rich presentations.
• 57:42Thanks everybody.