Child Mental Health Series - Episode 3

Transcript

• 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&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&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.