Child Mental Health Series - Episode 3

May 22, 2024

Information

May 22

Transitioning to Parenting – The Impact of Stress and Trauma

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00:03Go ahead and welcome everyone to the Pros
00:07for Peers webinar series this afternoon.
00:09We really thank you for for taking the
00:11time to participate in this really rich
00:13conversation and encourage you to enter,
00:15answer, enter your questions in
00:17the Q&amp;A section of the chat please.
00:21I just wanted to let you know that
00:22the Pros for Peers program is a
00:25collaboration between the Yale School of
00:26Medicine and the Yale New Haven Health
00:28System and it's brought to you by the
00:30Office of Academic and Professional
00:32Development in the School of Medicine
00:34and the and the Chief Wellness Officer
00:36in the aligned clinician enterprise.
00:39I want to just remind everyone that
00:42the OAPSOAPDS mission is to elevate
00:45well-being among faculty and staff
00:46and we really welcome everybody
00:49to this conversation today.
00:50I do want to just quickly turn it
00:52over to Doctor Christine Olson,
00:53who is the Chief Wellness Officer for
00:56the medical staff across the aligned
00:58clinician enterprise as I've mentioned.
01:00And Christine will talk a little bit
01:02more about the Pros for Peers program
01:04and the impetus for this webinar series.
01:07And then turn it over to our our host,
01:09Doctor Linda Mace.
01:10Thank you so much and welcome,
01:12Doctor,
01:12Doctor Olson.
01:14Thank you, Peggy. Welcome everyone.
01:16Normally, Deputy Dean Rohrba would
01:18be by my side to welcome you here.
01:21He regrets he can't be here today,
01:24but I can certainly on behalf of both of us,
01:26welcome everybody here.
01:28Today, the Pros for Peers program
01:30recognizes that at Yale School of
01:32Medicine and Yale New Human Health,
01:35we are surrounded by renowned
01:37experts in all aspects of well,
01:39Wellness and well-being.
01:40And in the same spirit that we care
01:43for our patients and our community,
01:45we care for one another.
01:47And so when we seek input of
01:49how do we care for one another,
01:51we receive requests and things
01:53that people are looking for
01:55to maintain their well-being.
01:57And one topic that came up on previous
02:00on our last survey was that people
02:03wanted to know how are we at Yale
02:06addressing the mental health of young people?
02:10And how can we take care of
02:12the young people in our lives?
02:13How can we support their mental health,
02:15especially during these times?
02:17And so,
02:18of course we reached out to our
02:21globally renowned Yale Child Study
02:24Center to seek out that expertise.
02:27And so this mental health month,
02:29every Wednesday,
02:30we do have a podcast and we
02:33have these experts here.
02:34And today we're talking about
02:36transitioning to parenting,
02:37the impact of stress and trauma and
02:39how we can support our young people.
02:42And so with no further ado,
02:44I'd like to introduce you to the chair
02:45of the Yale Child Study Center and our host,
02:48Doctor Linda Mays.
02:49Thank you,
02:50Doctor Mays.
02:52Thank you, Christine,
02:53and thanks everyone for being here today.
02:55We really appreciate the opportunity
02:58to to join you and I I also want
03:01to add my welcome to you coming for
03:03the third of our pros for peers,
03:05webinars around child and
03:06family and mental health.
03:08It's a very appropriate topic
03:10for mental health Month.
03:12Before I introduce my colleagues,
03:14I'll just tell you very briefly
03:16about the Child Study Center.
03:17For those of you that don't know that
03:19we're a department in the Yale School
03:20of Medicine and we're focused on
03:22providing clinical care for children,
03:24adolescents and their families and on
03:27developmental science that ask how
03:29children grow in their understanding
03:31of the world and their skills that
03:33they have to navigate that world.
03:34We have a very large educational
03:36program that we train the next
03:38generation of researchers and clinicians
03:40and we're very multidisciplinary,
03:42have over 20 perspectives or trainings
03:45represented in in our community of
03:47just over 500 people in the department.
03:50Clinically,
03:50we serve over 3000 children and
03:53families annually through about
03:56little over 60,000 scheduled visits.
03:58And as I'm sure you've been reading
04:00in the news,
04:00we have a steady increase in need for
04:03our clinical services across all ages
04:05with a dramatic increase in children's needs.
04:08Children are simply needing services
04:10earlier and presenting with more
04:13challenges that require more intensive
04:15services and that is true for
04:18their parents and families as well.
04:21We provide services across a
04:22continuum from working in homes,
04:24we provide services in homes,
04:26we consult with pediatricians.
04:27We see children in our hospital
04:30emergency room,
04:31our inpatient unit and outpatient services
04:35and deliver our care virtually as well.
04:37Post Pandemic,
04:38we're still working at about 1/3 of
04:41families coming to us are coming
04:43for through virtual means.
04:46I think what you're going to hear
04:48today and I'm pleased very much to
04:50introduce you to my colleagues is we
04:52think about two and three generations
04:54in the trial studies center.
04:56We don't we think obviously very
04:58much about children and helping
05:00children flourish and thrive.
05:01But we we think about families
05:03and we think about parents and how
05:05parents are developing too.
05:07So today you're going to hear
05:09about that area of our work and 1st
05:12you'll hear from my colleague Dr.
05:14Helena Rutherford,
05:15an associate professor in the Child
05:17Study Center who looks at how the
05:20brain changes when we become parents
05:22and postpartum mental health.
05:24Then we'll go to Doctor Kieran O'Donnell,
05:27an assistant professor in the center
05:30who looks at pregnancy health and
05:32how the basically the environment
05:34of a pregnancy pre part of and
05:38parent and child together.
05:40We'll move to Hilary Hahn who does
05:43interventions to support mothers
05:45mental health in the community and
05:47again continuing the theme from
05:49our webinar last week of how we
05:51work in the community moving into
05:53Karla Stover and Doctor Stover is a
05:56professor in the Trial Studies Center.
05:58Dr.
05:59Stover looks and works with fathers
06:01and looks at the impact of stress and
06:04trauma on fathers parenting
06:06and and how to help them.
06:09And we'll conclude with Carrie
06:11Epstein who does a family focused
06:14approach to looking at trauma and
06:16children and and their parents.
06:19So to get us going, let me turn
06:21to Doctor Rutherford Element.
06:25Thanks Linda and good afternoon, everybody.
06:27It's a real pleasure to
06:28be able to join you today.
06:30So I wanted to get the discussion
06:32started by sharing with you how
06:33we've been using neuroscience as a
06:35way of informing our understanding
06:37of parental mental health.
06:39So Linda previewed that we're going
06:40to be focusing on the transition to
06:43parenthood today In our discussions and
06:45we think about the transition to parenthood,
06:46we often tend to think about the joys and
06:48the excitement of welcoming a new baby,
06:50whether it's the first baby,
06:52the 2nd baby, 3rd, 4th or 5th.
06:54But really there's a a bias of
06:56thinking about, you know,
06:57the the excitement and the positive
06:58feelings around this time.
06:59But for those of you who've had children
07:01or who know people who have had children,
07:03that it's also a time that is
07:05marked by significant stress
07:06and significant challenges,
07:07often challenges that parents
07:09have never faced before.
07:10And so for this reason,
07:12for this elevated levels of
07:13stress and challenge around the
07:15transition to parenthood,
07:16it's also been described as an
07:17inflection point for mental health.
07:19So specifically we see that there
07:20are heightened rates of risk and
07:23vulnerability to mental health
07:24symptoms and mental health disorders
07:26during this transition to parenthood.
07:28And so that's particularly true
07:30for birthing parents,
07:31but we also see increase in rates
07:33for non birthing parents as well.
07:36So we know during the transition to
07:37parenthood that there are hosts of
07:39different psychosocial changes that happen.
07:41There are changes in levels of occupation,
07:43finances,
07:43relationships,
07:44but more recently we're starting
07:45to learn and understand about how
07:48there are newer biological changes
07:50that accompany this transitional
07:51period for adults as well.
07:53So what's been very striking in recent
07:55work has been evidenced to suggest
07:57that the transition to parenthood,
07:59the period from pregnancy to postpartum
08:01is a time of neuroplasticity.
08:03So there are structural as well as
08:05functional brain changes that happened
08:07during the perinatal period that we
08:08think are important to promoting
08:10caregiving and adapting caregiving and
08:12nurturing of the infant post natally.
08:14What's even more fascinating though,
08:17in addition to these changes happening,
08:18there also seems to be that a lasting
08:21impact of the brain on pregnancy that
08:23exists years if not decades later.
08:25So one area in my lab that we've
08:27really been trying to understand
08:28more about this intersection
08:30between parental brain or maternal
08:31brain and mental health is in the
08:33context of maternal addiction.
08:34And this is particularly interesting
08:36because many of the areas of the brain
08:39or the neural circuits are important
08:40to parenting are also those neural
08:42circuits that are affected by addiction.
08:44So it really allows us to think
08:46about the underlying biology of
08:48what it means to be a parent,
08:50but then also what it means to have a
08:52mental health disorder in this context,
08:53addiction itself.
08:56And so underscoring parental brain
08:58networks or areas of the brain
08:59that are important to parenting
09:00and regions of the brain that are
09:02important to how we regulate stress
09:04and stressful feelings and emotions as
09:05well as areas of the brain that are
09:07important to how we experience pleasure.
09:09So what we find rewarding.
09:11So not surprisingly most people find
09:13infants cute and there's a very
09:15good biological reason for that,
09:16that the infants inherently rewarding
09:19irrespective if you're a parent or not.
09:22And So what we find we do experiments
09:24using on your imaging methods is it
09:26areas of the brain that are important
09:28to reward processing a responsive
09:30when when individuals are looking at
09:32photographs of infant faces or listening
09:34to infant cries or infant Coos.
09:36So there it's really helpful to know
09:38that even in non parents we see these
09:40reward brain responses and to infant stimuli.
09:42And not surprisingly then when we
09:44have parents come into the scanner
09:46or when we have parents look at these
09:48infant faces where there's this
09:50commutative signal from the baby that
09:52if it's a mum looking at a photograph
09:53of her own baby smiling,
09:55the brain lights out like a Christmas tree.
09:57These are very salient important signals
09:59for infant from infants to mothers.
10:02So that's what we see in mothers
10:04without substance use disorders.
10:05When we've looked at the maternal brain
10:07in women who are managing substance use
10:09disorders or or addiction or even just
10:11in heightened substance use severity,
10:13what we see is a different pattern
10:15of results.
10:15Instead of seeing this heightened
10:17reward response to looking at
10:18photographs of their own child or our
10:20children they've not seen before,
10:22we see more of a dampening or
10:24a reduced response.
10:25So this suggests to us that these
10:27infant stimuli just may not be as
10:28rewarding or may not be as pleasurable
10:30to these to these women,
10:31given the nature of addiction,
10:34we also see concurrently increased
10:35levels of activation in the brain
10:37in areas that are important to
10:39the regulation of stress.
10:40So we think these infant signals
10:42are not only less rewarding for
10:43parents with substance use disorders,
10:45but may also be more stress triggering too.
10:48So we've argued in our work in our
10:50experimental work as well as our
10:52theoretical work that neuro circuits
10:54are important to parenting may be
10:56Co opted by addiction.
10:57And that leaves us with a biological
10:59basis for understanding how parents
11:01with substance use disorder may have
11:03challenges in their caregiving role.
11:05Importantly,
11:06we've extended this inquiry to
11:07look at other clinical symptoms.
11:09So we've thought about mothers with
11:11with depression as well as with
11:13anxiety to see how those intersect
11:15with maternal brain development too.
11:17Importantly,
11:18we think about this in isolation,
11:20so just looking at the impact
11:21of anxiety or depression,
11:22but also in terms of profiles
11:24of psychological risk.
11:25So thinking about what does the mum look
11:27like with a substance use disorder?
11:29Who's also managing elevated
11:30levels of depression,
11:31anxiety to really inform our
11:33understanding of clinical disorders
11:35individually as well as across
11:37the spectrum of symptoms too.
11:39So what we hope is that our work provides new
11:41directions for our clinical colleagues,
11:42but also provides something very concrete
11:44to parents to understand how mental
11:46health can influence their parenting
11:48very concretely and inform their own
11:49understanding of how they develop as parents,
11:51but importantly how they develop with their
11:54child and their own child's development too.
11:57So with that, I'm going to pass
11:58over to my colleague Dr. O'Donnell.
12:01Thank you so much, Helen,
12:02and good afternoon, everyone.
12:03Thank you for sharing this hour with us.
12:05I hope some of you at least are
12:06enjoying this wonderful sunshine
12:07as you're listening to this panel.
12:09As Doctor Mays mentioned,
12:10it's fantastic to be able to
12:12take part in this panel during
12:14Mental Health Awareness Month.
12:16And for those of you who don't know,
12:18world Maternal Mental Health Day is
12:20celebrated on the first Wednesday
12:22in May every year globally.
12:24But this year in the United States
12:27it's the first time that we recognize
12:29Maternal Mental Health Week and
12:31and I think this really emphasizes
12:33the increasing recognition of the
12:36importance of supporting pregnant
12:38and postpartums mental health.
12:40The timing of our panel is especially
12:43ideal given that the Task Force on
12:45Maternal Mental Health just reported to
12:47Congress a series of recommendations
12:49on how we can improve pregnant
12:52and postpartums mental health.
12:53And I'm happy to talk during the Q&amp;A
12:55about some of the recommendations
12:57that were made as part of this report.
13:01And also it's important to note
13:02anyone that's on the call that may
13:04be pregnant during the postpartum
13:06period or who may know someone who's
13:08pregnant during the postpartum period.
13:09We'll be happy to talk about some
13:11of the local resources available
13:13here in the New Haven area,
13:15both within the Child Study Centre,
13:16in the Department of OBGYN and
13:18also in social work.
13:19And for anyone who wants to provide that
13:22information to anyone that they may know.
13:24And for those of you who are looking
13:25for a hotline for your patients
13:27or for anyone that you may know,
13:29the first hotline on the tournament
13:31help is very easy.
13:32And to remember it is TLC Mama.
13:35So I think that really is an ideal
13:38title for the Hotline 1833 TLC Mama,
13:41for those of you who want to pass
13:43that on to anyone and that may
13:45feel the need to speak to someone
13:47about their mental health.
13:48In terms of my own research,
13:50the research in my group can
13:52be divided into two pillars.
13:54I'm fascinated by pregnancy as
13:56a developmental stage,
13:57both for the long term effects
13:59on the health of the mother,
14:00but also the potential intergenerational
14:02effects on the mental health of the child,
14:05adolescent and subsequent adult.
14:07And so my own research has shown that
14:09women who experience high levels of
14:12anxiety and depression during pregnancy,
14:14their children have approximately double
14:16the risk of going on to develop socio,
14:18emotional, and behavioural problems,
14:20with these effects being evident as
14:22early as as age, 4 years of age,
14:25and persisting until at least
14:27early adulthood.
14:28And it's critically important to
14:31emphasize that this research isn't
14:33the goal of this research isn't to
14:35blame or shame or increase stigma
14:38for experiencing mental health
14:40challenges during pregnancy,
14:41but it's to identify potential
14:44modifiable risk factors that we can
14:46target as a mechanism to improve
14:49both maternal health outcomes but
14:51also child mental health outcomes.
14:54Now,
14:54one of the fundamental challenges
14:55that I experience in
14:57my work is trying to identify children
14:58that are greatest risk of adverse mental
15:01health outcomes following exposure to
15:02anxiety or depression and pregnancy.
15:04And so in my group we make use of information
15:07from different biological systems,
15:09including the genome,
15:10so genetic variation and also the epigenome,
15:13which is a series of chemical marks
15:16or modifications to the genome to
15:18help us better identify which children
15:20are most likely to be affected.
15:22So for those of you who are
15:23unfamiliar with the epigenome,
15:24this is has been described as
15:26where nature meets nurture.
15:27It is a series of biochemical
15:30modifications that is sensitive
15:31both to genetic variation but
15:33also to environmental exposures.
15:35And so we know that there are changes
15:37to the epigenome across the the
15:39lifespan and also in a response to
15:41different environmental exposures.
15:43And my team has been part of a
15:45consortium that's developed a biomarker
15:46of aging for use in the pediatric
15:49age range that we've been able to
15:50implement in a number of cohorts to
15:52show that increased levels of anxiety
15:55during pregnancy are associated
15:57with accelerated biological aging.
15:59And the goal of this work is not
16:00just knowledge for knowledge sake,
16:02but then to implement these biomarkers
16:04and randomized controlled trials
16:06of early interventions that seek to
16:08improve maternal mental health as
16:10an early biomarker of the impact of
16:12treatment response to early intervention.
16:14And I'm happy to talk to you about
16:16some of the trials that we have
16:18under way both here in the United
16:19States but also in the global S that
16:21seeks to evaluate these biomarkers
16:23of aging in the context of early
16:26interventions that target maternal
16:28mental health as a mechanism to
16:30pursue to improve child outcomes.
16:32And as you can probably
16:33tell from the last minute,
16:33it's critically important that we have
16:36evidence based interventions that can
16:37improve maternal mental health plus to
16:39improve maternal physical and health,
16:41mental health as a clinical endpoint,
16:43but also potentially to improve
16:44the health of the next generation.
16:46And now I'd like to pass it to
16:47my colleague Hilary Hahn.
16:48He'll tell you about some of the
16:50wonderful work she's doing in
16:51the intervention space.
16:53Thanks so much, Kieran.
16:55And I'm really glad to be here today as well.
16:58And I I really appreciate, Kieran,
17:00the attention that you drew to
17:01what an important time this
17:03is for maternal mental health.
17:05And it's an exciting time as well.
17:07With the release of the federal agency
17:10Task Force on Maternal Mental Health,
17:12they released a a strategy that
17:14would be exciting to talk about
17:16a bit during our discussion.
17:17As Linda mentioned,
17:18one focus of my work is on community
17:20programming for maternal mental health.
17:23I'm the director of a program called
17:25the Mental Health Outreach for Mothers
17:27or Moms Partnership and our focus is
17:30really on mental health programming for
17:33overburdened under resourced mothers.
17:35Becoming a mother and the experience of
17:38motherhood is a dynamic and evolving process,
17:41and it's influenced by so many factors,
17:42social, cultural,
17:44environmental, and personal.
17:46And while any mother can be
17:48impacted by depression,
17:49research consistently shows that
17:50mothers who are living in poverty
17:53are much more likely twice as
17:55likely to experience depression as
17:57compared to more affluent mothers.
17:58And in fact,
17:59we now understand that there's
18:01actually a bi directional and
18:03causal relationship that exists
18:05between poverty and mental health.
18:07The worry and uncertainty that the
18:09conditions of poverty create can
18:11actually have detrimental impacts on
18:13the way that our brains function.
18:16Conditions of poverty can create
18:18a significant cognitive load,
18:20and at the same time,
18:22conditions of poverty can impact the
18:24way that our brain can process information.
18:27And so when we experience stress,
18:29the brain activates a stress response,
18:32triggering the release of stress
18:34hormones like cortisol and adrenaline.
18:37And the prefrontal cortex,
18:39which plays a really crucial
18:42role in executive functioning.
18:44Things like decision making
18:46and problem solving,
18:47is vulnerable to exposure to
18:50those continued stress hormones.
18:51And the hippocampus,
18:53which is involved in memory
18:54formation and learning,
18:56is also really vulnerable
18:57to stress in those ways.
18:59We also know that poverty
19:01coexists with stressors that are
19:03also damaging to mental health.
19:05Poverty means access,
19:07limited access to resources
19:09including education, healthcare,
19:11nutritious food, safe housing.
19:14Poverty means environmental stressors,
19:17things like noise,
19:18pollution,
19:19violence and crime and those have
19:22been well demonstrated to be directly
19:24linked to to mental illness and
19:26and poverty impacts social status.
19:28So people living in poverty
19:31frequently experience racism,
19:32discrimination,
19:33social stigma and social exclusion and
19:36and those can trigger emotional distress.
19:40The necessity of continually navigating
19:42the stressors that are associated
19:45with poverty can leave fewer resources
19:47available for relationships,
19:49including our parenting relationships.
19:51And we know that depressed
19:55mothers are can be,
19:56can can suffer in those circumstances.
19:59Mothers who are experiencing depression
20:01can be less attuned to the needs
20:03of their infants and and children.
20:05They may feel less securely attached.
20:08The non depressive mothers and and
20:11experience lower maternal instincts.
20:13We know that the the sensitive
20:16responsive caregiving relationship
20:17is so essential to children's
20:20development and as as my colleagues
20:23were just talking about when it's
20:25absent it can lead to poorer cognitive
20:28outcomes for children that exist
20:30and are demonstrated in in infancy.
20:33They're they're there and can it can
20:36show up in less school readiness and,
20:39for example, by age 5.
20:40And there's evidence that persists
20:43into into adolescence and and early,
20:47even early adulthood.
20:48The good news is that when mothers receive
20:51mental health supports that they need,
20:54their mental health and well-being
20:55can improve and actually the
20:57whole family can benefit.
20:58The focus of our work,
21:00the Mental Health Outreach for
21:01Mothers or Moms Partnership is on
21:03directly strengthening maternal
21:04mental health among under resourced,
21:06overburdened women.
21:07And that leaves a critical
21:09foundation for mothers to strengthen
21:11other areas of their well-being
21:12and their family's well-being.
21:14The Mom's partnership is offered
21:16in community settings and formats
21:18that emphasize accessibility
21:19for participants and moms,
21:21has been shown to help mothers
21:23and and parenting women to
21:25experience significant reductions
21:27in depressive symptoms in anxiety
21:30symptoms and perceived stress,
21:32and also to experience
21:33improvements in perceived social
21:35support and emotion regulation.
21:37Even a really brief intervention such
21:39as the Mom Stress Management Course,
21:41which is offered in 890 minute sessions,
21:44can teach participants really
21:46powerful skills for mood management
21:48and emotional regulation.
21:50And it also offers opportunities
21:52for social connection,
21:53which we know is critical to mental health.
21:55Together,
21:56building those skills for mood
21:58management and having opportunities
21:59for social connection can lead to
22:01really positive changes in mother's
22:02mental health and well-being.
22:04And for children that can mean positive
22:06changes in social emotional health.
22:08Investing in mother's mental health really,
22:10truly becomes an investment in
22:12the whole family's well-being.
22:13So thank you so much for listening.
22:16And at this point,
22:17I'm going to pass this to my colleague Carla,
22:19who will talk about the role of fathers.
22:22Thanks, Hilary. Hello, everybody.
22:23I'm Carla Stover, and I'm going to
22:25take the mantle to try to shift the
22:27focus a little bit to think about
22:29the other partner in families,
22:31the father and the families,
22:32which fathers often get overlooked in the
22:36focus on mothers and infants and thinking
22:38about the transition to parenthood.
22:41And I want to start by just sharing a
22:44little bit from a recent survey that
22:47came out on the state of American men.
22:49And this survey was actually done
22:51by colleagues from the University
22:52of Pennsylvania.
22:52So it wasn't done by me,
22:53but it's an important study in that
22:56over 2000 men aged 18 to 45 were
22:58surveyed on a variety of issues.
23:01But one of the a couple of the key
23:03findings were that 44% of the men that
23:06were surveyed reported some amount of
23:09suicidal thinking in the last two weeks.
23:12And the majority of the of men,
23:14particularly young men,
23:15didn't feel any, didn't feel connected.
23:17They didn't feel a sense of social support.
23:19They didn't feel like they
23:21had strong friendships.
23:22And so what's happening is there
23:24really is a a a bit of a crisis in
23:26terms of men's health and well-being,
23:28I think because there's a lot of
23:31stigma around accessing mental health
23:32care or health care in general.
23:35If you think about who accesses care,
23:37any of you who are who are married
23:39or who are men,
23:40you know you tend to avoid going
23:42to the doctor.
23:42It's sort of like you have to be
23:44almost dying before you decide
23:45to go ahead and see a doctor.
23:46And so it's not only the the mental
23:48health care with physical health care
23:50and so there's a a lack and men are
23:52are more likely to die younger as a
23:54result of not taking care of their of
23:57their health and well-being connected
23:59to the the transition to parenthood.
24:01We we we can't we do and should
24:04think about mothers and postpartum
24:05depression but men also can suffer from
24:08postpartum depression after becoming
24:10new parents and about 18 between 8:00
24:13and 13% depending on the surveys.
24:15So about 9% overall of men will actually
24:18experience postpartum depression,
24:20and it's most common when their babies
24:22are between 3:00 and six months of age.
24:24So not necessarily right after the birth,
24:26but a few months later.
24:28And that it's for all of the same
24:30reasons in many ways that mothers
24:32experience postpartum depression.
24:33All the changes in the family
24:34life and the different pressures
24:35and stresses that can come about,
24:37and men are much less likely to
24:40be thought of in terms of whether
24:42they're having these symptoms.
24:43And they're also less likely to seek
24:44care or to actually know how to access
24:47resources for postpartum depression.
24:50And so this concern about,
24:53you know,
24:54stigma around mental health is
24:56really important because if we don't
24:58elevate this concern around dads,
24:59we really are are causing difficulties
25:01when the whole within the whole family.
25:03Because when fathers are suffering from
25:05mental health difficulties like depression,
25:07anxiety, trauma, related disorders
25:09or just high levels of stress, what,
25:12how this tends to come across in families
25:15is as irritability and anger and causing
25:17a lot of conflict in the families.
25:19And so what's acceptable for men
25:21to express is not necessarily
25:23feeling depressed or anxious or sad,
25:25but feeling angry or irritable.
25:28And so those sorts of behaviors
25:29are more acceptable.
25:30So we see higher levels of aggression
25:33coming from men in the community and
25:36with their families and partners.
25:38The other thing that's important
25:39to remember is that fathers have a
25:41really significant impact on the
25:42functioning of the whole family, right?
25:44So particularly in the time of new mothers,
25:46new motherhood and transition to parenthood,
25:48fathers support the mother, right?
25:50They support her breastfeeding.
25:52If there's a supportive father in the house,
25:54there's much more likely to be longer,
25:55longer breastfeeding and just better
25:58overall the health of the mother if
26:01the father is able to be available
26:03and supportive to her.
26:04And also fathers have unique
26:05contributions to their children
26:06in terms of their development.
26:08Overall, we know having a,
26:10you know,
26:10one really good caregiver is important,
26:12but imagine the strength of having 2
26:14and so having your father involved.
26:16They have unique contributions in terms
26:19of child children's social development.
26:21The way the way they play with their
26:22children is different than the way
26:24mothers play with their children often,
26:25And that has unique contributions to
26:27children's social, emotional health.
26:29They're functioning in school.
26:31They do better academically in school
26:33when their fathers are also doing well.
26:35So when dads aren't getting the
26:37mental health care that they need,
26:38this can impact their kids.
26:40And so you may be wondering,
26:42well, what are,
26:42what are some of the things
26:44that that dads need?
26:45A couple of the things that are,
26:46I'll just mention two things that
26:48I think are really important.
26:50One is men need other support from
26:52other men and it just connections
26:54with other men and so we need
26:57to try to elevate that.
26:58As you know, making friends,
27:00spending time with friends is really
27:02important for men as well as women.
27:04And also when we do interventions
27:07and provide treatment,
27:08focusing on development of emotion,
27:11Healthy emotion regulation is
27:12something that men often have not
27:14been taught because in society men
27:16are taught to repress their emotions
27:19and to try to tamp them down.
27:20And so in treatment and intervention
27:22sort of helping to think about
27:23what's healthy regulation,
27:24what's healthy expression
27:26of different emotions,
27:27so that they can also then
27:29teach that to their children.
27:30So if fathers are able to
27:33express their emotions,
27:34they're going to be less irritable,
27:35less aggressive and able to provide that
27:37support to their children as well and
27:40particularly model it to their sons,
27:42which is key for this this problem to to end.
27:46So with that,
27:46I will turn it over to my
27:48colleague Gary Epstein, who's also
27:49going to talk about intervention.
27:52Thank you so much, Carla.
27:54I'm so pleased to be here with
27:56you all today and to be presenting
27:58with my talented colleagues.
27:59And as Carla just said,
28:00I'm going to be sort of continuing the
28:02theme about talking about interventions.
28:05So as we all know and as you've been
28:07hearing from my colleagues today,
28:08parents are really critical in
28:11central mediators throughout the
28:13course of children's development.
28:15And while raising healthy
28:17children is never easy,
28:19there can be a host of challenges that
28:22can really significantly interfere with
28:24the parents abilities or capacities
28:26to meet the needs of their children,
28:29the ways that they'd like to.
28:31And chief among these sources of
28:34interference are difficult personal
28:36histories and the more immediate
28:38impact of adverse and traumatic
28:41experiences in parents own lives.
28:43So research has shown that parents face
28:46multiple challenges as a result of
28:49recent and earlier traumatic events.
28:51And that in addition to the personal
28:54experience of PTSD or heightened
28:57vulnerability to anxiety and depression,
29:00they're functioning.
29:01And their views of themselves as
29:03parents may also be impacted,
29:05as my colleagues have pointed out,
29:06in ways that have potential consequences
29:09for their children's development.
29:10And so keeping these potential
29:13vulnerabilities in mind,
29:15trauma treatment that takes a more
29:18family focused approach in which parents,
29:20experiences and needs are assessed,
29:24addressed and supported is really
29:26essential to effective care
29:28of traumatized children.
29:30So as part of the work in our trauma center,
29:32we've had extensive opportunities to
29:34see the impact of traumatic experiences
29:36not only on children and adolescents,
29:39but on parents as well.
29:40And as a result,
29:41the work that we do and the treatment
29:44that we've developed focuses on
29:46helping both parent and child better
29:49recognize and more effectively respond
29:51to and decrease the symptomatic
29:54impact of traumatic experiences on
29:56their own individual functioning as
29:58well as on their communication and
30:01interactions with one another with
30:03the goal of increased mastery and
30:06recovery from trauma symptoms that
30:08impair functioning and well-being.
30:10So the novel mental health treatment
30:12that we've developed that called the
30:15Child and Family Traumatic Stress
30:16Intervention or CFTSI is a brief 5
30:19to 8 session evidence based mental
30:21health treatment,
30:22which is the only mental health
30:24treatment that was specifically
30:26developed to be implemented just after
30:28a recent exposure to a traumatic event
30:31or recent disclosure of physical or
30:34sexual abuse in a forensic setting
30:36such as a child advocacy center.
30:39So through CF TSI,
30:41the clinician learns about both
30:43the parent and the child in terms
30:46of not only how they're doing,
30:47but in the broader context of their
30:50own experiences and development
30:52in order to increase recognition,
30:54appreciation and communication
30:56that can support healing.
30:58So our mom focuses on helping children
31:03communicate more effectively with their
31:05parent about their trauma symptoms,
31:07identifying and teaching them
31:08coping strategies to turn the volume
31:10down on those symptoms and really
31:12helping them heal and recover.
31:13And by having a strong focus on
31:16increasing communication between
31:17the child and parent about
31:19the child's trauma symptoms,
31:21CFTSI can really increase our family support,
31:24which is really so necessary for recovery
31:27in children impacted by traumatic events.
31:30So in this way, CFTSI really capitalizes
31:32on the clinical recognition of the
31:35central role that parents can play
31:37in supporting children's healing and
31:40recovering from traumatic events.
31:42So while our brief early psychotherapeutic
31:46treatment really aims to reduce and
31:49interrupt PTSD and related disorders,
31:51think the fuller focus and approach
31:54to both the parent and child has
31:57really yielded significant positive
31:59results for both our studies of CFTSI
32:02including our our original randomized
32:05control trial and our ongoing open
32:07trial in community based clinical
32:10settings consistently demonstrates
32:12CFTSIS effectiveness in significantly
32:14decreasing children's trauma symptoms.
32:17I mean one recent study approximately
32:1980% of kids who attended 5 to 8 sessions
32:21of CFTSI experienced a reduction of
32:24trauma symptoms to below clinically
32:26significant levels and were not referred
32:28on for additional trauma focused therapy.
32:31And children are not alone in
32:33experiencing benefits from CFTSI.
32:35So the model has also consistently
32:38demonstrated a significant decrease
32:40in the participating parents
32:42trauma symptoms as well.
32:44So 62% of parents who participate
32:47in CFTSI experienced clinically
32:49meaningful improvements in their
32:51post traumatic stress symptoms.
32:53And I think it's so important to
32:55point out that this is particularly
32:57significant because we know and you've
32:59heard from my colleagues that parental
33:01relief from symptoms and suffering
33:03is really also a key predictor for
33:06improved outcomes for children
33:07following traumatic experiences.
33:09So I just think in closing I'd like
33:11to finish with the following thought
33:13that as we've all come to learn more
33:16about trauma and stress through
33:18our clinical work and research,
33:20we fully recognize that evidence
33:22based treatments such as CF,
33:23TSI and other evidence based mental
33:26health treatments and interventions
33:28really can offer opportunities for
33:30recovery and an alternative to a
33:32lifetime of suffering and symptomatology
33:34that too often is a consequence
33:37of unrecognized and untreated
33:40traumatic experience.
33:41So I'd like to thank the planning
33:42committee for inviting me to
33:43present on the panel and I really
33:45thank you all for listening.
33:47Thank you so much, Carrie,
33:48and thanks to everyone for presenting.
33:50So let let me kick it
33:51off with a few questions.
33:53I mean, please do submit your
33:55questions in the question and
33:56answer or if you want to just
33:58raise your hand and shout them out,
33:59that's fine as well.
34:02Maybe going back to to Helena,
34:05we've been going back and forth between
34:08mothers and fathers and Helena,
34:09could you talk a bit about the
34:12brain changes and dads and the
34:15intersection with mental health?
34:16Yeah,
34:17absolutely. So I think as Connor
34:19alluded to that we we are
34:21also learning lots about Mums.
34:22Our knowledge around ADS is still
34:24playing a significant catch up
34:26and so that's true not only in the
34:28neuroscience field but I feel more
34:29general more broadly generally as well.
34:31But what we do know when just in
34:33terms of normative paternal changes
34:34in the brain is that they they do
34:37happen that they tend to happen
34:39post natally more so than we see
34:41from pregnancy to postpartum.
34:42And so I think it was really
34:44poignant that where Carla was
34:45sharing about rates of depression
34:47symptoms onsetting within kind of
34:48three to six months post natally,
34:50that also reflects what we think a
34:51lot of the neuroimaging findings are
34:53coming out where we're seeing dad's
34:55brain changes occurring based on
34:56experience as it's more seems the
34:58brain change is happening in fathers,
34:59seems to be more around experience based
35:02plasticity having spent more child,
35:03more time with their children
35:05across the postpartum period.
35:07What's interesting is when we have
35:09looked at kind of neural markers of
35:11stress and reactivity to stressful cues
35:13in expected mothers and expected fathers,
35:15we see comparable brain responses
35:17and comparable impact by stress.
35:19So even though there are,
35:20there seem to be different trajectories
35:21of neurobiological changes that are
35:23happening in mothers and fathers,
35:24that stress reactivity and that stress
35:26approach appears comparable to what
35:28women and women are experiencing.
35:31Carla, do you have anything to add?
35:35Not specific to the brain changes,
35:37but I do think the, the,
35:40the focus on the stress response
35:41and the stress of the postpartum
35:43period is really important in
35:45helping teach parents like what is
35:47it that's happening in their bodies.
35:49Actually is very helpful.
35:50And particularly I think men are keen
35:52to understand that because it feels
35:54controllable and then we're normalized like,
35:56oh, this is something that's
35:57happening in my brain, oh,
35:58my body's stress response system
35:59is turning on because I'm really
36:01having a lot of stress and anxiety
36:03around around having this new baby
36:04or care providing for this new baby.
36:06And so those sorts of things I think
36:08are very helpful to forefathers.
36:11You know, Karnam,
36:12one of the things that, I mean,
36:13you talk specifically about fathers,
36:15but could you say something more
36:18broadly about what interventions
36:20are beneficial to parents generally
36:23who are struggling with parenting?
36:25Well, I think there's
36:26a lot of different choices out there.
36:28I mean, that's the good news.
36:29I think there's been, you know,
36:30we've developed a lot of interventions
36:31here at the Child Study Center and
36:33there's but there's lots, you know,
36:34nationally and internationally that
36:35are out there that are evidence
36:37based that we know are helpful.
36:38But a couple of the key things I think
36:41interventions that particularly target
36:45parents and children together that
36:46are dyadic that really help parents
36:49and support them like in in person
36:51developing attachment with their baby
36:52or their child and sort of developing
36:55their confidence and being able
36:57to to parent are some of the ones
36:59that are the most helpful. I think.
37:03I think long term in terms of
37:05long term benefit versus something
37:06that's more of an education.
37:08This is how you change a diaper.
37:09This is you know those
37:11those classes exist too.
37:12But I think the ones that have the
37:14longer term impact are those that
37:16really help parents develop that
37:17healthy connection with their baby and
37:19also support the the parent to manage
37:21their own mental health difficulties.
37:23I don't know if other of my colleagues
37:26have other things they want to add.
37:27I'm not the only one doing that work here.
37:30Anything else to add across the
37:33group? I think I would just
37:34add to the to build on Carla's
37:36point around focusing on the dyad
37:37or the triad that a lot of that
37:39can happen in pregnancy too,
37:40that we don't have to wait for
37:42baby to arrive in order to deliver
37:43intervention so that a lot can be
37:45done in pregnancy when there's less.
37:47You know some of these challenges
37:48and stresses we talk about are
37:49less than when baby arrives.
37:51And so I think you're that idea
37:53around moving interventions earlier
37:54and thinking about what we can do
37:56prenatally for men and for women is,
37:58is quite important here
37:59and engaging both parents together and
38:02talking proactively about Co parenting
38:04and how are you going to manage things
38:06together and thinking ahead of time
38:07I think is also really helpful. I
38:10think we just add to that then you know we
38:13we hear a lot about postpartum depression,
38:14but obviously symptoms of anxiety
38:16and depression are just as common
38:18if not more common in pregnancy.
38:19So really there's many windows of opportunity
38:21and I think going back to the issue of
38:24or to the point about interventions,
38:25the US Preventative Services Task
38:27Force has recommended two evidence
38:30based interventions that actually
38:31can prevent postpartum depression.
38:33So it's not inevitable that if you're
38:35struggling with symptoms of anxiety or
38:37depression that it's going to get worse
38:39and there are interventions that can help.
38:41And I think that's a key message
38:42for anyone who's who's listening.
38:46I just wanted to, oh, sorry,
38:48I was just going to sort of add
38:49on in two ways.
38:51One is that I think interventions for
38:54completely agree with what everything
38:55my colleagues are saying around the
38:58importance of dyadic interventions.
38:59And we know that there are other
39:01caregivers who are so important in
39:03the lives of children that we're,
39:04that we're working with and that we're
39:06seeing and that can be incredibly impactful.
39:08And I think you even opened up
39:10by saying that it's two and three
39:13generational work that we do here.
39:15And that is that is certainly true.
39:17And I know in our work in in mom's
39:19partnership and in other interventions that
39:20that we do here at the Child Study Center.
39:23Engaging those other other caregivers,
39:25grandparents, aunts,
39:26uncles across who may have
39:27involvement with children across
39:29the lifespan is is essential.
39:31And and helping them to understand
39:32their role and how they can support
39:34the health and well-being of children
39:36and also helping them to attend to
39:38their own mental health in the same
39:40way that we're talking about with
39:42children is incredibly valuable.
39:44The other point that I wanted to make,
39:45building on what you were just saying,
39:47Karen,
39:47is that depression in the prenatal
39:49period and the postpartum period,
39:52we should definitely draw attention to that.
39:54And we know that women may be
39:56likely to experience depression
39:58throughout their caregiving years.
40:01And so being able to find ways to have
40:03awareness of that and think about
40:05mental health and well-being throughout
40:07those caregiving years is is a valuable
40:10target for intervention as well.
40:14So there's a question and in
40:15our question and answer Karen,
40:17I know that you're typing an answer for it,
40:20but also want to just raise,
40:22I think it's a great question about
40:25raising the number of the evidence
40:27based treatments that we've talked
40:29about around stress reduction may also
40:32be quite relevant for non parents.
40:34And I think before I turn this open
40:37to the to all of you just to say that
40:40there and Hillary you touched on it,
40:41There are many,
40:42many people that are involved
40:44in the lives of children.
40:46And while we're talking a lot about
40:48parents and parent transition,
40:50transition to parenthood,
40:51anybody want to say more about these
40:54kinds of stress reduction for non
40:57parents or those more broadly involved.
41:09I mean I can say that certainly
41:11the stress reduction strategies
41:12like understanding your nervous
41:13system and how your nervous system
41:15responds to stress and different
41:17coping strategies that you can learn.
41:19Yes, that can help anyone.
41:20I mean, I tell when I train therapists,
41:22when I talk to other people in the community,
41:24I always talk about this and this.
41:26This can help anyone learning how
41:27to breathe properly can help anyway.
41:28You know, all these things are very
41:30helpful and some of them you know
41:32in terms of for parents that a lot
41:34of these programs you can assess.
41:35And here in the community that you
41:37know here at the Child Study Center
41:38we have specifically for parents,
41:40you have to be a parent for
41:41the Child Study Center.
41:42But you know, we have a lot of
41:43these sorts of programs here.
41:45But there are other agencies within
41:47the community that offer stress
41:49management kinds of support,
41:51and they're even, I mean,
41:52even just to learn the basics.
41:54There's even some online programs that
41:55you can access to just get some general
41:58information about about this sort of thing.
42:00I wouldn't suggest that in lieu
42:01of talking to someone or meeting
42:03with someone in person,
42:04but there's certainly ways of
42:06accessing those those resources,
42:12Hillary turning to you or maybe you
42:15and Carrie together, could you talk
42:18about the value of brief interventions?
42:23Yeah. Thank you, Linda, for that question.
42:26I think, I think what we've learned
42:30myself and and Carrie as well is that,
42:33is that even a brief intervention?
42:37And in our case we're doing an
42:40intervention that is I think
42:42we're talking about something
42:44here that's 890 minute sessions.
42:45So it's really it it's in some
42:48ways just an introduction to it
42:51could be greater introduction to
42:53longer term healthcare if needed,
42:55mental healthcare if needed.
42:56But what we're finding is that even
42:59that brief inter introduction can be
43:01impactful for many women and families.
43:03And you know at a time when we're
43:06experiencing such a mental health crisis,
43:08I think it's invaluable for us to
43:11find ways to to figure out where
43:14people can can get what they need.
43:16And some people who experience
43:18value in the brief treatment it,
43:21it's wonderful that that we can
43:23deliver that for those who need it.
43:25And Carrie,
43:25I'd love for you to to say
43:26more about that as well.
43:28Yeah, absolutely.
43:29You know I think you know research has
43:32really shown that brief interventions,
43:34targeted time limited treatments
43:35that improve symptoms and behavior
43:38at at critical moments can really
43:40have significant benefits.
43:41And we've definitely seen this
43:44in our Model C of TSI which
43:46is 5 to 8 sessions and I was.
43:48So I really echo what Hillary said.
43:51I think that that you see of TSI
43:56really acts as a as as a treatment
43:58unto itself with up to 80% of the
44:01kids at the end having symptoms
44:03below clinically significant
44:04levels and their caregiver,
44:06their participating caregiver or
44:08caregivers to drop you know having
44:10a significant drop in symptoms.
44:11And I think it's a really especially
44:14important to note that in the the
44:16current context where there there is
44:18not enough mental health therapist
44:19where they're more waiting lists that
44:22we've really seen from our perspective
44:24that the brevity and effectiveness
44:25of short term treatments like CF,
44:27TSI really help reduce the
44:29need for longer term care.
44:31They can alleviate a long wait list.
44:33It can create increase access and it can
44:36allow programs to serve more children.
44:42Just add to that, there's a really
44:44interesting study from colleagues in
44:45Canada and Brian then leash out that was
44:47published last year in JAMA Psychiatry
44:49looking at a one day CBT intervention
44:51for postpartum depression and actually
44:54showing benefits at 12 weeks follow up.
44:57I guess the question is whether or not
44:59that's sustained over time or whether or
45:01not top of interventions are required.
45:03And I think the other point that's
45:05important to note from a research
45:07perspective is thinking about the other
45:09contextual factors that might influence
45:10the efficacy of these treatments.
45:12And so trying to think about the place
45:14based stressors that can influence the
45:16efficacy and the treatment response to
45:18these evidence based interventions.
45:20And I think that's a really exciting
45:21area for us to explore.
45:22And from a research perspective,
45:27yeah, Karen, I think some of these
45:31things has been a kind of latent theme
45:34throughout is to think about how does
45:37stigma potentially associated with
45:40mental health interventions still?
45:42How not only does that impact your work,
45:44but how does it impact how we
45:46think about interventions?
45:48Yeah, I think it's one of the
45:50great ironies of my work is that,
45:51you know, I'm saying, you know,
45:53don't don't don't be stressed about
45:54being stressed. And you know,
45:56I'm trying to kind of while still
45:57highlighting the issues of stress
45:59during pregnancy and child development.
46:00So I'm acutely aware of how that
46:04can cause worry or anxiety.
46:06And I think the key thing is trying
46:09to remove the emphasis on individual
46:11level behaviour and thinking about
46:13what are system level changes
46:14and societal changes that we can
46:16implement that can reduce stigma,
46:18increase access to treatment so that the,
46:22you know, the blame doesn't lay
46:25with the individual.
46:25And that I think is 1 mechanism
46:28to reduce stigma.
46:29I think that what we've seen in some
46:31of the epidemiological studies is
46:33that there's been a generational
46:35increase in symptoms of anxiety
46:37and depression in many cohorts now.
46:39And I think that while that could
46:41be alarming and concerning,
46:43it might also have a silver lining
46:46that people are feeling more willing
46:48to discuss mental health and symptoms.
46:51So I think we,
46:53I think we need to do a lot more
46:56to address stigma and blame,
46:58particularly in marginalized
47:00and minoritized groups.
47:01You know,
47:02I think that where mental health symptoms,
47:04especially substance use disorder has
47:07been weaponized against certain groups.
47:09And so I think that there are real
47:11reasons why people might be concerned
47:13about disclosing mental health symptoms.
47:15And I think we as a society,
47:16we as researchers,
47:17we as clinicians need to think about
47:19what we can do in our everyday work
47:21to to reduce blame and stigma.
47:24Carly, you touched on some of
47:25that too in what you were saying.
47:27Do you have things to add?
47:30Well, I think, you know, yeah,
47:32stigma and blame is a really,
47:34really big one. And, you know,
47:36I think what happens with men is they don't
47:39tend to seek treatment unless they're
47:41being forced to by either, you know,
47:43that they've been arrested for something.
47:46So that by the criminal courts,
47:47child protection gets involved with
47:48their family in some way or some family
47:51member basically gives them an ultimatum.
47:53She says if you don't go to treatment,
47:55you know, you know this marriage is over.
47:58If you don't go to treatment,
47:59I don't know what's going to happen.
48:00You know, there's sort of
48:01an ultimatum that's given.
48:02Think that
48:05that that creates a real problem in terms
48:07of when people then show up for treatment,
48:10are they motivated for it or are
48:11they doing it because someone
48:12is telling them they have to.
48:14And so we we have to try to
48:17elevate the change that narrative,
48:19I think in our society around
48:20like everyone needs care.
48:21Everyone needs mental health care.
48:22Taking care of yourself,
48:24you know, you deserve to heal.
48:26You deserve to get treatment.
48:27You deserve to get standard health care.
48:30We all deserve that.
48:31And so if we can speak that way,
48:34you know, not only for our, you know,
48:35we should say that to ourselves,
48:37but also for our for our loved ones.
48:38I think that changes.
48:39Then you know, people will say,
48:41you know, they're worried about feeling,
48:43you know, people think you're crazy or
48:45they think I'm crazy and it's like,
48:46no, I don't think you're crazy.
48:48I think you deserve to get
48:50healthcare for yourself including
48:52mental healthcare so that you
48:54can you know be at your best
48:57what do maybe this is a question for
48:59all of you what what do you think we
49:01can better how can we better advocate
49:03at both the state and federal level,
49:05especially for what parents need at
49:09this time. Anybody want to jump in?
49:17Well, I think access to universal
49:19health care that includes mental
49:21health care would be,
49:23you know, the the first task.
49:26I don't, you know,
49:27because if people can't access, you know,
49:29they don't have health insurance,
49:30they can't access mental health care
49:31or if their their health insurance
49:32doesn't cover mental health care,
49:34they're not likely to go.
49:38And I think there's, there's some
49:40really wonderful recommendations in
49:41that task force report on maternal
49:43mental health and part of it relates
49:45to infrastructure in you know,
49:46kind of increasing access to to expert
49:51care for perinatal mental health issues.
49:55And then also you know about
49:57affordability and reimbursement.
49:58So thinking about whether or not
50:00insurers are actually covering
50:01behavioral health and if they're
50:03reimbursing at an adequate level,
50:05which we know has been an issue and
50:07that has been faced by many in the
50:09child Study Center and then they
50:11call for greater research as well.
50:13You know, and I think that's the
50:14point that I was mentioning about
50:16trying to understand what can
50:17limit the impact of interventions.
50:19And one of the other recommendations is
50:21something that we spent a lot of time
50:23talking about today is incorporating
50:25the partner as an important,
50:26often ignored component of maternal
50:29mental health and also listening to
50:32individuals with lived experience.
50:34So trying to learn from those individuals
50:36that have experienced anxiety,
50:37depression,
50:38stress in the perinatal period and
50:40to find out what are the barriers
50:43to help seeking and to to Wellness.
50:45So I think there's some really key
50:48points made in that that report that
50:50hopefully Congress will act on.
50:52And you know,
50:52something I chime on maybe too
50:54much about is paid parental leave.
50:55So I'm coming from Europe.
50:58I think that having extended
50:59parental leave and flexible parent
51:01parental leave might also be one
51:03thing that we could do as a society
51:06that would support Wellness.
51:07That's
51:09a very good point.
51:10I want to just be sure to emphasize
51:13and again anyone comment that
51:16we talk a lot about children and
51:18children's development and how we
51:20support children's development and
51:22and we do that through education.
51:23We do that through a whole range of means,
51:25but but what we're actually
51:27talking about is that adults,
51:29when they become parents,
51:31are also developing.
51:32They're changing in their brain level.
51:34They're changing and obviously what's
51:37important and what they need to do.
51:39And so we need also to think about
51:42how we support adult development
51:44in this critical life period.
51:46Anyone want to add to that?
51:49I think I would just
51:50add having that as a discussion point in
51:52and of itself is really important too.
51:53Because I think when we talk about
51:55development, we think about it
51:57stopping when you become an adult.
51:58But it's where we have to think about
52:00the baby or the child or the adolescent.
52:02And you know, it stops when you're
52:04in your 20s and the reality of
52:06it is that that's not the case.
52:07And we're increasingly seeing that.
52:09Your transition to parenthood I think
52:10is a great example of a period of
52:12neurodevelopment that's still, you know,
52:13that happens later on in adulthood.
52:15I think we're going to learn about
52:16other periods of development that
52:17are going to that are happening too
52:19that we've we've not necessarily
52:21taken seriously before either.
52:22So I think there needs to be a fundamental
52:24conversation about the transition to
52:25parenthood as a developmental period in
52:27its own right and what the demands and
52:29challenges are of that that we need.
52:30I think that there needs to be a movement
52:32away from the romanticization of becoming
52:34a parent that you got that there is some,
52:37you know, there is some joy
52:38and there's some excitement,
52:39happiness there,
52:39but it's also incredibly stressful
52:41independent of mental health symptoms.
52:43So I think normalizing that conversation
52:45is, is incredibly important as well.
52:46And go ahead, go ahead. I could
52:51just add what what also
52:53we need to advocate for,
52:55continue to advocate for and
52:57connect I think to is continue
52:59to build an educated workforce.
53:01So making sure that there's support and
53:04Congressional support for programming.
53:06That's about the continued research
53:08and development of models and
53:10adapting them for new communities,
53:12different communities,
53:13including not only sort of more
53:15Western focus, but indigenous
53:17communities and around the world,
53:18both in our country and around the world.
53:20And then also really, you know,
53:22making sure that there's ways to support
53:24the infrastructure for dissemination
53:26so that therapists can gain access
53:27to these very effective treatments
53:29so that the communities and families
53:31can gain access to them as well.
53:34No, thank you, Kerry. That's a very,
53:35very important point. Let me just,
53:39we have just a few minutes left.
53:41Any closing comments from
53:43any one of my colleagues
53:48or from the audience?
53:49We'd love to hear any more
53:50questions that you might have.
53:54I might just say that for
53:56the work that I presented,
53:58unfortunately,
53:58I did what a lot of us do in science.
54:00I framed it in the negative.
54:01There's almost crisis framing of
54:03there's increased risk and there's
54:04adverse mental health outcomes.
54:06But perhaps we can reframe
54:07that and think about how we
54:09can promote pregnancy health,
54:10promote Wellness during pregnancy.
54:12We can actually stand to reduce
54:14risk and improve Wellness for both
54:16mothers and children and their
54:18families And trying to end on an
54:21optimistic node Norm can do I think
54:23is a is a key important message
54:25And I think promoting promoting parental
54:27health like throughout their children's
54:29lives, this was just mentioned.
54:30It's like we do focus a lot on and it's
54:33a very important period the transition
54:34to parenthood and parents are often
54:36more open to intervention at that time.
54:38But you know if anybody had told me
54:39how stressful it was going to be to
54:41have adolescence or to launch children,
54:43I, you know, it's like where's
54:45the support group for that, right.
54:46So just you know recommend that you know
54:48that the health and Wellness throughout
54:50your life as a parent is going to
54:52kind of benefit your your children.
54:54Thank you both. I think one of the
54:56things we tried to emphasize about
54:58what we do in the Child Study Center
55:00is yes we do provide care for when
55:03families and children are in need,
55:06but our all complete goal is
55:08to help children flourish and
55:11reach their fullest potential.
55:13So we're always looking for ways to optimize
55:15all children and families development.
55:20So thanks everybody.
55:21Thanks so much for joining.
55:23We really appreciate all of you coming
55:25online and on this beautiful day.
55:27And we have one more in the
55:29series for next week and look
55:31forward to seeing you then.
55:33Thanks so much.