Trauma & Anxiety

December 12, 2020

Trauma & Anxiety

ID5998

To CiteDCA Citation Guide

00:00And we want your feedback
00:02about how this format works.
00:04This is, we think,
00:05a chance to embrace the future and
00:07embrace a new way of reaching people
00:09and telling them about the child
00:11study center and getting your input
00:13about the Child study Center as well.
00:16So today's session is about trauma and
00:20working with children under adversity
00:23and who have experienced trauma.
00:26And we have two members of our faculty,
00:28Steven Marans and Ellie
00:30Liebowitz to kick us all.
00:33The other point that I just want
00:35to make is that perhaps there is
00:37never been a time even more than
00:40now where children's behavioral
00:41health services are in need.
00:44You may have been aware of the
00:46recent report just from the
00:48Center for Disease Control shows.
00:51The dramatic increase in need for
00:53behavioral health services from
00:55children from birth through age 18.
00:57We are in the sense we're in a
01:00parallel surge of parallel pandemic
01:02of the need for behavioral health,
01:05and nothing perhaps contributes more
01:07than the stress and uncertainty of the
01:10current circumstances that all of
01:12our communities and
01:13families find themselves in.
01:15So it is fitting that we start
01:18with this particular topic.
01:20I mean, I want to turn it over
01:22now to Doctor Steven Marans who
01:24is some Professor Harris professor
01:26in the trial study Center.
01:28The leader of our child development
01:30and Community Policing Program,
01:32and provides a tremendous amount of
01:33services to children and families
01:35who have experienced both acute
01:37and chronic trauma.
01:38So may I turn it to Steven to
01:40you and to kick us off in this
01:43new format on this day?
01:45Thank you.
01:48Great, so now I'm hoping that I can
01:51get back to slides. Duncan you can I.
01:55Point me in the right direction here.
01:57Yeah, if you got your slides up,
01:59go to the share screen
02:00button in the bottom
02:01of those in window there.
02:05Got it. OK, there you go.
02:09So thank you Linda and thank you
02:12all for being together today.
02:14I want to begin by first
02:17thanking the the Harris family,
02:19who in doubt my chair that
02:22actually allows the trauma section.
02:24The childhood Violent Trauma Center,
02:26which I'm the director of to continue
02:30to work and thrive as well as to.
02:33Well, thanks and gratitude to Thomas.
02:37I could ask to one moment, Steven,
02:39if I could ask everyone else to mute
02:42while Steven and others are talking.
02:44And Duncan, can you help us with
02:46the muting? Sorry Steven. Maybe
02:47you could go.
02:51OK, so just get Tom.
02:54You get to have a another
02:56thank you opportunity.
02:58I bet the support of the the
03:01associates is enormously important,
03:03especially in these times,
03:05with funding cuts continuing
03:07and demand increasing.
03:08So I want to begin by thinking about.
03:14Oh my goodness. Sorry.
03:22I am trying to back OK.
03:25Yeah, I want to begin by thinking about
03:28some of the common sources of threat,
03:32danger, and distress that all
03:34of the shares human beings and
03:36unfortunately all of us are feeling
03:39to some extent or another.
03:41Do the covid covid pandemic.
03:43None of these will surprise you,
03:45but they are all dangers that
03:47as human beings we share.
03:52We think about these dangers as being
03:55the context for considering what
03:57we mean by psychological trauma.
03:59We consider psychological traumas
04:01and injury that occurs when there's
04:04an overwhelming unanticipated
04:05danger involving some of the things
04:08with which we are all familiar.
04:10That leads to a subjective experience
04:13of helplessness, loss of control,
04:15and the experience of what we
04:17call feeling overwhelmed.
04:20This is a situation in which there
04:23is an immobilization of our usual
04:25normally available capacities to
04:28defend against danger and to decrease
04:31feelings of fear and anxiety,
04:33and in fact,
04:34there's a neurophysiologic dysregulation
04:36that significantly disrupts our
04:38affect of cognitive, somatic,
04:40and behavioral responses to stimuli.
04:43We've learned a lot about the
04:46phenomenon of trauma through 30
04:48odd years of our work as a trauma
04:51section in addressing the needs of
04:54children and families who've been
04:56exposed to a host of potentially
04:59traumatic events ranging from murder,
05:01sexual abuse to accidental injuries,
05:03an mass casualty events.
05:06And we've had, we know,
05:08not only from our work,
05:10but from research around the world,
05:13that the longer term consequences
05:15are incredibly significant when
05:17there's a failure of recovery from the
05:20traumatic dysregulation that occurs
05:21when children are exposed to the
05:24kind of circumstances that I was outlining.
05:27And in fact,
05:28we know that two of the most significant
05:31predictors of poor outcome is the
05:34failure to identify affected children.
05:36Or for them to receive the adequate
05:39social supports that aid their recovery.
05:43We know that the long term sequelae
05:46I do not just include PTSD,
05:49but also higher risk for substance abuse,
05:52school failures,
05:53anxiety disorders,
05:54mood disorders,
05:55and increased risk of victimization as
05:57well as increased risk of perpetrating
06:00the very violent circumstances to
06:02which they were originally exposed.
06:05We also know that there's a
06:08way of changing the math.
06:10We know that unrecognized.
06:13Trump trauma plus being untreated
06:16plus failure.
06:17Recovery leads to poor outcomes.
06:22We can change that math when we apply what
06:25we know to increasing identification,
06:28increasing early intervention,
06:29and support for recovery.
06:34So I want to just briefly review
06:36some of the areas of work of the
06:39childhood violent trauma center.
06:41This includes, as Linda mentioned,
06:43or child development
06:45Community Policing Program,
06:46a longstanding partnership with
06:47police in order to better immediately
06:50respond to children and families
06:52impacted by traumatic events,
06:53and that has led to the development of
06:57a national model that has been broadly
07:00disseminated here in the States and abroad.
07:03It's also led to the development of an early.
07:07The only early evidence based trauma
07:09focused treatment for children.
07:11The child and family,
07:12traumatic stress intervention it has
07:14led to an increased collaboration
07:17with Neil New Haven Hospital's
07:19pediatric emergency room and sexual
07:21abuse clinic and has led to the
07:23development of what is now a nationally
07:26disseminated trauma informed policing
07:28tool kit and training and continues
07:30to involve training psychology,
07:32child psychiatry and social work.
07:34Fellows and trauma focused treatments.
07:36As well as psychodynamic psychotherapy.
07:39And through our work,
07:41the center provides trauma focused cognitive,
07:44behavioral therapy,
07:45and psychodynamic therapy to help children
07:48who need work beyond our early intervention.
07:52We've also been involved in responses
07:55to mass casualty events and have worked
07:58closely with policy makers to take what
08:01we've learned to translate into policy.
08:04That includes increase the resources
08:06for children and families who are
08:09affected by potentially traumatic
08:11experiences to aid in their recovery.
08:15So very briefly,
08:16the child development Community
08:18Policing program began in 1991.
08:21And involves and aims to increase
08:23the provision of clinically relevant
08:26services to children and families
08:28and communities impacted by violent.
08:31Another catastrophic catastrophic events.
08:34And the elements involved.
08:36Training for police officers.
08:38Training for clinicians.
08:39A 24/7 acute response consultation service
08:43follow up home visits an referral for
08:46clinic based trauma focused treatments.
08:53What you're seeing in front of you
08:55is a slide of what is now a national
08:59nationally available toolkit for law
09:01enforcement agencies that increase
09:03the opportunities for police officers
09:06to serve an important function in
09:08initiating recovery by first recognizing
09:11and responding in a developmentally
09:13appropriate way to the children
09:16and adults who are impacted by the
09:18events that require police presence.
09:23The child and family traumatic
09:25Stress Intervention is a 5 to 8
09:28evidence based early intervention.
09:30That is for children who've been
09:33exposed to potentially traumatic
09:35event or after the recent disclosure
09:37of sexual and physical abuse.
09:39What's been impressive is that
09:41this is really taking a family
09:43strengthening approach to treatment.
09:46Increasing communication
09:46between child and caregivers.
09:48An increasing support for children
09:50impacted by traumatic events.
09:52You'll see that we've developed adaptations.
09:55But perhaps most significant is
09:57what we've learned that CF TSI can.
10:00Decrease the likelihood of
10:02development of PTSD and related
10:05disorders by 65 to 73% and more
10:08recently we've learned that CF.
10:10TSI can also significantly
10:12decrease the post traumatic
10:14reactions of adults involved.
10:20Again, we are.
10:21This is now being broadly disseminated.
10:24We've now trained,
10:25close to 800 providers nationally
10:27and internationally,
10:28and we have developed a database,
10:31a research database of over 3000
10:34children that we're using to
10:36further evaluate the effectiveness,
10:38and the active mechanisms in the
10:42successful outcomes of CF TSI.
10:44Damaged with develop virtual adaptations
10:47of CF TSI treatment and training and
10:50have shared that with CFTO site grant
10:53providers around the country and abroad.
10:56In response to COVID-19,
10:58we have developed guidelines to help support
11:01the impact of the pandemic on adults.
11:04Help, we've developed guidelines
11:06to help parents and caregivers
11:08support their children.
11:09Through COVID-19,
11:10these have been broadly
11:12disseminated through news media.
11:14US Congress Hill, New Haven Hospital,
11:16and others.
11:17We've also developed along with my CF TSI Co.
11:21Developer carry up steam carrying.
11:23I developed the acute stress intervention.
11:26For adults,
11:27this is was developed in order to
11:30support hospital staff in New Haven
11:33who have been significantly impacted
11:36by the intense experience of treating
11:38the volume of COVID-19 patients,
11:41and we have trained over 100 mental
11:44health professionals locally who
11:46are available to provide one on one.
11:49Consultations for hospital staff
11:52who are feeling the understandable
11:54reactions to the heavy load of.
11:57Their work.
11:58We've also conducted an acute
12:01stress intervention training for
12:04over 400 mental health providers.
12:07Um, both, both nationally and abroad as well.
12:14And again, what we know is that
12:17when reality converges with an
12:19evokes our most powerful fears,
12:21there's a disruption in the way
12:23that our brains work and our
12:26abilities to normally reduce stress,
12:28not just traumatic experience,
12:30but stress is undermined,
12:31and it's not surprising that
12:33many of us may be familiar with
12:36the intensified feelings of loss
12:38of control and helplessness,
12:40and we see a host and may
12:43have experienced a host.
12:45Of of stress related symptomatic responses.
12:50In the physical and semantic arenas.
12:54In the cognitive arena.
12:57In the affective or emotional arena.
13:02And in interference with some of the
13:06standard expectations of optimal behaviors.
13:12So when so much of our external
13:15world is in fact out of our control,
13:18it's important to find
13:19ways to increase control,
13:21and so the guidelines that we developed
13:23in much of the consultation we do with
13:27our pediatric and internal medicine,
13:29health care providers and others
13:31has been focused on 1st helping
13:33people to understand what's going
13:35on with them and then to provide
13:38guidelines for walking through both
13:40recognizing one's own symptomatology.
13:42And identifying coping strategies and why
13:45these coping strategies might be effective?
13:49So we've developed this first for
13:52adults and then subsequently we
13:54developed a guideline for parents
13:57helping children to cope with COVID-19.
14:00And and children's response to that
14:02also help parents to better understand
14:04their children and to find strategies
14:06for decreasing the increased stress
14:08that children may be experiencing,
14:10not only as a result of the
14:12fears and worries about COVID-19,
14:14but also because of the enormous
14:16impact that they just that the
14:18disruptions have had on their lives.
14:23We've, as I mentioned,
14:24also developed the acute stress intervention,
14:27which is a one to four session model for
14:30consulting with health care providers
14:32and others who may not yet need a
14:35more extensive clinical involvement,
14:37but are aimed to help support their
14:39ability to get a better handle
14:42on their symptomatic reactions
14:43and to take greater control.
14:48We've also, as I mentioned,
14:50develop Connect virtual training,
14:52which has been broadly offered to mental
14:55health providers around the country,
14:58so I will stop there.
15:00This was meant to be a.
15:05Rapid sort of introduction
15:06so that we can look forward
15:08to a discussion with you all,
15:11and I will now turn it over if I can.
15:16To my esteemed colleague Eli
15:18Boards talking review, it's before
15:20you before you start,
15:21let me just remind everyone if
15:23you have a question to please
15:25put it in the chat. Mr slash.
15:28I see that you were Doctor Marincin
15:30and will let both speaker speak and
15:33then we'll go to the questions.
15:35But please use the chat and will.
15:38Her and get your questions
15:40answered as soon as Doctor
15:42Liebowitz feeds Doctor Liebowitz.
15:45Thank you. Well, thank you very much Steve.
15:49And those inspiring and thank you Linda.
15:51And of course thank you to each
15:54and everyone of the associates.
15:56All of you for joining us today and
15:59for the really critical support that
16:01you provide to the work that we do
16:05at the Child study Center. So my.
16:09The presentation is pre recorded in,
16:12perhaps in a nod to the uncertainty
16:14that we're all living through,
16:16so I'm going to be playing a
16:19pre recorded video for you,
16:21but I am here and will be happy
16:24to address any questions together
16:26with together with Steven and Ann.
16:29This is a little bit less of a
16:33formal presentation and innocence.
16:35You might say a reflection on this
16:38past year and what we have been living
16:41through and the work that we have been
16:43doing to try to meet the challenges
16:46that all of us have been experiencing.
16:48So let me try to bring that up now.
16:56OK.
16:59Is that up?
17:01What's up?
17:03Good Ali, thank you
17:04very much. OK, so you get
17:06a peek at my living room.
17:11Thank you for the opportunity
17:13to talk with you all about
17:15the work we've been doing in the
17:17area of childhood anxiety disorders.
17:20Even in the best of times,
17:22anxiety disorders are the most
17:24common mental health problems
17:25in children and adolescents,
17:27causing tremendous distress and
17:29impairment to the lives of millions
17:32of children and their families.
17:34But let's face it,
17:36this has not been the best of times.
17:39The entire globe has been thrown
17:41into turmoil by a pandemic,
17:43the likes of which none of us have
17:46ever seen before lives livelihoods
17:48have been lost at a staggering pace,
17:52and our world sometimes seems unrecognizable.
17:55This country has been rocked by an
17:59explosive outpouring of pain and
18:01anger at injustice and unfairness.
18:03These are what one might normally
18:06think of as issues for adults,
18:09but in 2020 no child is oblivious.
18:13I think my own school aged children
18:16probably know more about Epidemiology
18:18today than their dad did a year ago.
18:21It's now almost exactly one year
18:23to the day since the first known
18:27COVID-19 patient became ill.
18:29In that year,
18:30children's lives have changed more
18:33rapidly and more dramatically than any
18:35of us would have thought possible.
18:38Even for children without a
18:41pronounced predisposition,
18:42word anxiety problems this year
18:45has been anxiety provoking.
18:47And for the one in three children with a
18:50natural vulnerability to anxiety disorders,
18:52it has been a challenge that at
18:55times has seemed insurmountable.
18:58Consider the ways in which anxious
19:00children tend to approach the world
19:03and the situations they confront.
19:05We tend to shy away from change
19:07and to feel most comfortable with
19:10familiarity patterns, repetition.
19:12They tend to dislike surprises
19:15and unpredictability,
19:16preferring the predictable in the
19:19foreseeable whenever possible.
19:20And they tend to abhor uncertainty,
19:23seeking positive assurances and absolutes.
19:28Change unpredictability uncertainty.
19:31Maybe the three best words to
19:35describe this entire year.
19:38It is no surprise that so
19:41many children are struggling.
19:43For some,
19:43the hardest part comes when their life
19:46seems to change almost overnight,
19:48and so many of the patterns they
19:50rely on of the things they take
19:52for granted as making up their
19:54daily world are suddenly either
19:57different or completely suspended.
19:59For others, it's actually.
20:00We ask them to resume a semblance
20:03of normality that they seem to
20:05struggle the most for the child with
20:08separation anxiety disorder who's not
20:10been separated from his parents for
20:13months because there's really nowhere to go.
20:16Going back to school can seem daunting,
20:19and for the child with
20:21social anxiety disorder,
20:22who's been socially distancing
20:23and even isolating at home,
20:25walking back into a classroom
20:27can feel overwhelming.
20:31The anxiety and Mood Disorders program
20:33under the leadership of Doctor Wendy
20:36Silverman and the broader clinical
20:37services of the Yale Child Study Center
20:40has taken an active role in helping
20:42children and families face this challenge.
20:45As a program that was already providing
20:48Tele treatment to many families,
20:51we were uniquely poised to transition to
20:54a completely online model and to continue
20:57to provide therapy and consultation.
20:59Through countless interviews on radio
21:01and television and print and online,
21:04we have been there to offer guidance and
21:07support to parents struggling to adapt to
21:10the new and constantly changing realities.
21:13We help parents.
21:14Sessions consulted the schools.
21:16One remote learning as well as the
21:19return to classrooms and we held online
21:22webinars and information sessions for
21:24both the lay and professional Publix.
21:27But this year hasn't only been
21:29about bad news,
21:30even while we juggled the
21:31shutting down and reopening of our
21:34in person clinical services,
21:35we continued to make strides in our
21:38key missions of research and education.
21:40With funding from NIH,
21:42we completed the first ever clinical
21:44trial of childhood anxiety disorders
21:47that used brain imaging before and after
21:49treatment to learn about what changes
21:51in a child's brain due to treatment.
21:56The clinical study focused on a
21:58parent based treatment called space
22:00or supportive parenting for anxious
22:02childhood emotions that we developed
22:05here at the Child Study Center.
22:07Space focuses on teaching parents
22:09to respond to their child's anxiety
22:12symptoms in a supportive manner,
22:14showing them both genuine acceptance
22:16of their distress as well as confidence
22:20in the child's ability to cope with
22:22and to tolerate that distress.
22:25Parents in space learn to systematically
22:28reduce the accommodations that
22:30they've been making to the child.
22:32Symptoms allowing the return of
22:35normal functioning and healthier
22:37interactions in relationships.
22:39In a previous randomized clinical
22:41trial of space,
22:42we compared it with cognitive
22:44behavioral therapy and found that
22:46space was just as efficacious as
22:48working directly with the child.
22:50The findings from that study were
22:52published in the Journal of the
22:55American Academy of Child and
22:57Adolescent Psychiatry one year ago,
22:58and became the most cited article in
23:01the Journal during that past year.
23:05In the study we just completed the findings
23:08of which are not even published yet.
23:11Children looked at images while we
23:14used functional magnetic resonance
23:16imaging or fMRI to observe patterns
23:18of activity in their brains.
23:20We did this both before the start of
23:23their first treatment and after they
23:26ended their last treatment session.
23:28By comparing brain activity when the
23:31child lay alone in the scanner to
23:33brain activation when their mother
23:35stood nearby and held their hand,
23:38we were able to observe just how dependent
23:41each child was on their attachment,
23:43figure their mother to regulate
23:46their fear and anxiety.
23:48Following space treatment compared
23:50with the control comparison condition,
23:52children were significantly better relabel
23:54to regulate their own fear independently,
23:57and they were less reliant on their parents
24:01for family accommodation and less anxious.
24:05We're continuing this research
24:07and yet another clinical trial.
24:10This year has also been one of tremendous
24:13progress in the dissemination of our
24:15work to a broader and broader audience.
24:18News about the new parent based treatment
24:21for child anxiety out of the Yale Child
24:24Study Center has received attention
24:26everywhere from NPR to the Atlantic,
24:29to CNN and countless other news sources.
24:33Let me share with you one example
24:35from a local news channel.
24:37Going to the National Institutes of Health,
24:40the number of kids struggling with anxiety,
24:42depression and other mental health
24:44conditions has steadily been underlines.
24:46That's right,
24:46therapy and medication may help,
24:48but for some kids and their families,
24:50that's little relief. Tonight.
24:52Now Anderson tells us how researchers
24:55are studying a new method that
24:57helps parents help their children.
24:59Bedtime for some families
25:00can become a struggle,
25:01but when the goodnight routine
25:03for Nicole Murphy's son began to
25:06stretch for up to three hours,
25:08she knew she needed help
25:09with his separation anxiety.
25:13Non stop, so it's kind of hard.
25:17Allie Liebowitz and his colleagues
25:18at the Yale Child Study Center
25:20developed a method of training
25:22parents to support anxious children.
25:24It's called space or supportive
25:26parenting for anxious childhood emotions.
25:28Parents go through training to help
25:30their child face anxiety level.
25:32It says the first step is to
25:34show support and not downplay
25:36what their child is feeling.
25:38I did it.
25:39This is really hard but I know
25:42you can handle it label. It
25:44says. Parents also learn to help their
25:46child by not accommodating them.
25:49For example, a parent who would
25:51limit visitors for a child who gets
25:53anxious around strangers or speaks for
25:55a child who gets nervous speaking,
25:58learns not to take those steps in the
26:01study of 124 kids and their parents.
26:03The Yale researchers examined whether
26:05the space intervention was effective
26:07in treating children's anxiety even
26:09though the children never met directly
26:11with the therapist and all the work
26:13was done for the
26:15parents, we found that
26:16space was just
26:17as effective as CBT. In
26:19treating childhood anxiety disorders.
26:21The Monkees used the techniques learned
26:24through space to coach their sign
26:26through bedtime within a few weeks.
26:28He was falling asleep in 30 minutes.
26:30It was practically like like
26:32changing constant for news 10.
26:34I'm Mallory Anderson,
26:35reporting Mallory.
26:35Thank you For more information about
26:37space or to find a practitioner in Michigan,
26:40click on the links in this
26:42article on our website.
26:45It's so brief, but in just under 2 minutes
26:48parents can learn some key points that
26:51can have long lasting impact on their
26:54children's anxiety and development.
26:56Therapists around the world have also
26:59been eager to learn how to deliver
27:01space treatment in their own work,
27:03and we have held training workshops
27:05each month so that hundreds of
27:08clinicians around the world can now
27:10offer space as another option for
27:12helping children and families impacted
27:14by childhood anxiety disorders.
27:17Recently we received a grant from
27:19the National Institutes of Health
27:21to continue the work of studying
27:23this treatment and its impacts on
27:26child anxiety and brain functioning.
27:28In other areas of research,
27:30we're making exciting discoveries with
27:32the potential to inform future treatments.
27:34One example is our work in the
27:37fibroblast growth factor system.
27:38This system was first shown in animal
27:41studies that we linked to behavioral and
27:44biological models of anxiety and depression.
27:47We conducted the first study of this
27:50potential novel biomarker in human
27:52children with anxiety and depression,
27:54and the findings are consistent
27:56with what was shown in rodents.
27:59Fibroblast growth factor 2,
28:01which plays important roles in brain
28:03development and in the generation
28:05of neurons throughout life,
28:07is linked to symptoms of anxiety
28:10and depression in children.
28:12One thing that makes this research
28:15so exciting is that the fiberglassed
28:17system is not targeted by any
28:20current treatments for anxiety.
28:22Discovering a new layer of the
28:25biological infrastructure underlying
28:27anxiety problems could lead to an
28:30entirely new class of treatments for
28:33these common and debilitating problems.
28:36So it has been a difficult year for all
28:40of us are year truly unlike any other.
28:43But the Child study Center and the
28:46anxiety program have been there
28:48throughout doing what we can to help
28:50children and families struggling
28:52today and learning what we can to help
28:55children and families in the future.
28:58Thank you.
29:07So thank you Doctor Liebowitz and
29:09Doctor Mehrens we now have two
29:11questions in the chat which I'd
29:12like to and I encourage encourage
29:15everyone to either speak up and ask
29:17questions or put them in the chat.
29:20The first one, Steven was about
29:22your work and there are any other
29:25providers trained in your model
29:27serving young people impacted by
29:29family home destruction such as the
29:32Hurricanes or wildfires or earthquakes.
29:34So would you like to address that?
29:37Yes, so many of the things that
29:39we're doing in the midst of of
29:41COVID-19 in terms of the broad
29:44public health approach was which is
29:47about increasing information and
29:49strategies for the broad populist.
29:51Have been applied in past hurricanes
29:54and and other catastrophic natural
29:58catastrophic events, and.
30:00They are available currently,
30:02as well as folks who are trained in CF
30:06Geosci in affected areas are employing
30:09CF TSI for families who are able to
30:14have access to those clinical services.
30:19Thank you Ann.
30:22Doctor Califon oh has asked both of you.
30:24Could you speak to your thoughts
30:26about the next stage of the
30:28pandemic that we are actually
30:29in the mid staff and what you
30:32would anticipate the next level
30:33of needs might be and how all of
30:35us as clinicians should respond.
30:38I only wanted to take that first.
30:43Thank you.
30:46I, I think we're actually entering where are
30:50in a really critical phase of this entire.
30:54Saga when it comes to mental health needs,
30:58and not only because of the increasing
31:01empirical evidence for the frequency of
31:04mental health problems among individuals
31:06who are diagnosed with COVID-19.
31:09And there has been some really troubling
31:13research around the prevalence of those
31:16of mental health problems among people who
31:20do get covid but also the cause of the.
31:26The wear and tear in a sense that
31:30repeated and long-term challenges have,
31:33you know, many of us, really.
31:39Shine in the initial moments of crisis.
31:42It is true that many will struggle,
31:45but many will also.
31:47China those sure shorter term initial
31:50moments of crisis we we may recruit
31:53resources we may rise to the occasion,
31:56but that gets increasingly
31:58harder to do as time goes by.
32:01And as we cycle through
32:05another another cycle of.
32:07Loss in many cases,
32:09many children are going to be
32:11experiencing the loss of family members,
32:14loved ones and relatives and also repeated
32:18cycles of loss of our of all those
32:21things that make up our daily lives.
32:24And I think that we're going to see
32:28tremendous need in in children as they.
32:32You know,
32:32come to terms with this new phase,
32:35an everything that it's going
32:37to mean and we don't even yet.
32:39No what it is going to mean for
32:42different places around the country
32:44and we're going to see tremendous
32:46need in parents who are going to
32:48be coping themselves with all of
32:50the obligations that they have.
32:52Whether those are financial,
32:54physical,
32:54health related and the requirements
32:56of their children.
32:57So what I think we can foresee
32:59is really a high level of.
33:02Need and and I think we need to be.
33:05Braced for that because it's
33:07going to be substantial.
33:10So I would agree with
33:12everything that they do.
33:14We're just saying Ellie and I would.
33:16I would add just a few a few comments.
33:20One is that no right now we are
33:23confronted with and in the midst of
33:25a of a huge resurgence that brings
33:28home not only the threat of death,
33:30but continued disruption an
33:32that fear and helplessness.
33:34Is are powerful enough factors,
33:37but the length of time that people have
33:41been sustaining the impact of COVID-19
33:44also can lead to 1/3 ingredient,
33:47which is a sense of hopelessness.
33:50Fortunately,
33:50the announcement about the vaccines
33:53can help to hopefully offset the
33:56impact of that latter factor,
33:59but there's no more time and
34:02no harder time than now.
34:04After this long haul to recognize the
34:07extent to which we are all impacted.
34:11There is a version of Covid fatigue
34:14that makes us want to turn away,
34:17including from our own experiences
34:19that in turn has implications
34:22not only for us as adults but
34:25also for adults as parents.
34:27And so again,
34:28the idea of our task of being able to
34:31increase and focus attention not only
34:34on individuals ability to identify that
34:37what they're experiencing is normal,
34:40but not nice.
34:41But there are also some ways of
34:43attending to structured approaches
34:45to mitigating the impact and
34:48the symptoms that follow is
34:51especially important right now.
34:55Thank you Steve and Eli.
34:57There is a question from Julie
34:59Klingenstein, can you provide a link
35:01to the space guidance for parents?
35:05Yes, in fact I will write a link.
35:08I'll say it, but I will write a
35:10link in the chat because maybe that
35:13will be even easier. So I just did.
35:16So the best place to get information
35:18relating to space treatment is on
35:21the website spacetreatment.net,
35:23which I maintain. Any resources?
35:26There's information for professionals
35:28who are interested in becoming trained,
35:30but there's also many resources for
35:32parents and others on the Resource tab.
35:35There are links to both books
35:37and research articles,
35:38as well as many media articles
35:40like I mentioned in the video,
35:42and there are also forums where
35:45parents and professionals can
35:46interact and write and get advice
35:48and connect with each other,
35:50so that's the best place to
35:52visit for information about space
35:54is really space treatment.
35:58And also another question,
35:59is there a specific age range that the
36:01interventions are best suited for?
36:02And I think that actually in many ways
36:04could go to both of you, but Eli,
36:06do you want to start? Sure, so.
36:11We have conducted clinical trials of
36:13space across a fairly broad age range,
36:16with the youngest study being
36:18in preschool age children.
36:19So we're talking about
36:21children ages three and four.
36:23Proximately we've done several clinical
36:25trials in school age children,
36:26so like 6 through early adolescence,
36:29and we even have worked with not just
36:31older parents of older adolescents,
36:34but using a version of space,
36:36even with parents of adult children
36:38who struggle with anxiety and other
36:40mental health problems and remain highly
36:43impaired and dependent on their parents.
36:45And unable to function independently
36:47as adults in in the world.
36:49So really, across a fairly broad
36:51age range with with the most
36:53research focusing on school age.
36:56Steven, do you want to comment about CF
37:00TSI or others other inventions? Well,
37:03I think that the what's what's really
37:05quite wonderful about the CF TSI
37:08dissemination is that we've worked
37:10with organizations like the National
37:13Children's Alliance that has helped to
37:16proliferate the the number of clinicians
37:18who are trained in offering CF TSI
37:21and the National Children's Alliance
37:23represents 900 child advocacy centers.
37:26These are centers that deal with children.
37:30Who are sexually or physically abused,
37:32and we're also working closely with our
37:35colleagues in a network of pediatric
37:38emergency rooms to increase the
37:41availability of C FTSI to children
37:44who are seen because of of injuries
37:46or because they have witnessed
37:48terrible events that bring their
37:51parents to the emergency Department.
37:53We are also working on evaluating a version
37:57of CFT aside for three to six year olds.
38:01And that work is is continuing apace,
38:05in spite of the the pandemic.
38:09I think I would direct this question
38:12to both of you as we are waiting for
38:15other questions to come to the chat as
38:17we've had to switch over to Tele Health
38:20and converted so many services that
38:22converted all of our services to that.
38:24Could you both comment on the differences?
38:27The advantages disadvantages that you've seen
38:28in the models that you're speaking about.
38:34Ellie, why don't
38:35you start and I'll chime in after your
38:37soul and I want to
38:39be clear. I understand the question.
38:41So the delivery of CF TSI,
38:43for example through virtual
38:45means or the delivery of
38:47space through virtual means.
38:48What are the advantages and
38:50disadvantages that you've seen?
38:53Well, with younger children under
38:55under five and six, it's harder,
38:58but with with the older kids it's
39:00it's really been quite interesting.
39:03In some ways it actually provides a special
39:06time for a child and parent to be together
39:10because it is a con joint treatment,
39:13so that above and beyond the efficacy
39:16and treating post traumatic symptoms,
39:19the opportunity to be together
39:21in the midst of of.
39:23It is often very busy.
39:26Households has its advantages.
39:27We've also actually seen an increase
39:30in continuity of engagement,
39:32and we think in part because some of
39:36the additional burdens of coming to the
39:39clinic and juggling work schedules, etc.
39:42As has been decreased,
39:44we've actually been quite impressed with
39:47not only the the number of families that
39:51have been able to engage during the.
39:55Covid pandemic,
39:56but also equally impressed by
39:58the fact that there are so.
40:00More children who are currently
40:02being exposed to increases in
40:04domestic violence abuse and other
40:06potentially traumatic experiences,
40:08and it is good fortune,
40:10not only in New Haven but around
40:12the country that children and
40:14families have an opportunity to
40:17be treated early and to recover.
40:22Kelly, you have thought.
40:24Yes, well, first of all it is such
40:27an important question because the we
40:30we love meeting in person with with
40:33our patients and really appreciate
40:35that sort of direct connection
40:38that in in person meeting provides.
40:41However, we're also really keenly
40:43aware of the barriers that the need
40:46to meet in person puts in place,
40:49even in a non covid world.
40:52Whether that is distance,
40:54not everybody lives.
40:55In close proximity to a skilled therapist,
40:58whether that is time right having
40:59to go to a meeting in person triples
41:02the time at least typically wear for
41:05many patients 'cause you have to get
41:08there and you have to get back and it
41:10has other costs like transportation,
41:13parking and things like that.
41:14And so being able to provide treatment
41:17to people even outside of kovid.
41:19Even putting that aside,
41:20being able to provide treatment remotely
41:23is actually a really important goal,
41:25and because of that.
41:26We were actually doing space over
41:28talent even before the pandemic.
41:30We offered it as an option to all
41:33the families that we were seeing
41:35through the program and many of
41:37them collected to do it that way,
41:39which meant that any we had good
41:41practice and be we had good data
41:43and it showed us that we can do
41:46this treatment efficaciously now
41:48during social distancing.
41:49Of course it made it easier for
41:52us to transition to doing all of
41:54our work in over over Taylor,
41:56although now we are.
41:57Active providing and hope and
41:59I hope we are able to continue
42:02providing at least some in person,
42:04but we were well positioned for it
42:06and space itself lends itself to
42:08Tele treatment in a way that not
42:11every therapy does. It is hard.
42:13I won't say it's impossible,
42:15but it is hard to do play therapy over.
42:18Tell it you know, with with a young child,
42:21that's that's a challenging thing for sure.
42:24Space is done with parents.
42:26It's a meeting between a therapist and.
42:28One or two adults,
42:29and that means that it is easier
42:31to do now we have learned a little
42:33bit about what it requires.
42:35We do need to still treat it as
42:37a therapy session.
42:38We can't do it while people are
42:40waiting in line at the supermarket.
42:42Or, you know, working out at the at the gym.
42:44But we are able to do it.
42:46And this treatment.
42:47I really do think lends itself to
42:49that kind of modality in a way that
42:51not every therapy actually does
42:53that we're very happy with the
42:55ability to do space over overtime,
42:56and we will continue to offer
42:58it as an option even when social
43:00distancing is no longer.
43:01Are required.
43:03Yeah, I just had to add one other
43:06comment that with CF TSI we had been
43:09struggling prior to the pandemic about
43:11how to address the needs of families
43:14in rural communities or where there is
43:17a paucity of mental health services.
43:19And in many ways learning quickly how
43:22to adapt CF TSI to a virtual format has
43:25actually solved an enormous problem that
43:28is now making safety sign much more
43:31available regardless of families locations.
43:33Guess even add tongue Israel.
43:35Thank you for the comment that these
43:37great programs work well in New Haven.
43:40Are you also asking do
43:41they work well elsewhere,
43:43which I'm assuming would be the.
43:46Implication of the question.
43:48Stephen Lady want to talk
43:50about dissemination?
43:50I think you both touched a little bit on it,
43:53but maybe to make it more explicit.
43:57Yeah, I, I think that number one
44:00being able to we've been doing in
44:02person trainings for many many years
44:05in which we both travel to other
44:08States and other countries to do
44:10in person training an we have a an
44:13annual training that brings people
44:15together from around the country
44:17and sometimes from around the world.
44:19Every year in New Haven.
44:21Since the pandemic we've continued
44:23our trainings an we've learned
44:26how to we've developed a virtual
44:28training approach that.
44:29We conducted a virtual training this
44:32summer involving 75 clinicians from around
44:35the country and several from abroad,
44:37and we're about to do a round of
44:40training for Scandinavian countries
44:42and Eastern European countries
44:44several months down the road.
44:47So actually that part has been very doable.
44:51There's ongoing consultation that has is
44:53done telephonically as well as virtually,
44:56which is always been part of CFT assign.
45:00With regard to the policing trauma,
45:02informed policing,
45:03not every community has a child study center.
45:06None of the every community has the
45:08opportunity to engage in this kind
45:10of partnership that we've done in New
45:13Haven and that other communities have.
45:15It's one of the reasons that we developed
45:17the trauma informed Policing tool kit
45:20in conjunction with the international
45:22associations of the Chiefs of Police,
45:24which is now just been turned into an
45:26interactive web web based training for
45:29police officers around the country.
45:31This training has now been approved
45:33in 35 states for officers to engage
45:36in this training and it enhances
45:39their ability to affectively respond
45:41to children and families in the
45:44throes of traumatic experiences,
45:45even in the absence of of clinical partners.
45:49We're also working with Saint Louis,
45:52virtually to replicate CD CP,
45:54and they have the wonderful
45:56advantage of also having a Contra
45:59of clinicians who are trained in CF
46:02TSI so there's a seamless response.
46:05From the police interaction to
46:08the clinical recovery efforts
46:11available through CF TSI.
46:13Thank
46:14you Steve and Eli. Do you want to talk
46:15about dissemination and replication?
46:19So a lot of my answer is echoes.
46:22The first half of of Stevens answer
46:24in terms of the training that we
46:27continue to provide over over Tele.
46:29And we really are training
46:31people from around the world.
46:33In fact, people do visit that website
46:36thespacetreatment.net website.
46:36You can. There's a searchable list
46:39of space trained providers and it's
46:41searchable not only by state in the US,
46:44but by country because there are
46:46providers now around the world.
46:48And because we continue to provide
46:50consultation and remaining.
46:51Respondents with providers from many places.
46:53We also get a lot of feedback and
46:55are able to think through things
46:58like cultural adaptations of the
47:00treatment to different places.
47:01We have providers who are doing
47:03space in the Middle East and we
47:06have providers who are doing space
47:08in multiple countries in Asia and.
47:11Australia and many other places.
47:14Europe and and.
47:15And so we learn a lot about what
47:17refinements may be necessary
47:19for different cultures,
47:21but the But the short version of the
47:24answer would be that it is applied
47:27successfully in by by providers really
47:29from a very broad variety of low cats.
47:35Have you seen any cultural differences
47:37in the efficacious or efficacy?
47:41We have not had no.
47:42I don't think we've seen
47:43differences in efficacy.
47:44I think the efficacy has been
47:46maintained and preserved in the
47:47different places and I should say
47:49that not everywhere where it is done,
47:51it is done in the context of research.
47:53There are many providers and programs
47:55and clinics that are doing it and not
47:57necessarily doing clinical trials,
47:58but those that and there we get more
48:00anecdotal feedback from the providers,
48:02but where we have actual clinical trial data,
48:04we actually see similar levels of efficacy,
48:06but we do need to be thoughtful
48:08about culture and that is true when
48:10we're working in the United States.
48:12Even if you're just working here in
48:14New Haven, it's always a mistake.
48:16That one's own culture is the culture,
48:19and so we have to be sensitive to
48:21cultural differences when we're
48:23working right here locally and when
48:25we're working in places where it's
48:28a lot easier to keep that in mind.
48:30And where were more obvious?
48:34So Doctor Patalano has put
48:36a question in the chair.
48:38Ellie, can you see it?
48:40Do some parents insist that you
48:41meet with their parents to be
48:43sure that they're not missing
48:45any of their child's problems?
48:49OK, I do see it, but I think he
48:52added not be with their parents as
48:53in the grand no no that was an auto correct
48:56meeting with their child sorry Ellie.
48:59Got it. Good question,
49:02although by the way we do me
49:05grandparents, not all that.
49:06But do your two year
49:08question whenever possible.
49:09Our assessment involves the
49:11child as well as the parent,
49:13and so we do think that a thorough
49:16comprehensive evaluation and
49:17assessment should, whenever possible,
49:18not be only parent based.
49:20But we should meet with the child and
49:23we do as a regular practice and so
49:26that absolutely informs the treatment.
49:28The only thing to add to it though,
49:31is that one.
49:32Of the advantages of having as as an option,
49:36having an entirely parent based
49:38treatment is there for those cases where
49:41meeting with the child directly is
49:43not feasible because the OR assessing
49:45the child directly is not feasible.
49:48Sometimes that is because the child
49:50is unwilling to participate directly
49:52with a contact with the therapist.
49:55Sometimes they are unable that maybe they're
49:58not verbal or have other issues that.
50:00Clude they're act evaluation
50:02in those situations,
50:03having a treatment option that can be
50:06effectively applied only through parent
50:07work is actually a tremendous advantage,
50:10but in in the routine normal
50:12course of our work,
50:13we regularly assess the child
50:15directly as well as the parent,
50:18even when the intervention is
50:20going to focus on parents.
50:23Thanks
50:23very much. Thank
50:24you so we have time being respectful of
50:27everyone's time on this virtual space.
50:29We have time for couple of more questions.
50:32Looking to the chat but also again if you
50:35would like just shout your question out.
50:46And just to give a preview of
50:49where we're headed tomorrow,
50:50we will talk about school based services
50:53and delivery of services within schools.
50:55The impact of Covid on those services
50:57and and how we're thinking about
51:00education in a covid environment.
51:02On Wednesday we will talk about diversity,
51:05equity and inclusion,
51:06what we're doing in the Child study center
51:09in response to what many have called
51:12another pandemic social injustice over the
51:14summer and continuing in all of these things,
51:17will tie together.
51:18We hope and there will be opportunities
51:21on Thursday for further questions, but.
51:23Please if you have other questions.
51:29As I say, shout them or put
51:31them in the chat. Trump.
51:35And Steve, can you hear me? Yes,
51:38I think in the you know I'm NYC centric,
51:42although we're living in Westchester
51:44since March 11th, but I still love
51:47New York City and I work with an
51:50organization that not for profit
51:52that deals with the people of the.
51:57It's in the
51:58work situations and was policing is a
52:01big issue these days and I believe at
52:04some point you had reached out to them,
52:07or like someone tried to put you
52:10together with a very unsuccessful result.
52:13I may be wrong on that. But what?
52:18If any communication do you have with New
52:21York City, which as you probably know,
52:23the crime rate has more than doubled,
52:26you know, during covid it's down from its
52:29peak of several years ago, but it's it's.
52:32On everybody's mind,
52:34then there's everybody,
52:35gets forced indoors and gets crazy.
52:38Or crime is only going to get
52:41worse and New York City certainly
52:44need your kind of help, yeah,
52:47so we are in regular contact with
52:50colleagues in New York and you know,
52:53the good news is Tom,
52:55that that actually the NYPD did
52:58move ahead with with training and
53:01developed a specialized unit.
53:03Under the domestic violence
53:04section of of the Department,
53:06all of those officers have been
53:09trained and they are now working
53:11with colleagues that we've trained
53:13in CF TSI as well as cute response
53:16protocols from Safe Horizon,
53:18which covers the five boroughs,
53:20and they have actually been
53:22incredibly active.
53:22You're absolutely right,
53:24and by the way,
53:25the one of the training that we did
53:28in the acute stress intervention for
53:30adults was hosted by the Columbia
53:33School for Social Work and involved.
53:361400 mental health providers
53:37from around the city and the
53:39country and internationally.
53:41So yes,
53:41many of us have very close ties
53:44to New York City and and continue
53:47to work closely with them.
53:49The challenges to policing
53:51in this country are enormous.
53:53Hopefully there will be an opportunity
53:55in the coming years to return to
53:58some of the basic police reforms
54:01that were in fact driven by a
54:03very different model of policing.
54:05Then some of the symptoms of
54:08the the poor forms of or models
54:11of policing that we've seen too
54:14many examples of recently,
54:16and we hope to be very involved in the
54:19discussions of moving things forward
54:21in a in a much more productive,
54:25Humane, and just fashion.
54:28Thank you Steven. Healthy planet.
54:33So I'm going to put in the chat.
54:37Well, trying to put in the chat here.
54:41That's the link to the ongoing virtual
54:44poster session that's you can visit
54:46anytime over the week where we have
54:48posters from across the center,
54:50and some of them are actually narrated
54:53by the developers of those posters.
54:55We will meet tomorrow in the
54:57virtual space again at 2:00 o'clock
54:59to talk about education,
55:01our programs in schools in this time of
55:04kovid and have four of our colleagues who
55:07are working in schools to speak with us.
55:10Again, I just want to thank all of
55:13the associates for your support for
55:15your joining us on this inaugural
55:17virtual event and look forward to
55:18you being with us through the week.
55:21So thank you.
55:22Thank you so much and
55:23Linda, just to just to have one.
55:25One thing, if people are
55:27interested in seeing or having
55:28available the guidelines that we
55:30developed for adults and kids,
55:32we will make sure that they
55:34are available to you if you
55:35give it to a Steven, we can actually
55:38disseminate it even tomorrow or Sunday.
55:41Excellent, I'll forward
55:42it to Rosemary fantastic.
55:43Alright, thanks so much so thanks everyone.
55:46Thank you all. See you tomorrow.