YCSC Welcome Back & State of the Department

October 17, 2022

Information

YCSC Grand Rounds September 13, 2022
Linda Mayes, MD
Chair, Yale Child Study Center

ID8173

To CiteDCA Citation Guide

00:00Good afternoon, everyone.
00:02Welcome. It's great to hear this,
00:06this, this, this noise.
00:09It's great to see everyone here in person,
00:11so please, I hope you've all had a chance
00:13to enjoy some coffee and some of the food.
00:16And I'd like to start with a
00:19heartfelt thanks to Rosemary Serra.
00:21Rosemary has been just a tremendous support
00:24and she's responsible for the food and
00:26the drinks that we're sharing today.
00:28So thank you, Rosemary,
00:29who's joining us from afar and
00:31supporting us even though you're
00:32supposed to be resting at home.
00:34And so welcome to the first
00:36of our new series,
00:37our new Grand Round series.
00:39The pleasure to be with you here
00:41today and to see so many people
00:42here in the Cohen and to see and
00:44those of you joining us via zoom.
00:46And I'd like to start by thanking
00:49the Grand Rounds committee.
00:51My Co-chair Andres Martin,
00:53Laurie Cordona,
00:54Julie Chilton and Michael
00:57Crowley and Amanda Lowell,
00:59Tara Davila and Krystal Finch.
01:02And we have put together what
01:04I think is a very exciting
01:06grand rounds program and we're
01:08looking forward to sharing that
01:10with you.
01:10And next week we'll hear from Hector Chaidez,
01:14Ruacho and Anna Maria Orozco on
01:17culturally informed treatment approaches
01:20and using dichos with Latinos.
01:22And now this will be a fully
01:24virtual event next week.
01:26So please do join us on zoom.
01:28And then following that we'll
01:30have Doctor Nicholas Allen,
01:31who will be joining us in person here
01:33in the Child Study Center to talk
01:36about digital mental health and its
01:38application to understanding adolescent
01:40depression,
01:40and that will be followed by compassionate
01:43care rounds and a whole series of
01:46very interesting talks in October,
01:47November and December that will be
01:49occurring here in the Cohen Auditorium.
01:52I'd also like to thank Crista for keeping
01:54us well informed of our grand rounds program.
01:57And so you can see the calendar
01:59of events on each of our weekly
02:02e-mail updates from Crista.
02:04And just a reminder,
02:06please do send on your suggested speakers,
02:09many of the faculty.
02:10Trainees have already sent on
02:11some wonderful suggestions.
02:13We really want grand rounds to reflect
02:17the Child Study Center's mission
02:19to showcase cutting edge research,
02:22best clinical practice,
02:23and best practices in clinical education.
02:26So if there's anyone that's
02:28influencing your practice you
02:29think is doing fantastic research,
02:31please do send suggestions our
02:32way and we'd be delighted to add
02:35them to the program.
02:36So without any further ado,
02:37please join me in welcoming our chair, Doctor
02:39Linda Mayes.
02:45Are we unmuted up here?
02:50Can you hear me OK in the back?
02:53And may I ask your permission?
02:55May I take mask off? Unveiled.
03:00So thanks so much for everyone being here.
03:03It's really, really lovely.
03:05Do we need to adjust anything?
03:08Sorry, is your microphone on?
03:10I hope so. Yes, it is OK. One second.
03:18You're good. I think we're good.
03:19All right. Please check.
03:23All right, try again. Excellent.
03:26OK, great. So. So again,
03:28thank you so much for being here in
03:30person and for being here on zoom.
03:32We're already doing something somewhat
03:35disruptive that I gather it's
03:37better if I stand behind the podium.
03:39But as you know,
03:41I much prefer to be out and present.
03:43And so we're going to give this a try.
03:46And Kieran, if it is not working,
03:48you'll let me know.
03:49OK, good, great.
03:50So let me just move ahead.
03:53The purposes of opening meetings - and we
03:55always have one in September and then
03:58we always have a meeting in January.
04:00And so for this meeting,
04:02for our getting together in
04:04September following a summer,
04:06we often think about pausing and
04:08reflecting of where we've been and
04:10where we're going, to welcome new people -
04:13and now we welcome on Zoom as well
04:16as welcome in person - and to look ahead.
04:19And in January,
04:20what I will do just as a preview
04:22is to get more detailed about
04:24the state of the department.
04:26But today I really want to talk
04:28about the goals of the department
04:30for this new academic year because
04:32we're welcoming a new academic year.
04:35And sometimes New Years start in January,
04:38sometimes they start in September.
04:39As you'll hear, there's fiscal years,
04:42but this is our new academic year
04:45and one of the traditions of our
04:47department over the last six,
04:49now seven years.
04:51Has been in September to open
04:54up this meeting.
04:55With a series of themes or
04:57a theme for the year.
04:59And as you can see,
05:00beginning in 2016,
05:02the themes began to be somewhat playful.
05:06Our vacations and sojourns and
05:09summer frames of mind,
05:11and even the original one.
05:14But actually, COVID interrupted that.
05:18And COVID, by 2020,
05:19when we had no idea actually in
05:23September of 2020 of what was coming,
05:26we still had a bit of a not so playful theme,
05:29but a bit of a theme about rejuvenation.
05:32And then last year was very much
05:34about matters of the heart.
05:35And the loss and the change and
05:38all that was before us.
05:40So this year there's a number of
05:42things that we need to think about.
05:44And we've been talking a lot
05:46about returning to a new normal,
05:49to a changed and changing world and
05:51what that world looks like and that
05:53we're in the middle of that world.
05:56Not to be down,
05:57but I just want to remind you that it's
06:00been 912 days since March the 12th, 2020.
06:06912 days since we have been in
06:09this changing world of COVID,
06:10that we continue to be in this changing
06:13world of COVID with new more peaks,
06:15more ups and downs of new variants.
06:18There's a new vaccine.
06:19I hope you all will get it.
06:20I hope you got the communication
06:22of the new bivalent vaccine.
06:25Do we wear a mask?
06:26Do we not,
06:27do we ask permission,
06:28do we not,
06:29are we working virtually,
06:31are we working hybrid,
06:33how are we seeing our patients?
06:35And then the tremendous also and very
06:38productive and much overdue social unrest.
06:41But our world is continuing dramatically to
06:44change and even as we're back in person.
06:47Sorry, even as we're here in person,
06:50we have to actually learn now how to
06:53again to work together in person.
06:57It would be amazing to think that as humans
06:59we would have to relearn it as human adults,
07:02but we do. And as you can see
07:04on the bottom of this slide,
07:05if you actually survey people and ask them,
07:09does the digital world do the
07:11same as the in person world,
07:13well, majority, well,
07:14more than a majority say no.
07:17That you miss the things they they the
07:20socializing over coffee in the back,
07:22the beginnings,
07:23the inter interstices of meetings
07:25that you don't get on zoom.
07:27But we're still needing to learn how
07:29to come back together and how to work
07:32in this virtual and hybrid world.
07:34And I'm very well recognized that we
07:37will not only be sitting in this room
07:39or online, but we need to get much,
07:41much better about the hybrid world.
07:44And I'm also recognizing and
07:46want to call out.
07:48And also I'm aware,
07:49Kieran,
07:49that I'm starting to move,
07:52but but I want to call out that
07:55we are at this point still living
07:58learning how to find certainty.
08:01While still surrounded by tremendous
08:04uncertainty and a sense of loss.
08:07And that's going to continue to be a theme.
08:10Our country continues to be
08:13divided into red and and blue.
08:17There are new variants that we don't
08:19even know yet what the names will be,
08:21but they continue to come.
08:24The war in Ukraine has left
08:26an uncertainty for all of us,
08:28as well as a tremendous sadness.
08:32Unbelievably, there have been over 200
08:36mass shootings since the beginning of 2022.
08:41Defined as four or more people, over 200.
08:46And if you actually look
08:48at the rate of inflation,
08:50the economy is not so stable.
08:53So we are actually living in a very
08:56changed and changing world and we
08:58are needing to actually still,
09:00as we look ahead, the dealing with the
09:03tremendous uncertainty of that world.
09:05And actually one good thing that's come
09:07out of COVID is it has spurred a huge
09:10amount of scholarship on coping with
09:12uncertainty and living in uncertainty.
09:15That is what's before us as the department.
09:18So I'm about to introduce the
09:20theme for this next year,
09:22and it's going to actually
09:24sound like a clanging symbol,
09:26having just laid that that groundwork.
09:30And this is what I think this
09:32year's theme should be.
09:33Generativity, imagination, and grace.
09:36Because what we had before
09:39us is to look ahead.
09:41Look ahead to those people.
09:44That we might not ever meet.
09:47To be thinking about the department,
09:49the community that we want to create,
09:52not only for those of you
09:54who have just joined us.
09:56But those who will join years later,
09:59whose names we don't know.
10:02Who we will still create a place for them,
10:05and that is a tremendous amount of
10:08trust that they place in us and the
10:12responsibility that they give to us.
10:14Now, why do I think that should be the theme?
10:17But first, what in the world is generativity?
10:20I'm assuming that in this
10:22audience everyone knows,
10:24but I actually had an experience a bit
10:25over a year ago of presenting this,
10:27and people were on their iPhone
10:29searching what the definition was,
10:31so I just want to be sure.
10:33That generativity is the idea.
10:36That you think about the next generation.
10:40And beyond and obviously for
10:42the survival of the species,
10:44but but really for the survival
10:46of the family,
10:47the sustainability of the community,
10:49a town, a society.
10:51And Eric Erickson coined the term.
10:54And he coined the term with this definition
10:57that you have to read several times.
10:59The one thing that can save us as
11:02a species is seeing how we're not
11:05thinking about future generations
11:07in a way in the way we live.
11:10He could have written it in the positive,
11:12but he wrote it in the negative,
11:14so that that's the definition.
11:17That we actually invest in ourselves
11:20by investing in the next generation.
11:24So what then is the role of grace?
11:26Now,
11:27I don't mean grace in the spiritual sense,
11:29though there may be a spirituality in it,
11:32but I really mean in these tremendous,
11:34uncertain times that grace is
11:37about compassion.
11:38It's about compassion and stressful times.
11:41It's about compassion in the midst of change,
11:44of offering to help when you
11:46see things that need to be done.
11:48About actively trying to understand.
11:51Why something is as it is and
11:53how we can make it better?
11:56Forgiving because we're all making mistakes.
11:58Because remember, most of us,
12:00I don't think anybody has been
12:02in this kind of post COVID world.
12:05So we're trying to learn it,
12:07we're learning it together and then
12:10regularly expressing gratitude.
12:11Last year, when it was matters of the heart,
12:14we did talk about gratitude and
12:16actually the science behind gratitude
12:18that gratitude improves health.
12:20But that is a tremendous,
12:22important part of grace.
12:25And then why to bring this theme and this
12:29particular time in this particular year?
12:32The first point to say.
12:34Is that in imagining the world for
12:36those whom we will never know, perhaps,
12:39or those who will come after us?
12:41We cultivate grace among us
12:44all as a shared goal.
12:46That brings us together.
12:49The second goal,
12:49the second point, though,
12:51is that COVID has seriously challenged our
12:54cohesion as community and has presented
12:56us with a developmental challenge.
12:57And I'm going to say more
12:59about that in just a second.
13:013rd is that generativity and grace?
13:03Actually, there's a science to this.
13:06Build stronger,
13:07healthier teams.
13:08If you're thinking about others,
13:10those who come after you,
13:12your team works better.
13:16It's also very consonant with our ongoing
13:19focus in this department on inclusion,
13:22belonging and service leadership.
13:26And finally, it actually pushes us to
13:29focus not just on the uncertainty,
13:31not just on all the things that
13:33COVID has caused us to lose.
13:35But it actually focuses on what we
13:38are nurturing and building together
13:40that we will then pass on to all
13:43of you who have just joined us.
13:46And then two other points about this
13:48is what is our developmental challenge.
13:50COVID. Dastardly little virus that it is.
13:56Has has really brought us to focus
13:58on what we've lost, on what we need,
14:02crisis, fear, loss,
14:03separation is naturally pulled
14:05this to an inward focusing stance
14:09of how do we preserve what we had.
14:13Rather than what we will be.
14:15And actually there is a very
14:17well recognized human response to
14:19the change cycle.
14:20And I think that not just we here,
14:22but I think the country,
14:24I think the medical school,
14:25we're all kind of in the trough.
14:28We're in the trough of looking back
14:30to what we've lost and now we need
14:32to go up or another way to put it
14:35that Ericsson put it actually was
14:37embracing how what embracing generativity.
14:39You know,
14:40Ericsson talked a lot about contrast,
14:42so he contrasted generativity
14:45with stagnation.
14:46It's a very negative contrast,
14:49but I would imagine that it's the COVID
14:51virus that's pulling us back to stagnation.
14:54But look at what generativity is.
14:57It's open to experience.
14:59It's open to difference.
15:01It's open to being inclusive,
15:03a broad scope of concern,
15:05conscious of being a guide for others
15:09and focusing on interpersonal values,
15:12encouraging others to lead, to be a mentor.
15:15And look what COVID pulls us back to.
15:18It pulls us back to really
15:22being conservative.
15:23Focusing on what we've lost,
15:26being more self absorbed.
15:28Being as a as a group more self-interest.
15:32Focused on an emphasis on Transactional Ness.
15:37Rather than on restoring
15:39community and building community.
15:43Then the other point, just to be science,
15:47is that generativity actually does
15:48make stronger more productive teams,
15:50and I can give you a whole
15:52host of references on this.
15:54And then finally that actually
15:56it echoes everything we're
15:58trying to do in this department.
16:00We have a tremendous agenda on diversity,
16:02equity and inclusion.
16:03As you'll hear, we're focusing on
16:06building a larger mentoring program,
16:07focusing on welcoming individuals into
16:09our community and on service leadership.
16:12That is, how do leaders serve the community.
16:15And how do we make that better?
16:19The justification for the thing.
16:22So here's what we're going to
16:24do in the next bit of time.
16:26Is going to welcome everyone and in the
16:29past when we could all be in this room
16:32rather than virtually and scattered
16:34around and then and also in this room.
16:37We had this tradition
16:38which COVID has changed.
16:40I've asking everyone who was new to
16:42stand up and then everyone greet them
16:44and shake hands and no masks could be
16:47really close together and standing over each,
16:49so we'll never go back to them.
16:51So we're gonna do something
16:53different about that.
16:54And then I'm going to focus on challenges
16:57and goals and these particular areas,
16:59those particular 6 areas.
17:00And in at the very end,
17:03I want to return back to remind you of
17:05the theme for this year of generativity,
17:08imagination and grace.
17:10So first, to welcome everyone.
17:14And this is a challenge to welcome everyone.
17:17But first let me welcome then
17:18the one those of you who have
17:20joined us most recently.
17:22Our new fellows across psychology,
17:24social work and our child psychiatry track.
17:27You see the New Haven track,
17:29you see the Solnit S track to put a map
17:32so that you know everybody is welcome,
17:35welcome.
17:39So glad that you're here.
17:40I want you to everyone to notice
17:42on the pictures, the diversity of
17:44places that our new fellows are from,
17:47the diversity overall and and we really
17:50look forward to learning from you as
17:53much as you will be learning from us.
17:56And perhaps we will learn more
17:58from you than you will from us.
18:00But really glad you're here.
18:02Want also to welcome we have a number
18:04of interns and practicum students
18:06that come to our clinical settings
18:09working as social work interns and
18:12psychology and nursing and counseling
18:14and again coming from really diverse
18:17places and once again really
18:19wanting to learn as much from you.
18:22Our research training program
18:24from MM and Michael,
18:26we have 4 new fellows that you can see.
18:30And on this slide,
18:31we showed their mentors just to recognize
18:33that this is really a generative program.
18:36It is a heavily mentored
18:39program of Elizabeth Bennett,
18:41Allen and Yelena.
18:43Very glad that they're there.
18:45And this is a long standing program
18:47and thanks to Mike and his team
18:49for getting it re, you know,
18:51re upped.
18:51We also have 15 master students
18:53from the Yale University College
18:56London program this year under the
18:58direction of Helena Rutherford,
19:00coming from all over the world and
19:03many of you are mentoring them.
19:05You'll get a chance to hear their
19:07work through the years but or
19:08through the year and but really
19:11delighted to welcome them.
19:13And we've also welcomed into the
19:16department over 30 new postgrad and
19:19postdoctoral fellows over this year,
19:22many of them having come just
19:24this just in the last month.
19:26So we're really glad to have you.
19:28And we welcome the number of new
19:30staff in both clinically and
19:33clinically and in the research world.
19:36I would love to pause on every
19:37one of these and have everyone
19:39talk about what they're doing,
19:41but at least wanting you to know
19:42that you are welcome into this,
19:44into this place and this community.
19:48And we're growing our physician
19:50scientist in the center with the
19:52Emily and Kartik and Uche who have
19:55joined us as assistant professors
19:57now in the research tracts.
19:59So very, very glad to have both.
20:02Their work is tremendously
20:03synergistic as well as very different.
20:06And I look forward to your hearing
20:09very much from them.
20:10And then we've added a number of
20:13clinical and research faculty
20:15from child circuitry.
20:16Jose probably has had the most
20:19difficult transition as a new faculty
20:21member with fracturing one ankle and
20:24spraining another in his first month.
20:27So Jose,
20:27I hope the rest of your faculty
20:30career is much less difficult,
20:32but really, really glad.
20:34And you see adjoining the vaccarino
20:37labs across our outpatient
20:39services in home services.
20:40In our psychology program and
20:43Center for emotional intelligence.
20:44So things were growing and it
20:47really is a generative thing.
20:50And then we've had a number of
20:53faculty transitions to celebrate.
20:54Adam and Carla and Sharon have
20:57gone from associate research
20:59scientist to assistant professor,
21:01so pleased to celebrate Laurie Cardona
21:04becoming an associate professor.
21:09Megan Gosselin actually, literally
21:11just last week the promotion official
21:14of becoming an associate professor.
21:19And similarly, last week was a
21:21really good week. Ellen Hoffman,
21:22also promoted to associate professor.
21:28Dorothy was became a professor over
21:30this last year, so we really need
21:32to continue to celebrate that.
21:34And then Jamie just this just within
21:37the last couple of months named
21:40to a new endowed professorship.
21:42There's many more transitions here.
21:44I know a number of you have been
21:46entered leadership positions and
21:48there's many more to highlight,
21:50but just wanted to at least call out those.
21:53And then as you've heard in previous times,
21:55we've been building a with following
21:58on the great work that Laurie and
22:01understood and pediatric oncology
22:03building and behavioral health and
22:05pediatric oncology welcome Nancy
22:07Vorstellen in February of this year.
22:10And just last week I welcomed
22:13Justin Gardner from Saint Judes
22:15around education special education
22:18for children in oncology.
22:20And then finally,
22:21in the terms of the welcome things
22:23I've we've I've told you about
22:26Sherlane McRae over the last few
22:28months that the former First Lady
22:30of New York joining us here as a
22:34Yale presidential visiting fellow.
22:36But Chirlane will be offering
22:37a number of seminars,
22:38and so please stay tuned so that you
22:41get to know more about Sherlane's work
22:43and her work can thrive New York.
22:47And finally, and well, not finally,
22:50but in the spirit of gratitude,
22:52Michelle Matta is leaving to
22:54go to another position at Yale.
22:57Michelle has done so much for us and
23:00welcoming everyone and bringing us
23:01to a whole new level of onboarding
23:04and faculty promotion and transition,
23:06and we're just so grateful to Michelle.
23:09And then also Tanya Cologne,
23:12who has worked for Dorothy and worked
23:13with so many of you over so many
23:16years and brought all of our training
23:17programs together in this lovely wife,
23:20brought us to a whole new level.
23:21A Tanya is also going to
23:24another physician at Yale.
23:25What I think neither of them really
23:27know is that when they leave,
23:28we actually plant little tracking
23:31device so that they're actually
23:32always a part of the CHILD Study
23:34Center and community and family.
23:36And I do hope they'll take that very
23:38seriously and we owe them a tremendous
23:41gratitude for all they've done.
23:43So now turning to our goals and
23:46challenges for 2022 to 2023 in these
23:49particular areas that I I highlighted.
23:54I'm not going to speak.
23:55I am going to speak about challenges,
23:56but I'm not going to go Pedantically
23:59area by area and say the challenges.
24:01I'm actually going to go area
24:03by area and say the goals and
24:06talk about challenges overall.
24:09We really want to also bring you
24:11into this idea of a smart goal.
24:14What is a smart goal? We all have goals.
24:18New Year's resolutions are
24:20notorious for being. Uneatable.
24:24We have smartphones and so they
24:26should be highly specific.
24:27They should be measurable.
24:30We should be able to attain
24:31them in this year, and that,
24:33perhaps,
24:33is the point I want you most to hold in mind.
24:36It should be relevant to the mission
24:38and the values of this department and
24:41they should be time bound that we give
24:43ourselves a disciplined year to meet them.
24:46So hold it in mind,
24:47because that's what I'm proposing of these
24:50various goals that we can actually do.
24:53And then here are what I think are the
24:56challenging areas before our department,
24:57no surprise talked about these before
25:01defining our post COVID world.
25:03What is that world?
25:06I've already said that it's a world
25:08that's filled with uncertainty,
25:09but what will it look like?
25:12What is the world we want to
25:14give to those coming after us?
25:17Continuing to improve our culture.
25:20High priority dealing with this
25:22incredible behavioral health surge
25:24and what I would say is not just
25:27dealing with it and we'll talk
25:29about how we're dealing with it,
25:32but how we think about how that has
25:35never should revise how we think
25:37about behavioral healthcare delivery.
25:39Then filling in gaps in our
25:41research portfolio,
25:42continuing to grow and diversify our
25:45community with an emphasis on diversify
25:48and then continuing to improve and
25:50broaden our communications and we have,
25:52I'll talk about it,
25:53but we have made light years
25:55change with christo's input.
25:57All of these areas,
25:58I'm not going to go area
26:00by area, but these are the challenges
26:02that in one way or another cut
26:05across all of these different areas.
26:07So first, turning to climate and culture.
26:11And 1st to to bring us into this
26:13idea of how these two are related.
26:16Culture is what we say we want.
26:19Culture is what we say we the
26:21values that we want to espouse.
26:23So we want to be an equitable,
26:25inclusive culture where everyone feels
26:27they have a place and a valued voice.
26:31Can anyone disagree with that?
26:34That's what we want. Climate, however.
26:38That's how people feel.
26:42And climate is do what we is do
26:45our actions reflect the culture
26:47we want and the values we set?
26:50So I think we can agree on
26:52the culture we want,
26:53but we have a lot of work
26:55on the climate we set.
26:56And I think we've made tremendous progress,
26:59thanks to Tara and her team,
27:01but we have a lot of work to do.
27:04So you've seen this slide before,
27:06thanks again to Terra creating
27:08it really the continuous circle
27:11over history of learning that we
27:13all need to do beginning with
27:15restorative practices and I would,
27:18I would actually equate
27:20restorative practices.
27:22As with grace.
27:23That beginning with restorative
27:25practices that we acknowledge and
27:27we repair when there is that need,
27:30we learn how to do that.
27:31We've come together as a community,
27:33we build more trust as a community.
27:36And we've been doing that,
27:37as you know,
27:39with Yasmine Davis and her team
27:42and then going to racial equity
27:44training that we understand bias.
27:46We don't just just say,
27:47yeah,
27:48there's bias,
27:49but we actually understand bias and we
27:51understand how we how we deal with it and.
27:54That it is a lifelong process and
27:56we are continually learning and
27:58we've been doing this with Ingrid
28:01Cassidy and her team at Cirque.
28:03And Ingrid and her team will
28:05continue to be much more involved
28:06with us over this year as well.
28:08Yasmin.
28:10And perhaps it's the pink box that
28:12they're well, they're all important.
28:14But the pink box is especially important,
28:17again, in this spirit of grace and that
28:19we're actually constantly learning.
28:21We're learning for what worked,
28:23what didn't work,
28:24how we do it better,
28:25being forgiving,
28:26and it moves us to a transformative
28:29change and to transformational
28:31change and how we do it.
28:33Transformational change in our climate.
28:36So what's really been happening
28:38and again this is from Tara
28:41and what's happened so far,
28:43it's hard to fit it into one slide actually.
28:47But going around that circle in
28:49those boxes has been a lot of
28:51work on restorative practices,
28:53beginning very,
28:54very early in our initial
28:56association with another group,
28:57not Yasmine, on leveraging
29:00conflict for constructive change.
29:03With Jasmine,
29:03we started introductions to
29:05restorative practices all
29:06the way back to last summer,
29:08even before this meeting last summer,
29:13office hours with Tara and Yasmine,
29:15Community building workshops,
29:16and then this summer.
29:18I hope that a number of you have been able
29:21to join the restorative practices
29:23for leadership some seminar series.
29:25Under the DIB learning again a
29:28series of workshops that have
29:30been really quite powerful,
29:32but I would say even after that the
29:35reflection sessions offered so that
29:36people can come together and talk.
29:39And that Tara's restarting her Monday,
29:42Friday focus meetings and then
29:43doing a lot of work clinically
29:46of how do we actually think about
29:49culturally appropriate sensitive care?
29:52Community learning has been just
29:54absolutely wonderful over this last
29:57year of celebrating Black History Month,
29:59celebrating Hispanic Heritage Month.
30:02Returning to work conversations,
30:04even though I know we have a lot more
30:06work to do on returning to work in person,
30:08but still having those conversations.
30:10Juneteenth was a great
30:12event about Juneteenth.
30:13Hope you saw those pictures.
30:15And then continuing to create
30:18reflection spaces.
30:20And then transformative change where
30:21you may be actually thinking, yeah,
30:24that's all great, that's all wonderful,
30:25but what's the result?
30:28We've revised our clinical job
30:30search process, so it's very clear.
30:33I hope transparent or more transparent.
30:36We've now expanded where we post
30:38our jobs so that we can reach
30:41a more diverse group.
30:42Now we've established the DE IB Action Group,
30:45which I'll show you in a minute.
30:47We are really working incredibly
30:49hard on masters level clinician,
30:52both salary equity but also
30:54holding meetings to hear what our
30:56Masters level clinicians most need.
30:59And as you can see,
31:00I'm very grateful actually for
31:02the last point.
31:03Around how do we are more transparent
31:06about naming vice chairs and that
31:08process and that all came out
31:10of this TV EIB Action Group.
31:12What they thought, what they fed back,
31:14how we listened. It really is important.
31:18So where are we going?
31:19And here's the goals for 2022 to 2023.
31:24Tara's group and Tom.
31:27See, this is the the hybrid thing.
31:28I point that way,
31:30but they're hybrid in the hybrid space.
31:33So terrorist group and Tom are
31:35working on a mentoring effort that
31:37cuts across all of our missions.
31:40How do we better on board and those
31:42of you who have just come probably
31:44can tell us something we do that
31:46better and let you know we're
31:48continuing to refine the search
31:50with which also will include bias
31:52training for for as many people who
31:54would want to do it so that then
31:57we have a cadre of people who are
31:59trained and and unconscious bias
32:01and can join search processes.
32:03Accountability,
32:04a word that often sends shivers.
32:08But we should embrace it as a positive
32:11learning work of what can we do better?
32:14Have we met the goals for this year?
32:16Have we met our individual goals?
32:18Have we met our department goals?
32:19So we will be doing more annual
32:23assessments about climate,
32:24doing exit interviews to find out?
32:26What could we have done better if
32:29then someone decides to leave?
32:31The workshops and learning will continue,
32:34and it's really important for us to
32:36build the pipeline for Fellows and
32:38postdocs and staff so that we can
32:40actually build a pipeline of
32:42individuals who would like to stay,
32:44who would like to be with us.
32:46But we can cultivate a more
32:48diverse pipeline and then how do
32:50we engage our Community better,
32:51not just this Community?
32:54People sitting in this room and virtually,
32:56but the the New Haven community,
32:58where we work, where we are,
33:00how do we engage them better?
33:03And I should have also said when I
33:05started this particular section on DEID.
33:09That I hope that everyone feels
33:11and sees that this is a tremendous
33:13priority for this department.
33:15We are a very diverse department,
33:17both discipline wise,
33:19age wise, gender wise,
33:22and in certain pockets,
33:24race and ethnicity wise.
33:26This is incredibly important to
33:28us and something that we need to
33:30get not only right but continue
33:32to do because it will sustain
33:35the health of this department.
33:37A few things just to call out,
33:39but first to call out the D EIB Action Group.
33:42Here are the individuals who have set,
33:44who have stepped off,
33:45stepped up and said that they will help
33:48and they've been helping a huge amount.
33:50Thank you.
33:51But anyone else, I'm assuming Tara,
33:54you would welcome.
33:56Just a few other things around this
33:58particular theme as the Viola Bernard
34:00years ago feels like years ago,
34:02I think it was 2016,
34:04we got an endowment from the
34:07Viola Bernard Foundation to create
34:09a Viola Bernard program and
34:11HealthEquity and social justice.
34:13Two things have emerged from that
34:15has been a lecture series and we've
34:18already had some really wonderful speakers,
34:20Carolyn Roberts from the
34:21Department of History,
34:22just extraordinary speakers,
34:24but more to come on that.
34:26But now there's an innovation
34:28fund that focuses on projects
34:30that will impact the Community.
34:32To deal with that last goal
34:35of community engagement,
34:36there's 4 letters of intent,
34:383 proposals under review and
34:40we would very much encourage
34:42we'll present about those.
34:44But this is really important.
34:46And then finally,
34:47in this area,
34:48I know I've already said that
34:49we need to learn how to be
34:51together in person and all that.
34:53I think actually a part of climate
34:56change is learning how to be
34:58flexible and think together about
35:00how we work in this hybrid world
35:03and this new new post COVID world.
35:05That's why it's cited here simply to
35:08say that I think it's an incredibly
35:12important part of our climate as well.
35:15Turning to organizational operations,
35:16and this can often sound like both
35:19going into organizational numbers.
35:24Really important,
35:25because organizational operations
35:26address that top of the iceberg.
35:30They address the climate.
35:32How we do things addresses
35:34how it reflects our values.
35:37So let me just show a few things about
35:39what we're trying to do and what's happened
35:41so far and how we run this department,
35:44how we think about this department,
35:46how we manage this department,
35:47which is by the way, over 500 people now.
35:50So a lot of people.
35:53So here are some of the things
35:55that have happened so far.
35:56Our ongoing we clarified the organizational
36:00structure for department governance
36:02especially around clinical mission,
36:04but clarifying notice it's
36:07clarifying and not clarified,
36:09it means that it's an ongoing process.
36:13Also doing the same for job responsibilities,
36:15how do we match what someone's doing
36:19with their description of their job
36:20so that we can be sure that people
36:23have enough support for what they
36:24need to do if we can be sure that
36:26they're also is a clear who do you
36:29go to when you need to ask X or Y?
36:32We've installed or I'm beginning
36:34a series of leadership workshops
36:36and learning around leadership and
36:39Darren David's been leading that.
36:41Very grateful to Darren for doing that,
36:43introduce this concept of service leadership,
36:46which we will continue to do.
36:49And then I would just say that
36:51we've actually increased,
36:52really remarkably increased our attendance
36:54at faculty meetings by having a clear agenda.
36:58It's kind of 1 on one I know about meetings,
37:00but a clear agenda and then having
37:03incredibly detailed notes created by
37:05Krista so that if you aren't able to attend,
37:07you can come and read what happened.
37:10Goal of that.
37:11Goal of all of that.
37:13Is to make the organizational structure
37:16of this department accessible.
37:18Transparent in a much overused word,
37:20but transparent and I know we
37:23have a lot more work to do.
37:26Just to say that Krista is also updated
37:30the intranet so you can get a lot of
37:32this information on the intranet,
37:33and this is meant to drive traffic to
37:36the intranet go there's a lot there.
37:38It's not dusty,
37:39it's not virtually dusty.
37:41There's a lot of good stuff there.
37:44And then the organizational chart
37:46too small for you to see,
37:48but importantly to call out the stewardship
37:51and strategy team that is helping me.
37:54This is not a one person job very
37:57much helping me and guiding guiding
37:59us as a department and where we
38:01will continue to add positions to.
38:04And then these blue boxes are a number of
38:06director roles in our clinical mission.
38:09This does not reflect the whole department.
38:11But again,
38:12this is a work in progress.
38:15So where are we going organizationally?
38:19The vice chair I want to add a vice
38:21chair for professional development,
38:23education, and professional development.
38:26Talk about that more in education.
38:29To clarify, continue to clarify the
38:31organizational chart across all missions,
38:33not just for the purpose of doing it,
38:36but actually for the purpose of making clear.
38:38Who do you go to?
38:39What are the, what are the potentials?
38:41What's the structure of the department?
38:43Updating all of our committees.
38:45We have so many committees.
38:46You could populate a small city with
38:48a number of committees we have.
38:50So clarifying. What are they doing?
38:52How long did they stand?
38:53What are the charges?
38:54Would you like to join?
38:56Refining all leadership job descriptions,
38:59continuing our leadership
39:00skills workshops with Darren,
39:02and then regular assessments
39:04of how we're doing,
39:05which gets to the accountability
39:08and the DI goal.
39:10For research turning to research.
39:15Our research mission is core to what we do.
39:18It's absolutely core.
39:19And we've had this circular diagram
39:21for a long time and it's intended
39:24to be circles rather than boxes.
39:26It's intended to show how each
39:27bills and nest on the other.
39:29But we are a department really
39:32based around developmental research,
39:34whether it's clinical or basic.
39:36And that things flow from that.
39:38Now we could do a lot better job on
39:40the bridges between our research and
39:42our other missions, a lot better job.
39:45But that's the intent.
39:47And so what's happened today has
39:49been the vice chair and you know
39:52that Tom has been doing just an
39:54outstanding job of Vice Chair of
39:56research and bringing people together.
39:59You may be surprised that we have 30.6
40:01million of grant or grant portfolio
40:05that's nearly a little about 65% of
40:10our total budget revenue on the center.
40:13And that's divided across that number
40:15of grants and contracts of 295?
40:19Tom has brought us together around
40:22researchers for shared goals,
40:23building a regular research
40:25internal communication.
40:26We have new recruits that you saw
40:29as clinical and basic scientists.
40:32I'm very grateful to Kareem Kareem.
40:37Pointing to cream.
40:38Ohh cream, great, wonderful.
40:39Thank you.
40:40Very grateful to Kareem for build
40:42building the research and progress
40:44session with others in your Group 3.
40:47And then we've had the cross talk
40:49sessions at faculty meetings that
40:51are really intended to start making
40:53this bridge across the missions.
40:56So where do we wanna go?
40:57What are the goals?
40:59Tom is going to be trying to help us
41:02update our strategic goals for our research.
41:05We've had strategic goals in these
41:08areas of stress and adversity,
41:10innovation and clinical practice,
41:12social policy,
41:13but it's time to ask where are the
41:16gaps and where are the opportunities?
41:19The enhanced mentoring approach
41:20with Tara's team trying to
41:22bring all this together.
41:23One mentoring effort for the center.
41:26A plan for sharing common
41:28resources across lands.
41:29Why can't we do that?
41:31Why does every lab have to be its
41:34own ship when there are common needs
41:37across and Tom will be leading that?
41:40Guidelines for space allocation.
41:42We should probably put blinking
41:43neon lights around that.
41:45There are a lot of guidelines from
41:47the medical school about that.
41:48And how do we take those
41:50and make it local as well.
41:52And then two others to guidelines for
41:54applying for a K part of generativity.
41:56How do we help people apply
41:58for K Awards career awards?
42:01And finally,
42:01I think we need more center
42:03and training grants.
42:05Not for the whole purpose of getting grants,
42:07but actually to unite us with other
42:10departments in the medical school.
42:15Clinical services.
42:18Of all of our missions and of all
42:21of our sections, clinical services,
42:23because of a number of things,
42:26are the things where we actually have
42:28the perhaps not most work to do,
42:31but the work that is perhaps
42:33the most challenging.
42:34And it is the most challenging because
42:37of exactly what's on this slide.
42:39That there is a mental health
42:41crisis in this country.
42:43There is a surge in mental health
42:45needs post pandemic that usually
42:47follows the economic crisis,
42:48as that's intended to show.
42:50But we are in the middle of an
42:53unprecedented crisis in this country
42:55and children's mental health.
42:57And that has caused a lot of stress
43:00and strain and cracks in our process.
43:02So what I'm going to do in the next
43:05few minutes won't in any way capture
43:07the total complexity and all the
43:09work that's being done in this area,
43:12but only meant to highlight it for
43:14you and also meant to say roll
43:16up your sleeves and be with us.
43:18Remember grace. Remember forgiving.
43:22So here we are just to remind you of
43:25the range of our clinical services
43:27that go from outpatient use where
43:30we provide assessments and a range
43:33of evidence based interventions.
43:34We also provide the same for
43:37adults or parents.
43:39We have a range of hospital
43:41based services from emergency
43:42room to inpatient units today,
43:44hospitals to consultation liaison.
43:48And we've been building a lot of
43:50pediatric that is in the Department
43:52of Pediatric based Services where
43:55we embed in pediatric clinics.
43:57Our clinical portfolio is big,
44:00it is very big and it crosses
44:03these various domains.
44:04It's not just outpatient,
44:06it's not just asked or why, it's very big.
44:09The other piece to remind you is
44:12that we're part of a larger system.
44:15We're part of Yale New Haven
44:17Hospital right across the street,
44:18the Children's Hospital.
44:19We're invested as a practice within Yale.
44:22Madison.
44:23Yale Medicine is the practice
44:24within the School of Medicine,
44:26and the School of Medicine
44:29lives within Yale University.
44:30So we are part of a very complex system.
44:34And where we managing this
44:36practice just on our own,
44:38it would be different from it how it
44:40is and managing it in the system.
44:42There's opportunities and there's challenges.
44:48So here's our current state,
44:50and thanks to Aaron for pulling these data.
44:53And these data right now on the
44:55graph go through December 2021.
44:58But the trends continued from
45:00January to the present in 2022.
45:02So you can see that just extraordinary
45:05increase in referrals across really the
45:08two as you can see across the two areas,
45:12the very top our Youth Services.
45:15And but there's there's a
45:18general increase across.
45:19What I must want to perhaps
45:21call your attention to,
45:22not just with the increase,
45:23but the fact that because of this surge,
45:26we have 500 children right now
45:29on our current waiting list.
45:32Now that's that's impractical.
45:33We can't do that.
45:35But it means that there's 500 individuals
45:38out there seeking services from
45:40somewhere that we need to figure out.
45:43Or at some point they'll
45:44find services somewhere.
45:45Some of it will be with us,
45:46someone will be with someone else.
45:48But there's 500 people that are seeking
45:51mental health services for their children.
45:55And I don't say that for everyone to feel.
45:59Say it for us to start thinking, think, OK.
46:02We can't do business as usual.
46:05What are the ways to start thinking
46:07about this that are different?
46:08How do we design services in a different way?
46:12And then here are just some more,
46:13again thanks to Aaron, to see that
46:16there's 102% increase in referrals,
46:1960,000 scheduled appointments
46:21just over this last year,
46:2482,000 scheduled video visits.
46:28Greater than 2500 unique families.
46:31And then there's a little footnote for
46:33me to put here to say that this number.
46:37If I can manage backwards.
46:40That this number, sorry.
46:43This number actually the
46:452500 would be greater,
46:47but we have fewer clinicians now.
46:49So that number is modulated by the number,
46:52just the sheer volume of clinicians.
46:54You can see the average age,
46:56you can see the distribution of
46:58racial identity, and you can see
47:00the distribution across gender.
47:02And we actually need to be more fine
47:04grained about that distribution across
47:05gender and not just female, male.
47:08And then that just for your interest,
47:10is the distribution across the various
47:13racial, race, racial identity.
47:16Let me show you also.
47:19Then where these kids come from?
47:22OK, come on, arrow.
47:23There we go.
47:27So this is actually our current emergency
47:30room inpatient unit and day hospital.
47:32The things to call your attention
47:34to on the first one on the
47:37behavioral health emergency room,
47:38it's not that the number of the
47:40volume of kids is increased.
47:41It has increased,
47:42but it hasn't increased exponentially.
47:45What's increased is look
47:46at the number of borders.
47:51So the number of borders from FY21 or FY20
47:56at 328 has gone to 524 to date in FY22.
48:04That's kids sitting in the emergency
48:06room waiting for some disposition.
48:09Waiting to go to our inpatient unit,
48:11waiting to go to some other place
48:13sitting in our emergency room
48:15and look at the border hours,
48:18the literal hours that they're sitting there.
48:21Has gone from 9000 in FY20
48:25to 32,000 projected for FY22.
48:30It's a fractured system.
48:32That's a system that needs
48:34some innovative thinking.
48:35It's a fractured system.
48:37It's not just putting more people in there.
48:40It's got we've got to rethink it.
48:42And then look at the children's.
48:45The eating disorders,
48:46look how those have dramatically changed
48:48something that Laurie has talked about
48:51and Rebecca talked about tremendously.
48:52But you can see it's it's a near doubling.
48:56Just over this time.
48:57And we could go more and
48:59more into those data,
49:00but basically I think you get the picture.
49:03We have a stressed delivery system.
49:06So what are we trying?
49:07What are we actually seeing
49:09that referrals are increasing,
49:11there's an increase in those disorders.
49:13There's greater severity,
49:14fewer programs are available
49:16in this continuum of care,
49:18which is why you have so many borders.
49:21And there's a workforce shortage.
49:25Right now, there are not enough
49:27mental health clinicians out there
49:29of any discipline to meet this need.
49:31There is a tremendous workforce shortage,
49:34not just for us, but for the whole country.
49:37So you've got actually a perfect storm.
49:40With all of this leading into every,
49:43it's feeding on each other.
49:46So everybody's sufficiently depressed.
49:52So what have we been trying to do?
49:54So one other thing to the financial reality.
49:57So all of our lines of
49:59business in the department,
50:00the research and education
50:01lines of business are balanced.
50:03Our clinical line of business has about
50:06a 6.6 million deficit in fiscal year 22.
50:10That is not because people are
50:12not working hard.
50:14That is because actually of a tremendous
50:16structural issue and how behavioral health
50:18is reimbursed and paid for in this country.
50:21So 91% of our clinical expenses
50:24are salaries and benefits,
50:26reimbursement rates do not cover
50:28the cost and our patient population
50:30actually now is down to 40% Medicaid.
50:33So what did that tell you that commercial
50:36payers don't cover the cost either?
50:39That's what it tells you.
50:41So if you want to go out and
50:43make a change in the world.
50:45Actually,
50:46importantly to note is that mental
50:49health is inadequately supported
50:51across all payers in this country.
50:53So what are we doing?
50:55First off,
50:55I just want to thank the Clinical Vice
50:58Chair Group of Yan and Michelle and Aaron.
51:01And here are some of the
51:03things that we're trying to do.
51:04And it cannot be one thing.
51:06This is not a single solution issue.
51:09We're working with the health
51:11system to increase funding.
51:13We're working to increase the salary
51:15support for our masters level clinicians.
51:17A number of you emit involved with a
51:20consultation with Doctor Ken Kraft,
51:21who is an organizational psychologist,
51:23about how do we run this practice better,
51:26what's the interface of research
51:28and practice.
51:29Beginning to start to fill
51:30some of these vacant positions,
51:32but remember there's a workforce shortage,
51:35so it's really hard to find people.
51:38And then we're growing that bought
51:39that box which was hospital based
51:42services where we're embedding pediatric
51:44psychology into the practice into
51:46pediatric subspecialty clinics as
51:49a way of improving access to care.
51:53And what's on the horizon are
51:55a number of these things.
51:58To clarify and enhance the
52:00clinical research interface,
52:02we have to and we are working now
52:06and I know I've said this last year.
52:08So I feel really quite mixed about
52:10saying it with this strength that
52:11we need to adjust our salaries to
52:14meet market rate and we are trying
52:15to find the funding to do that.
52:19To increase the number of clinical
52:21contracts to add teleconsultations services
52:23to develop an eating disorder program,
52:26establish a self pay practice
52:28and also improve measurement
52:30based care in our services.
52:32All of this will work.
52:34All of this will have an impact,
52:37but most importantly.
52:38Really need people to think.
52:41How do we rethink behavioral
52:45healthcare delivery?
52:46How do we do some things that are very
52:48different and that and that we can do it.
52:50We can do it because we're a department
52:53where research is embedded in so.
52:57Thank.
52:59Let me just go to the last two missions.
53:01But first,
53:01before I do that,
53:02I want to actually express
53:04gratitude to everyone who's been
53:06dealing with this tremendous
53:08behavioral health surge.
53:10All of you who are working
53:12on the clinical front lines,
53:13seeing more children than you
53:15ever thought you would see.
53:16Seeing children that are sicker
53:18than you ever thought you would see.
53:20That tax you that you take home
53:23at night and your thoughts?
53:24I want to thank you for all that
53:26you're doing for those families.
53:34So let me go to education
53:36and professional development,
53:37and that is the new vice Chair role
53:40that I we have a job description,
53:42we'll post it, we'll get our nominations.
53:46But what are we doing now is we've had,
53:48you saw, you saw the slides.
53:49We have a diverse group of fellows.
53:51It's wonderful.
53:52We have very strong
53:54professional training programs.
53:55We have incredibly well subscribed
53:57with Kasha and Wendy and others
54:00professional development efforts.
54:02We just just in the last couple
54:05of months initiated a reach
54:07training for pediatricians to help
54:09them learn about mental health.
54:11And we are reaching many,
54:13many schools through the Yale
54:15Center for Emotional Intelligence.
54:17What else can we do, though,
54:19in the education mission?
54:22And so and also to thank all of
54:25our training directors and to just
54:28note that Carolina is the new
54:30training Director for social work.
54:32I'm very grateful to all of them
54:34and the vice chair role is not
54:36to in any way supplant that,
54:37but to add this lens of
54:41professional development.
54:42And just to say.
54:43But here's what I think we can do
54:46for professional development that
54:48we need to develop a professional
54:50development program where we're
54:52actually uniformly branded,
54:53so reaches reaches one effort.
54:56And perhaps a certificate program in
54:59child and family behavioral health policy.
55:01And reinvigorate relationships.
55:03We had those schools.
55:05But to really think how do
55:08we consistently across have
55:10a professional label?
55:11So that everyone who sees all,
55:13there's a training at the Child Study Center.
55:15I know that's going to be good
55:17because I went to one on anxiety,
55:19I went to one on autism.
55:21I know exactly what I'm going to get.
55:24So that we really develop a professional
55:27training effort not for revenue,
55:29although it could be revenue,
55:31but but that really gets our word out
55:34there and that we impact the Community.
55:36That, I think,
55:38is an attainable goal for
55:40this year and we should do.
55:42In the last few minutes.
55:44Communication is the glue
55:47that holds us together.
55:49And Krista is, I think,
55:51of another metaphor besides glue.
55:52Krista the uniter.
55:55Krista has done so much,
55:58has brought us to another level of
56:00communication that we just didn't see.
56:08You can see since Christa joined in November,
56:11it's not even a year yet.
56:13All the things that she has done,
56:16including not only the
56:18insider but a new newsletter,
56:20a new virtual bulletin board,
56:22those two notes from faculty
56:25meetings are unbelievable.
56:27This is all christo's work.
56:29And communication is really unites across
56:32all the things I've been talking about.
56:35And where I think that we will
56:37be going with Krista again,
56:38guidance is refreshing the website
56:40that has turned out to be herculean
56:43in the most sense of the metaphor
56:46pushing things up the hill.
56:47Expanding our social media
56:49presence and again,
56:50did I mention go to the intranet?
56:52Because there's a lot on the intranet
56:55and Krista is making the intranet
56:56a place where we really can go
56:58and you can get what you need.
57:02So the last minute I want to
57:05return then to generativity,
57:06imagination and brace.
57:09And only to conclude with these
57:11particular with these these points.
57:15To make the point that I think
57:17if we can bring ourselves.
57:20To have the focus on those who will
57:22come after us, it will unite us.
57:25And remember, we've been divided,
57:27not divided like the country.
57:30But divided just because
57:31we've all been at home,
57:33we've all been in our offices,
57:34we've all been working virtually,
57:36we've not been present and we are present
57:39now, both in person and and and online.
57:42But we need to come together and we need
57:44to come together in this goal for others.
57:47And imagining a future.
57:50Imagining what we can be and what we
57:53could be and who we will be for the
57:56next people actually tempers loss.
57:58It tempers also the uncertainty
58:00that COVID remains with us.
58:03And I would just finally argue that
58:05building it for those who come
58:07after us and ensures that all the
58:09work we're doing as hard as it is,
58:11will have a lasting value and we'll
58:14feel like it is something that is deeply
58:16within us that we are giving beyond us.
58:19So thank you very much.
58:21I appreciate your coming.
58:34If those of you who want to stay,
58:36we can have some time for questions,
58:37there's also still coffee and
58:39food in the back. And Karen,
58:41will you monitor anything online?
58:44Thank you for coming.
58:47Thank you so much, Linda,
58:48for getting us off to such an
58:50inspiring and hopeful start.
58:51Are there any questions for Linda?
58:56Anything online I always do this by the way.
59:01Well, that was my fault for taking
59:03up five minutes at the start.
59:06Thanks again.