CFTSI in the Time of Telehealth

July 24, 2020

ID5416

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00:07So I'm I'm Steven Marans Amoco,
00:09developer of the child and family.
00:12Traumatic stress intervention an I am
00:14just delighted to be with you all today
00:18were all from the AHL team and I think
00:21from around the world it's a It's a real.
00:24It's a more than a tree.
00:26That's an honor to be with you all
00:29and I think one of the things I
00:32just wanted to begin the discussion
00:35today by pointing out the obvious.
00:38That TSI is was developed in order to
00:41help children and families have been
00:45impacted by potentially traumatic,
00:47overwhelming events in greater
00:50control over what they can control.
00:53And I think we're we're operating in this
00:57meeting is happening at a time of enormous.
01:01An opportunity.
01:03And there were only impacted
01:06were only impacted by the.
01:09Over 19 brawl impacted by the foment of
01:13of protest against racism and injustice
01:16in our country and around the world,
01:20and this adds additional burdens,
01:22challenges and opportunities
01:24for all of us as clinicians.
01:27Um, when we too are affected by
01:30the events that are also affecting
01:33the people we hope to help.
01:36I wanted to state the obvious because
01:39I think too often we we may operate
01:43in a vacuum and may not be able to
01:47adequately support each other as
01:49we attempt to continue to do work
01:53that is so essential now and always,
01:56and dealing with the most vulnerable.
01:59Navarre populations but we are part of
02:02this part of this world and were part of the.
02:08Potentially overwhelming impact of
02:10events that are affecting us daily.
02:13So it's actually a a wonderful chance,
02:18a wonderful opportunity to be together.
02:21For the first time in quite some time.
02:24But to be together at a time where
02:27we all need each other to lean on to
02:31support each other as we continue to to
02:35support the children and families who are.
02:38Overwhelming events in their lives with
02:41the aim of helping them to recover.
02:44I do want to say that.
02:47You know for many years,
02:49some of our colleagues have been.
02:51Pushing and and actually exploring
02:54and implementing the use of Surfside
02:57via Telehealth.
02:59And so if there is any silver
03:02lining in any of what's occurring,
03:07the opportunity to develop and put into
03:11practice new methods of delivering cai.
03:14This is why we we,
03:16one of the reasons for coming together
03:19today to talk about how we how we can
03:22learn from each other in moving forward
03:25in a in a new age and to continue to
03:28help those that need safety aside the most.
03:31So with that,
03:32I'm going to turn this over
03:34to carry up steam.
03:35Who's the Co developer of CFC who's
03:38going to lay out what we have in mind
03:42for what we hope will be rich discussion.
03:45Thanks,
03:46Kerry.
03:47So welcome everyone, I want to Echo.
03:50Stevens comments were so glad you're all
03:52here. It's really the first time that we've
03:55been able to come together as a full CSI
03:59community and really acknowledging that
04:00we're in the midst of that many things,
04:04particularly in our country, and also
04:06something that we've never as a country.
04:09Extendo, if you get the world will
04:11experience before this particular pandemic.
04:14I mean, so it also seems important
04:16to start out by acknowledging that
04:18the events that are going on and
04:20this pandemic are impacting all of
04:22us were not just to providers that
04:25were also impacted ourselves. So.
04:27Today we really wanted to create an
04:30opportunity to bring people together.
04:32The sort of special community of providers
04:35who do acute Perry dramatic work.
04:37It's also an opportunity to share
04:39some of our experiences as a full 50
04:42side community that challenges we've
04:44been facing as well as you know how
04:47we've been meeting those challenges.
04:49So this is really a time when
04:52being able to offer.
04:53EMT SI may be more critical than ever,
04:57so our goal today is to discuss.
04:59Find Egypt Elehouse Therese and discuss
05:02any questions or challenges coming up
05:04in regards to implementing CSI via
05:06Telehealth and discussing solution.
05:11So just to predict what are
05:12sessions going to look like today?
05:14As I said, We are going to be recording
05:17this event since not everyone could
05:19join and we want to make sure that
05:22the content is available to everyone.
05:25Because of the large number of attendees,
05:28this event, as you entered,
05:30everyone's been put on mute.
05:32In fact, I think we have around 75 people
05:35just acknowledging calling in from
05:37the United States, Australia, Sweden.
05:40As well. And because of the large
05:43number we want to actually ask vote
05:46if they could keep themselves on mute,
05:48but feel free to type into the chat box.
05:51Any comments?
05:52Any questions you may have.
05:53You can feel free to use the razor
05:56hand feature will be pausing
05:57between each of our sections of
05:59our initial discussion to check in
06:01with the chat box to review.
06:03Any questions or comments
06:05that are being raised.
06:07That was the end of our initial discussion.
06:10Will be opening up conversation,
06:11a dialogue to have a dialogue
06:13with everyone joining us,
06:14joining today and we're really looking
06:16forward to hearing from all of you.
06:18So again,
06:18because the large number of attendees
06:20will use the chat box for people
06:22to indicate if they have a question
06:24or comment and then we can even
06:26invite people to come of- need to
06:28join and contribute to the dialogue.
06:32So welcome, you are joining
06:34me and Steven today.
06:36Our colleagues and faculty members.
06:38I'll start with Kristen Hamill.
06:42Christian are you there? Can you say Hello?
06:44Hi Everybody, it's so
06:45nice to see you all
06:46and it's really nice
06:47to see some friends in the audience.
06:49I haven't seen in awhile. Thank
06:52you Kristen and Megan Gosselin, everyone.
06:59And Katie just perm. Everybody.
07:04And for those of you who
07:06attended trainings for if you
07:08sign master trainers, again,
07:10formally introducing myself,
07:11carry up soon as could developer.
07:13And of course even marriage you've
07:16already heard from Co developers CSI.
07:19I also want to acknowledge a few
07:21others who are joining us today.
07:24I'd like to acknowledge our wonderful CSI
07:26master trainers were joining the call.
07:28Also. Acknowledge Jenn Brown,
07:30who's managing or redcap
07:31database and as managing the
07:33technology under the presentation,
07:35and Hilary Hahn Co.
07:36Developer of our red cap database system
07:39and just to name the 50 side master
07:42trainer ship joined Rachel Sheller,
07:44Victoria Dexter, Ann Rodriguez,
07:45Carlos Tovar, who is a key member of art.
07:49Skip TSI Corda Veltman team as well.
07:54So today we're here to support
07:56clinicians supervisors in
07:57implementing CSI via Telehouse.
07:59There has a question that's been
08:01raised about whether CTS I can be
08:04implemented via Telehealth and
08:05for some of us there may have been
08:08a May continue to be a concern.
08:10That Telehealth creates situations
08:12in which it's more difficult
08:14to engage patients or clients.
08:15It may be that in fact these are
08:18the same engagement issues as
08:20we might experience in person.
08:22It's just playing out until a health.
08:25And the question is,
08:26how can we work with what we have?
08:28How can we recreate being there
08:30with a child in caregiver?
08:32and I know Megan Dawson is going to
08:34be speaking to this in a little bit.
08:39So the context for this conversation is
08:41very important for some people in the call.
08:43Talla Health, maybe something that
08:45you've been doing for quite a while.
08:47For others they moved to tell a
08:49health may have happy relatively
08:50quickly in the context of a pandemic,
08:52and therefore may have felt somewhat
08:54sudden as a result of that,
08:56it may have felt a little disorienting,
08:58or man raised a lot of questions,
09:00and so when when is shifting to talla
09:02health into summit more unexpected sudden
09:04way we want to figure out how we could
09:07we ground ourselves in the political
09:09process is in the clinical guidelines.
09:11That we know so well as clinicians,
09:13and that we followed prior to
09:15starting to implement via telephone.
09:17So our message to see if she's
09:19like community is that CF TS.
09:21I can definitely be implemented via
09:23Telehouse and both at Yale and organizations,
09:26both in the United States and
09:28in other countries.
09:29Donations have been effectively
09:31delivering CSI in this manner,
09:33so you'll hear an overarching.
09:36Beam today that is reminding ourselves that
09:39our goal is to work with what we have.
09:42Be creative.
09:43Content consider how you might be flexible.
09:47We've talked a lot in CSI training
09:49and consultation calls about
09:50Fidelity with flexibility.
09:56So Jennifer could take me to the next slide.
10:01Now I'd like to talk a bit
10:03about implementing this idea.
10:04Telehealth using the different technologies
10:06and platforms that you may be using.
10:08So we really want to acknowledge that people,
10:11clinicians are using a range of technologies
10:13and platforms to provide telehealth.
10:16Some clinicians are conducting to
10:17allow sessions through advanced
10:19technologies with video capability
10:21and screen sharing and Whiteboarding.
10:22Some of you may be conducting Telehouse
10:25sessions through simple phone calls,
10:27and for some it's anywhere in between,
10:30so everyone is in a different
10:32place in terms of the technology.
10:34So our goal is really to talk about
10:37how CSI is possible and effective,
10:39regardless of the technological venue
10:41you're using to conduct the session.
10:44Again, we want to remind ourselves.
10:46Of the overarching theme of
10:48working with what you have,
10:49being creative and reaching
10:51for Fidelity with flexibility.
10:52So as a very basic example,
10:54when we're talking about Plex ability,
10:56one example might be that in cases
10:58where a clinician is carefully planned
11:00to share materials with a client
11:02or patient through screen sharing,
11:05something may happen.
11:06For example,
11:06why fire Internet issues and we may
11:09need to improvise and depend on the
11:12relationship to do the work to really
11:14use the Relationship and rely on it.
11:17For those of you conducting
11:19CSI over the phone,
11:21sometimes conditions have big worries
11:23about whether this is doable and one
11:26of the things we've talked about as a
11:29group of CSI providers and developers
11:31is that this is an opportunity to make
11:34use of the silver lining here that,
11:37as we all know,
11:39one of the goals of Cai is finding words,
11:42increasing observation.
11:43Ull capacity about symptoms,
11:45and increasing communication
11:46about symptoms so.
11:47When a collision is conducting,
11:49either sessions 3,
11:50four and five over the phone.
11:52When you're working with the
11:54child and caregiver together,
11:55for example,
11:56the clinician may not be able to
11:58see the nonverbal communication.
12:00The body language of the child
12:02and caregiver sort of what's the
12:04dynamic happening between the two?
12:06So in this circumstance those clinician
12:08could actually say to the child and
12:11caregiver something like remember,
12:12I can't see what's going on right now.
12:16How would you describe each others reactions?
12:18So in this way you're dealing with
12:20the limitations of the telephone
12:22and that technology,
12:23but you're actually using the
12:25limitation to further some of the
12:27overarching clinical goals of Cai.
12:29You're really increasing observation.
12:30Ull capacity you are increasing
12:32communication about symptoms and
12:34observations between the parent,
12:35the child and caregiver,
12:36and you're really helping them
12:38put words to their experience.
12:40So this can really be built into
12:42the treatment and blended in,
12:44and it's actually a very helpful.
12:46Way to help them describe what's
12:48happening and putting it into words.
12:50So next slide please Jen.
12:54Thank you.
12:56So some of you may have already
12:58received a lot of guidance when it
13:00comes to the basics of conducting.
13:02Tell health,
13:03while others may have received less guidance.
13:05We thought we would just start with
13:07a very brief review of some of the
13:09basics regarding provision of Taylor
13:11Health and focus most of today
13:13on actually the provision of cai
13:15screening preparation for screening,
13:16screening and treatment.
13:18But as you can see on this slide,
13:21some of the basics are for the clinician,
13:24making sure that you've been able
13:26to identify a private location where
13:28you can be for the CSI screening
13:30sessions and treatment sessions,
13:31ensuring that there's some kind
13:33of neutral background that limits
13:35distractions and then also ensuring
13:36that you have emergency information
13:38for the caregiver readily accessible.
13:40For example,
13:41when you are meeting alone with
13:43the child during session 2.
13:47Slide. Thank you John.
13:49Let's take a moment and talk a little
13:52bit about what we can do prior to even
13:54starting CSI screening and talk about some
13:57considerations really setting up for success.
13:59So as we prepared to conduct CSI
14:01screening and later treatment,
14:03ideally will want to schedule a session that
14:05will be held prior to the screening session,
14:08during which we can review some
14:10considerations that will set up for success.
14:12But this session will give the
14:14clinician and the family time
14:16to really think things through.
14:18It's an opportunity for the clinician to set.
14:20The expectations and will really
14:22help to make the safety aside.
14:24Screening and treatment sessions
14:26that feel more predictable,
14:27which is an important goal in the
14:29paragenetic phase of Trump response.
14:31So first the condition can identify
14:33a time to hold a session with the
14:36character in family during which they
14:39can Orient the family to tell about.
14:41And this session could be seen
14:43as part of intake.
14:45For example, leading up to conducting CSI,
14:47screening and treatment.
14:48The idea is for this to be one of
14:51the first clinical interactions
14:52that clinician has with the family,
14:54so the clinician would likely
14:56set up the call,
14:57initial effect caregiver and again,
14:59perhaps the condition.
15:00Consider setting up a separate
15:02call with a child if appropriate.
15:04For example,
15:04if you're working with an adolescent
15:06and the idea is to proactively spend
15:09some time focused on how the clinician
15:11can work with the family to make the
15:13sessions as useful to the caregiver,
15:15and child is possible.
15:17So there are a few areas it might
15:20be understandably important
15:22to review with the families.
15:24For example,
15:25they may be thinking of the
15:28virtual session as a phone call.
15:30They may be,
15:31so they might be holding the call
15:35when they may be multi tasking.
15:38So for example when there are
15:41making dinner when they're going
15:43grocery shopping when they are
15:46talking or texting to friends.
15:49Jenn, actually,
15:50if you could go to the next slide,
15:51that would be great.
15:55Thank you. So we really want to help
15:58them to think about how they might set
16:00up the time when they are most focused
16:03spending time during that initial call,
16:05helping him think differently about how
16:06the therapy sessions are conducted over
16:08the phone or the computer, or a tablet,
16:10how they're different from other
16:12kinds of calls that are more informal.
16:14So our goal is to really help
16:16predict some of these expectations.
16:18And next slide please John.
16:21So the idea is really to discuss a
16:23plan for creating a sense of walking
16:25into the therapy room each week,
16:27and it's really a nice way to begin the work.
16:31It helps to engage the caregiver
16:33parenting role and really help set
16:36the tone for everything that follows.
16:38Which I think can be incredibly important.
16:41So we want to work with the caregiver
16:43to brainstorm and identify,
16:45ideally consistent location where
16:46the caregiver and child will be
16:48during the CSI sessions.
16:50Will want to Orient the caregiver and
16:52child participating in virtual sessions.
16:54Meaning how do we create that sense of
16:56walking into the therapist office so that
16:59they really have an appropriate space?
17:01Meaning privacy as much as possible,
17:03with ideally as few distractions as
17:05possible so that they're grounded
17:08and ready to participate.
17:09And I also might say that at the start
17:11of each other screening session,
17:13or see if TSI session that the clinician
17:15may want to consider starting the
17:17session with some kind of checking
17:19in so to speak about whether they're
17:21actually in a location where they're
17:22focused and where there's as much
17:24privacy as possible.
17:25Perhaps by asking something like you know,
17:27are you settled in your room or your space?
17:29Or do you need a minute before we begin?
17:33Another piece is taking the time to
17:35talk with a caregiver about identifying
17:37a space for the therapy session.
17:39Again,
17:39we've talked about as identifying where
17:41it will have as few interruptions as
17:43possible so that privacy is insured
17:45and really lends itself to the
17:47caregiver and child really engaging
17:49into the work so the family may
17:51need to really come up with unique
17:53spaces for the therapy sessions.
17:55And again,
17:55this is the moment for working
17:57with what we have.
17:58This is the time to be creative,
18:00inflexible,
18:01the family may have ideas or may
18:03need help to think through or.
18:05Think outside the box in terms of
18:07the setting for these sessions.
18:09So for example,
18:10we know that families that are
18:12participating in CSI who are living,
18:13for example,
18:14very small studio apartments that the
18:16bathroom may be seen as the therapy space.
18:19As this is the only space with the door.
18:23So thinking creatively,
18:23we also want to talk to the caregiver
18:25about how they can plan for a
18:27child care during the sessions
18:28said they were able to focus.
18:30So for example,
18:31in session one we want to ensure that
18:33the caregiver has the opportunity
18:34to focus on the discussions that
18:35arise in the session,
18:37and we want to make sure that they
18:39have the space that they need for any
18:41reactions that they may come up for them.
18:44We also want to Orient the child in
18:46caregiver to this new way of working and
18:48address the reality of tell Alls so.
18:50For example, as you can see on this slide,
18:52the clinician might decide to say
18:53something like you, even though
18:55we're not in the same room together.
18:56We're going to do our best to have
18:59helpful productive sessions in spite
19:00of the fact that we're not in the
19:02same room together and that our
19:03goal is to make this as useful and
19:06helpful as possible so that you get
19:07the most out of it as best we can.
19:17So Jen, if you want to move to
19:20the next slide. If you're using a
19:23video component,
19:23telehealth positioning the cameras.
19:25Also something to think through.
19:27We want to review how the position
19:29of the camera can ensure that you,
19:32the therapist,
19:33or able to in the initial sessions
19:36to see the caregiver to see the child,
19:39and then to see the child care
19:42Gerber Dyad in later sessions.
19:44It's important to note that in
19:46the diotic sessions of CSI,
19:47if the child and caregiver don't
19:49feel comfortable to sitting
19:51right up close next to each
19:52other to fit in the camera view,
19:54just to remind ourselves and remind
19:56them that they can position the
19:58camera a little bit farther away
19:59so that the therapist can really
20:01see them both and they make more,
20:03maybe more comfortable where there sitting.
20:06I'm in terms of lighting.
20:08It can be helpful to ensure that there's
20:10enough lighting during that LL sessions.
20:12We have really found that sometimes
20:14it's hard to see the child and
20:16caregivers faces and expressions
20:17when there isn't enough light and
20:19that the clinician may want to
20:21proactively bring up an address.
20:23The challenge of where to direct
20:25their gaze or their eye contact,
20:27particularly maybe when implementing
20:28the symptom assessment instruments,
20:29but the one possibility is for the
20:31therapist to proactively acknowledge
20:33that it can be tricky to decide
20:35whether where to look at the camera.
20:37To look at the video looking right
20:39into the camera of the caregiver,
20:41child or looking at the picture of the
20:43child that maybe if you're using video
20:45technology a little bit to the side.
20:48So the clinician might say,
20:49Dwight you know at times I
20:50might be looking at the camera.
20:52At times it might be looking at you
20:54and we can have a discussion about.
20:56So,
20:56just to summarize that it's really
20:58this is all about setting the frame.
21:00It's about reviewing the common
21:02pitfalls of families understandably.
21:03May need to review with the therapist.
21:05It's really worth spending the time
21:07in a first session with a caregiver,
21:09perhaps with the child as well.
21:11It's about sending the message to the
21:13family that they've come to the right
21:15place that they're in good hands with you,
21:18the CSI therapist,
21:19and it can be really helpful
21:20and important for the family to
21:22experience this message that they're
21:24in good hands and will get relief.
21:26By participating in CSI via Telehealth.
21:30Jenn next slide please?
21:32And just a note about structure.
21:35Before we pause,
21:36I think during safety as I training
21:38we discussed the importance
21:40of structures and intervention
21:42unto itself in trauma cases,
21:44which really involves lots of
21:46clinical of loss of control as a
21:49clinical scheme and the structure of
21:51the therapy session can really lead
21:53to an experience of predictability
21:55and therefore sense of control.
21:57So for this reason,
21:59as we've discussed for traumatized clients,
22:01and patients are more directive
22:03structured approach is really warranted.
22:05And in fact,
22:06is a really good match for Telehealth.
22:08So In addition,
22:09the structure can be really helpful and
22:11important when it feels like there
22:13are so many other unknowns in a
22:16person's life and you have knowledge
22:18ING that definitely in the context
22:20of what is happening for this
22:23country in this world at this time.
22:25So now I'd like to pause for a moment
22:27to check in with the chat box so Jen can
22:30you let us know when we can all check it,
22:32but can you let us know about any
22:34questions that have come in that
22:36we may be able to respond to? So
22:38so far the
22:39main question is if the power
22:41point will be available to all
22:43the attendees afterwards so that
22:45they can reference back to it.
22:47So I'm really glad you asked that question.
22:49Absolutely, we will send this out along
22:51with the link to the presentation,
22:54both for you all for attending,
22:55but also for folks were not able to
22:58attend today, so will make sure that
23:00everything gets out to everyone.
23:03Just to get the moment whether there's
23:07any other comments or reflections
23:09or questions from anybody
23:12else before we move on.
23:19OK, so at this point I'd like to turn things
23:22over to our colleague Megan Gosselin.
23:25Great so thanks Kerry um and just
23:27to read before I dive in to the
23:30material that I want to present,
23:32I just want to reiterate what
23:34Kerry and Steven both said,
23:35which is just how appreciative I feel
23:37to be here amongst all of you I've been
23:40personally I've been trying to kind
23:42of find Silver Linings where I can
23:44during these these months that have
23:46been so challenging for so many reasons.
23:49In the end, I'm personally finding
23:50the fact that so many people,
23:52somebody, clinicians,
23:53felt that it would be a good
23:55use of their time.
23:56You been during the middle of the night
23:59to figure out how they can continue
24:01to hone their skills and helping
24:03traumatized kids and families in this venue.
24:05I just to me, that's a silver lining,
24:08so I just wanted to begin by saying how
24:11glad I am that to be part of this so Jen,
24:14would you mind going to the
24:16next slide please?
24:17Great,
24:17so I'm going to talk with us today
24:19about some of the engagement challenges
24:21that we might experience while we're
24:23implementing Cai Entella Health and you
24:25can see that we've listed a couple here.
24:28So we may.
24:29We may run into this situation where
24:31the child or the caregiver is saying,
24:33You know,
24:34I don't want to start treatment at
24:36this time I feel uncomfortable with
24:38this idea of of meeting with you
24:41over the phone or through a screen,
24:43or by the way,
24:44can't we just wait until the the
24:46pandemic is over or when we would be
24:49able to to be able to be in person?
24:52and I think,
24:53especially toward the beginning of.
24:55The pandemic,
24:55some of those comments may have
24:58reflected either I'm misunderstanding
24:59or A wish that this would be kind
25:02of a quick disruption in all our
25:05lives that actually hasn't panned
25:07out to be the case.
25:09And even once a family has
25:11agreed to begin cai,
25:12I think we've we've all had the experience
25:15where there may be some dead ends
25:18or some silence during the sessions,
25:20either from the child or the caregiver,
25:23or both.
25:24So the the clients who are
25:26really not offering much or.
25:28I think you know they adolescent
25:30who is kind of in their hoodie
25:32and just kind of shrugging,
25:34I don't know,
25:35so I imagine that some of these scenarios
25:37might be familiar to people on the call.
25:40And I think one way that we could
25:42go would be to take these statements
25:45in these kind of behaviours at face
25:48value and kind of agree and say,
25:50OK, well you know,
25:51let's wait until we can do this
25:54in person or either or explicitly,
25:56or even implicitly give the
25:58message that we agree.
25:59Yeah, you know, Telehouse is just not.
26:02It's just not as good.
26:03It's second best,
26:05but I think we're all here because
26:07we believe that taking that approach
26:10is really going to do a disservice
26:12to the kid in the family,
26:14and that leaving trauma reactions untreated,
26:17you know what we know is that they
26:19are likely to continue or or even to
26:22to get worse so I can quickly share a
26:26personal anecdote which helps me as I'm
26:29thinking about engagement challenges
26:30with new families. Which is it?
26:33I reflect back on the initial moments here.
26:36When the RR agency was the schools in
26:38Connecticut had just closed the day before.
26:41It was a Friday and we were all kind
26:43of scrambling around in our agency
26:46thinking about the following week.
26:48We were likely going to be closed and
26:51moving to tell a health and another
26:53a senior kind of trauma supervisor
26:55from a different program came to
26:58consult with us and said,
27:00how are you guys going
27:01to implement these these?
27:03Um trauma focused interventions in
27:05this new way and I'll never forget my
27:08reaction at that point was to say,
27:10well, we're not.
27:11We're going to.
27:12We're going to do case management
27:15and supportive checkins,
27:16and now looking back and reflecting on that,
27:19I can really acknowledge that that was
27:21largely driven by my own acute stress
27:24reactions that were really limiting
27:25my ability to think broadly and
27:28creatively and to problem solve an end.
27:30So Fortunately,
27:31I've been able to move forward
27:33from that initial kind of frozen.
27:36A feeling.
27:36And now as I see it,
27:38the question isn't whether we can
27:40implement cai intella health because
27:42we've had such such tremendous success
27:44in doing that over these months.
27:46But really, the question isn't.
27:48It is now about how are we going to do it?
27:52So let's talk more about that.
27:54So Jen,
27:54would you please go to the next slide?
28:01Thank you so as we're encountering this,
28:03this range of engagement challenges,
28:05I think, really the first thing that we
28:08really should try to do is understand
28:11what were clinically observing.
28:13So I think everyone on this call would
28:15agree that assessment is necessary
28:17before effective intervention.
28:19So I would encourage us all to shift
28:21away from thinking about engagement
28:23challenges that we're facing in this in
28:26this period as being exclusively or even
28:29necessarily driven by or caused by Telehouse.
28:31And instead we want to get back to our
28:35broad kind of clinical perspectives.
28:37And also remember what we really
28:39know about the traumatic response
28:40during this very dramatic phase,
28:42which includes, for example,
28:44often high levels of Termo Avoidance.
28:46And also high levels of overwhelm.
28:49So it's really our goal to keep and
28:52maintain that clinical perspective,
28:54for example by identifying and uncovering.
28:56What is the clinical concern?
28:58What is the concern or the clinical
29:01issue that's actually resulting
29:02in the engagement challenge?
29:04And then once we have more
29:07precisely identified that we can be
29:09more effective at addressing it.
29:11So, for example,
29:12this can be accomplished through questions
29:15like help me help me understand your worry.
29:18What's the worry about?
29:20About participating in treatment in this way.
29:23Next,
29:24slide Jen.
29:25And so as I said,
29:27once we have kind of better understood
29:29from the the clients perspective what
29:31is driving the engagement challenges.
29:34Think we're going to be more prepared to
29:37affectively intervene and help engage
29:39the kid and the caregiver into a trauma,
29:42focus screening and treatment that
29:43we all believe is really going
29:46to be helpful for them.
29:47and I think we need to kind of
29:50dig deep back into our knowledge
29:52about Perry dramatic symptoms,
29:54the role of prevention.
29:55And then you realize some of that evidence
29:58based engagement strategies that we
30:00have relied on even outside of Telehouse.
30:03So for example,
30:04if engagement challenges are playing
30:05out with kids or caregivers,
30:07saying You know they don't want
30:10to participate in treatment or
30:12they want to wait to be in person,
30:14we might Taylor or clinical discussions
30:16to help increase the motivation
30:18to participate in treatment and
30:20to participate now and we.
30:21So, for example,
30:22we might focus on what's really
30:24in it for them to participate.
30:27What are the most distressing or
30:29impairing symptoms and what might be?
30:32What might we predict will happen to those
30:35symptoms when they're not treated overtime?
30:38Again,
30:39the focus on the role of cai as
30:42prevention model or when engagement
30:44challenges take the form of,
30:47you know, I'm just too overwhelmed.
30:49It's too hard to fit in this
30:52treatment right now.
30:54I think it's important for us to.
30:57Conceptualize it's important for us to
30:59think about how we conceptualize our
31:01role as clinicians in those moments.
31:03So our goal,
31:04I think as clinicians is to help make
31:07things easier and more manageable
31:09for families and, you know,
31:11I think sometimes we can feel like
31:13we're imposing on families when
31:15we're trying to schedule with them,
31:17when, especially when they're letting
31:19us know so much is going on for them,
31:22and I think that might be particularly
31:25true when were also may be feeling
31:27overwhelmed at times during this period.
31:30But if we can shift the
31:32frame for our patients,
31:33but also perhaps if it's necessary for
31:36ourselves from this idea that treatment
31:38sessions are a burden to treatment is
31:40really an opportunity that can strengthen
31:43the family functioning in an ultimately
31:45lead to in a short amount of time,
31:48less stress and less overwhelming the family.
31:51So I think, of course,
31:53we all want to validate that
31:55sense of overwhelmed that we know
31:57as Perry dramatic providers.
31:59This is a really common
32:00experience that we heard.
32:02A pre pandemic,
32:03but it certainly there may be
32:05additional burdens right now that
32:07are contributing over and above too.
32:09That sense of overwhelm.
32:10So we do want to validate that we get that.
32:14But then how can we help caregivers
32:16and kids reframe the idea of this
32:19session is kind of just another
32:21thing that's on the families plate,
32:23but instead can we help them think about
32:26these sessions as an investment that
32:28the family is making that could and we
32:31believe could have a big payoff for them.
32:34So for example,
32:35if we're successful.
32:36Through see after yes I in reducing
32:39the caregivers on symptoms we
32:41can actually help the case.
32:43Management concerns become more manageable,
32:45so that's because we know that lowering
32:49anxiety and trauma reactions you know
32:51we can allow that caregiver to be in
32:55a place to be making better decisions.
32:58To be able to problem solve more creatively,
33:01and similarly.
33:02Getting the kids trauma reactions
33:04down can certainly improve.
33:06And I think we've all seen this as
33:08safe TSI providers that can improve
33:10the parent child relationship,
33:12reduce the parent child conflict,
33:14and lead to less stress in the
33:16family as a whole and just improve
33:18the family functioning.
33:20So if we're able to convey that
33:22that idea of these sessions as yes
33:24taking up time but as really being an
33:27investment where the payoff will be worth it,
33:30I think that could be an important
33:32part of engaging families.
33:33Now, this second scenario when families OK,
33:36they've said yes we want to,
33:38uh, begin this treatment.
33:39But then,
33:40as you're going through the treatment,
33:42we're running into engagement challenges.
33:44Then I think you know we've been
33:46depending on where we are at with
33:48our professional development.
33:49In our experience,
33:50we may have become comfortable with the
33:53idea that in clinical sessions in person,
33:55you know their silence, their space,
33:57and we become kind of comfortable
33:59with how to work with that.
34:01But I think for many of us where
34:04Tele Health is a new venue.
34:06It can be awkward and uncomfortable.
34:09You know when long periods
34:11of silence on a phone.
34:13It feels uncomfortable,
34:14but I think again,
34:16if we can kind of try to
34:18unpack with the family,
34:19what might be going on
34:20and then that will help
34:22us to better approximate what
34:24strategies we might have done in person.
34:26So I'll just go through a couple of examples.
34:29Although these are not
34:30meant to be exhaustive.
34:32So if a child is quiet or just keeps
34:35repeating, you know I don't know.
34:37I think you know we might
34:39comment on what we're noticing,
34:41so you know I'm noticing that
34:43you're not really saying much.
34:45Have you noticed that?
34:46Do you have any ideas about you
34:49know why that might be the case and
34:51see if the child can bite on that.
34:54And if that more open ended approach
34:57is is is not getting anywhere,
35:01we might kind of utilized the the role
35:05of psychoeducation throughout CF side
35:07and being grounding for families.
35:10But we might utilize it by.
35:14By offering some, uh,
35:16some of what we know.
35:19So, for example, we might say something like.
35:23You know,
35:23for some kids in especially when
35:25their first meeting with me,
35:27they might be having yucky
35:29feelings in their bodies,
35:30and that could make it really
35:32hard to talk for other kids even
35:34outside of our sessions there.
35:36Noticing that it's really hard,
35:38it's harder than usual to
35:39concentrate and pay attention,
35:41and so that could make it hard
35:43for you to know how to answer.
35:45Some of my questions.
35:47For other kids,
35:48they may really believe that the
35:50best way to manage all the big
35:52changes that have happened in
35:53their bodies and their feelings
35:55and their thought is to kind of
35:57don't talk or think at all about
35:59what the what happened to me.
36:01And that might be going on,
36:03and then I would include potentially
36:05the possibility that it is the venue
36:08of technology by saying something
36:09like an for some kids it just feels
36:12strange to talked through through
36:13a screen or talk over a phone and
36:15then you know trying to open a
36:18conversation with the child about
36:20any of these things sound like
36:21they might be happening for you.
36:24So, uh, you know?
36:26In conclusion,
36:26I think it's it's always been,
36:29as Carrie said,
36:30it's always been important.
36:32I believe as cai providers that we convey
36:35this sense of confidence and optimism
36:37as families are initiating cai with us.
36:40The idea that we really believe that
36:43they came to the right place and
36:46we have the medicine for what is
36:49ailing their child in the family.
36:51But I think that to the extent that we can.
36:55Convey that same sense of growing
36:57optimism and growing confidence about
36:59the venue of Tela Health as well,
37:01even if at the beginning,
37:03as to steal a line from Carrie,
37:06we need to be borrowing from
37:08other people's confidence.
37:09I think that would be important.
37:11So Jenn, could you go to the left side?
37:14And so before I close,
37:16I just wanted to briefly raise an
37:18issue that can certainly present a
37:20particular clinical challenge in one
37:22that we absolutely need to have at
37:25the forefront of our consideration.
37:26So I think we're all familiar with
37:29situations where the child in the
37:31caregiver are continuing to live
37:33with the perpetrator of their abuse,
37:36and so we could be speaking about
37:38domestic violence or child maltreatment,
37:41or or both, and I think it's
37:43important to acknowledge that it's
37:45always been a challenge to engage
37:47those families in treatment with the
37:50perpetrator remaining in the home.
37:52But it's also important to really
37:54consider how Tele health can pose even
37:57greater challenges for these families.
37:59And then in clinic appointments potentially.
38:02and I think the message that we all
38:04want to convey is that a prioritization
38:07of the family safety is really
38:09important when we're scheduling and
38:12then implementing cai in the home.
38:15So what do we do as Carrie was describing
38:18this kind of pre work work with the
38:21caregiver and setting things up for success?
38:25I think we want to be similarly working
38:27with the participating caregiver.
38:30So as you recall,
38:31in CF CS I would be the non perpetrating
38:33caregiver to think about how we can
38:36really get creative and be flexible and
38:39problem solve around ways that we can.
38:41We can offer this treatment so for
38:43example some things to consider are
38:45is there a consistent time when the
38:48perpetrator is not actually at home?
38:50Are they working?
38:51I've had one family that I worked with
38:54in the past where there was a pretty
38:57consistent nap time of this individual
38:59and we were able to work around that.
39:02If not,
39:02if there's no time where where
39:05that person is not in the home,
39:07is there a safe place where the
39:10child in the in the caregiver
39:12could go just for the CF sessions,
39:15and if not,
39:16how could we be creative within the
39:18home environment to find a place that
39:21allows for the privacy that would
39:23be necessary to have these sessions?
39:26So, as Carrie mentioned,
39:27I have one adult patient that I'm
39:30routinely meeting with in her bathroom.
39:32Um,
39:33and if that's not an option is
39:35would it be safe for the child and
39:38caregiver to meet with us in a car?
39:41And there are additional ideas that
39:43we could share, but so to conclude,
39:46you know,
39:46I think hopefully we're all in this call,
39:50because we believe that leaving the
39:52child and family with no treatment
39:54is actually not a great option,
39:57not the option we want to go with,
40:00Because Articularly for those
40:01children who are continuing to
40:04live at home with the abuser,
40:06that child is is at potentially even
40:08greater risk for trauma reactions,
40:10given that.
40:11You know the presence of this
40:13person may serve as a powerful
40:16trauma reminder for them,
40:17even if the actual violence has stopped.
40:20So I think the overarching message
40:22and strategy is how can we be as
40:25creative and flexible and kind of
40:27collaborative with that participating
40:29caregiver as we can in order to be
40:33able to provide this treatment that
40:35we believe can be really helpful.
40:38So I'm gonna pause there and an John.
40:41Maybe we can talk about if there were
40:44questions that came in related to this
40:47content before we move on to the next topic.
40:53Alright, we have a few questions.
40:55Uhm, one from Carla Arroyo due
40:57to the high demand and shortage
40:59of therapists in our agency,
41:0190% of the clients a Spanish speaking.
41:03What are your thoughts of using peer
41:06support specialists meeting with apparent
41:08to review the telehealth settings,
41:10what to expect etc?
41:11And having the parents attend
41:13a Psycho Ed Class led by a
41:15trained peer support in general
41:17information about trauma in the
41:19brain. OK, and I think this
41:22you know all anyone from the
41:24panel should feel free to jump
41:26in with their their thought.
41:28I guess I have a question.
41:30Where do you mean instead of
41:32a moving might be connected
41:33to prior prior to engagement
41:35prior to screening. Is that what
41:37you're thinking of Carla? Yes,
41:39yes. So we have. I mean, there are very,
41:41very few therapists available, period, right?
41:43And so when we have so many so many
41:46people trying to access surface is
41:49what we find is that you have a lot of
41:51people in the waiting list and then
41:53they don't qualify for DFCSCFDSI or
41:55then you know it's too late or then
41:58they don't want treatment anymore.
41:59But then what we find?
42:01Is that when you use a case management
42:03you can make it you're looking at
42:06there at the basic needs right?
42:08And then and then,
42:09but then by the time they get to
42:12the therapist is almost like well,
42:14we're good.
42:15You know the the things are moving
42:17so so my idea is how could you
42:19keep him engaged by providing
42:21their basics basic needs,
42:23but also by starting working
42:24with them on what to expect,
42:26not just entirely help but with trauma.
42:28What emotional, like even doing some sort of.
42:31So it's I made at least with the
42:34population were working with,
42:36sometimes you get to that first session
42:38with the parent an and they don't like it.
42:42It's a complete Psycho
42:43Locational session on emotions,
42:45just is not just good and bad.
42:48It's about emotions and what?
42:49What are the works?
42:51Because in our culture.
42:52We were not talking about how
42:54like what are emotions is good
42:56and bad and that's about it.
42:58And you don't cry,
42:59you don't complain and so that has been
43:02one of the hardest things for us in
43:04implementing this model that you know it's.
43:07It's almost like when in session too
43:09and we gotta move are in station 3
43:11and it feels like you can't even
43:14finish and just things seem too
43:15convoluted and still were trying
43:17to figure out how can we use the
43:20continuum of air into helping these families,
43:22but it's still trying to
43:23maintain flight Fidelity.
43:24Within within the
43:26model. So. On
43:30faculty I'm I'm. I'm happy to
43:32sort of start of.-. The response.
43:35Check. I'm so Carl, I really appreciate
43:39you bringing this up for multiple reasons,
43:41and I think it really appreciate the
43:43understaffing and also wanting to keep folks
43:45engaged so that they actually transition in.
43:47Does the TSI and also trying to address
43:50the issue of making sure that they're still
43:52in the pair dramatic days when you start.
43:55And so I think that it's a really lovely
43:58idea that you've come up with to use peer
44:02support specialist to keep them engaged.
44:04and I think that as you wrote in
44:06your question reviewing telehouse
44:08settings and what to expect,
44:10having caregivers attend a group that's
44:13focused on general psychoeducation
44:14about trauma, etc.
44:15That's being conducted by a peer support
44:18specialist sounds like a really wise
44:20thing to do I think that you might also.
44:23You're also bringing up some things
44:25that are about not just be a
44:28safety aside via Telehealth, But.
44:30In general,
44:31where you're saying that actually
44:33there's a piece of our culture that we
44:35need to address in terms of discussing
44:38and putting words to feelings, etc.
44:40And I'm wondering whether that could be
44:42built in at all to anything that the
44:45peer support group would be talking about.
44:48I do think that once one gets.
44:51Connect to the clinic.
44:53Deceive TSI clinician.
44:55Reviewing some of these things
44:58in a pre screening.
45:00Giving yourself the space is
45:02what you're talking about.
45:03Setting up a call that you could build
45:04for case management of Billington issue,
45:06where you actually have the space.
45:08It talk about review that out,
45:10because I think it's begins the engagement
45:12between caregiver an therapist,
45:13so that if the peer support specialist
45:15reviewed it a little bit of we review
45:18because it's about engagement and
45:20it gives you the space to discuss
45:22things prior to screening and then
45:24prior to treatment.
45:24So I'm wondering if that addresses
45:26some of your concerns,
45:28and whether other faculty has
45:29anything else to add.
45:33But I I
45:34don't I. I think it's a.
45:37It's a really creative way of thinking
45:40about a very real constraint in
45:43terms of just the number of folks.
45:46and I completely agree that it's such a
45:49shame if there is this initial opportunity.
45:52But then the delay interrupts the
45:55possibility of folks getting help that
45:58actually having some of the Psycho ad
46:00and the general description of something.
46:03In between good and bad feelings
46:06sounds like a lovely idea.
46:09I do want to emphasize that that would
46:13not replace when they do enter into CSI
46:17that doesn't replace discussing the frame.
46:20The shared frame of reference around what
46:23we know about trauma and and treatment,
46:27because again it is shared so
46:30that there may be some repetition,
46:33but I think reviewing.
46:35Again, once one is able to start,
46:38the treatment is a very important
46:41central ingredient to then being able
46:44to move through CFTSI with an anchor
46:47point in what is shared about what
46:50is known about traumatic reactions.
46:54So I'm sorry to enter into
46:56interact again and again.
46:57This is just something that
46:58we're trying to figure out,
46:59so if if their peer support was to do this,
47:02type educational piece and it's looking
47:04at at the trauma and the brain.
47:05I mean we're looking at just what are,
47:08what's the impact, right? What?
47:09What is it that what are some of?
47:11What are some of the things that we
47:13can start seeing in our children and
47:15why it happens and all this stuff?
47:17So then by the time they get to
47:19the therapist, they're looking at
47:20the symptoms and processing and.
47:22And it's almost like a more
47:23in depth conversation.
47:24But uhm, so when when is it
47:27possible that when they say that
47:29the peer support could be doing,
47:31the CPS is as with the with the
47:34parent before in and the children
47:36so that the therapist is not
47:38used to that time in decision.
47:40So that's another complain that we've had.
47:42You know, that they're going.
47:44There's just a lot of time we
47:46don't have the time to do this,
47:49but can we use supportive services
47:50to help with it with the paperwork,
47:53and then we can review it as a team in our?
47:57In that immediate some weeks,
47:59you know, as we move into the cases.
48:03Can we?
48:04Again,
48:04I guess I'm struggling with keeping Fidelity,
48:08Anne, Anne,
48:09Anne,
48:09and really the realistic way
48:11of of running and moving an
48:14organization when you have all
48:16kinds of barriers such as timing,
48:19you know insurance is
48:21payments and all this stuff.
48:25Well, I think we could. We could
48:27continue this discussion further.
48:29An happy to do it offline so
48:31that we make sure that we have
48:34an opportunity for you know,
48:36the continued points of discussion.
48:38I would simply say I don't
48:40think it's an either or,
48:42and I think that what you're
48:44describing in the interim about
48:46being able to engage folks and keep
48:49people engaged while they're waiting
48:51by giving information in the way
48:53that you're describing can be, uh.
48:55A very creative approach.
48:57I would underline the fact
49:00that that again CF cyan.
49:02All the intervention strategies are based on.
49:05Again something that shared
49:07between the provider,
49:08the clinician and the family.
49:10So regardless of what
49:12occurs prior to session,
49:14one being able to refer back to that
49:17shared frame of reference will be
49:20a significant and important shared
49:22anchorpoint throughout the cai sessions.
49:25But.
49:26More than happy to continue this discussion.
49:29You know,
49:30following this web and R,
49:32this is actually a great opportunity
49:35to identify broader issues
49:37that don't just apply during a
49:39pandemic and turmoil. Steven I
49:42think we're going to move forward and have
49:44Katie thank you so much. Carla Katie.
49:46I'm going to turn it over to you.
49:49Great thanks Kerry Mom.
49:50I wanted to do it just another
49:52little borrowing of language.
49:53There you go. Thanks
49:54Jennifer me. The next slide
49:55there go kicking a man. Just echo
49:57what Megan said in terms of silver
49:59lining and being here with you
50:01all during the current time.
50:02So I'm grateful to be with you all and
50:05excited to be a part of this event.
50:07So I'm going to jump into talking
50:09about CSI screening and then
50:11going into the actual sessions.
50:13So overall, we really want to
50:15think about doing the screening in
50:17the way that you would in person.
50:19In general, I think that the key piece
50:22in preparation that we want to think
50:24about is using the pictorial rating sheet.
50:26How we're going to incorporate that
50:28depending on the means of Telehealth
50:31that we're using again emphasizing
50:32as you'll hear us say over and over.
50:35This creativity with flexibility.
50:36So depending on how you're
50:38conducting the session,
50:39for example whether or not it's by
50:41phone video that can help influence
50:43and determine how we're going to
50:45incorporate the patrol reading sheet.
50:47So if you,
50:48for example are on video,
50:50you can have the capacity to hold
50:52it up and show it on the screen.
50:55I know Carrie test on these as
50:57well a little bit in the beginning.
51:00Another option can be to share the
51:02screen as was mentioned as well
51:04before as well as sending it by email.
51:07If that is something that you feel
51:09comfortable in the relationship with
51:10the family or you have the capacity to do.
51:13We also as a team we're talking
51:15about getting really creative.
51:16In another option that could enhance
51:18himself observation capacities or
51:20abilities for kids to be really engaged
51:22and involved could be to help them
51:24develop their own pictorial rating sheet,
51:26so walking them through the different
51:28categories of their rating sheet
51:30and having them draw or create one
51:32on their own in preparation to
51:33do the CPS escalating measure.
51:35And so if the therapist is
51:37conducting the CPS by phone,
51:39this is still something that
51:40we feel is really feasible,
51:42but wanted to highlight some of the
51:44differences as well that doing it by phone.
51:47In the areas that you could go into,
51:49that might be helpful to make
51:51that a little bit more seamless,
51:53so it's really important to review the
51:55frequency categories at the start and
51:57repeating the frequency categories
51:58again as needed throughout the CPS measure.
52:00If the child in Gig Harbor needs
52:02it in particular,
52:03but reminding them throughout and
52:05making sure to sort of be aware of
52:08who's in front of you and listening
52:10for you know what's going on in
52:12terms of our their pauses,
52:13or making sure that their comprehending
52:15and needing the prompting as you go along.
52:17For those rating categories,
52:19another important point that I think
52:21has been helpful in Telehealth and
52:23been useful to me as an emphasis
52:25on the amount of times per week
52:27in those rating categories.
52:28So really honing in on for example if
52:30their rating is to that two or three
52:33times per week this is occurring and
52:35that can help with them assessing
52:37where there at in their symptoms and
52:39having a clearer sense.
52:40and I find that to be particularly
52:43useful on the phone as well.
52:45Then I'm so similar to conducting
52:47safety sign person sharing
52:48that control rating shooting.
52:49Thinking carefully about
52:50this really helps them focus.
52:52It helps raise awareness and it really
52:54does help have an easier time reporting
52:57on symptoms in the frequency of those.
52:59And then concretely thinking about
53:01going into this CPS measure,
53:03just as we do in person.
53:05Again, the Commission will read or walk
53:07through the CPS symptoms questions and
53:09as the caregiver or child response,
53:11depending on who you're meeting with at that,
53:14I'm going to select the one that
53:16feels describes the frequency of
53:17the symptoms for them, and really,
53:19using how you prepared that
53:21patrol rating sheet again,
53:22whether that's on the phone and
53:24you're going through it in terms of
53:27reminders of the frequency ratings,
53:28or showing them on the screen.
53:30Etc.
53:31However, you set it up.
53:33And then after conducting
53:34the screening again,
53:35just as you typically would make your
53:37recommendation for treatment and really
53:39by conducting the assessment in this way,
53:41you're conveying to the family we've got
53:43this and that they are accessing a helpful,
53:45effective treatment through this.
53:47Then you will tell.
53:49Alright,
53:49we can go to the next slide.
53:55Thanks Jenn. Alright so
53:57now to jump into conducting actual and
54:00managing CSI sessions to think about
54:02sessions one and two again follow the
54:05same format as you would in person.
54:07Provide a quick reminder of the clinical
54:09goals of session one and two at the onset,
54:13and similarly to the screening.
54:14Find a way to be creative and
54:17affectively inappropriately used.
54:18A pictorial rating sheet according to the
54:21measures that you're using in those sessions.
54:23So for example, session one.
54:25That's the PCL PTS DRINMFQ.
54:27And then in session two
54:29of the PTS dri another Q.
54:31And then I'm gonna spend a little
54:33bit more time thinking about
54:34this setup for session three.
54:36But again,
54:37the over Arcing and overall theme is
54:39to conduct it as you would in person,
54:41but reminding them in preparing
54:43them that you've reviewed the same
54:45questions with both of them about the
54:47big events in the child's life and
54:49how the child has been doing since
54:51the events have happened and that
54:52we're going to be walking through what
54:54you've reported to me in our recent sessions.
54:57Obviously in reference to both session one
55:00session 2 for the caregiver and the child.
55:02Just as he wouldn't receive
55:04TSI in person session,
55:05think about the dire that you have,
55:07whether that's persons on the other
55:09line on the phone or in front of you
55:11in the video in both the cab driver
55:13on the child and think about what
55:15preparation specific to this family that
55:17might be helpful to set them up for.
55:19This can join session,
55:20whether that's prompting whatever
55:22support that might be,
55:23but you need to that family and
55:25you should have a good sense of
55:27this from your session and wanted
55:29to interactions with them so far.
55:31And this was already emphasized as well,
55:33but I think is important to say again
55:35in the context of session three,
55:38that this structure of CSI and the
55:40use of these structured instruments
55:41to help the family helps him regain
55:43a sense of control.
55:45But it also,
55:46particularly in the time of Telehealth,
55:48helps us as CSI conditions.
55:49She really Orient ourselves and
55:51anchor ourselves in the model
55:53and in the clinical work.
55:55An and some of these examples are
55:57also mentioned, but just to reiterate,
55:59in terms of if someone's being quiet,
56:01if you can see the nonverbals and make
56:03observations of those and comments on that.
56:05If there's pauses over the phone to
56:07also be particularly aware of these
56:09particular during session three,
56:10given that there together,
56:12and what that might be bringing
56:14up for families in the event that
56:16the child and cake over don't
56:17want to sit next to each other.
56:19This is when this instance,
56:21I know is mentioned in the beginning.
56:23But this is one most likely will come
56:25up might be at session three as it.
56:28Potential barrier,
56:28but thinking about the problem solving
56:30options about moving the camera
56:32back and discussing with them about,
56:33you know the options for having
56:35them since so you
56:37can see them, but that
56:39they are also comfortable.
56:41OK, we can go on shoes at
56:43the next slide, perfect.
56:44And so by session four and five,
56:47you're really going to have a nice
56:49sense of the family in terms of
56:52what setup and support Phil mean.
56:54As I mentioned,
56:55going into these last two sessions,
56:57but again, just thinking about
56:59the big tool reading sheet that
57:01corresponds to the instruments
57:02you reviewing for these sessions.
57:04Being creative,
57:05using what you've learned,
57:06and gathered clinically about
57:08these families so far using their
57:10words and hopefully at that
57:12point the capacity to continue in
57:14the framework that you set up.
57:15Well, have really gotten some
57:17case at this point in treatment.
57:20So I'm gonna before we parted.
57:22I'm actually going to pass it on to Kristen,
57:24'cause she's going to continue
57:25with some of the structure of
57:26the sessions from there.
57:28Thank you Katie.
57:30'cause I'm going to
57:31start my talking about teaching
57:33coping strategies. We have
57:34Telehouse so you teach them
57:35very similar to
57:36what you would do in person in your office.
57:38You're going to teach them with
57:40the child and caregiver together.
57:42You're going to rely on in vivo
57:43practice in the session so you're going
57:45to teach them the strategies right
57:47then and there during the session,
57:49and you're going to choose strategies
57:51that target the symptoms you have
57:52decided to work on and have them
57:54practice just those strategies at home
57:56as the symptoms arise between sessions.
57:58Like other areas,
57:59we've discussed regarding regarding how
58:01to implement safety S Ivy Hotel Health,
58:03it's a time to be flexible and
58:05use your creativity.
58:06If you're a clinician who typically
58:08uses tools or props in the office,
58:10such as stress balls, feathers, etc.
58:12You don't have those available
58:13to be a tile health,
58:15but you do have what families
58:17have in their home.
58:18They may have slime or play DoH
58:20drawing or coloring materials.
58:21Those free coloring apps
58:23that exist for all ages
58:24are really great.
58:26And if you
58:27feel like, um, like they may be struggling
58:30to grasp the strategies via Telehealth.
58:32For example, if you're teaching
58:33something like focused breathing
58:34or progressive muscle relaxation by
58:36phone and they're not able to see you
58:39demonstrating those steps strategies,
58:40there are some fun videos you may
58:42want to suggest to help reinforce
58:44the use of those strategies.
58:49Channel you please
58:51up. You already
58:52did OK, thank you, um.
58:55So I'm going to talk about the
58:57post and for this you're going
58:59to introduce an administer that
59:01assessment measures for the post,
59:03just as you would in person.
59:05You're going to start by re and re
59:07orienting them to the measures.
59:09The CPS in the PCL you're going to start by.
59:13Talking about,
59:13remember when we first met during the
59:15intake I asked you these questions
59:17regarding how your child was doing.
59:18We're going to do that
59:19same measure right now.
59:21The same thing with the PCL.
59:23And even if it's possible that you
59:25can share the pictorial rating sheets
59:27using the method that's been working
59:29with for you up until this point.
59:33It's also a really good time to
59:34point out where key trauma symptoms
59:36started and where they have changed,
59:38and you may have to narrate a little
59:40bit more about what you're doing,
59:42because when you're in the office,
59:43you can see that you're looking at
59:45the different measures they can see.
59:47Oh, that symptoms were all fours
59:49and fives in the beginning,
59:50and maybe now there are ones and
59:52twos and you have to say hold on.
59:54I'm going to add up these scores
59:56and just walk through what you're
59:58doing and so they have an idea.
01:00:02Disposition planning. It might be a little
01:00:04bit more difficult than
01:00:05it typically does for kids who
01:00:07need longer term treatment.
01:00:08There may be less capacity for referrals
01:00:10as we were just hearing an you might
01:00:12have feelings about having children
01:00:14placed on a wait list during a pandemic
01:00:16and in a similar vein for kids whom
01:00:18you're not recommending longer term
01:00:20treatment but whose families are
01:00:21more isolated due to the pandemic,
01:00:23it may feel harder to end with them as well.
01:00:27So this is where we can really
01:00:29take advantage of the one month,
01:00:31three month follow ups that are
01:00:32already built in to see if TSI we
01:00:34can use them either as a bridge to
01:00:36longer term treatment or with families
01:00:38where treatment is not recommended.
01:00:40Further treatment,
01:00:41but who are really more isolated
01:00:43because of the pandemic.
01:00:45Generally, go to the next slide, please.
01:00:49So a couple of key challenges
01:00:51that are coming up consistently.
01:00:52I'm going to talk about now.
01:00:54One is that children and adolescents
01:00:57who really don't want to be on video.
01:00:59Some may say outright to you and somebody
01:01:01just appear really uncomfortable.
01:01:03It's important not to assume
01:01:05what's going on for them,
01:01:06but to think about what's happening
01:01:09clinically 1st and then try to address it.
01:01:11Talk it through with them.
01:01:13An once you've determined
01:01:14that that is what's going on,
01:01:16try to problem solve and determine
01:01:18what's the right solution for the
01:01:20family that you're working with.
01:01:21You can play around with what's possible
01:01:24and what you have to work with in
01:01:26terms of what venue you're using.
01:01:29For example,
01:01:29video platforms like zoom and some others.
01:01:32They have an option to pin participants,
01:01:35so the patient will only see the
01:01:37therapist or to make themselves really small.
01:01:40I had a teenage boy that I was working
01:01:43with last week that I met with for
01:01:45the very first time and he was very
01:01:48far back and looking down the whole
01:01:50initially and so we started talking
01:01:52about and I knew this was somebody who
01:01:55was also very avoidant due to his trauma.
01:01:57I had already known this prior
01:01:59to meeting with him,
01:02:01but.
01:02:01He talked through a little bit
01:02:03about What is this like to do this
01:02:05via video and what it's like to see
01:02:07you on your screen and and I said,
01:02:09You know,
01:02:10there's an option where you can pin so
01:02:12the participants so you only seeing me
01:02:14and he lit up right away and was like wait,
01:02:16can you show me that?
01:02:18Can you show me how to do that?
01:02:20And he still sat back and
01:02:21didn't look up very much,
01:02:23but he was much calmer and more engaged.
01:02:26And you know why we really do?
01:02:28If we have the option to use video,
01:02:30it's helpful to see what's
01:02:32happening nonverbally.
01:02:32We also we had one family with
01:02:34a teenage girl who she was just
01:02:36so uncomfortable being on video
01:02:38that she just wasn't engaging.
01:02:39We tried a couple of different tactics,
01:02:42changing the video,
01:02:42and then ultimately we decided to try
01:02:45switching to phone an that actually it made
01:02:47a huge difference in her ability to engage.
01:02:49So it's really it's problem solving
01:02:51in working with what you have.
01:02:54Another challenge is distracted children.
01:02:55We know that kids get really distracted
01:02:57during sessions in our office as well.
01:03:00So just like you would in your office,
01:03:02it's helpful to think about
01:03:04what might help them focus.
01:03:05So maybe it's setting up so they
01:03:07are able to engage in a specific
01:03:10activity during the session,
01:03:11like drawing, coloring,
01:03:12playing with Plato or slime.
01:03:14My 8 year olds that I I met with
01:03:16a couple of weeks ago.
01:03:17She brought materials to the session.
01:03:19She practice braiding while she
01:03:20was talking to me and it really
01:03:22helped her be able to sit.
01:03:24Instead of running around,
01:03:25sit calmly and focus on what
01:03:27we were talking about.
01:03:28The you know the difference
01:03:30between them being at home or be in
01:03:32the office is that the child care they
01:03:34need to bring and find the materials
01:03:36and bring them to the session.
01:03:37Since you can't put it out for them and
01:03:40there's a lot more for them to choose
01:03:42from and to show you when there at home.
01:03:44So it's helpful to have that discussion and
01:03:47prepare about what they might want to use.
01:03:49If a child needs to take a movement break,
01:03:52you can help orchestrate that for them.
01:03:54For some children, engaging in that
01:03:56need to move can be really helpful.
01:03:59And as with many challenges,
01:04:01remember that engaging the caregivers
01:04:02help with all of these things
01:04:04can just be really useful.
01:04:08OK John.
01:04:30OK, so a couple of questions
01:04:32that have come through.
01:04:34Wi-Fi freezing and not being
01:04:36able to tell if the client is quiet
01:04:39or if they're actually frozen.
01:04:41Maria Blanchard asked that question,
01:04:43Kelly Stout actually commented that
01:04:45she's heard the suggestion of putting
01:04:47something having them put something
01:04:48in the room that moves so you can
01:04:51actually see if it's if that freezes.
01:04:53Then you know it's the Wi-Fi connection,
01:04:55but that's still moving.
01:04:57Then you know that's the client.
01:05:01Do you have any suggestions
01:05:02from our our panel here?
01:05:07Anyone? No, just that I like the
01:05:11creativity that's that's being offered
01:05:13there an and I think we've all had the
01:05:15the awkwardness of the frozen Wi-Fi
01:05:17or the Wi-Fi connectivity issues.
01:05:19And you know, I think this is
01:05:21where are being are genuine selves
01:05:23that you know just talking about?
01:05:25Yep, this is one of the things that
01:05:27were going to be flexible about,
01:05:29and to the extent that we can kind
01:05:31of have a sense of humor about
01:05:33it and and even for the question
01:05:36that I think Maria asked,
01:05:37maybe even just being very
01:05:39direct with the family about.
01:05:41There are times when I'm not sure.
01:05:43Whether it's actually the
01:05:44Wi-Fi that has kind of frozen,
01:05:46or whether you're not,
01:05:47you're not responding,
01:05:48and so maybe we could come up
01:05:50with a way so that I could better,
01:05:53better know that perfect. I think
01:05:56it's not. You know it's not only the our
01:05:58clients and families Wi-Fi that freezes.
01:06:00Mine was freezing all last week and
01:06:02I would start by telling them I'm
01:06:04having some Wi-Fi issues
01:06:05and if this happens we
01:06:06that we would, we
01:06:07would switch to talking by phone
01:06:09if it was happening or the IT was
01:06:11dropping. I like that Christmas,
01:06:14so we're talking about maybe
01:06:15even having a pro actively
01:06:16bringing this and saying
01:06:17that it might happen.
01:06:18And I've even talking about we have a
01:06:20backup plan. I would agree with all this
01:06:22and the only minor thing I would add
01:06:24is that I think that the message going
01:06:27into all of this in the preparation
01:06:29is that we're in this together.
01:06:30TSI but also in the telephone mode that
01:06:33while difficulties come up or not,
01:06:35the clinician and the family are
01:06:36in this together in terms of the
01:06:38difficulties that could arise.
01:06:40Can help with engagement as well.
01:06:47There was a question about using puppets
01:06:50to engage kids, and
01:06:51if anybody had
01:06:53thoughts on that.
01:07:03Anyone respond about
01:07:08using puppets? As a way to engage
01:07:12the child into the treatment. Well,
01:07:16I I think one of the points that was raised
01:07:20was that it it and tell me if I got this
01:07:24right but that it seemed to work great.
01:07:27But then the child gets distracted by the
01:07:29puppet if I understood that correctly
01:07:31and it seems to me that that's where
01:07:34again the child's using the puppet for
01:07:37displacement and that one can use join in
01:07:40that displacement and talk directly to
01:07:42the puppet about what might be going on.
01:07:45That may be a. Very short response,
01:07:48but that's what came to my
01:07:51mind in in in our experience.
01:07:55But others might have other ideas.
01:07:58I guess my only other
01:07:59ideas that you know the themes
01:08:01that we've been talking about,
01:08:02our flexibility, creativity,
01:08:03and one thing that we didn't talk
01:08:06about that for me has been a mantra
01:08:07has been like self compassion,
01:08:09which is that if something doesn't go well,
01:08:11I try not to beat myself up tonight, right?
01:08:14OK, well that was a good try.
01:08:16Let's let's try something else.
01:08:18So I guess if you're finding
01:08:19that this is a successful way
01:08:21to help engage especially kids
01:08:23on the younger and roll with it.
01:08:25And if it's not working with
01:08:26a particular patient,
01:08:27kind of saying but without us.
01:08:29Something we tried and let's
01:08:31try something else.
01:08:36Nicola hurting also said that she
01:08:38commented on the connection issues
01:08:40with specific cases when
01:08:41it seems to happen alot.
01:08:43She actually calls a cell phone and
01:08:45does the audio over the cell phone
01:08:47so that she always has connection.
01:08:49So even if the Wi-Fi freezes
01:08:51they can still talk through it.
01:08:53But she also mentioned that she has done,
01:08:56you know use like puppet type things
01:08:58with her younger children to animate
01:09:00and be playful over Telehealth.
01:09:02And it's been very successful
01:09:04and kind of helping to
01:09:05engage them. Pause for a moment.
01:09:07Nickel, I know you've been doing a lot of.
01:09:11Tell a Health Ministry is going to help.
01:09:13Do you mind coming off like for a moment and
01:09:17just? Hi, good to see
01:09:20you see you too. Uhm, Yeah, Uh, I've
01:09:25been doing most of my Telehealth is with TF
01:09:29CBT and PSBCBT. And
01:09:31then we've been doing our
01:09:33assessments and screening which we
01:09:35include the CSI measures all over.
01:09:38Tell a health. And so.
01:09:41I think I'd
01:09:42like to say that
01:09:43I you know
01:09:44when I when I
01:09:45moved some kids from in person to
01:09:47to tell a health because of Covid.
01:09:50Uhm, the puppet idea,
01:09:51that was something we had used in session.
01:09:54She loved this stuff animal I had.
01:09:56It was her favorite thing and so
01:09:58using that having that be kind of
01:10:00a transitional object in terms of
01:10:02like we can still connect and we
01:10:04can still do some similar things
01:10:06that we did in person was important.
01:10:09So if you have got kids that you.
01:10:11Transitioning over to tell a
01:10:13health at this point probably not
01:10:15was the empty side
01:10:16being a shorter Reaper
01:10:17intervention, but that can be very helpful
01:10:20to utilize some of those
01:10:21same items that you would in
01:10:23in person. I don't care if you
01:10:25have specific questions, no, I
01:10:27just wanted to
01:10:28know it's just nice to sort of
01:10:30hear your experience with it,
01:10:32and I do think that we may be
01:10:34definitely in this country.
01:10:36Possibly be experiencing going back
01:10:37to having therapy in person and
01:10:39then because of things happening.
01:10:41Maybe note back to Telehealth.
01:10:42So I think that your comments
01:10:44are things that are helpful now.
01:10:46And possibly in the future,
01:10:48so it's very much welcome. You've
01:10:51done without with measures as we
01:10:53utiliza PowerPoint where we have one
01:10:56question at a
01:10:57time on the screen 'cause we use a
01:11:01lot utilize shares
01:11:02screen sharing. So that's how kind of how
01:11:05we've we've done the measures, and then we
01:11:08have the clinician
01:11:09have the whole measure also on
01:11:11their part of their screen,
01:11:12and then have fillable forms to be
01:11:15able to fill it in so that it's not
01:11:18overwhelming for a caregiver
01:11:19or a child to see like 20 questions at once,
01:11:23and that the you can also have
01:11:25the rating scale with the stars
01:11:27up underneath each question.
01:11:28So that's something that we've
01:11:30been doing in terms of screening
01:11:32and assessment that we find it.
01:11:34Very effective and kind
01:11:36of not as overwhelming and
01:11:38as close to how we
01:11:39usually do it in person.
01:11:41Thank you Nicola. Anyone from
01:11:44our team want to talk a little
01:11:46bit about maybe how? Additionally,
01:11:48how we've sort of been approaching
01:11:51using the control rating sheets
01:11:53and using the how we use the
01:11:56instruments when we've been doing it.
01:11:58When we drink telehealth when
01:12:01there's a visual or not. Or not.
01:12:04There was also a question
01:12:06about um from Shannon.
01:12:08Carry about if they're sharing
01:12:10the actual forms and session 3
01:12:12on a screen share or favorably
01:12:14going over the questions.
01:12:17For me, I I don't share the
01:12:19actual measure I've been sharing,
01:12:22just just very much in the way that
01:12:25Nicola you were describing.
01:12:27I think it's a lot can be a lot for
01:12:31some families to kind of see that,
01:12:34and I'm sure you know,
01:12:36as we're all getting more and
01:12:38more familiar with the items on
01:12:40the various measures, you know,
01:12:43a lot of them require kind of caustic,
01:12:46explain and change the
01:12:48language to help my kiddo.
01:12:50Or I caregiver understand and so for me,
01:12:53I've been just putting up the
01:12:55the pictorial rating scale
01:12:57and not the actual measures.
01:13:01Alright, I'm done
01:13:02it that way to Megan Ann also.
01:13:04Um, I've shared the screen and
01:13:06I've also used on one of them.
01:13:09I used like a whiteboard option
01:13:11an and wrote them out and
01:13:13so trying trying different.
01:13:15Our techniques that seemed to work.
01:13:19Great. I also wanted to sort of also
01:13:24acknowledge that you know there was.
01:13:26You know, we really want to be aware
01:13:29that we were talking about this,
01:13:31that we realized that everyone
01:13:32calling in repeating what I'd
01:13:34said earlier is using technology.
01:13:36Different technologies in different
01:13:37platforms in different ways.
01:13:38And, you know, we really want to be
01:13:41sending the message that we understand
01:13:42that there's sort of a disparity in
01:13:45terms of resources that can exist
01:13:47between clinicians and families.
01:13:48So we really respect that
01:13:50some families we may be using.
01:13:52Tablets, laptops,
01:13:53computers and other families
01:13:54we may be using the telephone,
01:13:56depending what?
01:13:57Technology is available and
01:13:58what they have or they may
01:14:00not even have the Internet
01:14:02or Wi-Fi. So I
01:14:04really wanted to address well
01:14:05in just just to figure that.
01:14:08That that so if you are
01:14:10doing it over the phone,
01:14:12I think this was said earlier,
01:14:14but the idea of really using a
01:14:16lot of repetition anry grounding
01:14:18in the answer choices.
01:14:20But which is we know,
01:14:22and I know this is deep deeply
01:14:24embedded in the training that
01:14:25repetition in paramedic work is
01:14:27actually not bad and it's actually
01:14:30grounding and helpful to people.
01:14:32So if you were doing this
01:14:34without any visuals,
01:14:35I would just think that the repetition of.
01:14:38Uh, with the various answer choices
01:14:40are could be really helpful.
01:14:44I just wanted to add to
01:14:46that about their phone.
01:14:47I've actually done a lot more by
01:14:49phone than I was anticipating doing,
01:14:51just by the nature of the
01:14:53families I'm working within,
01:14:54the resources they have or glitches etc,
01:14:56and I found it really feasible.
01:14:58You know the repetition
01:14:59pieces key in terms of.
01:15:01Sometimes I've even repeated the
01:15:03frequency rating categories after
01:15:04every question and walking through it,
01:15:06so sometimes it does take
01:15:07a little bit longer.
01:15:08However, I do find it to
01:15:10still be just as effective,
01:15:12and I've been pleasantly surprised by that.
01:15:16Thank you well, I also want
01:15:18to acknowledge we have.
01:15:19Lisa Wright is joining us today from
01:15:21Virginia and at least I know that you
01:15:23have been doing CSI via Telehealth
01:15:25and wanted to just ask if you would
01:15:28take a moment to just make a comment.
01:15:30Reflection on your experience in doing this.
01:15:37But Loose Lisa.
01:15:42She may have had to get of-.
01:15:44OK, well we'll find a way to
01:15:47convey leases, experiences,
01:15:47but I do know that least actually has
01:15:50written up a piece on her programs.
01:15:52Experience with doing CS.
01:15:53I would tell a health,
01:15:55and that's actually been disseminated
01:15:56by the National Children's alliance.
01:15:57The MCA, which is the organization
01:15:59in United States that overseas all
01:16:01child advocacy centers so will make
01:16:03sure that we get out to all of you.
01:16:05At least is written up in her
01:16:08experience with doing that.
01:16:10I know that just because I know
01:16:12I'm before we run out of time.
01:16:15There have been questions asked about.
01:16:17Upcoming training so I will
01:16:19write something in the chat about
01:16:21upcoming training while we continue
01:16:22asking additional questions
01:16:24or actually opening it up.
01:16:25Now that keep coming with people's
01:16:27comments would really like this
01:16:29to be a dialogue and conversation
01:16:31from to hear from all of you.
01:16:33So if you want to actually raise
01:16:36your hand through the chat.
01:16:37Uhm,
01:16:38let us know you have something
01:16:39you'd like to say.
01:16:40We'd really love that and have
01:16:41you come up Mike.
01:17:04When they have a covered a lot today,
01:17:07I'm glad people's questions have been
01:17:10coming throughout the presentation.
01:17:19So the the only thing I would I would
01:17:22add and I want to be very brief so
01:17:25that give people have a moment to
01:17:28kind of figure out whether they want
01:17:31to add anything to the discussion,
01:17:33but in the the point about children
01:17:35and families where the perpetrator
01:17:37is still present in the home,
01:17:39I think that there is something
01:17:42important to remember that you know
01:17:44the the idea that the what's in it for
01:17:47them also applies to the perpetrator.
01:17:49That again, the focus is not on
01:17:52retailing and the perpetrator can be
01:17:54reminded of the alleged perpetrator.
01:17:57Be reminded that is not about repeating.
01:18:00You know. Whatever the accusations are,
01:18:02but actually trying to help the
01:18:04child in a way that the.
01:18:07With the family can benefit by
01:18:10decreasing the child's distress
01:18:11and similar symptomatology,
01:18:13but there was a comment that just came in.
01:18:18Uh from Brittany?
01:18:26Yeah, Brittany said
01:18:27that her center has been offering
01:18:29in person sessions for engagement
01:18:31at screening session three and
01:18:33the last session if the family
01:18:35is comfortable and would like to
01:18:37come in there doing the normal.
01:18:40The screening in the lobby,
01:18:41temperature taken and given masks,
01:18:43and but they're doing the remainder
01:18:45of the session through Telehealth.
01:18:51So my my reaction to that is really,
01:18:54you know our agency and I think it
01:18:56depends on where where people are at
01:18:58in terms of where their state is that
01:19:01where the countries that in terms of
01:19:03overall kind of levels of infection and.
01:19:05Terms of weather in person.
01:19:07Appointments are available at this point,
01:19:09but my question for a it was a
01:19:12Britney Yeah my question for Britney
01:19:14I thought I would find myself
01:19:17curious about whether it's hard to
01:19:19shift back and forth between the in
01:19:22person and then the Telehealth.
01:19:24I'd be curious about what
01:19:26her experience was of that.
01:19:36Do you mind coming out great? Yeah sorry,
01:19:38I just went ahead and had to type it.
01:19:41Yeah, several of our clinicians have been
01:19:43offering that and there's been families
01:19:45that have have liked that and haven't
01:19:48seemed to have too much of an issue.
01:19:50Kind of transitioning back and forth,
01:19:51but again, you know many of our
01:19:53families are more comfortable
01:19:55just doing it all remotely,
01:19:56which is totally fine as well,
01:19:58so I think it's been kind
01:20:00of mixed on that point.
01:20:06When it sounds like your
01:20:09agency has the capacity,
01:20:10then to provide some choice which you
01:20:13know we know from the themes of trauma
01:20:16that you know we feel caught off-guard,
01:20:19powerless, helpless and overwhelmed.
01:20:21You know, during and then following
01:20:23these traumatic experiences so your
01:20:26agency is helping to reverse that
01:20:28by providing some choices that,
01:20:30while maintaining kind of physical safety,
01:20:32so that sounds great.
01:20:37Any other questions or comments,
01:20:43either from focusing in
01:20:48or from our team?
01:20:55Yeah I have
01:20:56a question. This is Anna Maria
01:20:58I I think I put it in the chat.
01:21:01I'm not sure if you guys saw it,
01:21:03but I'm wondering if you
01:21:05have any upcoming training
01:21:07specifically for Spanish speaking. CF TSI.
01:21:10So I think that's a really interesting
01:21:14question, and I don't mean
01:21:16to put one of our lives inside
01:21:20master trainers on the spot, but.
01:21:23Anna. If you're still there,
01:21:26I'd love you to speak to your thoughts about.
01:21:30I think the question on Maria is
01:21:32there specific training about
01:21:34how to implement this model.
01:21:36With. Um, folks who are Spanish
01:21:39speaking is not right. Yes.
01:21:43OK, honey. I
01:21:50guess we have been done at my.
01:21:52My initial thought is
01:21:53thinking how we might be able.
01:21:55I guess I have to initial thoughts and
01:21:57we haven't really talked about it,
01:21:59but that a lot of
01:22:00that can be
01:22:01discussed on the consultation
01:22:02calls like water.
01:22:03What if any or adaptations that
01:22:05need to be made for engaging
01:22:07families in this process?
01:22:08and I guess it links back to some
01:22:11of Carl's comments of like even
01:22:12using support staff to provide those
01:22:14initial psycho edge kinds of sessions.
01:22:16And then my other thought that
01:22:18we haven't really talked about
01:22:19Carrie or the rest of the team.
01:22:21I don't know if there's like.
01:22:23Almost like a booster session or like
01:22:26a like a like an additional uhm.
01:22:29Training or something for a couple of
01:22:32hours that looks at what are some of the.
01:22:36Issue is more specific to
01:22:38Spanish speaking families,
01:22:40but it's also like it's
01:22:42such a diverse group that.
01:22:44You know that you know anyway,
01:22:46so those are my my initial thought,
01:22:49so like that part of it can be
01:22:51addressed in the consultation calls
01:22:53and so and we can do thoughtful of
01:22:56some of the cultural considerations
01:22:57within the training so,
01:22:59but it sounds like you
01:23:00had a follow-up question.
01:23:02Yeah, so if in the consultation
01:23:04calls there are no
01:23:05other Spanish speaking clinicians, you
01:23:07know. I know that TF CBT models
01:23:09off they have like a Spanish
01:23:11speaking call specifically for
01:23:12Spanish speaking clinician.
01:23:14So I guess I'm just wondering
01:23:16if there's a possibility to do.
01:23:18To do that because all the safety
01:23:20cases I have our Spanish so.
01:23:23What do we think team I got
01:23:26and I really
01:23:27I really liked your suggestion and
01:23:29I think that one of the things we
01:23:32could think about doing is setting
01:23:34up an additional call or calls in
01:23:37the future to talk about and have
01:23:39the community come together to
01:23:41talk about things just like this.
01:23:43It's really here and for us to listen and
01:23:46hear from folks in this seaside community.
01:23:48What is it that we think we need to
01:23:50tweak and address in order to support
01:23:53families who speak other languages
01:23:54who come from different backgrounds?
01:23:57And so I think that it might be a
01:23:59wonderful opportunity for us to
01:24:01maybe set up something in the future
01:24:03to actually press to listen for
01:24:05us to discuss those very things.
01:24:08Yeah I do for I also train in child
01:24:11parent psychotherapy and so I know there's
01:24:12a monthly group for Spanish speaking.
01:24:14So with this for Spanish speaking therapist
01:24:16that are working with Spanish speaking
01:24:18families where they come in present
01:24:19cases so I don't know if there's like a
01:24:22version of that that maybe we could do.
01:24:25Right, so I don't think these
01:24:27are these are mutually exclusive,
01:24:29but I agree with Kerry that In addition
01:24:31to whatever you know discussion group,
01:24:33there might be for Spanish speaking
01:24:36providers, clinicians that this is an
01:24:38opportunity for us to to find the silver
01:24:41lining into not just have this be a
01:24:43one off a community meeting because
01:24:45the more that were able to learn from
01:24:48our colleagues about some of the the
01:24:51additional tweaks and additions to how
01:24:53we deliver CF TSI to Spanish speaking.
01:24:55Clients that that's a benefit all of us.
01:24:58So it's, uh,
01:24:59I think this is a great opportunity to
01:25:02actually take this forum and to begin
01:25:05to identify some of the other topics
01:25:07that we want to share as a group and
01:25:10to continue to learn from each other.
01:25:13So then it's a
01:25:15great idea. Great
01:25:16idea. Things that I wanted to as
01:25:18we start to wrap up so on America.
01:25:20Thank you for your questions and I think
01:25:22that I'm already seeing in the chat.
01:25:24People responding to liking the idea
01:25:26of are having future events like
01:25:28this that might be topic specific.
01:25:29I think that people should feel free.
01:25:31I've given one of my email
01:25:33addresses at to reach out to me.
01:25:35If you have a topic that you think it
01:25:37might be good for us to actually bring
01:25:40the commute together to talk about,
01:25:42so we'd like to plan for that.
01:25:44I also put information in
01:25:45the chat about upcoming.
01:25:46Virtual training that will be held in July,
01:25:50so all of you if anyone is interested in
01:25:53having someone attend this virtual training,
01:25:56please feel free to reach out to me directly.
01:26:00Again, given my email address and let me
01:26:02know one who can still exists on your team.
01:26:04If you have a CSI.
01:26:06Supervisors came for me to know and how
01:26:08many people would like to train the timing
01:26:10of the training in terms of time of day,
01:26:13where it's still a little bit on the table
01:26:15because we're trying to incorporate take
01:26:17into account as many times as possible.
01:26:19I'm very much thinking particularly about
01:26:21of our Australian and Swedish of college
01:26:23to run the call as well as our East Coast
01:26:26and West Coast folks from the state.
01:26:28So I think this is a time
01:26:30we're going to be wrapping up.
01:26:32We really want to thank you all for coming.
01:26:35It's been a wonderful opportunity
01:26:36to bring our safety side community
01:26:38together for the first time at
01:26:40this very important moment in time.
01:26:42and I know on behalf of myself, my Co.
01:26:45Developer Steven Marans,
01:26:46the rest of our team.
01:26:48We really thank you for coming
01:26:49and really appreciate your joining
01:26:51in towards in the dialogue.
01:26:55See when you're on mute.
01:26:59Thank you all so much.
01:27:01Um, what a great opportunity to be
01:27:03together and if nothing else, uh,
01:27:05it's been a great opportunity to realize
01:27:08that we need to do more of this so.
01:27:11Tattoo moving forward will will
01:27:13figure out the next time we can meet
01:27:16In addition to the training in July.