Child Study Center Grand Rounds 09.14.2021

October 29, 2021

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Matters of the Heart: Reflections on Our Past Year and What Lies Ahead

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00:00Well, good afternoon everyone
00:02and on behalf of Doctor Andres
00:04Martin and Doctor Crystal Finch,
00:07my Co chairs of the Grand runs committee
00:09and the entire Grand Rounds Committee.
00:11I'd like to welcome you to the start
00:14of our new grand rounds series.
00:16It is such a pleasure to see so many
00:18of you here in person at the cone.
00:24And also wonderful to see so many
00:26people on zoom virtually so obviously
00:29this is our first hybrid event,
00:31so please bear with us if we have any
00:33teething problems or technical difficulties,
00:36and I'd like to start by thanking
00:38Rosemary and Mark and Duncan and Kyle
00:41for really helping support us to bring
00:43this hybrid event and into reality.
00:46And so you know, as a ground round committee,
00:49we're really hoping that this new
00:51series will continue to be a forum that.
00:54Brings our entire community
00:56together to learn together.
00:58We've put together really a
01:00stellar program of speakers where
01:02we'll expose you to new ideas,
01:03new perspectives, cutting edge
01:06research and clinical innovations.
01:08And as I said,
01:09I hope you'll be able to join us
01:12regularly for this grand series.
01:13I'll just point out that next week will
01:16have doctor Jonathan Posner from Duke
01:18University who will talk to us about
01:20the effects of maternal depression
01:22and pregnancy and the treatment.
01:24Maternal depression in pregnancy
01:26with antidepressants on trajectories
01:28of child development,
01:29and I do hope that you'll be able to
01:31join us for that presentation now.
01:34I joined Yale from University in
01:36Canada and on days like today where
01:38we look forward with excitement,
01:40we also take a moment to pause and
01:43reflect on the past and to reflect on
01:46a history that is often overlooked
01:48and that is the history of the land
01:52on which we stand the land on which.
01:54The university is built upon and we
01:57do so through a land acknowledgement
01:59which is a sign of respect and
02:02inclusion to our indigenous and Native
02:05American colleagues, friends and peers.
02:07And Yale does actually have its
02:10own land acknowledgement,
02:12which I'd like to share with you now.
02:15So Yale University acknowledges
02:17that indigenous peoples and nations,
02:19including Mohegan man,
02:21tortured peak, Watt, eastern Pequots,
02:23Schaghticoke, Golden Hill, pygas,
02:25it, nehantic,
02:27Quinnipiac and other Algonquian speaking
02:29peoples have stewarded through generations.
02:32The lands and waterways of what is now
02:35known as the state of Connecticut.
02:38We honor these unrespected these
02:41enduring and deep relationship
02:42that exists between these peoples.
02:45And nations and this land.
02:47And I encourage any of you that are
02:49interested to learn more about land
02:51acknowledgements to visit the Yale
02:53Native American Cultural Center.
02:54And I believe Linda will share a link
02:57either during her presentation or
02:58shortly after, so without any further ado,
03:01I'd like you to join me in welcoming
03:04our chair Doctor Linda Maze.
03:06To kick off this season of Grand Ryans.
03:13Thank you very much, Karen,
03:14and it's so great to see everyone
03:17in this room as well as on zoom.
03:20So I actually want to begin
03:21though with a question.
03:22This is our first hybrid event.
03:24Are you comfortable with my
03:26speaking without my mask?
03:29Alright, thank you.
03:33Oh, that's great. That's wonderful.
03:39Touch this. Just touch it
03:41down a bit. OK, great.
03:46So this is our opening meeting.
03:48And we have a tradition here in the center
03:51of actually having two opening meetings.
03:53The first one in September,
03:55which I'm going to reflect on what
03:57we do at this opening meeting and the
04:00one in January where we talk more
04:02about the state of the department.
04:04September brings us to a time
04:06where we've come through a lot.
04:08I'll talk about that in a minute.
04:10And I want to always try and
04:12September to be a bit reflective
04:14and looking forward to what?
04:15So head of us.
04:17So I think why do we do opening meetings?
04:20The first is we come back from
04:23our summer rhythms.
04:24This is the rhythm of the academic world.
04:28Things gear back up in September.
04:31We come back to welcome and we come
04:34back to look ahead to a new year.
04:37Now here in the CHILD Study Center over
04:39the last few years we've had a bit of a
04:41new tradition or a bit of a tradition,
04:43and that is that we actually have a
04:45theme for each of our opening meetings.
04:48And we began this,
04:49if you can count back five years ago
04:51we began with an Australian word spine
04:53bash about spending time, ideally.
04:56Then vacations, then sojourns,
04:59then a summer frame of mind,
05:01then rejuvenation.
05:04But this September and looking back.
05:07That actually all seems a bit off key.
05:11And a bit out of tune.
05:14So what I want to suggest is.
05:17Here we are that we have come
05:19off a summer like no other.
05:24With elbow bumping wearing masks,
05:28we sit in this room wearing masks.
05:30We have many colleagues on zoom
05:32for all together in different ways.
05:35We have the delta variant.
05:37We began this summer with hope because
05:40of the vaccine that was tempered
05:42then by caution and uncertainty,
05:44and still remains tempered
05:47by caution and uncertainty.
05:49These have been since March the 12th,
05:54552 days.
05:55Like no other that we have experienced.
05:59We have as a Community come together in
06:03a way and gone through something that is
06:06historic that we will tell our children,
06:08our grandchildren,
06:09our nieces and or nephews about
06:12and they will write that history.
06:15And those days are still not ended.
06:18We are still a stressed, tired,
06:21afraid community and society.
06:24And I want to call that out.
06:27And to acknowledge that.
06:29And what we are still living through
06:31are the challenges of uncertainty.
06:33We seek certainty,
06:34but we are faced now more
06:37regularly with uncertainty.
06:39What will happen to the delta
06:40variant whilst the new variant?
06:42How many people are vaccinated?
06:44Should we wear mask or not?
06:45Should we ask permission or not?
06:47Should we wear faith?
06:48We should we wear eye coverings?
06:50All of the uncertainty and then
06:53just frankly tremendous fatigue?
06:55Now I know you may be feeling
06:58that this is starting to go down.
07:00But I really want to call it out
07:03because I think it is incredibly
07:05important that we share this
07:07together in these 552 days.
07:10So the reason that then our theme for
07:13this year is matters of the heart.
07:16Is captured in some ways by this
07:19quote from Titus Andronicus.
07:21But my heart suspects more than
07:24my eyes can see.
07:26And oftentimes,
07:26when you think about matters of the heart,
07:28you're thinking about romance and
07:30romance novels and things like that,
07:32but I'm actually suggesting that there
07:35are three areas for matters of the heart.
07:38That are very relevant to this
07:41September to those 552 days.
07:45The first is that it often refers
07:47to deep emotional experiences that
07:49have often been in relationships
07:52and could that not be more apt
07:55about this pandemic?
07:56But it also speaks to healing and gratitude.
08:00And it speaks to community service,
08:02leadership and values.
08:03So I'm going to touch on those three.
08:07And we've been together.
08:10But before I begin that,
08:11I also want to acknowledge that a lot
08:13of times when we came together in September,
08:15we would share more light with things
08:18about what we did in the summer
08:20where we went on our vacations,
08:22all the various things,
08:23what we experienced, who we saw.
08:26But again,
08:27this has been a summer like no other,
08:29and speaking more personally,
08:31for me,
08:32a number of you may know that actually
08:35I lost my mother earlier in this summer.
08:38And I don't tell you that or bring that
08:41up to actually turn it back to me.
08:44But simply to say that that experience
08:47has heightened my awareness for
08:49what has been.
08:51What is really a theme of all
08:53of this pandemic
08:55for us? Of our collective loss.
08:58And to suggest that we as a community
09:01are experiencing a collective grief.
09:04That we have lost a great deal.
09:07We've lost our grounding routines are or
09:09even the fact of coming into this room.
09:11You all applauded for the fact
09:13that we are in this room.
09:14Together we came back to
09:17our grounding routines.
09:18Our organized activities social
09:21contact with friends, families,
09:23even those rites of passage
09:25that are so key for us.
09:28I don't know how many of you lost
09:31family members or friends or lost.
09:33Just contact with them if not
09:35lost them to the to the pandemic.
09:38But we've had also changes and
09:40and goals or delays in your goals,
09:43even predictability, and most fundamentally,
09:46the assumption that the world
09:49is a safe place.
09:51Our heart has seen on one level much more
09:55than our eyes and our ears have taken in.
09:59And if we are listening to our heart,
10:02we know that we are all
10:05experiencing this together.
10:06And what does it look like to be
10:09experiencing as a community brief?
10:12Well, it looks like a number of things.
10:15It looks like a feeling of
10:17not being in control.
10:18Anybody had that feeling over the last year?
10:21It looks like a feeling of
10:24being distracted and tired.
10:26Of anxious,
10:27irritable,
10:28and fragmented as a group of feeling
10:32powerless and also even thinking about
10:35others but not thinking about others
10:37necessarily always in a caring way.
10:39But those people that aren't
10:41wearing their masks.
10:42Those people that aren't vaccinated.
10:44The othering of our world around us.
10:47And that is not only I would say a
10:50measure of our grief as a community.
10:53But it's also ironically a measure
10:56of what it means to be in this
10:59virtual world for a very long time.
11:01Do you remember with longing?
11:04When we sat in this room and
11:07we didn't worry about who had
11:08masks and who didn't have close,
11:09we were how we actually were really,
11:11really happy when people were
11:13standing up in the back and crowding
11:15and falling over each other.
11:16We did not worry a bit about that.
11:19And I would dare say when you
11:21came in today and started sealing
11:23of those of you in the room,
11:25seeing more people, you started thinking.
11:27Well, let's see.
11:28I believe they said no more than 20.
11:30No more than 10.
11:31How many you're supposed to be in the room?
11:33Our sensitivities have changed.
11:34We've gone from squares.
11:36We've gone from full to squares.
11:39And there actually is some really
11:42interesting data about the impact
11:44of this virtual world now of
11:46552 days of it on our being.
11:50And on as we work as a community.
11:53The first comes at two of these are two
11:55papers and I give you the references.
11:57Both are published in Nature.
11:59One talks about the impact of the
12:02pandemic is a natural experiment.
12:04Heaven knows we didn't design it.
12:07A natural experiment and comparing
12:09it to prolonged spaceflight.
12:12And also.
12:14For a long spaceflight and also to technology
12:18and the impact of technology transfers.
12:21The other article is actually
12:23really very interesting.
12:25Because it also looks at the effect
12:27of the pandemic on specific social
12:29behaviors and how groups work
12:31together as well as individuals.
12:33And looks at how prolonged virtual
12:36working has had an impact on things
12:40such as an understanding thread.
12:43How we respond.
12:45Actually to various prejudice
12:47and discrimination,
12:48in particular how we actually think 0
12:52sum thinking or our ability to cooperate,
12:56or even to make decisions from a moral frame.
12:59I can give you these references,
13:01but all this is to say is that there
13:04now is an emerging literature that we,
13:06as social scientists and its clinicians,
13:08should be aware about the effect of
13:11prolonged amounts of time in a virtual world.
13:15However. We've also learned a lot.
13:19In our virtual world,
13:20we've learned how to do things
13:21in different ways.
13:22We've learned some very positive things,
13:26and we've learned that, for example,
13:28the pandemic may actually hasten
13:30certain things about well being,
13:32and we're working in a virtual setting.
13:35It may actually in some ways
13:37influence performance in good ways,
13:39as well as a decrease in.
13:42So all of this we need to
13:44be extraordinarily aware of.
13:46Yet at the same time,
13:47I'm also very aware that everybody.
13:50To 1 degree or another are
13:53worried about returning.
13:55And what does return mean?
13:57It doesn't mean coming back to normal.
13:59What does return mean?
14:02The lovely flower.
14:04They just don't get those on zoom.
14:08So return,
14:08we've had a number of things that people are
14:11worried about the being exposed to kovid.
14:13We're all sitting in this
14:15room or sitting with masks.
14:16They're worried about losing flexibility,
14:19which means the ability to take care
14:21of your children or your loved ones at
14:23the same time you're balancing your work.
14:26They're worried about the time of
14:28commuting now and many other things
14:31that are very much on people's minds.
14:34And so as we think about that,
14:37and as we think about the worries
14:39that we've had about coming back,
14:41I'm also extraordinarily grateful.
14:44To the fact that we actually
14:46can come back together.
14:48And that we can come back together
14:50to talk about the joy and the dread
14:53and how we can work together as a
14:55community and that people have been
14:57very willing to share their stories.
14:59And very willing to start talking
15:02openly about how do we do this?
15:05So another part of matters of the heart.
15:08Is expressing gratitude.
15:11And indeed,
15:12there is also a literature about
15:15expressing gratitude and its impact
15:18on healing a pretty big literature.
15:21Of how regular, intentional noticing,
15:25expressing thanking what people your
15:28colleagues, all of us for how we are.
15:30What we are doing.
15:32How we are working together.
15:33Has a positive effect on health.
15:37Captured perhaps in this quote,
15:39but very old quote,
15:40that gratitude is not only
15:41the greatest of virtues,
15:43but the parent of all others.
15:45But you can see that from a
15:47Pediatrics most recently or recently,
15:49expressions of gratitude impacting
15:51medical team performance.
15:53A potential role for mu opioids in
15:56the positive effects of gratitude.
15:58A number of these references to give to you
16:01that are really about the positive effect.
16:04Of being grateful.
16:06We've come through 552 days,
16:09but being grateful for all that
16:11we can do and have done together.
16:13And so, let me just express some
16:16of my gratitude to call out.
16:18I'm very grateful that so many of you
16:21have engaged in our virtual world,
16:23and I've been willing across that
16:26virtual and strange world of many
16:28squares on a screen to contribute.
16:30I'm grateful for our smooth
16:32transition to Tele health,
16:33where in less than two weeks we
16:35got the majority of our patients in
16:37March onto a Tele health platform.
16:41That we've been able, not without trial,
16:44not without challenge.
16:46To balance your families and personal
16:49needs in this very stressful environment.
16:52And for everyone's extraordinarily
16:54hard work to keep families engaged,
16:57whether it's on a research or
16:59clinical or whatever basis.
17:01There are a number of you I
17:02suspect in this room,
17:03but I know virtually that joined
17:07the CHILD Study Center last year
17:08at the time of the pandemic,
17:10and you have actually literally not been
17:13in person with the people that you work with.
17:16That takes tremendous patience to actually
17:19join a place and live in your apartment,
17:22but yet you're a member of
17:24the Child Study Center.
17:25I'm very grateful that you've
17:27had the patience for that.
17:29And the patients that shown as our
17:32communications have not always been thorough,
17:34and they've not always been
17:35just right on key.
17:37But that you've been willing
17:38to ask questions,
17:39and you've been willing to say
17:41what else could you tell us?
17:42And really, trying to push us to do better.
17:45And finally the and not really,
17:47finally, but just on this slide.
17:50The willingness to try different ways of
17:52coming together and to share your stories,
17:55however, however painful.
17:56Or however whatever you think about
17:59them to share them in the spirit of
18:02are actually trying to do better.
18:07But this is also been a
18:11time of enormous change.
18:13Enormous change.
18:16In October of 2019.
18:18How far away does that seem?
18:21We moved into our new building at 350 George.
18:25We had no idea what was coming on March 12th.
18:30We moved into this new building.
18:32We brought various practices
18:34within the center together.
18:36We started learning how to work as one
18:39integrated practice and going through
18:40the bumps and the ups and downs of
18:43that and adjusting to our new space.
18:45And then March 12th happened.
18:48But we've been going through
18:49a lot of other change.
18:51We've been going through a
18:53tremendous upheaval in a good or
18:55people a long overdue upheaval
18:57in matters of social justice.
18:59We're also going through the
19:01unseen tolls of the pandemic,
19:02which I will talk about in a little bit more,
19:04but the rise in behavioral health
19:06needs not only a chipmunk children,
19:08but among adults.
19:10And we're coming together we're seeing
19:13a change in how people work together.
19:16Slow overdue,
19:18but a tremendous change in our culture.
19:23And as we think about the change,
19:25now that is before us in 2021 to 2022.
19:28I want to suggest that we need another
19:32metaphor for change or not metaphor we
19:36need actually another frame for change.
19:39Change that to date has been changed
19:41that we come up with an idea.
19:43We move it forward and then we
19:44can be various constituents.
19:46We move it forward and we try to
19:48make it happen. It's transactional.
19:52What do you want to get to watch your goal?
19:55How are you going to make the change?
19:57What are the steps forward?
19:58It's very transactional.
20:01What I want to suggest is what we are in,
20:03not just as apartment,
20:05not just as a school but as a
20:08society is a model of social change.
20:11And social change has a different emphasis.
20:15Social change is this.
20:17It changes in human interactions
20:20and relationships that transform
20:22culture and social institutions.
20:25That is what we are in the middle of.
20:29And if you want a historical,
20:31relatively recent but historical.
20:34A event of social change.
20:37Think of the civil rights movement.
20:39Incomplete.
20:40Not in anywhere finished,
20:43but actually certainly changed the
20:47way institutions work together.
20:49It's explicitly driven when you think
20:52about a social change frame by shared values.
20:55Values about collaboration,
20:57mutual support,
20:59gratitude that we talked about.
21:02And it begins with how thinking
21:04about social change movements,
21:06social change processes begin with thinking
21:09about how we actually work together.
21:12How do we listen?
21:14How do we contribute and how do we critique?
21:17In retrospect,
21:18in October 2019 there were
21:20elements of social change when
21:22we moved into that new building.
21:24We were just so focused on the
21:26concrete elements of getting
21:27us into that new building,
21:29but it was driving different
21:31ways of working together.
21:33And heaven knows this
21:35pandemic has both set us back,
21:38but also put it more conscious.
21:40Other ways that we miss
21:42and working together in the
21:43ways that we can.
21:45So social change model is really,
21:47I think, app for all the change
21:49that's going on for this department
21:52and all the things that we will
21:54need and are trying to move forward.
21:57An other piece though
21:59that I want to talk about.
22:01Is within great social change times.
22:05There are different approaches to
22:08leadership that may be required.
22:10And I want to speak once again
22:12just a bit personally,
22:13and to say that as I've thought about it,
22:17and as I thought about my role in this
22:20department and my role as your chair,
22:22I come to think about particularly
22:25now and this time.
22:27And in this time of collective grief,
22:29gratitude coming together.
22:31That we need to rethink how
22:34we lead all of us really.
22:37So in a traditional way of
22:40leadership around change.
22:42It's this. Triangle pointing up.
22:46And if it's,
22:46this is better over here on this graphic
22:49that the teams serve the leaders.
22:51That the teams answer to the leaders.
22:54What I'm suggesting,
22:55and this time in this post,
22:58COVID world,
22:59whatever that world will look like.
23:01That we are in a time now of
23:04servant leadership.
23:05Where leaders serve their teams.
23:08Where the goal is to
23:10actually bring us together,
23:12the goal is to actually help us come together
23:15in the most productive and creative ways.
23:18And that actually the characteristics that
23:21I would suggest are most important now.
23:24That all of us really should
23:27embrace our of stewardship.
23:28Commitment to the growth of
23:31people and to building community.
23:33To bring us back.
23:35Bring us back in whatever way
23:38that looks like.
23:39And it's.
23:42I think it's not that one
23:44stays in one style or another,
23:46or one approach or another,
23:47but for a period of tremendous social change,
23:50we need to be thinking in these ways.
23:55Now I want to just call out one thing though.
23:59That I know that those are words.
24:02And there may not be words that
24:03I've always said is explicitly,
24:05but I know there are words.
24:07And that right now we're also at
24:09a time which is characteristic
24:10of social change,
24:12where action is as a action really
24:16drives today. As in the quote.
24:20Culture change takes time.
24:22It does take time.
24:24But I would also suggest it is
24:26a time for change.
24:28And you have my commitment
24:29for change on the areas.
24:31Now that I'm about to talk about.
24:33It is a really important time
24:35for us to change but and,
24:37but I'm also aware that
24:39all the words won't matter.
24:42They may be beautiful,
24:43they may not,
24:44but unless we put action behind them.
24:48So less transition with that frame.
24:52And with that talk of community and that
24:54talk of coming together and social change,
24:56let's just transition to what we
24:58used to do in this room on early
25:01September by asking everyone who had
25:04been you or it's just new in the
25:07child Study Center to stand up and
25:09then we had this coming together.
25:10Nobody thought about COVID or
25:12mask and hugged each other and
25:14shook hands and did all of that.
25:16Let me just do it for a moment with
25:18pictures and welcome our cat fellows.
25:21So we have our new headmen track fellows
25:23we have are sold at South Track Fellows.
25:26We have our integrated
25:28residence really great.
25:29Nine new people coming together for us.
25:34I want to welcome as well.
25:37Our psychology fellows.
25:39Who come from a whole
25:42diverse areas and places.
25:44For example armarillo which I'm hoping I
25:47pronounced correctly coming from Colombia.
25:50Emily coming from the
25:52University of Tennessee.
25:53Anna coming from Sony and Albany
25:56and and Sarah coming from Yeshiva.
26:00I'm not going to be able to do
26:02it from memory for everyone,
26:03but just to give you a sense of
26:05where people are coming from.
26:07And our social work colleagues
26:08were delighted.
26:09Now that we have a two year
26:11social work fellowship,
26:11our social work colleagues with Emma
26:14coming from Catholic University and
26:15Dakota from the University of Pennsylvania.
26:21We have our research training program
26:23fellows and on this slide we want.
26:26This will foreshadow a theme
26:29throughout about mentorship,
26:30but Tara with Kieran as her
26:33mentor Francesca was Helen's.
26:35Her inventor and Taylor with Dylan jeez.
26:39Mentorship, intergenerational and then
26:41we have just a remarkably bumper crop.
26:46A masters fellows here
26:48from our Yale UCL program.
26:50Really the biggest class we
26:52have ever had internationally.
26:54The majority of them are
26:56actually in New Haven now,
26:58but that's just an amazing number.
27:01We've also welcomed a number of Members
27:03and new members to our staff work
27:05working across different programs.
27:07As you can see.
27:09And we have welcomed another
27:12incredibly large number.
27:14Or postgrad associates and new postdocs.
27:18And I'm very delighted to see,
27:20although can't see in person yet,
27:21but very delighted to see a couple
27:24of new post grants who were here as
27:27summer interns not too long ago.
27:29So coming back and coming back
27:31to the center and new roles and
27:33new professional development.
27:37I want to turn to looking
27:40ahead to the new year.
27:43And I want to turn to two areas.
27:45One is that we are apart.
27:49We are a part of a larger system.
27:51We are part of the School of Medicine,
27:53the School of Medicine is
27:54a part of the university.
27:55There's also across the street.
27:57This very large health system.
27:58We're apart of multiple systems.
28:01And I want to become more intentional
28:04over these times to talk to
28:06you about news from different
28:08areas that truly impacts us.
28:11The other part,
28:12the other reason is to bring
28:14some news from the school is to
28:16also talk about opportunities.
28:17It offers us.
28:19And the second point is that I
28:21should have said earlier about action
28:23in words that we are a part of a
28:26larger system and sometimes it seems
28:28like our actions go at tortoise,
28:30shell speed or tortoise speed and we
28:32are working our way through these systems.
28:35So I want to get more intentional
28:37about talking about systems.
28:39But let me turn to news from
28:41the medical school.
28:43And just tell you about
28:443 new four new offices,
28:46well,
28:47three new offices and one office
28:50that's greatly expanded.
28:52And the reason is not to be bureaucratic
28:55and not to talk about offices.
28:57The reason is actually to say that
28:59there's a tremendous theme here
29:01going on in the medical school about
29:04fostering professional development.
29:06About career development.
29:08About mentorship.
29:09About creating an inclusive climate
29:12about helping everyone find their
29:14voice and find their talent.
29:17And there are some very concrete
29:19opportunities as well here to tell you about.
29:21But that's the theme and the
29:24reason to highlight these.
29:26So the first is the office of Physician
29:28scientists and scientists development.
29:30So open for MD's and pH D's on
29:34directed by Doctor Keith Choate
29:36from dermatology and the goal of
29:38this office is really to try to
29:40bring people early on in their
29:43career development and mentor them,
29:45mentor them into a full career that
29:48that has collaborations across the school.
29:51There are a number of opportunities,
29:53such as funding for early physician and
29:56scientist development awards to help.
29:58There's a professional society,
30:00and the thing that I'm actually
30:02very excited about that I think we
30:04should take tremendous advantage off
30:06contributing some of our own grants to it.
30:08It's a grants library that serves
30:11as a template for writing grants.
30:14Once again, though,
30:15the goal and the mock study sections
30:17as people learn how to review.
30:19Again,
30:19though,
30:19the reason to bring it up is
30:22there's a with Dean Brown's arrival.
30:24There is actually a real focus on
30:27bringing central mentoring resources.
30:31The second is quite relevant to RT
30:3332 is that there is new now a new
30:36office of Team Science and a new
30:38director of Team Science of Khaki Mashburn.
30:41I have a very small personal
30:43story about khaki.
30:44You may have noticed my mask
30:47wherever it went to.
30:48Ah.
30:49The purple mask khaki actually
30:51happens to be a graduate of Sewanee,
30:54the University of the South,
30:56went by by way of Vanderbilt.
30:58She was an English major and then learn
31:00to actually do large grants so career
31:03transitions can be a variety of things.
31:06But most importantly,
31:07as we start to think about multi site
31:10multi collaborative opportunities,
31:11this is an office now available to help us.
31:15And I looked to a number of people
31:17that might be interested in this.
31:19This is really important for us.
31:22There's also now a new office for postdocs.
31:26And the whole again idea is to build
31:29mentorship and mentoring skills to help
31:32with grants, leadership development.
31:34All of these kinds of things that you're
31:36going to see bumbling more and more.
31:38We as a department will do are doing a lot,
31:41which I'm going to get to.
31:42But this is happening at
31:44the level of the school.
31:46And then finally in Dean Latimer's office
31:49that Tara knows a great deal about.
31:52There's a number of initiatives,
31:53but I want to call your attention to
31:56to actually, specially on inclusion.
31:59About creating workshops and
32:01trainings on promoting an inclusive
32:04climate and promoting sponsorship.
32:07Now I'm going to come back at the
32:10end to this idea of sponsorship.
32:12For sponsorship and mentorship are different,
32:16they overlap, but they're different.
32:19And the effort of sponsorship
32:21becomes responsibility of all of us
32:24to try and think of opportunities
32:26to that we can offer our colleagues
32:28and I'll come back to it in a bit.
32:31But these are just I will make
32:33these slides available to you,
32:34but these are just to call
32:36your attention that.
32:37We are a department and a school.
32:41And a school that is growing its
32:43resources for helping everyone
32:45develop and reach their potential.
32:48So to be aware of that.
32:52So now back to us.
32:55What are the challenges before
32:57our department? And you know,
32:59I don't usually talk in terms of challenges.
33:02I usually try to reframe it as opportunities.
33:05But I want to actually be really,
33:07really direct, but the thieves are the
33:10challenges I think for 2021 to 2022.
33:15The first is to improve and
33:17strengthen our culture to work
33:19seriously on our culture and climate.
33:21We this system, this is not idle.
33:24This has to be an imperative.
33:27Our post COVID world what is that
33:29world in there going to look like?
33:32We got a little tiny microscopic
33:35taste of it right here.
33:37All of us sitting in a room with
33:39mask and people in virtual as well.
33:41Let's get a little more granular.
33:43What's it going to look like?
33:46The behavioral health surge that
33:48I alluded to earlier is impacting
33:50a tremendous number of children.
33:52How are we going to meet it?
33:54What are we going to do?
33:56And it is upon us, and it is not going away.
34:00And then growing and diversifying
34:03our community.
34:04Those I think are are challenges
34:06for this upcoming year and embedded
34:08within those of course are many
34:10many practical details.
34:11But let me let me outline them.
34:14So the first is around attending to
34:16our culture and I'm very grateful to
34:19Terra and to all the people that have
34:21come together to help Tara for all
34:23the work that she is bringing forward
34:25and that we are already starting.
34:27But it is starting.
34:29It is a long journey and it is a journey
34:32that we need to just continue and be
34:35vigilant for and work very hard together.
34:38But to develop an agenda around recruiting
34:41and retaining a diverse faculty and staff.
34:44What we might think about
34:46is our talent pipeline.
34:47And to be much more intentional about that.
34:50With those of you who have
34:52stepped forward to join Terra,
34:53to think of yourselves as DI ambassadors.
34:57That throughout our community,
35:00and began to engage not
35:03only in conversations,
35:04but generating ideas of how we can do better.
35:08And you've heard,
35:09probably in various settings
35:10and various communications,
35:11and we can't communicate enough about
35:14facilitating we're having outside
35:16consultants Yasmeen to come to train
35:18us and restorative justice tools for
35:21how we create a safe and respectful
35:23culture and how we facilitate that.
35:25That's intensive work.
35:27And then we will,
35:28with the state education Resource Center,
35:31also begin our anti racism training.
35:34But these are, I think,
35:35are pressing concerns.
35:38In this improving working on our culture.
35:43The first is we must address
35:45the equity issues this year for
35:48our Masters level faculty.
35:50Those of you in that space
35:53as masters level faculty.
35:55Help then in meetings,
35:56heard the conversations about the
35:58various things that we must do,
35:59but we must do it.
36:01And again,
36:01remember that we're part of
36:03this larger system,
36:04but we need to keep pressing
36:06on the gates and doing it.
36:07Around salary around opportunities for
36:11professional and academic advancement.
36:13We need to think about the
36:15impact of the tremendous clinical
36:16demands on our clinical faculty.
36:18I am very aware.
36:19That many of you working in the
36:22clinical setting are feeling burned out.
36:24And that we have a challenge on
36:27morale because it just seems like
36:29the children just keep coming.
36:31They do actually just keep coming
36:34and that we actually and that
36:36we don't perhaps acknowledge
36:38how your hard work enough.
36:39But also that oftentimes we
36:41find ourselves in the trap.
36:42So thinking about productivity and
36:44and talking about that without
36:46always regularly acknowledging how
36:48are we standing together to meet
36:50these children and how do we pay
36:53attention to those demands and the
36:54impact on all of you seeing them.
36:58I feel very strongly about ensuring
37:01inclusion and a sense of belonging
37:03across roles and experience.
37:05If one person in this department has the
37:09experience of not feeling as if they belong.
37:12That's that is obviously not right.
37:15That is not where we should be.
37:17And we need to understand it.
37:19We need to correct it.
37:21We need to find every way we
37:23can and will make mistakes.
37:25It won't always be perfect,
37:27but to have this as a priority.
37:30And to ensure equal access to opportunities
37:32in the center and what that actually means.
37:34Quite frankly,
37:35it's posting every opportunity
37:37we need to get better about that,
37:40posting every possibility that we
37:42have so that people have equal
37:44opportunity to take advantage of that.
37:47And we haven't always done this
37:49well on that as we should,
37:50but we need to do that going forward.
37:55Our post COVID world the
37:57challenges of our post COVID world.
37:59The first one we're doing right now.
38:03Is learning how to work in a hybrid model.
38:05This is one kind of hybrid model.
38:08And I have to confess to you and
38:10to those of you on zoom that.
38:12That we are as human beings.
38:14We are such social people and that
38:17my brain right now is seeing people
38:19in three dimensions in front of me.
38:22And it's just getting an
38:24extraordinary dopamine surge.
38:26And yet at the same time I'm very aware
38:28of those of you on zoom who are in the
38:31squares and I don't want to ignore you.
38:33And I think Tom,
38:34it was in one of the faculty meetings
38:36where you lead a small group
38:39where I buried very strong theme
38:41was do not have people on zoom.
38:43Second class or not present.
38:47So if we're going to work hybrid like this,
38:49which I hope we do,
38:51we need to attend to that that you on
38:53zoom are as present as everyone here
38:56filled out in all of your three dimensions.
38:59And that's going to take work
39:01'cause we're going to go against
39:03the social brain if you will.
39:05We need to be thinking more about
39:07flexibility and work arrangements.
39:08What does it really mean?
39:10We use that word.
39:12Can I be flexible?
39:13And of course,
39:14being good people we would say of course,
39:17but what does that actually mean?
39:19How do we put in place?
39:21How do we work again within this
39:24larger system and yet allow people
39:26the flexibility to do childcare to do
39:28elder care to do whatever they need to do?
39:30And to still do their job as they have
39:34learned to do in these past 552 days?
39:38Diversifying our approaches to communication.
39:40We do a lot.
39:42We do a lot on email.
39:44We do alot electronically and I still,
39:47I think probably the lesson that
39:49I will continue to learn as you
39:51can never communicate enough and
39:53even if you think you've said it,
39:55you probably need to say it
39:57another 10 times minimally.
39:59And so we need to learn how to say
40:01this and diverse in different ways
40:03and need everybody's input work.
40:05What works for you.
40:07And then finally to continue to communicate
40:09about the diversity of work in the center.
40:12And so we've started something
40:13now at the faculty meetings.
40:15And if you read the faculty notes,
40:16you'll see some reason we just had one.
40:19Dennis gratefully started us off,
40:23where at every faculty meeting
40:24we will have 10 to 15 minutes of
40:27someone talking about their work.
40:29That was what was asked so that we could
40:32try to cross Cross Bridge across programs.
40:34So we get a better sense of
40:37the diversity of the center.
40:39And then we are hiring.
40:41Hopefully we have a search for a
40:44new communications officer and
40:45hopefully we'll have someone in
40:48place that will especially help
40:50about numbers three and four.
40:52But there are more post COVID challenges.
40:56In my times of meeting with so many
40:58of you around the faculty reviews,
41:01I learned about a number of odd projects
41:04where you're still very seriously catching
41:06up on recruitment needs across projects,
41:09and there's just a number of people that,
41:12while they've worked really,
41:13really hard in the pandemic to get people
41:16participating to get people coming,
41:18that's a major major issue.
41:20That we've lost ground in that way.
41:22And families, of course,
41:23have been reluctant to come as well.
41:26And so it raises the question.
41:27For example,
41:28should we actually start to think
41:31about centralizing recruiting processes
41:33across our studies so that we if
41:36we find ourselves maybe not find
41:38ourselves in this dilemma again,
41:40but that we're actually starting to work
41:43together and more collaborative ways.
41:45We need to resume recruitment and
41:47replacement for clinical staff.
41:49We've been on a hold for that and
41:52so we've had this perfect storm.
41:54This imperfect storm where behavioral
41:57health surge and staff being
42:00relatively constant or going down,
42:02and it doesn't actually take calculus to
42:05understand that that's a recipe for burnout,
42:08and so we truly need to re be resuming
42:11recruitment and replacement and working
42:13closely with our Yale Medicine colleagues.
42:16And then once again to continue to
42:18work towards more integration and
42:20sharing expertise across services.
42:22And I don't mean just clinically.
42:24I actually mean again our research.
42:26How do we? How do we bridge?
42:28I see that as a tremendous need in our
42:31post covid world because in our covid world.
42:36We've spent a lot of time at home.
42:39And a lot of time in virtual space
42:41and virtual space you just don't
42:43have that cup of coffee.
42:46You just don't have that opportunity
42:47to run into somebody in the hall,
42:49masked or not.
42:50And find out that they're going to meet
42:53the same person that you just met last week.
42:56Maybe,
42:56or that there are these kinds of
42:59serendipitous moments that we need to regain.
43:05We also need to work smarter.
43:09And I see this as really a priority.
43:11I know the title of the book is more humorous
43:15but but I see this as a real priority.
43:17That we use need to use our meeting
43:20times much more effectively.
43:22With setting clear goals,
43:23clear agendas and then follow up,
43:26follow up on items that come out of it.
43:29We started the process of
43:31reviewing our committee structures,
43:32but we need to finish that with
43:34clear charges for each group and
43:36sunset committees if they finished.
43:38And give people more opportunities
43:40to join and be a part of the world.
43:44It's such a.
43:46Interesting idea.
43:47Suppose that we should actually have
43:49job descriptions for what we do.
43:53And we go to someone and say,
43:54would you chair this committee?
43:56But we don't actually have a job description,
43:58let alone a charge for the committee.
44:00Or would you take on this this role?
44:02But we need to actually be much more
44:05intentional about creating that,
44:06and I won't go into School of
44:08Management speak at this point,
44:09but it actually will help
44:11us work Better Together.
44:13And it will actually help us work smarter.
44:16And then to align our different missions.
44:20A number of you have talked about the gap
44:22between our research and clinical work.
44:25Not gap in activity,
44:26but gap in who knows who's doing
44:29what and is it aligned and and and
44:32we need to be better about that.
44:34And then we've started the process
44:37of refreshing our strategic goals,
44:39but we need to finish that
44:41and especially focus.
44:42In those discussions,
44:43what has come out so far as
44:45people's continued interest in
44:47stress and adversity and policy.
44:49But we need to be very,
44:51very intentional about where
44:52is our basic science going
44:54in the department as well.
44:56But work smarter is the key.
45:01So let me spend just a little time on the
45:03pandemic and a behavioral health surge.
45:08Fortunately in history,
45:09there aren't a lot of pandemics.
45:12Otherwise, I think we would.
45:14Well, that would be a Darwinian moment.
45:17There aren't a lot of pandemics,
45:19but oftentimes what happens is different
45:23kinds of pandemics followed the initial one.
45:27Or so we've had a physical health crisis with
45:31COVID and we're still in the middle of it.
45:33But that was followed very
45:35quickly by an economic crisis,
45:37which drove a lot of decisions.
45:39As you know about reopening businesses
45:41reopening this reopening that really
45:44driven not by public health always,
45:46but by the economic crisis.
45:49And the third wave you can think of now
45:52is that we are in a mental health crisis.
45:54The cumulative effect of this pandemic.
45:58The cumulative effect of grief and mourning.
46:01All of the things that
46:03we've been talking about.
46:05And the numbers are quite striking.
46:07But I want to return just briefly to grieve.
46:11And that is that.
46:12As you know, it's been over 600,000 people
46:16in this country who have died in COVID.
46:20And each person who dies from
46:23COVID has left behind two children.
46:264 grandchildren, on average,
46:29nearly nine family members.
46:31Just take those numbers alone.
46:34And you have a society in a
46:38collective grief and mourning.
46:40A society that has been upended.
46:43And we begin to see it in the news reports,
46:46and there's more in the New York Times,
46:49I think yesterday and we begin
46:51to see it all over the headlines.
46:54About waiting list.
46:56Emergency room services.
46:58Children's mental health services
47:00needing to be overhauled overburdened.
47:02All of these things.
47:04You start to see.
47:06And if you look locally for us.
47:09Here are our data.
47:13So in this goes through July 21,
47:17so interestingly, this dotted line are
47:20actually the total data outpatient.
47:22All of our outpatient services,
47:25and this dotted line right here is January,
47:27February 20. So notice something.
47:33January, February 20.
47:34We were started.
47:36We had this uptick.
47:39And then the pandemic hit.
47:42So we don't really know.
47:43Was this actually headed up
47:46or was it actually a blip?
47:48Don't know,
47:49but the pandemic hit so this is the pandemic.
47:52This is when we were on Tele
47:54health and nobody was coming in and
47:57nobody was making any referrals.
47:59And then here you are around June,
48:01July of 20.
48:02And you can see that it starts to go up.
48:07And now this is where we are.
48:10We're heading up. And this may be.
48:13I don't think we actually
48:15have taken a sudden dip.
48:16I think this is stock market
48:18fluctuation kind of graphics.
48:20So on average we are about 74% up in
48:24referrals and these are actually referrals
48:26where we've been able to contact the parents.
48:30If you just take all the calls that come in,
48:33this number will be higher.
48:35So we're about 74% up,
48:37but if you look at Youth 6 to 818 years,
48:41those numbers are higher but 100%
48:45not so tremendous actually increase.
48:48And I summarized it more on this slide.
48:52Were up 91% on those referrals less than
48:55six years up 106% in home services.
48:57Those of you working in home I don't really
49:00have to tell you that the demand is up.
49:03Uh, our overall up 74% are red borders,
49:07that is, children who stay in the Ed for more
49:11than 24 hours has dramatically increased.
49:14And if you compare.
49:16Let's see,
49:17I think it's from 19 fiscal year 19 to now.
49:22It's a 4000% increase in Ed border hours.
49:27And that's not the reason.
49:29Is this down enough beds to accommodate?
49:32So they have to stay in the
49:34Ed and they are sicker.
49:36And so they're sicker,
49:37so they can't go home and it's undress
49:40and Suman and Luke and so many other view
49:44and Lori working on the inpatient unit.
49:46Now the inpatient unit has been
49:48close to four or a long time,
49:52fluctuating but close to full.
49:54So we are truly in the middle of a crisis.
49:59And we need to ask the right questions.
50:02We could be asking the questions I've
50:04just more and more and more clinicians.
50:07Or are there other ways just
50:09like working smarter?
50:10Are there other things that we can do
50:13to impact the entry into the pipeline?
50:15That is the entry into the E,
50:17D?
50:17Are there other things we can do
50:19up front that change that?
50:22So I think some things are putting working
50:25very closely with pediatricians as
50:27Dorothy does with access mental health.
50:29Dorothy and her team to try and
50:32really impact the inflow in embedding
50:36in pediatric subspecialty areas.
50:39And then we also very much.
50:41Need to address this pipeline
50:43issue because there are a shortage
50:46of behavioral health providers.
50:48As Michelle knows,
50:49we if we were able now to post
50:52positions would take us six,
50:54often six to nine months, to find people.
50:57There is a tremendous shortage now.
51:00So we need to address the pipeline issue.
51:03And we must address payment models
51:05for behavioral health services,
51:07so we're in active negotiation right
51:09now with our colleagues in the health
51:12system about further supporting us as
51:14we deliver care for this children.
51:17But we are in the middle of this.
51:19We are in the middle of the third
51:20wave of the pandemic.
51:23So in the last slides,
51:25what I want to do is then also address
51:28growing and diversifying our community.
51:30And I give you these this profile
51:32just to give you a sense.
51:34First off of our size.
51:36That we are 520 people. Overall.
51:41And then here's the distribution of
51:44our gender and race distribution
51:46so you can see that we are.
51:49We are about 2/3 or more female.
51:52If you cut across.
51:53And while we have distribution
51:55as you see or no round race,
51:58we need to do much better.
52:00Much, much better,
52:01but this is our numbers as of now.
52:05The other point though,
52:05I want to make or several points.
52:07I want you to note.
52:09Is that we need to attend to the pipeline?
52:13'cause we have 10 assistant professors,
52:1512 and 12.
52:15And if you think of that as
52:17a developmental progression,
52:19we should actually really have more
52:21assistant professors because this
52:23is going to start this number,
52:25though I don't.
52:26I don't encourage anybody to retire,
52:28but this number will go down
52:31and you want this number.
52:32This pipeline to be robust.
52:36We need as I've said several times
52:38to diversify our recruiting pool.
52:40Our clinical track is growing as
52:42you can see we have 102 people in
52:44the clinical track with the majority
52:46among them as assistant professors.
52:49We need to think about how we put
52:51people on that associate research
52:53scientist track and how they progress.
52:55And we need to think very carefully
52:57about how we help people develop
52:59their careers.
53:00That's really how we diversify our faculty.
53:04We've been doing a number of things
53:06Darren David has been leading her
53:08leadership from the beginning course.
53:10We had peer coaching groups.
53:12We had the junior faculty department
53:14support for people, but we need to do more.
53:18And I want to come back then to Dean
53:22Lattimore's mentorship and sponsorship.
53:25There's a lot more that we can do as
53:28sponsors for our colleagues all around.
53:31If you hear about an award,
53:33nominate them.
53:33We're trying to get a little bit
53:36more proactive about listing all the
53:38possible rewards and sending out nominations,
53:41and but nominate them.
53:42If you hear about opportunities
53:44for professional development,
53:46nominate them.
53:48But also if you have opportunities yourself
53:51to present a case or to present a poster,
53:55bring a younger colleague along
53:57or give them the chance to be the
54:00author and the presenter and others.
54:02Those are examples of sponsorship that
54:06we very much need to be very proactive about.
54:09And we're actively,
54:10and I hope this is another priority
54:13for this year,
54:14developing more very concrete
54:17mentoring plans for or more people.
54:21And we need to be much more
54:23proactive about it.
54:26I want though, to end by calling
54:28your attention to things.
54:31These are the values of the Yale
54:33School of Medicine and these came
54:35out of the Yale School of Medicine
54:37Leadership Committee that was about now,
54:40heaven knows three years ago
54:42and 2019 or 2 1/2 years ago.
54:46I was a part of that group.
54:48And these were initially values
54:50that were to guide leadership but
54:52had been adopted by the school.
54:54And if you'll notice,
54:55we've been talking about a
54:56lot of these values.
54:57We've been talking about
54:58diversity and inclusion,
54:59and engaged in productive community.
55:02But in the spirit of growing our faculty.
55:05Generativity is the value
55:07that is most key to that.
55:10How do we think about the department,
55:12the place, the?
55:13How do we think about what we want it to be?
55:16For the colleagues that will come after us?
55:19That is absolutely totally central.
55:23So let me just conclude with reminding us.
55:27But these are our challenges in a
55:30time of tremendous social change.
55:33Cultural change adjusting
55:34to our post COVID world.
55:37The tsunami of behavioral health needs and
55:41nurturing and diversifying our community.
55:44We are meeting these in this time of
55:47tremendous upheaval and social change.
55:50And going with a social change model.
55:54My last two slides were actually
55:56my next to last line.
55:57That I'm about to put up is a suggestion
56:00for how we might work together.
56:03And and other meetings,
56:04Dean Brown has put up what she has
56:07called her rules of engagement.
56:09That's not exactly on the frame,
56:11and a social change kind of model.
56:14But I have borrowed some of those
56:16ideas and I want to suggest in this in
56:19that next to last slide how we work
56:22together and this is my adapted list.
56:26That we engage with discussion
56:28and planning together.
56:30That we share problems,
56:32but we also think about solutions.
56:34No surprises if you're worried about
56:37something or something's happening.
56:38Let's talk or come to me, whatever.
56:40Let's talk.
56:43Talk more, email less.
56:46And I truly mean that.
56:48Let's talk even if we have to
56:50talk over zoom, let's talk.
56:52Uhm? Debate is healthy,
56:55but then once we come together,
56:57let's come together around our decisions.
57:00And then I hope from this talk that
57:02the last three will not be a surprise.
57:05To express gratitude often.
57:08We can talk about problems we
57:10can talk about challenges,
57:12but express gratitude often.
57:15To listen with an open mind.
57:17That's part of the diverse,
57:19inclusive belonging community we
57:21want to create and to be genuinely
57:24curious about perspectives.
57:26And to reach them for our best cells.
57:30So I want to return in the
57:33last minute to this.
57:36To return to matters of the heart.
57:38And as we talk about our best selves
57:42to encourage all of us for that.
57:44And to actually intentionally and
57:47clearly renew my commitment to you.
57:49For my stewardship on this department.
57:53My commitment to this community.
57:56And my commitment to see that
57:58we will thrive and flourish
57:59and we will come back together.
58:01We have had 552 tremendously turbulent days.
58:06Our hearts are weathered and worn,
58:09but they have borne it.
58:11And let's make those 552 days.
58:14Then worth it.
58:15Let's make what we did,
58:16worth it and come back together with
58:19this department in mind in the future.
58:22In mind,
58:23for a thriving and strong and
58:25excellent place that people
58:26will really want to work.
58:28And once they stay for their lifetime.
58:31So thank you so much.
58:39Now, I believe we're going to
58:40try questions on zoom although.
58:44And I'm going to unstop stop the share.
58:46You can stuff to share and we're going to try
58:49realize how many. How many
58:50phrases are now in our lexicons?
58:52Stop the share your muted.
58:58Yeah, trying to figure it out, yeah?
59:05Yes, so Larry will question their enemies.
59:08Assume that wants to raise their hand.
59:10We lemme ask you to raise your hand
59:13and we'll we'll call on you to
59:15say state your question. The first
59:20I mean, this makes us all
59:22proud to be an apartment video.
59:24That's just. It just feels like.
59:27Yeah, but you know it's really somewhere
59:30for us to go and something you said
59:33that I just really want to size and
59:35that is around the diversification.
59:36I feel like we've all needed to survive.
59:39Yes, it's not. It's
59:40not just for the benefit of university
59:44as a whole, but really individually write
59:46this apartment to survive and that you
59:48know when we were in the olden days,
59:51our little silos. Wasn't so great.
59:55Burnout existed, right?
59:59Seeing so many cases for researchers,
01:00:01you know going crazy.
01:00:03With their next grant funding,
01:00:06it doesn't work, and so I just want to
01:00:07say that we've given us the
01:00:10opportunity. Lots of people.
01:00:14And I just think that's great. That's really
01:00:16helpful. Thank you, Larry.
01:00:21Got anything on Zune?
01:00:26Encourage again the zoom people.
01:00:28Yeah if you want on questions we really
01:00:30are open on zoom and let me just see
01:00:33I think I see something in chat here.
01:00:36Those were earlier messaging OK.
01:00:41Did I hear something Ding?
01:00:44That's over there, OK?
01:00:51Yes, Jim.
01:00:56Thank you.
01:01:01Thank you John, thank you.
01:01:07We will post these slides and I
01:01:09think we and I'm very open for
01:01:12questions submitted by email.
01:01:13I'm open for any kind of dialogue, obviously.
01:01:19We have a shy zoom craft well
01:01:22right well? Through the.
01:01:27Well, I understand I actually
01:01:29understand those of you on zoom.
01:01:31I understand 'cause this is our first
01:01:33time to do it this way and we've got
01:01:35people here in person and I think it.
01:01:37We've got to learn how to do it.
01:01:43OK, well thank you so much, I appreciate it.