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INFORMATION FOR

CSC Associates Week 2021

November 09, 2021

CSC Associates Week 2021

 .
  • 00:00So welcome everyone.
  • 00:03Mom, thank you for coming.
  • 00:04We'll get started.
  • 00:05For those of you who are new to our
  • 00:08annual associates event I'm Linda Mays
  • 00:11and director of the Child Study Center.
  • 00:13And for those of you who have joined
  • 00:15us yearly with this coming together,
  • 00:17welcome back.
  • 00:18We're really looking forward to the time
  • 00:20when we can greet you again in person,
  • 00:22but but it's just very nice to have
  • 00:25this way of getting back together.
  • 00:27I'll begin with just a
  • 00:29few introductory remarks,
  • 00:30and then we'll go right into the program.
  • 00:33Here we are.
  • 00:35We are 603 days since the beginning
  • 00:38of our pandemic journey and are
  • 00:41rapidly adapting to this forever.
  • 00:44It seems like really,
  • 00:46truly forever changing and changed world.
  • 00:50We're all very grateful for all of
  • 00:52your continued support of the center.
  • 00:53You're staying with us.
  • 00:55You're continuing to give us your ideas,
  • 00:57your encouragement,
  • 00:58and your financial support.
  • 01:01We are actually are coming
  • 01:02back and coming back.
  • 01:03By that I mean in person we now have
  • 01:07over 250 families who are receiving
  • 01:10services daily in person and we're
  • 01:12continuing though to also see almost
  • 01:15half of the families via Tele health.
  • 01:18Our research programs are back.
  • 01:19Our fellows are in person and then,
  • 01:22like every other service in the country,
  • 01:25we are experiencing a dramatic
  • 01:27behavioral health surge.
  • 01:29With doubling in many ways
  • 01:30and doubling in many places,
  • 01:32the number of our referrals.
  • 01:34Children with behavioral health needs
  • 01:36are struggling and they're needing
  • 01:38longer and more intense services.
  • 01:40It is truly a moment not only in
  • 01:43the Child Study Center's history,
  • 01:44but in the history for our country.
  • 01:46For child behavioral health.
  • 01:48And that will be a theme that you will
  • 01:51continue to hear throughout this afternoon.
  • 01:54For the afternoon we put together a
  • 01:56series of short presentations tastings.
  • 01:59We might call them to give you a
  • 02:01range and breadth of our research,
  • 02:03our clinical services,
  • 02:04and the different developmental
  • 02:06pathways of our faculty and fellows
  • 02:09that reflect our commitment to education
  • 02:11and mentoring across the lifespan.
  • 02:14You are going to hear examples
  • 02:16of our research that begins with
  • 02:17work based in our patients stories
  • 02:19and goes to clinical trials,
  • 02:21addresses the impact of new treatments.
  • 02:24Studies using zebrafish to model
  • 02:26key genetic mutations related
  • 02:28to developmental disorders.
  • 02:31Developing pluripotent stem cells
  • 02:32to create brain organoids and model
  • 02:35disruptions in brain development in
  • 02:37childhood. Psychiatric disorders.
  • 02:39The range of research is just
  • 02:41remarkable here in the center
  • 02:43and in these short presentations.
  • 02:45We really hope you get a sense of
  • 02:48not only that breath but also the
  • 02:50excitement for all of us as we work together.
  • 02:53We're also going to highlight in
  • 02:55greater depth than in we've had
  • 02:57done in the past.
  • 02:58Our clinical programs and the
  • 03:00dedication of our clinicians
  • 03:02seeing more and more children.
  • 03:04As I mentioned,
  • 03:05who need more and more services?
  • 03:07And now that our cutting edge treatments
  • 03:11actually reached now over 3000 families
  • 03:13annually and that number is growing.
  • 03:16And then you'll hear stories
  • 03:18from our faculty and fellows
  • 03:20about how they develop their
  • 03:21careers at the CHILD Study Center.
  • 03:23And our commitment to mentorship
  • 03:26and to helping every individual
  • 03:28find the path where they can excel.
  • 03:32So before turning over to our team and it's
  • 03:34really the team that I want you to hear from.
  • 03:37I want to encourage you to listen
  • 03:38for four themes that are going to
  • 03:41cut across each of these sessions.
  • 03:42Each of these three blocks of presentations.
  • 03:46First, patients are at the
  • 03:48center of our work.
  • 03:50Each of our researchers,
  • 03:52the clinicians,
  • 03:52the developmental stories that we they
  • 03:55have for improving care for children,
  • 03:57is that really at the core.
  • 03:59It's what brings meaning and
  • 04:01purpose to all of our work.
  • 04:04Whether it's in the lab and the clinic,
  • 04:06the community we are guided
  • 04:08by what families need.
  • 04:10And those needs have never been
  • 04:13greater with this pandemic.
  • 04:14Second is we're committed
  • 04:16to education and training.
  • 04:17We listen for how often I ask
  • 04:19you to listen for how often
  • 04:21we involve medical students.
  • 04:23Undergraduates in our work.
  • 04:24How often are fellows and faculties
  • 04:27found their path into this work in their
  • 04:30undergraduate or medical school years?
  • 04:33And actually, how often
  • 04:34we think about clinical work as
  • 04:37passing along skills and knowledge
  • 04:39to families to help them continue
  • 04:42their journey with their children.
  • 04:45The Third Point is we actually
  • 04:46strive for a virtuous cycle,
  • 04:48and what I mean by a virtuous cycle
  • 04:50is bringing our discoveries in the lab
  • 04:52and in the research into the clinic,
  • 04:55and vice versa.
  • 04:56Having the clinic in for my research.
  • 05:00It it's it's often really
  • 05:02challenging to translate across
  • 05:03research in clinical practice.
  • 05:05It requires a lot of work about different
  • 05:08domains of discourse and talking,
  • 05:10but we are extraordinarily committed
  • 05:12to this constant translation,
  • 05:14and we're trying regularly
  • 05:16to make that happen.
  • 05:19And 4th the 4th theme to listen for.
  • 05:23Is it that if patients are
  • 05:25at the center of our work,
  • 05:27everyone that you will hear
  • 05:30also regularly evidences?
  • 05:32Their humanity and how they
  • 05:34treat their teams,
  • 05:36how they ask their questions and how
  • 05:39they live and practice by their values.
  • 05:42This pandemic has been a time of
  • 05:44remarkable change for so many,
  • 05:46but it is also been a time that has
  • 05:49brought brought both brought forth.
  • 05:52The values that we all want to live by
  • 05:54and tested those values as resources
  • 05:57have become restricted in many ways.
  • 05:59People have become very stressed.
  • 06:02But I actually couldn't be
  • 06:04prouder of all of our community,
  • 06:06not just the people you were here from today.
  • 06:09But if everyone in our community,
  • 06:11the courage that everyone
  • 06:13has shown in this pandemic.
  • 06:15Their willing willingness
  • 06:16to go the extra mile.
  • 06:19To help each other and to help
  • 06:21so many families and the pride
  • 06:23they take in discovery and care.
  • 06:25Which is why we actually we
  • 06:27actually have as our tagline.
  • 06:29For the Child Study Center
  • 06:31where Discovery inspires care.
  • 06:33I'm really honored to present
  • 06:35them to you today,
  • 06:37and I'm honored to be a
  • 06:39part of this community,
  • 06:40and especially after many
  • 06:42years in this community,
  • 06:43but especially in these last 603 days.
  • 06:47And I hope that as you listen that you'll
  • 06:50be as inspired as I am on every day.
  • 06:54One other point,
  • 06:55before I turn it over to my colleagues
  • 06:57to encourage you to explore,
  • 06:59we've put some additional short talks
  • 07:01and posters online for you to view.
  • 07:03As you know,
  • 07:04if you've come to these events before,
  • 07:06we always have much more to say than we
  • 07:09can ever possibly say in the time we have,
  • 07:12and so we are putting more
  • 07:14online for you to look at.
  • 07:16And as you have time,
  • 07:17we hope that you might continue
  • 07:20to the continue the intellectual
  • 07:22feast and the caring feast.
  • 07:24That we're presenting to you in these
  • 07:27next in these next hours together.
  • 07:29Let us know what you think when
  • 07:31you look online and will also
  • 07:33hope that you'll send us questions
  • 07:36and then just one very pragmatic
  • 07:38issue is that as we as we present,
  • 07:40we're going to encourage questions
  • 07:43after in the research section
  • 07:45after each presentation.
  • 07:46And in the clinical and education sections,
  • 07:48at the end of all the presentations.
  • 07:51And you can put these questions
  • 07:52in the chat or you can raise
  • 07:54your virtual hand or something.
  • 07:56We've all gotten very used to on zoom
  • 07:58and we will be sure to either read your
  • 08:01question from the chat or call on you.
  • 08:04So let's start. Let's start the.
  • 08:07Formal program so we don't waste another
  • 08:09minute and let me turn to my colleague Dr.
  • 08:12Undress Martin to get us started undress.
  • 08:16Thank you Linda.
  • 08:26So, uh, good afternoon everyone,
  • 08:30I'm delighted to be here and to kick us off.
  • 08:33I'm doctor Andreas Martin and I'm honored
  • 08:36to be the revival revoked professor at
  • 08:39the Child Study Center and you will be
  • 08:43hearing today a lot of quality research,
  • 08:47a lot of quality research,
  • 08:49but probably I'm going to be the only
  • 08:52person talking about qualitative research.
  • 08:54For those of you who don't know what
  • 08:57qualitative research is, let me explain.
  • 09:00This is a very serious scientist
  • 09:02looking at brain pictures or
  • 09:05organoids or something very serious.
  • 09:07Probably something having to do
  • 09:09with patients, maybe brain images.
  • 09:11The problem with this approach is that over
  • 09:14the years we've thrown to the cutting floor.
  • 09:17Some of the best footage we've been so
  • 09:20interested in getting this one that we've
  • 09:22thrown away some of the best footage,
  • 09:24and by the best footage,
  • 09:26I'm referring to the histories,
  • 09:28the stories, the personal,
  • 09:30the individual granularity behind
  • 09:33each person in qualitative methods
  • 09:36is all about leveraging that.
  • 09:39Einstein said not everything that
  • 09:41can be counted counts and not
  • 09:43everything that counts can be counted,
  • 09:45and that is very true for
  • 09:48qualitative studies.
  • 09:49I'm going to give you 2 examples
  • 09:51of the qualitative research that
  • 09:53I've been involved in,
  • 09:54and both of these projects are,
  • 09:56I would say, not just important,
  • 09:58but they are existential E important.
  • 10:01They deal with existential issues and
  • 10:04I don't say this in a theoretical way.
  • 10:06The first one is of course,
  • 10:08the pandemic.
  • 10:10This is the first of two papers
  • 10:12pivoting in the pandemic in which
  • 10:13we talked to some 40 child and
  • 10:16adolescent psychiatrists across EU.
  • 10:18S. Learning what they had to say.
  • 10:21I underlined the name of Mattie
  • 10:23Digiovanni because she is a medical
  • 10:25student who took the lead and was the
  • 10:27first author on this paper that was
  • 10:29recently published and to give you a
  • 10:31flavor of what I refer to buy personal
  • 10:34histories and leveraging the personal,
  • 10:36I'm going to share the voice
  • 10:37of one of our participants.
  • 10:40Now,
  • 10:40to protect confidentiality,
  • 10:42it won't be the participant herself,
  • 10:44but rather a voice actor with a very
  • 10:47beautiful and mellifluous voice talking
  • 10:50about what we've all experienced.
  • 10:52This movie like Quality Bear in
  • 10:54mind that this study was done
  • 10:56in month one of the pandemic.
  • 10:58That's when we collected these data.
  • 11:02I was having an intake with patient and
  • 11:05then the mother and then the father came.
  • 11:08Then the grandparents sat here like this.
  • 11:10I think they were watching a movie.
  • 11:12This is not a movie The grandparents were
  • 11:15mostly there and saying yes that's true.
  • 11:17That's true. She does that a lot but
  • 11:20it was like they were watching a movie.
  • 11:23Indeed, we have all been
  • 11:26watching a movie of sorts.
  • 11:28This second pandemic related
  • 11:30paper viral time capsule.
  • 11:32What we did is exactly that.
  • 11:34Trying to do a capsule of what these strange,
  • 11:37strange times are all about.
  • 11:39Once I get we did it very early in the
  • 11:41pandemic and the methodology was very simple.
  • 11:44I should note again that the two
  • 11:46underlying names are Yale medical students.
  • 11:49Paper is very simple.
  • 11:50Do you have an iPhone or some other device?
  • 11:53Yes, everybody does in the planet.
  • 11:56Gives it have a camera. Yes it does.
  • 11:58Does it have a voice recorder?
  • 12:01Does it have a voice recorder?
  • 12:02And yes, it does well.
  • 12:04Take pictures and tell us your thoughts.
  • 12:06And what we did is that we collected.
  • 12:09Data, photographs and commentaries
  • 12:12from 134 submissions.
  • 12:13Individual submissions,
  • 12:14some of them with 20 and 30
  • 12:17photographs hailing from 54 countries.
  • 12:20And I'm going to give you just two
  • 12:22examples out of the menu that we received.
  • 12:25This one about disruption to daily routines.
  • 12:29We don't need to add much what has
  • 12:31happened to our kids and what will
  • 12:34be the impact of being out of school
  • 12:36behind this black wall for so long.
  • 12:39Or this other image coming from another
  • 12:40part of the world in northeastern India
  • 12:42as they dealt not just with a pandemic,
  • 12:44but also with record flooding.
  • 12:46And here they are doing the best of
  • 12:48child mental health, delivering food,
  • 12:51delivering mosquito Nets,
  • 12:53and being where the action is
  • 12:56in a selfless way.
  • 12:58The second study is of a
  • 13:01different existential nature.
  • 13:03Ecological awareness and how can we
  • 13:06move children from anxiety into action?
  • 13:09Isaiah Thomas,
  • 13:10another medical student,
  • 13:12is a key author here.
  • 13:14And what we did is analyzed newspapers.
  • 13:17The six top U S newspapers and use a
  • 13:21method of qualitative research called
  • 13:23discourse analysis and what we saw
  • 13:25is that over the past decade or so,
  • 13:27citations in the newspapers about
  • 13:30ecological issues involving children
  • 13:32have quickly gone up and the two
  • 13:35big peaks that you see there are
  • 13:37what I call the TT.
  • 13:39The first one is Greta Thunberg,
  • 13:42the child advocate for.
  • 13:45Environmental awareness and the second one.
  • 13:48Is the election of President Biden
  • 13:50after what was a very contentious?
  • 13:53Election having where there was a
  • 13:55lot of talk about the environment.
  • 13:58What we came up with is this
  • 14:00categorization of children viewed
  • 14:02in one of four ways as fierce young
  • 14:04activists as innocent victims as adult.
  • 14:07If I children bearing the responsibility,
  • 14:10perhaps a responsibility of being
  • 14:12our ultimate saviors.
  • 14:14Where next going to take this work
  • 14:16that we did in the newspapers to
  • 14:18do interviews of actual children?
  • 14:20We have started doing that in
  • 14:22the US and will be starting soon
  • 14:23in Brazil and in France,
  • 14:25and we're doing this in collaboration
  • 14:26with my good colleague Lillian.
  • 14:28Want a child psychiatrist but
  • 14:30with background in sociology.
  • 14:31Who's spending a year with us on a Fulbright.
  • 14:35And helping us learn how to
  • 14:37turn eco anxiety into
  • 14:39Eco aware action in this partnership
  • 14:42between Lilia and France and US,
  • 14:44is the newly developed Qual app.
  • 14:47The qualitative and mixed Methods lab,
  • 14:49which is our partnership with the
  • 14:52National Institute of Health in Paris.
  • 14:54And with that I will end messy beaucoup,
  • 14:56and I want to thank all of the
  • 14:58associates of the CHILD Study Center
  • 15:00for their support of the years,
  • 15:02and very particularly to the
  • 15:04Allenby Slifka Foundation.
  • 15:05And its leader,
  • 15:07the incomparable Reva Ariella Ritvo.
  • 15:11And again,
  • 15:11I am honored and delighted to be the
  • 15:14holder of the Reva Ariella Ritvo chair.
  • 15:16Thank you for your attention.
  • 15:19Thank you very much hundreds.
  • 15:20We have a moment for any questions
  • 15:23either in the chat or as we said,
  • 15:26raise your virtual hand.
  • 15:34These are existentially scary moments.
  • 15:36Maybe that's what's happening.
  • 15:40We will also have time as we go through
  • 15:42there as people start reflecting as well.
  • 15:45So may I call on Ellen Dr Ellen Hoffman.
  • 15:51Yes.
  • 15:57Hello everyone I'm Ellen Hoffman.
  • 15:59I'm an assistant professor
  • 16:00at the Child Study Center.
  • 16:01It's great to have the opportunity
  • 16:03to talk to you about the research
  • 16:06that my lab is doing an autism
  • 16:09risk gene function in particular.
  • 16:11We aimed to harness the power of
  • 16:14model systems to understand more about
  • 16:17the function of autism risk genes.
  • 16:19This is work that we've been
  • 16:22developing at the CHILD Study
  • 16:24Center so as some of you may know,
  • 16:26the largest.
  • 16:27Genetic sequencing study in autism
  • 16:30led to the identification.
  • 16:33Of over 100 genes that are strongly
  • 16:36associated with autism.
  • 16:38This is a study that involves sequencing
  • 16:40over 12,000 individuals with autism
  • 16:43and led to the identification of
  • 16:45102 genes that we consider high
  • 16:48confidence autism risk genes,
  • 16:49each of which is represented here
  • 16:51as an individual point and how
  • 16:53high up they are on this particular
  • 16:56graph represents the strength of
  • 16:58their association with autism.
  • 17:00Now, despite this progress,
  • 17:01one of the challenges that we face.
  • 17:03Is how do we advance from the
  • 17:05identification of this growing
  • 17:07number of autism risk genes towards
  • 17:09gaining an actionable understanding
  • 17:11of the biology of autism?
  • 17:13And this challenge is represented
  • 17:15by this figure where you can see
  • 17:16that even if we identify one gene
  • 17:18that's associated with autism,
  • 17:20this can lead to the disruption
  • 17:22of multiple different proteins.
  • 17:24Multiple different cells,
  • 17:25circuits and behaviors.
  • 17:27And the challenge is how can we begin
  • 17:30to identify points of convergence
  • 17:32or points of vulnerability?
  • 17:33Across these different cells
  • 17:35and circuits and behaviors that
  • 17:37might represent entry points for
  • 17:39identifying new pharmacological
  • 17:41candidates and new interventions.
  • 17:44And so in my lab we use this model system.
  • 17:46The zebrafish to answer these
  • 17:48questions and our goal is not
  • 17:51to recapitulate in zebrafish.
  • 17:53The clinical features of autism,
  • 17:55but rather we can leverage key advantages
  • 17:58of this system to begin to identify.
  • 18:02Uhm, points of convergence
  • 18:04across autism risk genes.
  • 18:06So,
  • 18:06for example,
  • 18:07first zebrafish are easy
  • 18:08to manipulate genetically,
  • 18:10so it's possible using these new
  • 18:13molecular scissors called CRISPR
  • 18:15that we can inject into zebrafish
  • 18:16embryos at the one cell stage
  • 18:19to actually generate zebrafish
  • 18:21mutants in different autism
  • 18:23risk genes relatively rapidly.
  • 18:25Second zebrafish have rapid
  • 18:28external development,
  • 18:29So what you're looking at here
  • 18:31is the 1st 24 hours.
  • 18:32Of zebrafish development occurring
  • 18:34in a Petri dish.
  • 18:36And because zebrafish have
  • 18:37fully transparent embryos,
  • 18:39we can visualize basic processes
  • 18:41of neural development in real time
  • 18:43and ask how these change when a
  • 18:45gene that's associated with autism
  • 18:48is not functioning properly.
  • 18:50And finally,
  • 18:50zebrafish are highly tractable in the lab,
  • 18:53and they have very simple behaviors,
  • 18:56so it's possible to pipette individual
  • 18:58larvae into the wells of a 96 well
  • 19:00plate and track different aspects
  • 19:02of their locomotor activity.
  • 19:04For example,
  • 19:05what you're looking at here is
  • 19:06a zebrafish larva undergoing a
  • 19:09visual startle response,
  • 19:10and we can quantify this response
  • 19:12and ask how it changes in response to
  • 19:15exposure to different psychoactive compounds.
  • 19:18And we can use these
  • 19:19behaviors. As a readout of how genes that
  • 19:22are associated with autism might affect
  • 19:24basic sensory processing and arousal,
  • 19:27circuits which have translational relevance,
  • 19:30and so, in my lab, we developed and
  • 19:32are currently implementing a pipeline
  • 19:34where we generate zebrafish mutants
  • 19:36in multiple different autism risk
  • 19:38genes and then ask how the loss
  • 19:40of function of these genes effects
  • 19:42basic processes of brain development,
  • 19:45and then we perform large
  • 19:47scale pharmacological behavior.
  • 19:49Based screens to identify potential
  • 19:51drug candidates that we can translate,
  • 19:55possibly to the mailing systems.
  • 20:00And thus far we have completed a screen
  • 20:02of over 500 different FDA approved
  • 20:04compounds and observed a readout of how
  • 20:07these compounds affect basic sensory
  • 20:10processing behaviors in zebrafish.
  • 20:12And we're now leveraging this database
  • 20:14to identify potential drug candidates,
  • 20:17and I'll just highlight two of
  • 20:19our recently published works.
  • 20:21This was written by.
  • 20:22This is work that was spearheaded
  • 20:24by a Yale undergraduate,
  • 20:26has worked in my work in my lab,
  • 20:27Kristen Enriques, where we begin.
  • 20:29To talk about potential convergent
  • 20:31pathways downstream of autism risk genes,
  • 20:33so we know that autism risk genes
  • 20:36converge on gene expression regulation,
  • 20:38synaptic function,
  • 20:39and excited to inhibitory imbalance.
  • 20:41Interestingly,
  • 20:42in one of our studies in zebrafish,
  • 20:44we found that drugs with estrogenic
  • 20:46activity can actually rescue or reverse
  • 20:49an abnormal behavior associated
  • 20:50with one particular autism risk
  • 20:52gene contact necessary protein.
  • 20:54Two and in this paper we highlight how
  • 20:56some of the pathways downstream of estrogens.
  • 20:59Actually overlap with pathways that
  • 21:02are also implicated downstream of
  • 21:04autism risk genes representing
  • 21:06a potential point of convergence
  • 21:09for further investigation.
  • 21:10Second,
  • 21:11in a recent paper on which was written by
  • 21:14a graduate student in a course in my lab,
  • 21:16we collaborated with a lab at
  • 21:18the Department of Neurosurgery,
  • 21:19studying genes associated with
  • 21:22congenital hydrocephalus,
  • 21:23and interestingly,
  • 21:23we found that there's an overlap
  • 21:25in genes that are associated with
  • 21:27autism and congenital hydrocephalus,
  • 21:29suggesting that these might also
  • 21:31represent a convergent biological
  • 21:33pathways and represent our potential
  • 21:37pharmacological pathways for
  • 21:39clinical translation.
  • 21:41And finally,
  • 21:42we're implementing whole brain
  • 21:44activity mapping in zebrafish mutants,
  • 21:46in collaboration with the Department
  • 21:47of Radiology here at Yale so that
  • 21:49we can begin to identify how genes
  • 21:52associated with autism might alter
  • 21:55baseline brain activity in a very
  • 21:57simple developing vertebrate brain.
  • 21:59And what you're seeing here are
  • 22:01changes in baseline brain activity
  • 22:03differences in baseline brain
  • 22:06activity in zebrafish mutant.
  • 22:08Lacking the function of a gene
  • 22:09that's associated with both.
  • 22:11Autism and epilepsy,
  • 22:12and we're currently doing in vivo live
  • 22:14imaging to begin to understand how
  • 22:17loss of functionality is different.
  • 22:19Genes alters basic circuit function
  • 22:22and I just want to highlight
  • 22:24acknowledge the members of my lab.
  • 22:25We've been involved in this work,
  • 22:27our collaborators, and of course,
  • 22:30thank you for your support and
  • 22:31thank the CHILD Study Center
  • 22:33for the support of this research
  • 22:35and I'm happy to answer any questions.
  • 22:37Thank you, do we have we have time
  • 22:39for our question from the audience?
  • 22:51OK, thank you. May I ask
  • 22:54Chirac to come forward?
  • 23:11Having technical difficulties, shrimp.
  • 23:18Strawberry there.
  • 23:27Alright, so so why don't we?
  • 23:30Why don't we move in the scramble?
  • 23:32Come back in a one link can you
  • 23:35come forward? Yeah yeah thank you.
  • 23:45Can you see my screen?
  • 23:48Yes, we can great.
  • 23:52Hi, my name is Wan Ling Ling.
  • 23:54I'm an assistant professor at the
  • 23:56Yale Child Study Center in Danville,
  • 23:58so the Pi at the Yale Child
  • 24:00Study Center effective Youth Lab,
  • 24:02the Yale app and in my lab we study,
  • 24:05irritability, brain and development
  • 24:09and these are the members of my lab.
  • 24:11And here I am.
  • 24:12The P and we also have grace.
  • 24:14Who's our lab manager and nelia,
  • 24:17who's a visiting PhD student
  • 24:20from Belgium and clear.
  • 24:21Who's a masters student from the
  • 24:24Yale UCL program and we have Vivian,
  • 24:27Sophia, Christina, Michelle,
  • 24:29Amanda and Eve were the undergraduate
  • 24:32students actively helping out in
  • 24:35various research tasks in my lab.
  • 24:37And we also have some group lab
  • 24:40photos lab photos pre covered
  • 24:43and also in the COVID era.
  • 24:49So in my lab,
  • 24:50our research, our research
  • 24:52can be broadly divided into 3 domains,
  • 24:55so the first area is to use longitudinal
  • 24:58study to study to look at their
  • 25:01developmental trajectories of your
  • 25:03debility and related constructs
  • 25:05such as anger and aggression,
  • 25:08and the second area is to better
  • 25:11understand the neural mechanisms of
  • 25:13pure ability and core covering symptoms
  • 25:16such as ADHD in anxiety. Using F MRI.
  • 25:20And the third one is to study
  • 25:23environmental exposures including pollutants,
  • 25:26chemicals and crime rate and their impact
  • 25:28on brain development and childhood,
  • 25:31emotional and behavioral problems.
  • 25:34So the goal of this research is to
  • 25:37leverage information from multiple levels,
  • 25:39including the brain behaviors,
  • 25:42social experience,
  • 25:43and environmental factors to better inform
  • 25:46prevention and treatment of your ability.
  • 25:50So why do I care about your disability
  • 25:52and related constructs such as anger
  • 25:55and aggression and why is it important?
  • 25:58It is important because it's common.
  • 26:00It affects about 3 to 5% of youth and
  • 26:03it is one of the most common reason
  • 26:05why kids were referred to the clinic.
  • 26:09And it is trans
  • 26:10diagnostic, meaning that it's
  • 26:12present in many pediatric disorders,
  • 26:14including ADHD, anxiety,
  • 26:17depression and autism.
  • 26:20And it is impairing many
  • 26:23highly irritable kids.
  • 26:24They have high rates of school
  • 26:28suspension hospitalization service
  • 26:29use and are more likely to be
  • 26:33on psychotropic medication.
  • 26:37And research has ocean shown that
  • 26:39early childhood irritability is
  • 26:41a strong predictor for later poor
  • 26:44outcomes in adolescence and adulthood,
  • 26:47and this includes high rates
  • 26:49of anxiety and depression,
  • 26:51high suicidality and low income,
  • 26:55and low educational attainment.
  • 26:58So in my lab we use fMRI to be able to look
  • 27:01at brain function and bring connectivity,
  • 27:05and along with the use of
  • 27:07clinical and behavioral measure,
  • 27:09we aim to better understand the
  • 27:11neural mechanism of your ability.
  • 27:13So the motivation behind this
  • 27:15line lab research is that there
  • 27:18is currently lack of evidence
  • 27:20based treatment for irritability,
  • 27:22so we hope that one day the knowledge
  • 27:25generated in the lab can be used.
  • 27:28In the future to guide the
  • 27:30development of Evidencebased targeted
  • 27:32treatment for irritability.
  • 27:36So this is just to give you an example
  • 27:38of one of the one of the studies that
  • 27:41we recently completed in 195 kids
  • 27:44ages 8 to 18 who completed a task and
  • 27:48that's designed to frustrate them.
  • 27:51So then we can observe the newer
  • 27:53responses associated with irritability.
  • 27:56So what we found is that.
  • 28:00Kids, uh,
  • 28:00the more irritable the travel is
  • 28:03is reported by parents and both
  • 28:06the child themselves,
  • 28:07the more activation they have
  • 28:10in the prefrontal cortex region,
  • 28:13such as this one, the singulate gyrus,
  • 28:16which is very important for emotion
  • 28:19regulation and attention control,
  • 28:22and this effect is particularly
  • 28:25strong in kids who have high
  • 28:28irritability and and young.
  • 28:30Age and so we think that this
  • 28:33increased as increased activity
  • 28:36associated with irritability
  • 28:38potentially reflect a compensatory
  • 28:40mechanism whereby irritable kids
  • 28:43when they're frustrated they need
  • 28:45to recruit this Pfc region more
  • 28:48and work harder in order to better
  • 28:51regulate their frustration and to be
  • 28:54able to focus on the task at hand.
  • 28:56And
  • 28:56we're taking this research
  • 28:58further by using the brain data
  • 29:01during appreciation task to
  • 29:04predict longitudinal developmental
  • 29:06cores of your ability,
  • 29:08and we're hoping to identify brain
  • 29:13signature that particularly help predict
  • 29:17high and persistent irritability.
  • 29:20Overtime, because this is the
  • 29:22group that's most at risk for
  • 29:24later anxiety and depression.
  • 29:26And suicidality.
  • 29:29So with that I would like to thank my
  • 29:32amazing colleagues and collaborators,
  • 29:34trainees and students.
  • 29:36Without them, this work would
  • 29:39not be possible and also thank
  • 29:40you for your
  • 29:41support for our
  • 29:42research at the CHILD Study Center.
  • 29:46Thank you honey. We're open, the virtual
  • 29:51floor is open again for questions.
  • 29:57And once again in the question
  • 29:59please. Thank you. Yes it's
  • 30:02a very interesting presentation. Thank you.
  • 30:07I wanted to know the brain
  • 30:09signature that you're looking for.
  • 30:11Would this then later on possibly
  • 30:13or hopefully serve as a target
  • 30:16for medication to to change this
  • 30:19pattern of irritability and prevent
  • 30:21the later consequences? Exactly
  • 30:24that's the rationale and
  • 30:26motivation behind this study is
  • 30:28to identify the neuro target.
  • 30:31Yeah, for future treatment.
  • 30:33Excellent thank you for your question.
  • 30:38Any other questions?
  • 30:47OK. So sure, and I believe I understand
  • 30:51that your computer is back alive.
  • 31:00Hello, I'm sorry about that technical glitch.
  • 31:04Good afternoon esteemed
  • 31:06guests and your colleagues.
  • 31:09My name is sheriff sharing law.
  • 31:10I'm a fourth year resident in psychiatry
  • 31:13here at here and I'm also a hilibrand
  • 31:16autism research fellow in the mug
  • 31:19pattern lab where we study brain
  • 31:21mechanisms in social neuroscience.
  • 31:23I'm here to talk about a project
  • 31:26we're planning on neuromodulation
  • 31:27for depression in autism.
  • 31:30As we explore early behavioral and brain
  • 31:32effects of our brain stimulation method,
  • 31:35like transcranial magnetic stimulation.
  • 31:38In autism spectrum,
  • 31:40we know that there is a significant
  • 31:42burden of Co occurring mental
  • 31:45health conditions like depression.
  • 31:47It is estimated that nearly one out of
  • 31:49every two individuals with autism will
  • 31:52have a lifetime diagnosis of depression.
  • 31:55In a large population study out of Denmark,
  • 31:58where they looked at six and
  • 32:00a half million individuals,
  • 32:01they found that individuals with autism were
  • 32:05four times more likely to die of suicide,
  • 32:08and if you were an autistic female,
  • 32:11you had an 8 times higher
  • 32:13risk of a suicidal attempt.
  • 32:15So the question that we're all
  • 32:17immediately inclined to think
  • 32:19of is how do we prevent this?
  • 32:22In this study,
  • 32:23they also found that 90% of the cases of.
  • 32:26Suicide had an underlying mental health
  • 32:29condition like depression and so.
  • 32:31How do we treat that?
  • 32:34This blank slide kind of sums up
  • 32:36what we know about the treatment
  • 32:38of depression for individuals.
  • 32:39Autism.
  • 32:40At this point there are some studies on CBT,
  • 32:44mindfulness or handful of medication trials,
  • 32:47but we really don't have
  • 32:48a specific treatment.
  • 32:49What we do know is that there's
  • 32:52higher utilization of services.
  • 32:53People are on multiple medications,
  • 32:55intensive therapies fully tolerate their
  • 32:58medications and often don't respond,
  • 33:01making them treatment resistant.
  • 33:04This is where transcranial magnetic
  • 33:07stimulation or TMS comes in.
  • 33:09It has been an FDA approved.
  • 33:11Treatment for treatment resistant
  • 33:13depression since 2008,
  • 33:15it was first designed in 1985 and if
  • 33:18you were to look at Pub Med today,
  • 33:20you'll find close to 19,800
  • 33:23scientific articles on TMS.
  • 33:25It is effective and it is safe,
  • 33:27but how does it work?
  • 33:29Demonstrating that on this
  • 33:31silhouette of a head using principles
  • 33:34described by Michael Faraday,
  • 33:37the physicist will place a magnetic
  • 33:40coil touching the surface of your head.
  • 33:42And if you were to pass
  • 33:44electric current through that,
  • 33:45it would generate a magnetic field,
  • 33:47and that in turn would induce
  • 33:50an electric current that would
  • 33:51stimulate your brain cells.
  • 33:53In this picture on the right.
  • 33:55Cassie and Maggie are excellent neuroscience.
  • 33:58Fellows are standing next
  • 33:59to our maxdome TMS device,
  • 34:01with Cassie sitting on the chair with
  • 34:04the TMS coil placed on her head as it
  • 34:07would for a treatment participants.
  • 34:10The area of the brain that we're
  • 34:12interested in is in the front.
  • 34:13It's the dorsal lateral prefrontal
  • 34:15cortex and we believe that it is
  • 34:18responsible for mood regulation.
  • 34:20When we target this region in depression,
  • 34:22we get remission rates of around 33%,
  • 34:25which is significant if you consider
  • 34:27that these are people who failed four
  • 34:30or more antidepressant trials,
  • 34:32and for individuals who are treatment naive,
  • 34:34that number goes up to 75%,
  • 34:36which is again significant if
  • 34:38you think about groups who may
  • 34:41not be tolerating medications.
  • 34:43So to summarize our study, we are
  • 34:46applying TMS to this part of the brain.
  • 34:49And capturing changes.
  • 34:50We look at the EG. This is a video
  • 34:54of an EG recording from our lab.
  • 34:56We look at eye tracking.
  • 34:58When we study how the eyes fixate
  • 35:01on particular parts of an image,
  • 35:03we also look at behavioral measures.
  • 35:05For example,
  • 35:07participants watch videos of these two
  • 35:11triangles that seem to be interacting
  • 35:13with each other and their responses
  • 35:16would indicate their social perception,
  • 35:18and so we hope to understand what brain
  • 35:22changes occur with treatment like TMS and so.
  • 35:25Finally speaking about hope.
  • 35:28In a recent pilot trial of GMs with
  • 35:31depression and autism, they found.
  • 35:34Is 70%.
  • 35:36Response rate,
  • 35:37and we believe that as we understand
  • 35:40how to modulate changes in the brain,
  • 35:43we can design better treatments.
  • 35:46It takes we effort and tremendous
  • 35:48talent of everyone listed here and in
  • 35:51this pandemic selfie to do this work.
  • 35:53I am so grateful to Jamie for
  • 35:55being my mentor and friend.
  • 35:57We are grateful to the Slifka
  • 35:59Foundation for helping us get started
  • 36:01and the Hilibrand Foundation.
  • 36:02Your support really lets me do
  • 36:03this work and I'm so thankful.
  • 36:05I hope I've been able to convey to you.
  • 36:07The timely need for this kind of
  • 36:09research and I thank you all for your
  • 36:12time and your continued partnership.
  • 36:13Thank you.
  • 36:16It's so much fun, so let's let's
  • 36:19open the floor for questions.
  • 36:22Questions, comments.
  • 36:25I have a question, yes, so your work showed
  • 36:31that using this type of magnet
  • 36:33was helpful with the depression.
  • 36:35Did it have any effect on the autism?
  • 36:38Or like you know,
  • 36:40in any adaptive behavior score
  • 36:41or something like that?
  • 36:44That that's such a great question.
  • 36:45I think that really fuels
  • 36:47the work that we're doing.
  • 36:48I think the consensus right now is that we
  • 36:51need more data and better design studies.
  • 36:53For example, we're collaborating
  • 36:55with the group in Australia,
  • 36:56Identicard Group,
  • 36:57where they're looking at specifically
  • 36:59targeting a different part of the brain,
  • 37:01not the front, but the temporal
  • 37:03parietal junction to see if there are
  • 37:06actual changes in the autism symptoms
  • 37:08persist within the autism symptoms.
  • 37:11Executive functioning,
  • 37:12repetitive behavior.
  • 37:13And social perception are areas
  • 37:15that are being looked at as
  • 37:17potential for being changed,
  • 37:19and we are also engaged in a study
  • 37:21where we're looking at if we can.
  • 37:23When we target a different part of the brain,
  • 37:25which is the posterior superior
  • 37:27temporal sulcus?
  • 37:28Can we, by targeting that region change,
  • 37:31social perception such that this stress
  • 37:33that some individuals face because of
  • 37:35their difficulty in social perception?
  • 37:37Maybe we can help treat
  • 37:38some of that.
  • 37:40If I can ask another question on that,
  • 37:42how often did you have to treat the
  • 37:44people or the individuals before
  • 37:46you saw positive results? Is it?
  • 37:48And is it something that you would
  • 37:50predict needs like sustained treatment?
  • 37:52Or is it something where you could
  • 37:54have whatever your course was and
  • 37:55then you didn't need to treat
  • 37:56it very often or periodically?
  • 37:59And again, so we are yet to do those
  • 38:02trials in our lab at this point.
  • 38:03But based on the work that's
  • 38:05already been done, people have
  • 38:07found initial the initial response.
  • 38:09But then around the six month mark,
  • 38:11it seems to fade away,
  • 38:13which kind of reflects the treatment
  • 38:14of depression in the community where
  • 38:16you do an acute treatment and then you
  • 38:18have some maintenance down the road,
  • 38:20and we hope that as we better design
  • 38:22trials will have clearer answers
  • 38:23as to not not just how to treat,
  • 38:26but how long to treat for.
  • 38:29We have a question in the chat
  • 38:31which is can you comment on how
  • 38:33well TMS is tolerated and people
  • 38:35with autism spectrum disorder?
  • 38:38Absolutely, and I think that that is a
  • 38:41very important question for us to consider.
  • 38:43Even as we plan our study and and
  • 38:45the trials that are going on,
  • 38:47especially if you have, for example,
  • 38:49a sensory integration difficulties.
  • 38:50That makes it that much harder.
  • 38:53I will comment those saying
  • 38:55that people do tolerate it,
  • 38:57just as in the general population,
  • 39:00and some people might have difficulties,
  • 39:02but the way it's being
  • 39:04administered right now,
  • 39:05the the dosing can also be.
  • 39:07So when you administer TMS.
  • 39:09You can also alter the dose so
  • 39:10that you don't have to give a
  • 39:12higher dose that is less tolerable.
  • 39:13You can give a low dose that's more
  • 39:15tolerable and may be as effective,
  • 39:17and so that is the way in which some
  • 39:19of these trials are being designed.
  • 39:22Cute. Additional questions may
  • 39:25I also ask
  • 39:26what age group to date you
  • 39:28personally have been working with?
  • 39:31So I worked as a neuro development
  • 39:33psychiatrist in India if I came over to EU.
  • 39:36S. To kind of do my training again and get
  • 39:38this wonderful opportunity at the CHILD
  • 39:40Study Center to do this work actively.
  • 39:42I administered TMS actively in the 18
  • 39:45to 65 age group where I I work at the
  • 39:47VA here where we we have a TMS clinic
  • 39:50and I do that kind of work and the hope
  • 39:52is then to translate this work into
  • 39:54younger populations as we find you know,
  • 39:57it being more effective in that group.
  • 39:58Yes, and
  • 39:59that's what and all of
  • 40:00these. People you've worked with our
  • 40:03with autism or in general with PMS.
  • 40:06So like I mentioned earlier,
  • 40:08a lot of times the treatment
  • 40:10resistance that we see there might
  • 40:13be an undiagnosed autistic spectrum.
  • 40:15And for example I do have one
  • 40:17individual that I'm treating right now.
  • 40:2022 year old male and he has
  • 40:22undiagnosed autism and he is
  • 40:23tolerating his treatments well
  • 40:24and starting to show improvement.
  • 40:26So that gives me hope for
  • 40:27the kind of work that
  • 40:28we're doing and what is the frequency
  • 40:31of the treatment of the sessions.
  • 40:33Initially it would be once a day for
  • 40:36five days a week for up to 20 sessions,
  • 40:39and then you start tapering it off.
  • 40:41But then there are different protocols.
  • 40:42There are absolutely accelerated
  • 40:44protocols now where you can finish
  • 40:46the entire treatment in a week.
  • 40:48And so the field is really evolving
  • 40:50and we're trying to be part of
  • 40:52that change at this moment.
  • 40:54Thank you very much. And to everyone,
  • 40:57just Jamie has put a statement in
  • 41:00the chat about a consensus statement
  • 41:02that speaks to the tolerability of
  • 41:05TMS in autism spectrum disorder.
  • 41:07So thank you Jamie for doing that.
  • 41:12So thank you, share for for
  • 41:15presenting appreciate it windy.
  • 41:17May I ask you to? Come.
  • 41:22Come virtually forward.
  • 41:50You see, do you see my screen?
  • 41:51Yeah, but you just need to go
  • 41:54to slideshow icon down below.
  • 41:56Do you see this screen icon?
  • 41:58OK, got it. Thank you.
  • 42:00Then go up there.
  • 42:02Thank you, thank you,
  • 42:03thank you very much.
  • 42:04Thank you very very much and thank
  • 42:06you all for the honor to present
  • 42:09at today's associates meeting.
  • 42:10I'm really thrilled to be here.
  • 42:13I'd like to begin by showing the
  • 42:15amazing team of that we have now
  • 42:18consisting of postdoctoral Fellows,
  • 42:20postgraduate associates,
  • 42:20and I want to give a special
  • 42:23shout out to Grace Hamill of a
  • 42:25lab manager and special thanks.
  • 42:27To Eli Lebowitz and Colin Moran,
  • 42:29who have been with me since I
  • 42:31first came to Yale in 2013.
  • 42:32I also want to thank you, the associates,
  • 42:35for you supported the CHILD Study Center.
  • 42:37And for those of you who have
  • 42:39supported the anxiety program,
  • 42:40thank you so very much.
  • 42:43This is what I'm going to be speaking about.
  • 42:46What do we know finally about enhancing
  • 42:48CBT outcomes for child anxiety?
  • 42:51And what's next?
  • 42:55Some background CBT is the
  • 42:58strongest evidence based treatment.
  • 43:01Depending on how you look at it, though,
  • 43:02the glass is either half empty or half full.
  • 43:05It's half full because in most trials
  • 43:0750 to 60% of the children respond,
  • 43:11but that means half empty.
  • 43:13Almost that many also do not respond.
  • 43:17It has been a journey for the field and
  • 43:20for myself for 30 years to figure out
  • 43:23what can we do to add parents to their
  • 43:27child's treatment to get enhanced outcome.
  • 43:30It takes.
  • 43:31I've been doing this for 30 years 'cause
  • 43:33it takes anywhere from at least five to
  • 43:35seven years to conduct one randomized trial,
  • 43:38and that doesn't include them getting it.
  • 43:40You know,
  • 43:41writing it up and publishing it,
  • 43:43so it's been a long journey.
  • 43:46And what the field has shown and these
  • 43:50are two of my trials that I've done one.
  • 43:53Looked at CBT and parents versus compared
  • 43:56to individual the other one group
  • 43:58CBT and parents compared with group.
  • 44:01We're thrilled that everybody is improving.
  • 44:04That's great.
  • 44:06However,
  • 44:06we were hoping to see if we can get
  • 44:09enhanced outcomes and this in the red
  • 44:12in the bottom is a recent meta analysis
  • 44:14that showed what we've been saying for
  • 44:17decades now that CBT in pounds does
  • 44:20not confer advantage over individual.
  • 44:23This is an enigma.
  • 44:25It's a conundrum, but when one looks
  • 44:27at these now over these 30 years,
  • 44:30the studies you will find
  • 44:31that most of these studies.
  • 44:33First of all, they're all over many
  • 44:35many different variables and mechanisms.
  • 44:37Second of all,
  • 44:38in many of these studies,
  • 44:40the mechanisms are very poorly described.
  • 44:43They're also extremely rare to
  • 44:45ever been ever been measured,
  • 44:47since somebody might be trying to
  • 44:48change something with apparent,
  • 44:49but they never measure it.
  • 44:51But besides the research, those of us.
  • 44:53You know who have parents and
  • 44:55those of us who are not parents.
  • 44:57We know it's hard to change parents behavior,
  • 45:00especially in a short amount of time,
  • 45:03especially in a very,
  • 45:05very complicated dynamic between
  • 45:07children and parents.
  • 45:08I'm sorry,
  • 45:09but the yellow gets to the heart of
  • 45:12what over these years would I have
  • 45:15distilled based on the work that in the
  • 45:18mechanisms appear to be side control,
  • 45:20reducing payment site control and reducing
  • 45:23parents use of negative reinforcement.
  • 45:26That is removing a negative event
  • 45:29and in the case of child anxiety
  • 45:32this is what that would look like.
  • 45:34Site control they act like
  • 45:36they own me at the bottom one.
  • 45:38Look at the thing of the panel
  • 45:39before this one where the child
  • 45:41is crying and upset and and then,
  • 45:43lo and behold,
  • 45:44the Charles happy because the trial
  • 45:46is now in the parents bed that has
  • 45:48will move the trials negative state.
  • 45:50These are examples.
  • 45:53We did the first and only trial.
  • 45:57That dismantled and specifically
  • 46:02concretized these parents mechanisms.
  • 46:05I want you to pay attention to the
  • 46:08red 'cause that's where we got
  • 46:10the the most important findings.
  • 46:12So we had CPT alone
  • 46:14with two different parent conditions,
  • 46:16large and single site.
  • 46:17A large sample size and we found in the
  • 46:20red when we trained very concretely to
  • 46:23reduce pain and negative reinforcement,
  • 46:25it decreased and it was
  • 46:27indeed associated with it.
  • 46:29Decrease in child anxiety outcome
  • 46:31when we targeted and we measured
  • 46:34site control it decrease and it
  • 46:36was in fact associated with a
  • 46:39reduction in child anxiety outcome.
  • 46:41Here's with findings.
  • 46:42Happy face at this paper was just published.
  • 46:45Like you know,
  • 46:46very short time ago the red colored
  • 46:48lines are showing the two payment arms.
  • 46:50The black is the individual CBT.
  • 46:53Overtime we find reductions
  • 46:55based on child ratings,
  • 46:57parent ratings,
  • 46:58other measures that I can't put up here now
  • 47:01and I'm based on child and parent reports.
  • 47:04And as I said,
  • 47:06other measures and over over follow up.
  • 47:08So what we finally know.
  • 47:11From this long journey is that if we
  • 47:13want to try to enhance child anxiety,
  • 47:16CBT try to reduce payments I control,
  • 47:19try to reduce pain and use
  • 47:21of negative reinforcement.
  • 47:22These reductions associated with
  • 47:24child anxiety outcome and they're
  • 47:26likely key parent mechanisms.
  • 47:30This is what I'm super now excited about
  • 47:33because I'm seeing the fruits of this work.
  • 47:35I believe that if we want to
  • 47:38get sustained strong effects,
  • 47:40we need something more available,
  • 47:42more ubiquitous and working on
  • 47:45a digital intervention is now
  • 47:47what I'm very excited about.
  • 47:49We're working on this and we're trying to.
  • 47:52We hope to get pulmonary data
  • 47:55to support further development.
  • 47:56Now those of you out there might
  • 47:59who use apps? You might say, oh,
  • 48:00but there must be an app for this.
  • 48:02Well, actually there was recently
  • 48:03a review published, just you know,
  • 48:05not in this in 2021.
  • 48:07Basically saying yes there were apps but.
  • 48:10None of them.
  • 48:12Most of them are assessed based.
  • 48:14There's never been one studied
  • 48:16in a randomized control trial.
  • 48:18Not one exists based on targeting
  • 48:21payment mechanisms, and even if they did,
  • 48:23they wouldn't be based on the
  • 48:24science that I've just shown you,
  • 48:26because many of these apps is
  • 48:27just developed by people who are
  • 48:29not working with scientists.
  • 48:31So imagine what can happen if
  • 48:33there is some type of ubiquitous
  • 48:35available tool for parents.
  • 48:37So I would like to just end by
  • 48:40thanking you all so much for.
  • 48:42Allowing me to have the privilege
  • 48:45and with the team to try to fill this
  • 48:48glass up with knowledge and to try
  • 48:50to help children and to try to help
  • 48:52parents of children with anxiety.
  • 48:54So thank you very much for your attention.
  • 48:56Question
  • 48:58Mrs. Reagan Hotel in Dallas.
  • 48:59When you're talking about parent control,
  • 49:04is it the child's perception
  • 49:06of parent control or what?
  • 49:07What? What are you measuring
  • 49:09when you say parent control? Yeah, so.
  • 49:12And I want to be really,
  • 49:14really clear on this.
  • 49:14And you know this is not at all.
  • 49:16But you know Pam and blame
  • 49:18or anything like that.
  • 49:19I I want to just make you,
  • 49:21you know, make that really clear.
  • 49:22But you know there there is though a
  • 49:25lot of evidence about certain behaviors
  • 49:28that parents do and and it is specific
  • 49:31to payments of anxious children.
  • 49:32I should say when people look at these
  • 49:34same pounds with other children,
  • 49:36you don't see that same behavior.
  • 49:38So that's why the business dynamic
  • 49:40between parents and their anxious child.
  • 49:42So I mean the.
  • 49:43Type of thing would be more like.
  • 49:44I'm kind of like the one
  • 49:47example was the guilt induction,
  • 49:48which is like you know what?
  • 49:50Why are you afraid you know
  • 49:51your brother can do this,
  • 49:52but you know don't be a Sissy or
  • 49:54like you know I know you know,
  • 49:55so that's that's the kind of type of thing.
  • 49:58It's so it's that kind of like as I said
  • 49:59in that slide you know that kind of guilt,
  • 50:01induction and trying to reduce that by?
  • 50:05Yeah yeah.
  • 50:06So that's what we mean by that.
  • 50:08Does that answer your question?
  • 50:09Yes,
  • 50:10kind
  • 50:10of, although I would, I would have defined
  • 50:12what you just described as negative
  • 50:14reinforcement as opposed to parent control.
  • 50:18Well, I mean we can, it's,
  • 50:19you know it's is it.
  • 50:20You know you saw that big
  • 50:22selectable dependent variable.
  • 50:23So they're all ways of measuring
  • 50:25this and operationalizing it.
  • 50:27And and I just want to say there is,
  • 50:29I'm happy to share with you.
  • 50:31There's a, you know,
  • 50:32the concept of sight control has been
  • 50:34actually in the developmental literature
  • 50:35for like half a century in fact,
  • 50:37so I didn't create that and so and
  • 50:39so it is a little bit different.
  • 50:42'cause again, the negative reinforcement is.
  • 50:44You know, if you go back
  • 50:46to the cartoon, I'm sorry.
  • 50:48Negative reinforcement is
  • 50:49rescuing or exactly thank you.
  • 50:52It's rescuing. It's a rescue.
  • 50:54Yeah, exactly exactly.
  • 50:55Negative reinforcements are very,
  • 50:57very high concept,
  • 50:58but you know the best example is when
  • 50:59you have a headache and you take,
  • 51:01and that's really distressing.
  • 51:02You take an aspirin that
  • 51:03gets Twitter the headache.
  • 51:05That's why we keep taking aspirin.
  • 51:06So that's a perfect example
  • 51:08of negative reinforcement
  • 51:09that I always like to use.
  • 51:11Thank you for your Question
  • 51:13Time for one more question,
  • 51:14Carol Schaefer had
  • 51:16submitted a question about.
  • 51:17Can you talk about Carol?
  • 51:19Be sure I'm framing this question
  • 51:21correctly about anxiety across
  • 51:23development and how your research
  • 51:26is addressing different ages. Carol,
  • 51:29I can always count on Cole for a really,
  • 51:31really hard question,
  • 51:32but thank you Carol for that.
  • 51:33Great question.
  • 51:34We actually are in the anxiety
  • 51:36program working across development.
  • 51:38I do want to say so. We work from
  • 51:42the ages of salt with age or six.
  • 51:44We we are not going yet younger although I
  • 51:48I do work with the people in development,
  • 51:51the toddler layout we're doing some work
  • 51:53with but we work from age 6 and you know,
  • 51:56and Ellie and Yuri Burger are working with.
  • 51:59All the way up to young adults with
  • 52:00the family to launch projects.
  • 52:02So we are working across the lifespan in the.
  • 52:04In terms of this app I'm working,
  • 52:06I'm going to talk at this to middle school
  • 52:08is I'm going to target middle school.
  • 52:11It's 'cause I believe that is
  • 52:13the pivotal group I believe.
  • 52:15I think the data show this.
  • 52:16It's that transition into middle
  • 52:18school where most things happen
  • 52:20with kids with the peers and and
  • 52:23and those kind of risky behaviors.
  • 52:25And so we're going to be targeting
  • 52:26middle schoolers with the app.
  • 52:27But in terms of the anxiety program.
  • 52:29Research and clinical services go across
  • 52:32young childhood through young adulthood.
  • 52:35Thank you so much, Wendy. Thank you, Soraya.
  • 52:43Oh hi everyone.
  • 52:48I hope you can see my my screen.
  • 52:50Yes, it looks perfect. Thanks
  • 52:53so high everyone.
  • 52:54It's a pleasure for me to be here and
  • 52:57speak about our new organized model of
  • 53:00human brain development. I'm sure I ask.
  • 53:03Barry and Associates are scientists
  • 53:04in the Vaccarino's lab where we
  • 53:07model neurodevelopmental disorder.
  • 53:09Like all these men trapped for
  • 53:11several years by using this system,
  • 53:13please visit our website For more
  • 53:16information about the other project.
  • 53:19But So what are brain organoids?
  • 53:21So we can generate them from Donald patients?
  • 53:25Somatic cells?
  • 53:26Like the fibroblast here,
  • 53:27and they're redoing it down to a stem
  • 53:30cell fate that can be done differentiate
  • 53:33in many kind of mature cells.
  • 53:36So in our body like kidney muscles
  • 53:38and in our lab we are specialized in
  • 53:42generate neurons brain organoids.
  • 53:44Please here you can see like a brain
  • 53:47organoids are under the microscope.
  • 53:50These are three dimensional cultures.
  • 53:54Cluster of stem cells. And new ones.
  • 53:57But so why we are really focusing
  • 54:00on studying organoids?
  • 54:01Because most of the child neuropsychiatry
  • 54:04disorders arise during brain development
  • 54:06and we know that one fundamental
  • 54:09obstacles beside the species species
  • 54:11differences is have access to the brain.
  • 54:14And so there is and look at their
  • 54:17cells that are specialized cells.
  • 54:19That's why we there is an urgent
  • 54:21need of a human cell based models
  • 54:24to study these disorders.
  • 54:26And they organize have become a very
  • 54:29powerful tools because as I told you,
  • 54:31like today are retained,
  • 54:33they have the same genetic background
  • 54:36of the donor and so we can feature
  • 54:38recap Italy there the future
  • 54:40of a disorder in the dish.
  • 54:42And also we can study them over
  • 54:46time and see how they say evolve.
  • 54:49And we can also use for drug discovery
  • 54:53and genetically manipulate them.
  • 54:56And then recently we are in trying also
  • 54:59to a better adapted system to generate
  • 55:03different human brain regions as many
  • 55:06are affected in various disorders.
  • 55:09So here on the left I'm showing you
  • 55:12a nice fMRI of you want an embryo
  • 55:15stage where you can appreciate the
  • 55:18words well our brain come from that
  • 55:21is basically this along neural cubist
  • 55:25structure that it's full formation
  • 55:28and subdivision rely on a small
  • 55:31molecules that we called morphogens
  • 55:33that if we imagine so this is our
  • 55:36neural tube are secreted in different.
  • 55:39Regions of the neural tube and their
  • 55:42cells that occupy and form the neural tube.
  • 55:45They sense these morphogens,
  • 55:47so if you look here on the bottom,
  • 55:49I imagine all of these are the
  • 55:51training cells on the neural cube.
  • 55:53They sense the morphogen concentration
  • 55:56and other respond they activate
  • 55:59the specific genes,
  • 56:00and so acquiring a specific faith
  • 56:03so they will become blue cells
  • 56:06or white cells and so on.
  • 56:08So our hypothesis that we can model
  • 56:12the different brain regions and
  • 56:14see if between disorders there
  • 56:17are differences in the capacity
  • 56:19of their cells and to do so.
  • 56:22But thanks to our wonderful collaboration
  • 56:24with a biomedical engineer department here,
  • 56:27I yell with left ankle up.
  • 56:29We designed.
  • 56:30This is a culture system.
  • 56:32Imagine in in vitro we have
  • 56:34we are able to create these
  • 56:37morphogen concentration gradient.
  • 56:39So here we have the massively
  • 56:41device has two sources in which
  • 56:43we can apply the morphogen.
  • 56:45Imagine the blue morpho Jenn and I,
  • 56:47yellow, morphogen and our organize
  • 56:50the stem cells are played with.
  • 56:52In between the source and
  • 56:54exposed to the to the gradients,
  • 56:56so you will see there the organs
  • 56:58close to the blue Morpho journey
  • 57:01will receive a higher those,
  • 57:03while the one that we are
  • 57:05occupied this area they see five.
  • 57:07They will receive less morphogen.
  • 57:09And so the same for the yellow morphogen.
  • 57:12So to monitor that we will be able to
  • 57:16recapitulate the different brain regions.
  • 57:18Of course we will use knowledge from
  • 57:21literature and other model system
  • 57:24where genes are expressed in different
  • 57:27position of the neural tube from the
  • 57:29left to the right or top to bottom.
  • 57:32And so here I'm very happy and dentist
  • 57:35to share with you our preliminary
  • 57:38results of the organized that we
  • 57:41differentiate in this massive lyric device.
  • 57:44To A to a double gradient,
  • 57:46and these are RNA sequencing,
  • 57:49so we look at gene expression and we
  • 57:51observed that the the organizing the
  • 57:54device are able to acquire different faith,
  • 57:57both anterior or posterior and also that
  • 58:00we can recognize you late important
  • 58:03regions like the cortex and the basal
  • 58:06ganglia by looking at specific gene
  • 58:09expression and not least I want to
  • 58:11show you how the system can be used to study.
  • 58:15Inter individual variability.
  • 58:17So in this experiment we
  • 58:20differentiate six line in.
  • 58:23That are coming so from different
  • 58:26individuals and we of course
  • 58:29I'm exposed to the morphogen,
  • 58:31our device.
  • 58:32And when we look at gene expression,
  • 58:35we noticed that overall the
  • 58:37pattern as you can follow each
  • 58:40of these line plot is maintained.
  • 58:42It's pretty similar among
  • 58:44individuals but with some exception.
  • 58:48For example here we can see that
  • 58:50the individuals in purple show a
  • 58:53different response to the morphogens.
  • 58:55So meaning that the itself sends
  • 58:58the morphogen differently.
  • 58:59So, uh,
  • 59:00I hope I can.
  • 59:01I show you how we can use this
  • 59:04massively device to recapitulate
  • 59:06different brain regions in vitro.
  • 59:09We can use the system to study
  • 59:12inter individual variability,
  • 59:13and so sooner we want to apply
  • 59:17this culture system to study
  • 59:21neurodevelopmental disorders.
  • 59:23So why this work would not be made
  • 59:25without the help of all the vaccarino
  • 59:27slab member and the left ankle apps.
  • 59:30And of course the support of
  • 59:32the Child Study Center,
  • 59:33our agency and Funding Agency
  • 59:36and not least Arnstine family.
  • 59:38So I'm I'm happy to take any
  • 59:42questions and thank you so much.
  • 59:44Thank you so much, Ryan.
  • 59:46Any questions from the audience?
  • 59:53If I if I mail in the.
  • 59:56Right, just like to
  • 59:57thank you for highlighting
  • 59:59some of the really amazing
  • 60:00cutting edge neuroscience work
  • 01:00:01that's going on in the center.
  • 01:00:02That was really fantastic.
  • 01:00:04And, you know, you hinted at this towards
  • 01:00:06the end of your talk.
  • 01:00:07I was wondering, you know if you
  • 01:00:08could talk a little bit more about the
  • 01:00:10specific neurodevelopmental disorders
  • 01:00:11that you think might be prioritized for.
  • 01:00:15You know the wind Sonic
  • 01:00:16hedgehog signaling pathway?
  • 01:00:17What kind of mental disorders do
  • 01:00:19you think would you prioritize
  • 01:00:20for the application of this work?
  • 01:00:22Yeah, like of course so this
  • 01:00:24work can be a bridge up with all
  • 01:00:27the previous like presenter,
  • 01:00:29researcher, the Child Study Center
  • 01:00:31because as ellenoff man showed,
  • 01:00:34like so many genes are affected as
  • 01:00:38being identified as a potential target.
  • 01:00:41But in the end the pathway the
  • 01:00:44signaling pathway that are very
  • 01:00:46converging and both the wind and
  • 01:00:48the Sonic hedgehog has been recently
  • 01:00:50associated with notice for sure.
  • 01:00:53And for example,
  • 01:00:54Sonic hedgehog is involved in the
  • 01:00:57mentalization of the neural tube,
  • 01:00:58UM, and the eventual isation is a
  • 01:01:01fundamental if we want to recapitulate
  • 01:01:04basal ganglia here on the left.
  • 01:01:07So definitely basal ganglia
  • 01:01:09is another regions, uh,
  • 01:01:10that has been identified even in our level,
  • 01:01:14like Flora, Vaccarino's,
  • 01:01:15my mentor was the pioneer studying
  • 01:01:19Tourette syndrome using true brain
  • 01:01:21samples and also more recently.
  • 01:01:24Our, UM our PhD.
  • 01:01:26My colleague Melanie Brady also
  • 01:01:29develop and study are accurate court.
  • 01:01:33So we have group of control and to
  • 01:01:35read patient and she was able to
  • 01:01:38recapitulate some of the features
  • 01:01:40like because into rap patient flow.
  • 01:01:43Please intervene there is a down
  • 01:01:47regulation of several population
  • 01:01:49of interneurons and this was
  • 01:01:52proven both by of course.
  • 01:01:54Actual brain sample for smarter
  • 01:01:56but also our system showed that
  • 01:01:59there is a developmental defects
  • 01:02:01in the generation of these cells.
  • 01:02:04So definitely many many disease we opt
  • 01:02:09to apply this system and of course all
  • 01:02:12the neuroimaging data from the other.
  • 01:02:15You can see it so I'm really
  • 01:02:17like interest to would be amazing
  • 01:02:20to have a common project.
  • 01:02:22All the labs be court.
  • 01:02:26Great, thank you so much, Ryan.
  • 01:02:28Thank you, thank you.
  • 01:02:30So we'll move now to our clinical
  • 01:02:34section and then right after that,
  • 01:02:36we'll have a brief break.
  • 01:02:38But I may.
  • 01:02:39I may I call on Terra Davila,
  • 01:02:43Terra is our Chief Diversity Officer,
  • 01:02:45as well as one of the senior
  • 01:02:48clinical supervisors in our
  • 01:02:49outpatient services, Tara.
  • 01:02:53Good afternoon and welcome.
  • 01:02:55My name is Tara D'avila.
  • 01:02:56I'm so honored and pleased to be here today.
  • 01:03:00I am an assistant clinical professor
  • 01:03:02of social work and as I said,
  • 01:03:04it's my honor and an absolute
  • 01:03:06pleasure to share with you and shine
  • 01:03:08a light on our clinical mission.
  • 01:03:10For the last ten years,
  • 01:03:12I've served as a clinical coordinator
  • 01:03:14for outpatient clinical services.
  • 01:03:1512 months ago I also became the
  • 01:03:18inaugural Chief Diversity Officer
  • 01:03:19for the Child Study Center,
  • 01:03:20and while I'm passionate about both
  • 01:03:22of those roles and could honestly talk
  • 01:03:24to you for hours about both today,
  • 01:03:26I'm really thrilled to speak to
  • 01:03:27you about the part of the CSC
  • 01:03:28that first stole my heart,
  • 01:03:29which is our clinical services.
  • 01:03:32We have a magnificent team of caring,
  • 01:03:34dedicated and gifted faculty and
  • 01:03:37staff committed to furthering
  • 01:03:39our clinical mission.
  • 01:03:41The
  • 01:03:41care experience at the Child
  • 01:03:42Study Center begins with a phone
  • 01:03:44call when families call us,
  • 01:03:46they're greeted in there,
  • 01:03:48greeted in both English and
  • 01:03:49Spanish by skillful, compassionate,
  • 01:03:51kind and supportive staff.
  • 01:03:54They're the first people our patients
  • 01:03:55interact with when calling our clinic,
  • 01:03:57and it is because of their excellent
  • 01:03:59support that they provide that we
  • 01:04:01have many families choose to return
  • 01:04:02and refer others as you'll hear
  • 01:04:04in one of our vignettes today.
  • 01:04:07I cannot say enough about how
  • 01:04:09important they are to our mission.
  • 01:04:11Our complete clinical care experience
  • 01:04:13takes a village in addition to our
  • 01:04:15clinical faculty and support staff.
  • 01:04:17Our village includes security guards
  • 01:04:18and environmental service team members
  • 01:04:20who each play a role in creating a
  • 01:04:23safe and welcoming environment for
  • 01:04:25our families when they come here.
  • 01:04:27Our clerk or clinical team is
  • 01:04:29comprised of psych cologist,
  • 01:04:31nurses professional counselors,
  • 01:04:33social workers,
  • 01:04:34marriage and family therapists,
  • 01:04:36pediatricians, interns and fellows.
  • 01:04:39We have about 3000 unique patients
  • 01:04:42in our care.
  • 01:04:43At any given time in fiscal year 2021,
  • 01:04:46we had about 45,000 derived appointments
  • 01:04:48and we're on track to have us to
  • 01:04:51have similar numbers this year.
  • 01:04:53It's a lot of sessions we see children
  • 01:04:55from ages 0 to 19 in our Youth Services,
  • 01:04:58but across our clinical services,
  • 01:05:00we go up to age 85.
  • 01:05:03We have six core clinical
  • 01:05:06areas which are outpatient.
  • 01:05:08Services are in home services,
  • 01:05:10assessment services,
  • 01:05:12parent and Family Services
  • 01:05:14or trauma services,
  • 01:05:16and our Children Day hospital.
  • 01:05:19So we have a variety of ways
  • 01:05:20that we can support families
  • 01:05:22at varying levels of acuity.
  • 01:05:24And I wish we had the time to
  • 01:05:26highlight every single piece of
  • 01:05:27our clinical mission and everyone
  • 01:05:29that contributes to it because the
  • 01:05:31work is really just so stellar.
  • 01:05:36In March of 2020,
  • 01:05:38along with the rest of the world,
  • 01:05:39we were faced with this global pandemic.
  • 01:05:42We were not only sharing the
  • 01:05:44very human experiences of
  • 01:05:45feeling terrified and uncertain,
  • 01:05:46but we were challenged to shift our
  • 01:05:48entire practice to Tele health,
  • 01:05:50something that we've never done before.
  • 01:05:52Our support staff,
  • 01:05:53who I mentioned to you earlier,
  • 01:05:54were so important in helping
  • 01:05:56us set our families up to be
  • 01:05:58able to access Tele health.
  • 01:06:00They were so incredible in taking
  • 01:06:01calls and walking the families
  • 01:06:03through the steps 'cause no one
  • 01:06:05had done this before for behavioral
  • 01:06:06health in our clinic and really
  • 01:06:08in the state of Connecticut,
  • 01:06:10everything got turned over with the pandemic.
  • 01:06:13We rally together and we continue
  • 01:06:15to provide services with the goal of
  • 01:06:18keeping children out of the hospitals
  • 01:06:20for psychiatric emergencies so that
  • 01:06:22all of the hospital resources could
  • 01:06:24go to caring for COVID patients.
  • 01:06:26Our team was challenged to find
  • 01:06:28ways to translate our treatment and
  • 01:06:29our supervisory practices to this
  • 01:06:31new way of delivering services.
  • 01:06:33It invited creativity and innovation
  • 01:06:35as a supervisor.
  • 01:06:36Here I have been in complete all of
  • 01:06:38the ways that our clinicians have
  • 01:06:40been able to engage children on the screen.
  • 01:06:43They are at never at a loss for
  • 01:06:46creative ways and methods using
  • 01:06:48whatever they could find at home
  • 01:06:50to make their work translate and
  • 01:06:52engaging on screen.
  • 01:06:55But we had this unique
  • 01:06:56experience of needing to support people
  • 01:06:58through the stressors that we
  • 01:07:00ourselves were also being impacted by.
  • 01:07:02We were managing our own fear and isolation.
  • 01:07:05Morning losses of our own and uncertainty,
  • 01:07:08which were some of the same things
  • 01:07:11their families were seeking support on.
  • 01:07:13Seemingly overnight.
  • 01:07:14Our clinicians learn how to do their jobs
  • 01:07:16virtually and still maintain great outcomes.
  • 01:07:19Our clinicians have been tried in many
  • 01:07:20ways and it remains steadfast through
  • 01:07:22a global pandemic transitioning to
  • 01:07:24telehealth and now to a hybrid service
  • 01:07:26delivery where we're doing a little bit of
  • 01:07:28Tele health and a little bit in person,
  • 01:07:31all while trying to meet the current
  • 01:07:33demands for behavioral health services,
  • 01:07:36there's a mental health crisis that
  • 01:07:38we're in right now that's been
  • 01:07:40imposed by the pandemic.
  • 01:07:41More children than ever are
  • 01:07:42in need of our services,
  • 01:07:44and they're more acute than ever before.
  • 01:07:47The demand is so great.
  • 01:07:49That for the first time in ten years,
  • 01:07:51or at least in the ten years that
  • 01:07:53I've been here, we have a wait list,
  • 01:07:55which is antithetical to how we practice.
  • 01:07:58We've always prided ourselves on
  • 01:07:59being available to families when
  • 01:08:01they took the brave step to call,
  • 01:08:03but we simply don't have the capacity
  • 01:08:04to meet the demand right now.
  • 01:08:06In addition,
  • 01:08:07behavioral health services are
  • 01:08:08not supported on part with other
  • 01:08:11health related services.
  • 01:08:12This really impacts access
  • 01:08:13and service delivery.
  • 01:08:15We have never been more needed,
  • 01:08:16and our system has never been more stressed.
  • 01:08:19Making support from our associates critical.
  • 01:08:22Many families in the greater New Haven
  • 01:08:24area have not had access to important
  • 01:08:26assessment services in the past thanks
  • 01:08:29to a fund created by generous donors,
  • 01:08:31we've been able to remove those
  • 01:08:32barriers and make these services
  • 01:08:33available to more families.
  • 01:08:37So today you'll hear from a small
  • 01:08:39sampling of our clinical faculty
  • 01:08:41about snippets of their work.
  • 01:08:43I'm confident that even
  • 01:08:44through these tiny samplings,
  • 01:08:45you'll understand why I'm often
  • 01:08:47heard saying that I love what I do.
  • 01:08:50I love who I do it with,
  • 01:08:51and I love who I do it for.
  • 01:08:53Thank you so much for being with us
  • 01:08:55and for your support of our mission.
  • 01:08:59So our first presenter today
  • 01:09:01is Doctor Jenny Dwyer.
  • 01:09:06Hi everyone, nice to see you.
  • 01:09:08I'll be at virtually.
  • 01:09:10I have a couple of slides so I'm
  • 01:09:13gonna go ahead and share those.
  • 01:09:15Are you all able to see the spines
  • 01:09:18of thumbs up would be good.
  • 01:09:20OK, excellent.
  • 01:09:22Well, I know I've spoken with
  • 01:09:24you all over the past couple of
  • 01:09:25years about my research program,
  • 01:09:27but I am thrilled to be able to talk
  • 01:09:29to you about our clinical work as well,
  • 01:09:31particularly during this
  • 01:09:33mental health crisis.
  • 01:09:36So I've started with a slide like
  • 01:09:38this before that adolescence is a
  • 01:09:40significant time for depression,
  • 01:09:41and it's a significant health problem.
  • 01:09:44So pre pandemic,
  • 01:09:45we know that nearly one in five
  • 01:09:47adolescents will experience
  • 01:09:48major depressive disorder by the
  • 01:09:50end of their teenage years.
  • 01:09:52And that depression increases the risk
  • 01:09:55for suicide by thirtyfold suicides.
  • 01:09:57Now, the second leading cause of
  • 01:10:00death in young people in America.
  • 01:10:02So it was this serious situation
  • 01:10:04even before COVID-19.
  • 01:10:06And then we layer on a pandemic,
  • 01:10:09UM,
  • 01:10:09so we know from recent data taking a
  • 01:10:11global perspective that internationally.
  • 01:10:14The prevalence of pediatric
  • 01:10:16depression and anxiety has doubled
  • 01:10:19compared to pre pandemic levels.
  • 01:10:21And then if we look specifically
  • 01:10:22in the United States,
  • 01:10:24we know that during these
  • 01:10:25intense phases of the pandemic,
  • 01:10:27the proportion of mental health emergency
  • 01:10:30visits increased substantially,
  • 01:10:32both in younger kids and in teenagers.
  • 01:10:35And when you look at these
  • 01:10:37broken into boys versus girls,
  • 01:10:38we see that the the pandemic increase
  • 01:10:42hits girls particularly hard.
  • 01:10:44If we focus in not just on
  • 01:10:47mental health emergencies,
  • 01:10:48but visits specifically for
  • 01:10:50suspected suicide attempts in girls,
  • 01:10:52we can see the huge increase
  • 01:10:54just by looking at this graph.
  • 01:10:56So this other line is showing 2021 and
  • 01:10:59the weeks are on the bottom on the X axis,
  • 01:11:02so showing through about May of
  • 01:11:04this year and you can see an over
  • 01:11:0650% increase in emergency room
  • 01:11:09visits and girls specifically
  • 01:11:10for a suspected suicide attempt.
  • 01:11:14And then if you look on the Y axis.
  • 01:11:15But the numbers this is thousands of
  • 01:11:19emergency suicidal presentations per week.
  • 01:11:22So while I used to have this title where
  • 01:11:23I say it's a significant health problem,
  • 01:11:26I don't think that quite
  • 01:11:27does it justice anymore.
  • 01:11:28And I agree with the American
  • 01:11:30Academy of Pediatrics and the AKAP
  • 01:11:32that we're really in a state of
  • 01:11:34a national emergency for child
  • 01:11:36and adolescent mental health.
  • 01:11:38So how do we treat depression
  • 01:11:39if someone comes in with a new
  • 01:11:42Depression diagnosis?
  • 01:11:42Are Firstline treatments are really
  • 01:11:45selective serotonin reuptake inhibitors.
  • 01:11:47So medications like Block City nor
  • 01:11:50Prozac and evidence based psychotherapies.
  • 01:11:53So things like cognitive behavioral therapy.
  • 01:11:56But we know that 40% of adolescents,
  • 01:11:59even if they're getting this
  • 01:12:00standard of care,
  • 01:12:01won't get better with
  • 01:12:03these initial treatments.
  • 01:12:05The second line treatment the
  • 01:12:07next evidencebased step,
  • 01:12:08is to switch to a different SSRI and
  • 01:12:11then add CBT if you haven't already.
  • 01:12:13But even then,
  • 01:12:15nearly half of these patients
  • 01:12:17will remain depressed.
  • 01:12:19And so if you put these numbers together,
  • 01:12:20that's about one in five pediatric patients
  • 01:12:23with depression that will have what we
  • 01:12:26call treatment resistant depression.
  • 01:12:27So depression that persists despite
  • 01:12:30getting evidence based treatments.
  • 01:12:32And so our question is how
  • 01:12:34do we treat these patients,
  • 01:12:35particularly in Pediatrics,
  • 01:12:36where the evidence base is very
  • 01:12:39thin compared to adult psychiatry?
  • 01:12:42And that is the purpose of this service.
  • 01:12:45So the pediatric treatment resistant
  • 01:12:47Depression service is really a relatively
  • 01:12:50young program we opened in November of 2019.
  • 01:12:54It's Co directed by myself and
  • 01:12:56Michael Block my colleague,
  • 01:12:57and it's really an outpatient
  • 01:13:00subspecialty consultation service.
  • 01:13:02So what do we actually do on this service?
  • 01:13:04UM, so we're providing comprehensive
  • 01:13:07assessment of complex patients,
  • 01:13:09and I will say the folks that come through
  • 01:13:11our door for this type of referral
  • 01:13:14are genuinely generally quite complex.
  • 01:13:16So the average number of prior medicines
  • 01:13:19before coming to see us is 9 medicines.
  • 01:13:22So I gave this level of
  • 01:13:23having tried at least two,
  • 01:13:25and most of our most of our
  • 01:13:28patients have tried many.
  • 01:13:29There's also a high number
  • 01:13:31of comorbid diagnosis.
  • 01:13:33Often several hospitalizations and
  • 01:13:35intense acuity with histories of suicide
  • 01:13:40attempts or non suicidal self injury.
  • 01:13:43So we review all of the prior
  • 01:13:46available mental health records.
  • 01:13:48We speak with their outpatient providers
  • 01:13:49and try to piece together really the
  • 01:13:52trajectory of the illness and and
  • 01:13:54the factors that seem to be at play
  • 01:13:57during periods of relative Wellness.
  • 01:13:59This is 1/2 day in person or virtual.
  • 01:14:03We also adapted to Tele Health during
  • 01:14:06the pandemic evaluation where we
  • 01:14:08do diagnostic interviews and also
  • 01:14:10structured rating scales and at the end
  • 01:14:13we provide a diagnostic formulation.
  • 01:14:15There are often questions about
  • 01:14:18primary diagnosis and that a set
  • 01:14:20of treatment recommendations that
  • 01:14:22span across the biological,
  • 01:14:24the psychological and the social.
  • 01:14:27There are times where we think the
  • 01:14:30helpful approach might be something in
  • 01:14:32the space of interventional psychiatry,
  • 01:14:34so it's kind of a new term,
  • 01:14:36but is talking about things like
  • 01:14:39ECT or KETAMIN or RTMS,
  • 01:14:42and in the cases that that seems
  • 01:14:44like an appropriate step,
  • 01:14:45we facilitate referrals to our colleagues
  • 01:14:48and interventional psychiatry.
  • 01:14:49Or if there's a research study that's
  • 01:14:51appropriate, we can refer them there.
  • 01:14:54So really,
  • 01:14:55my vision for this program is growth.
  • 01:14:57UM,
  • 01:14:58and and that growth would look like
  • 01:15:00an increased capacity not only to
  • 01:15:03deliver specialty level recommendations,
  • 01:15:05but also to start providing some
  • 01:15:07of the specialty level of care,
  • 01:15:10particularly when we're recommending
  • 01:15:12medication changes that can feel
  • 01:15:15daunting or complex compared to sort
  • 01:15:17of the standard medication regimens
  • 01:15:19that are typically being used.
  • 01:15:21So we hope that with the recruitment
  • 01:15:23of additional providers.
  • 01:15:24And resources will start to be able
  • 01:15:27to increase our capacity and really
  • 01:15:30meet the the surging demand for
  • 01:15:32treatment for these complex patients.
  • 01:15:35So thank you so much for giving
  • 01:15:36me some time to speak with you and
  • 01:15:38enjoy the rest of the afternoon.
  • 01:15:41Thank you so much Jenny.
  • 01:15:44Come take just a moment,
  • 01:15:46I know we said we would do
  • 01:15:47questions at the very end,
  • 01:15:48but any any questions at this point
  • 01:15:50or we'll move on to our next part.
  • 01:15:53I have a question again.
  • 01:15:54Reagan for child Dallas.
  • 01:15:55Hi, Jennie, thank you for help.
  • 01:15:59Still haven't found anybody
  • 01:16:00by the way Michael no.
  • 01:16:03The half day and the half day
  • 01:16:06assessment that obviously is
  • 01:16:07significant and in terms
  • 01:16:09of growing or scaling.
  • 01:16:11Is there any thought how that
  • 01:16:14might be compressed or so that
  • 01:16:17you could see more patients?
  • 01:16:18Yeah, so I mean, we've tried to gather
  • 01:16:21as much information at the beginning
  • 01:16:23as possible so we have them fill out a
  • 01:16:26pretty lengthy symptom questionnaire to
  • 01:16:28really try to target the focus of the
  • 01:16:31discussion and also the rating scales.
  • 01:16:33And I think I think a division of
  • 01:16:35Labor would probably help us right now.
  • 01:16:37Michael and I are the ones that
  • 01:16:39are actually doing the interview,
  • 01:16:40but also doing the ratings.
  • 01:16:42Scales and so I think being able to grow
  • 01:16:44our staff in a way that someone else is
  • 01:16:46able to do some other reading skills
  • 01:16:48while we're talking with the parents,
  • 01:16:50I think we could probably compress our time
  • 01:16:53if we had a little bit of a bigger team.
  • 01:16:56Thank you.
  • 01:16:58Carol, may I turn to you too?
  • 01:17:01Bring our next two speakers.
  • 01:17:05Mute. You know how
  • 01:17:08long we have to be in using zoom for us
  • 01:17:10to remember to check if we're on mute
  • 01:17:13before we start talking many months now,
  • 01:17:16but the next clinical story that
  • 01:17:19I'm going to share is one from
  • 01:17:20one of our social work fellows,
  • 01:17:22Hector shy this hotel so it is a video,
  • 01:17:24but he is also here to answer some questions.
  • 01:17:27Should you have any.
  • 01:17:28So bear with me 'cause the technology
  • 01:17:29for me is often a challenge.
  • 01:17:36Oh my, let's see. As I said,
  • 01:17:38it is blocking the challenge.
  • 01:17:40I can't seem to make it larger. Here we go.
  • 01:17:44My name is Hector Chandler Rachel.
  • 01:17:46I am a licensed Masters level social worker
  • 01:17:48and I am in my second year of the Social
  • 01:17:51work fellowship at the outpatient clinic.
  • 01:17:53My fellowship position here consists of
  • 01:17:55doing therapy with youth and their family,
  • 01:17:57as well as getting access and
  • 01:17:59to different forms of training.
  • 01:18:01I think I may have had a very
  • 01:18:03different experience than many
  • 01:18:04clinicians here since I started my
  • 01:18:06time here in the middle of a pandemic,
  • 01:18:08which is to say it lightly
  • 01:18:10has had several challenges.
  • 01:18:12I do want to start though,
  • 01:18:13by sharing a little bit about my.
  • 01:18:15Work with one of my families and
  • 01:18:17how this services have really made
  • 01:18:19a difference at the human level.
  • 01:18:21Yes, I'm sure you are all aware this
  • 01:18:24pandemic has created a major crisis
  • 01:18:26in the mental health field and as it
  • 01:18:30has exacerbated and problems that many
  • 01:18:32families already were struggling with.
  • 01:18:34This was specially the case for
  • 01:18:36one of the families who I started
  • 01:18:38seeing earlier this year.
  • 01:18:40My client is an 11 year old girl who
  • 01:18:42sense with a lot of anxiety and she
  • 01:18:44has also previously been diagnosed
  • 01:18:46with learning disorders in reading,
  • 01:18:48writing and math, among others.
  • 01:18:51This is why it was no surprise and
  • 01:18:53that you know she really struggled
  • 01:18:56to adapt to the virtual learning
  • 01:18:58offered during the pandemic.
  • 01:19:00One of the biggest stressors that
  • 01:19:02family first came in with was
  • 01:19:04that they had requested a meeting
  • 01:19:06with school so that they could
  • 01:19:08receive special education services,
  • 01:19:10yet they've had fallen through the cracks.
  • 01:19:12As is often the case for many
  • 01:19:14families of color.
  • 01:19:15Mum though,
  • 01:19:16is a fierce advocate for her daughter,
  • 01:19:19but even then she.
  • 01:19:20Reported to me that she often
  • 01:19:22felt like her voice was not heard
  • 01:19:24in those different systems to
  • 01:19:26do language barriers and because
  • 01:19:27they were a Hispanic family.
  • 01:19:29Unfortunately, you know,
  • 01:19:31coming back to in person school has only
  • 01:19:34increased her daughters symptoms as she
  • 01:19:36presents with a lot of school anxiety,
  • 01:19:39primarily due to her reported
  • 01:19:42team of feeling behind the rest
  • 01:19:45of her peers academically.
  • 01:19:47Despite the difficulties the families
  • 01:19:50experience, I cannot say enough.
  • 01:19:51Good things about the family.
  • 01:19:53Mum always comes back to me with
  • 01:19:55this phrase and she says like that
  • 01:19:58I can see in which angle by landed.
  • 01:20:00But we have to keep fighting moving forward.
  • 01:20:04So when I asked the family,
  • 01:20:06you know if I could share this story I I
  • 01:20:09felt it was important to elevate their voice,
  • 01:20:12specially moms voice and in our space.
  • 01:20:15And so I asked them what they thought
  • 01:20:18and what she thought would be important
  • 01:20:20that I share with all of you today.
  • 01:20:22She asked me to share how important
  • 01:20:24therapy has been for her and her family.
  • 01:20:26She told me to mention that she
  • 01:20:28has been treated like family not
  • 01:20:30only by me just by me, but by you.
  • 01:20:33Know front desk staff.
  • 01:20:35When when she first gets here
  • 01:20:37and even though up
  • 01:20:38to the prescriber who she sees her for
  • 01:20:41her other two boys and she mentioned
  • 01:20:43that these are services that are
  • 01:20:45so badly needed among our Hispanic
  • 01:20:47community and every time she is able
  • 01:20:50to achieve her first families to us.
  • 01:20:52Which I think speaks very highly of her
  • 01:20:55experience here at the CHILD Study Center.
  • 01:20:57I think it's important to acknowledge how
  • 01:20:59your contribution is making an important
  • 01:21:01difference for families at this human level,
  • 01:21:03especially right now when mental health
  • 01:21:05services are so urgently needed.
  • 01:21:07I want to thank you for making
  • 01:21:09fellowships such as mine possible,
  • 01:21:12as well as a Mexican immigrant.
  • 01:21:13Myself.
  • 01:21:14I feel strongly about not only
  • 01:21:16using my Spanish speaking ability
  • 01:21:18to serve community by community,
  • 01:21:20but also placing myself in environments.
  • 01:21:23Ranking grow to be the clinician.
  • 01:21:24My families deserve.
  • 01:21:25This is why I'm here and I think this
  • 01:21:28fellowship is so important to my growth here.
  • 01:21:32I have been able to have access to
  • 01:21:34a Spanish lead supervisor who has
  • 01:21:36helped me fill gaps in my learning
  • 01:21:38related to my work with Spanish
  • 01:21:40speaking immigrant families.
  • 01:21:42I also have access to opportunities
  • 01:21:44such as forming part of the trauma
  • 01:21:46clinic and being able to learn
  • 01:21:48it's exciting interventions such
  • 01:21:50as CFTS I which I plan and to use.
  • 01:21:53In my future work with Spanish
  • 01:21:55speaking immigrant families.
  • 01:21:57I am thankful for the opportunities
  • 01:21:59which all of you make possible
  • 01:22:00and hope they only continue to
  • 01:22:02grow for future social work films.
  • 01:22:05Thank you.
  • 01:22:11Thank you very much and just
  • 01:22:13on that connection to the
  • 01:22:14trauma service and to see FTSI let
  • 01:22:17me turn it over to Carrie Epstein.
  • 01:22:21Thank you Linda.
  • 01:22:30OK.
  • 01:22:38So hello everyone, I'm Carrie Upstein
  • 01:22:40and I'm the Co director of the Yale Center
  • 01:22:43for Traumatic Stress and Recovery along
  • 01:22:45with my Co director doctor Steven Marans.
  • 01:22:48I'm honored to be with you today.
  • 01:22:51I'd like to continue to shine a light
  • 01:22:53on the incredible clinical work is
  • 01:22:55being done at the CHILD Study Center,
  • 01:22:57particularly with respect to the clinical
  • 01:22:59work and research being done with
  • 01:23:02children and families impacted by trauma.
  • 01:23:04You'll you've heard from and will
  • 01:23:06continue to hear from other colleagues
  • 01:23:08about their important clinical work
  • 01:23:09with children impacted by trauma
  • 01:23:11you just heard from Hector and
  • 01:23:13what I'd like to highlight today.
  • 01:23:16Beginning with.
  • 01:23:18Sorry mommy.
  • 01:23:21What I'd like to highlight
  • 01:23:22today is an early intervention
  • 01:23:24called the child and family.
  • 01:23:26Traumatic stress, intervention or CF
  • 01:23:28TSI with which Hector just mentioned,
  • 01:23:31which is a brief 5 to 8 session
  • 01:23:34trauma focused evidence based mental
  • 01:23:35health treatment developed by myself
  • 01:23:38and doctor Steven Marans CFTS.
  • 01:23:40I grew out of more than three decades
  • 01:23:43of closely observing on learning about
  • 01:23:45the phenomena of trauma from children
  • 01:23:48and families impacted by abuse,
  • 01:23:50violence and other traumatic events.
  • 01:23:53Currently see if TSI is the only evidence
  • 01:23:55based treatment that was specifically
  • 01:23:57developed for implementation in the
  • 01:23:58early phase of trauma response.
  • 01:24:00Soon after a recent traumatic event
  • 01:24:02or soon after the recent disclosure
  • 01:24:05of abuse. So based
  • 01:24:07on a family strengthening approach,
  • 01:24:09CTSI increases communication between
  • 01:24:11the child and caregiver about the
  • 01:24:14child trauma symptoms and as a
  • 01:24:17result increases family support.
  • 01:24:19For children impacted by traumatic events.
  • 01:24:24CSI has demonstrated effectiveness
  • 01:24:27in significantly reducing traumatic
  • 01:24:29stress symptoms and reducing and
  • 01:24:31interrupting PTSD and related disorders
  • 01:24:33in children as well as their caregivers.
  • 01:24:36In fact, our studies indicate that
  • 01:24:38children who receive CFTS I are 65%
  • 01:24:41less likely to meet criteria for post
  • 01:24:43traumatic stress disorder and are 73%
  • 01:24:47less likely to be diagnosed with related
  • 01:24:50anxiety and depressive disorders.
  • 01:24:52In addition, in a recent study we
  • 01:24:55also learned that CFTS significantly
  • 01:24:57reduces trauma symptoms and caregivers
  • 01:24:59who participate in treatment as well.
  • 01:25:04Hearing about the horrors that too
  • 01:25:05many children are confronted with
  • 01:25:07when they're exposed to violence and
  • 01:25:09trauma can be especially unbearable if
  • 01:25:11we feel helpless in providing relief,
  • 01:25:13or if we believe that there is no
  • 01:25:15escape from their immediate suffering
  • 01:25:17or were convinced that their futures
  • 01:25:18are forever damaged or impaired.
  • 01:25:21CFTS, I not only reduces immediate suffering.
  • 01:25:28Of traumatized children and families,
  • 01:25:29and reduces long term damage
  • 01:25:31to their development.
  • 01:25:34But it also identifies and ensures
  • 01:25:36that they receive additional
  • 01:25:37psychotherapeutic help when needed.
  • 01:25:41Let me illustrate this
  • 01:25:43with the story of Alexa.
  • 01:25:45Alexa was a 10 year old girl who was
  • 01:25:48referred to us by Child Protective
  • 01:25:50Services following her disclosure
  • 01:25:51of sexual abuse and a long history
  • 01:25:54of exposure to domestic violence.
  • 01:25:56At the time of her referral,
  • 01:25:57Alexa was frightened.
  • 01:25:58She was withdrawn and had multiple
  • 01:26:00symptoms of traumatic dysregulation
  • 01:26:02that disrupted her daily life,
  • 01:26:04including her inability to attend school.
  • 01:26:08As for all children impacted by
  • 01:26:11trauma Alexis presenting symptoms of
  • 01:26:12traumatic dysregulation perpetuated
  • 01:26:14the original loss of control that
  • 01:26:16she experienced as a victim of abuse.
  • 01:26:19And as a witness to the violence in her home.
  • 01:26:22CFTS, I offered Alexa an alternative
  • 01:26:25to these painful,
  • 01:26:27disturbing reactions by helping
  • 01:26:28her to better observe and find
  • 01:26:31words for her symptoms.
  • 01:26:32Find recognition and understanding of her
  • 01:26:34distress by her foster parents as well
  • 01:26:37as learning strategies to gain support,
  • 01:26:39mastery and control over the
  • 01:26:42symptoms of her traumatic distress.
  • 01:26:45So over the course of seven sessions of TSI,
  • 01:26:48Alexa was re able to return to
  • 01:26:51school and was no longer having the
  • 01:26:53nightmares and angry outbursts that
  • 01:26:56had been happening on a daily basis.
  • 01:26:59And because she was feeling in greater
  • 01:27:01control of herself and her symptoms,
  • 01:27:03she was now able to re engage into a
  • 01:27:07safer world which she had withdrawn from.
  • 01:27:10And then three months after
  • 01:27:12finishing CTSI treatment,
  • 01:27:14when we checked in with Alexa
  • 01:27:16and her foster parents,
  • 01:27:17Alexa was continuing to grow and re
  • 01:27:20engage in a healthy, happier life.
  • 01:27:23Alexa is not alone in this experience.
  • 01:27:27Since the development of CFTS I cases
  • 01:27:30involving thousands of children in
  • 01:27:31New Haven around the country and
  • 01:27:34across the world have demonstrated
  • 01:27:35the clinical efficacy of CSI.
  • 01:27:39To date,
  • 01:27:40we've trained close to 1200 clinicians
  • 01:27:42around the country in the CF TSI model.
  • 01:27:45Additionally, in response to a
  • 01:27:48considerable interest abroad,
  • 01:27:49we've trained colleagues in 12
  • 01:27:51European countries,
  • 01:27:53Australia and Lebanon.
  • 01:27:56CF TSI has been and continues to be
  • 01:27:58an essential intervention for so
  • 01:28:00many children who have suffered in a
  • 01:28:02world that is now additionally altered
  • 01:28:04by the restrictions of the COVID-19 pandemic.
  • 01:28:07While so many children may be
  • 01:28:10impacted by violence and trauma,
  • 01:28:12it's so important for us to all
  • 01:28:14remember that these children can
  • 01:28:16also have the opportunity to heal
  • 01:28:18and although there is darkness,
  • 01:28:20there's also light and hope.
  • 01:28:23I'd like to finish with the
  • 01:28:25following thought.
  • 01:28:25As we've come to learn more about trauma
  • 01:28:27through our research and our clinical work,
  • 01:28:30we've also come to recognize
  • 01:28:32that however much we've learned,
  • 01:28:33just like the children and
  • 01:28:35families we work with,
  • 01:28:36if we are to have any chance of
  • 01:28:38being successful on their behalf.
  • 01:28:40We cannot do this work alone.
  • 01:28:42I for one could not do the work that I do
  • 01:28:45without my colleagues who bring their ideas,
  • 01:28:48their resources,
  • 01:28:49their shared experience and their true
  • 01:28:52dedication to the challenges that we
  • 01:28:54tried to meet together every day.
  • 01:28:57Our work is never done.
  • 01:28:59We are enormously grateful for
  • 01:29:01the support of our work
  • 01:29:02that we've received from the Harris
  • 01:29:04Family Foundation from the Israel
  • 01:29:06Family Foundation and the support
  • 01:29:07from the associates over the years.
  • 01:29:09I really want to thank you all for the
  • 01:29:11opportunity to speak with you all today.
  • 01:29:15Thank you so much Carrie.
  • 01:29:18So we have two more just clinical
  • 01:29:21clinical vignettes and teremia
  • 01:29:23turned back to you. Sure,
  • 01:29:26sorry about that interruption before.
  • 01:29:28I didn't realize it wasn't on mute and.
  • 01:29:31Carrie Epstein just spoke with us
  • 01:29:35about some of the trauma interventions,
  • 01:29:37and about 60% of the kids that come
  • 01:29:41through our clinic have had exposure
  • 01:29:43to at least one traumatic event,
  • 01:29:44and we're going to hear now from
  • 01:29:47one of our clinical faculty,
  • 01:29:49Stephanie Gary, who is going to share
  • 01:29:53a case that is related to trauma.
  • 01:29:56And you, I will ask for your Grace again,
  • 01:29:58because I will be sharing a video.
  • 01:30:00I'll
  • 01:30:00see what happens.
  • 01:30:10Hello everyone my name is Stephanie,
  • 01:30:12Gary and I am an outpatient clinician
  • 01:30:15at the Yale Child Study Center.
  • 01:30:18Professional journey began at the
  • 01:30:20center a little over six years ago and
  • 01:30:23during my time here I have served as
  • 01:30:26a clinician and clinical supervisor.
  • 01:30:29Reflecting on my career,
  • 01:30:30I recall entering this field
  • 01:30:33because I saw the value in mental
  • 01:30:35health and particularly early
  • 01:30:37interventions for children.
  • 01:30:39I was motivated by the idea of making
  • 01:30:42a positive impact on the lives of
  • 01:30:44children and it is my hope that by
  • 01:30:47introducing argued to therapy early on,
  • 01:30:49our society will come to
  • 01:30:52destigmatize mental health concerns.
  • 01:30:54Now before capturing a snapshot of my
  • 01:30:57clients treatment experience today.
  • 01:30:59I will lead with mentioning that it is
  • 01:31:01an honor and a privilege to share with
  • 01:31:04you all a glimpse of the clinical work
  • 01:31:06we provide to families in our care.
  • 01:31:08Thank you for this opportunity for
  • 01:31:11supporting this mission and for
  • 01:31:14your contributions to this practice.
  • 01:31:16To protect the privacy of my client,
  • 01:31:19I will refer to them using fictitious
  • 01:31:22names to begin Sierra and adolescent
  • 01:31:24female was referred to the clinic by her
  • 01:31:28mother Mrs Night for anxiety treatment.
  • 01:31:31Sierra,
  • 01:31:31an exceptional student,
  • 01:31:32was so overcome with anxiety that
  • 01:31:35she struggled to attend school
  • 01:31:37on a regular basis.
  • 01:31:38When she did attend school,
  • 01:31:40she would have panic attacks,
  • 01:31:42often calling her mother frantically
  • 01:31:44and requesting to get picked up
  • 01:31:47for early dismissal from school.
  • 01:31:48Other times,
  • 01:31:49her anxiety emerged during long
  • 01:31:52road trips and she had no idea
  • 01:31:55what was triggering her panic
  • 01:31:57attacks and working with Sierra,
  • 01:31:59it was initially very
  • 01:32:00challenging to engage with her.
  • 01:32:02Sierra was highly guarded
  • 01:32:04and understandably so,
  • 01:32:06as she worried greatly that therapy would
  • 01:32:08force her out of her comfort zone to Sierra.
  • 01:32:11Therapy was a place where she would
  • 01:32:13have to confront her fears so that
  • 01:32:16she could finally overcome anxiety.
  • 01:32:18With that mindset,
  • 01:32:19naturally she had her walls up.
  • 01:32:22However,
  • 01:32:23in building a therapeutic relationship
  • 01:32:25and creating a safe space to explore
  • 01:32:28Sierra's feelings,
  • 01:32:29she gradually opened up.
  • 01:32:31Meanwhile, in working with Mrs.
  • 01:32:33Night,
  • 01:32:33she supported CRS therapy in a way that
  • 01:32:36was anchoring for her daughter, Mrs.
  • 01:32:39Night learned ways to model courage.
  • 01:32:41She was also invested in supporting her
  • 01:32:44daughter to challenge negative thoughts
  • 01:32:47as she was instrumental in applying
  • 01:32:50problem solving skills to help her
  • 01:32:53daughter advocate stressful situations.
  • 01:32:55As Sierra symptoms stabilize,
  • 01:32:57she eventually revealed that
  • 01:32:59a traumatic experience was the
  • 01:33:01driving force behind her anxiety.
  • 01:33:04As a result of her commitment to therapy,
  • 01:33:06she ultimately arrived at a place
  • 01:33:08where she was ready to process
  • 01:33:10these underlying stressors,
  • 01:33:12and her anxiety was deeply rooted in trauma.
  • 01:33:16As treatment progressed,
  • 01:33:17Sierra had a revelation where she
  • 01:33:20discovered that when stuck in traffic
  • 01:33:22during long rides away from home,
  • 01:33:24it reminded her.
  • 01:33:26Feeling trapped like during
  • 01:33:28her traumatic experience.
  • 01:33:30Reading these insights to
  • 01:33:32Sierras consciousness,
  • 01:33:33she had finally found herself
  • 01:33:35in the driver's seat,
  • 01:33:36so to speak,
  • 01:33:37where she was in control
  • 01:33:39of her symptoms and her
  • 01:33:41symptoms no longer had the power over her.
  • 01:33:44This was truly an empowering and
  • 01:33:46triumphant moment for Sierra,
  • 01:33:48who continues to thrive today.
  • 01:33:51I'm happy to say that since
  • 01:33:53working through her traumas,
  • 01:33:54she attends school on a daily basis.
  • 01:33:57And she has taken several road
  • 01:33:59trips to visit college campuses
  • 01:34:01in the absence of panic.
  • 01:34:03Sierra is currently a senior in
  • 01:34:05high school looking to pursue a
  • 01:34:07college education at the nation's
  • 01:34:09top universities where she hopes
  • 01:34:11to major in forensic psychology
  • 01:34:14and to ask for Mrs Night.
  • 01:34:16She is feeling more confident
  • 01:34:17that her child is now equipped
  • 01:34:19with the tools necessary for
  • 01:34:21Sierra to travel away from home
  • 01:34:24for her collegiate experience.
  • 01:34:25Thank you for your time everyone.
  • 01:34:33Thank you so much and so we have
  • 01:34:35our last last clinical tasting.
  • 01:34:38Our clinical vignettes from that
  • 01:34:39doctor Nancy Close, Nancy. Thank
  • 01:34:43you Linda, and it's just an honor and
  • 01:34:46a pleasure to be here with all of you.
  • 01:34:49I'm going to share with you
  • 01:34:51the story of a little girl,
  • 01:34:53seven years old whose name is Tiana.
  • 01:34:55She is a child who has witnessed
  • 01:34:58intimate partner and community violence.
  • 01:35:00She's experienced neglect,
  • 01:35:02loss of her caregivers,
  • 01:35:04physical and sexual abuse,
  • 01:35:06and she is about two in one week.
  • 01:35:09Moved to her 10th foster home
  • 01:35:11since she was removed from.
  • 01:35:13Her mother at age 2 at age 4,
  • 01:35:16she was placed in her grandmother's home
  • 01:35:19and began child parent psychotherapy,
  • 01:35:21which we refer to as CPP
  • 01:35:24with her grandmother.
  • 01:35:25CPP is an evidence based treatment
  • 01:35:28that supports family strengths and
  • 01:35:31relationships and helps families
  • 01:35:33feeling grow after stressful
  • 01:35:35and traumatic experiences.
  • 01:35:37Unfortunately,
  • 01:35:37Tiana was removed at age 5 after she
  • 01:35:41was hit and bruised by her grandmother,
  • 01:35:44but CPP and supervised visits
  • 01:35:47continued with grandmother.
  • 01:35:48Grandmother still longs to be reunited
  • 01:35:51with Tiana and is working hard on her
  • 01:35:55case plan and her attendance is exceptional.
  • 01:35:58My work began with Tiana,
  • 01:36:00Tiana when she was five,
  • 01:36:02when her beloved clinician finished
  • 01:36:04her training and left the center.
  • 01:36:07This clinician had worked with Tiana and
  • 01:36:09grandmother to repair their relationship,
  • 01:36:12to support grandmother to understand
  • 01:36:15Tiana's trauma system symptoms,
  • 01:36:17things like difficulties regulating
  • 01:36:19her behaviors that were really
  • 01:36:21driven by deep sadness,
  • 01:36:23fear and anger,
  • 01:36:24and difficulties trusting that
  • 01:36:26adults would care for her.
  • 01:36:28Keepers save and really see her as
  • 01:36:31somebody who was worthy of love.
  • 01:36:33I was able to provide continuity
  • 01:36:36in this treatment because I
  • 01:36:39was her clinician supervisor.
  • 01:36:41Then COVID happened and in
  • 01:36:43person treatment and DCF.
  • 01:36:45Regular supervised visits were
  • 01:36:48suspended from March 2020 to May 2021.
  • 01:36:51The court date to determine permanency
  • 01:36:54was scheduled for June 2020.
  • 01:36:57It's been postponed multiple times.
  • 01:36:59Due to COVID and will not occur
  • 01:37:02until March 2, 2022.
  • 01:37:05I think that the CHILD Study Center
  • 01:37:07has been a stable and secure place
  • 01:37:10for Tiana during during COVID and
  • 01:37:12I want to talk a little bit about
  • 01:37:14what I've done and we've what we've
  • 01:37:16done as a team to ensure safety in
  • 01:37:19place and relationships for Tiana.
  • 01:37:22I've developed a very good working
  • 01:37:24relationship with the DCF caseworkers,
  • 01:37:27her various foster parents and
  • 01:37:29her grandmother.
  • 01:37:31We have regular conversations and
  • 01:37:33meetings and we discuss and acknowledge
  • 01:37:35the impact that trauma has had on
  • 01:37:38Tiana's development, her relationships,
  • 01:37:40her emotions and behavior.
  • 01:37:43I think I've really helped the team
  • 01:37:45to understand her difficult behavior
  • 01:37:47and I'm hopeful I really do believe
  • 01:37:50that their trauma lenses have grown.
  • 01:37:52I think they big now appreciate
  • 01:37:54the importance of being with her
  • 01:37:56when she's upset when she's engaged
  • 01:37:58in long and mournful crying.
  • 01:38:00It's not a good idea to let her
  • 01:38:02cry it out alone that she needs
  • 01:38:04somebody trusted to be with her.
  • 01:38:06They understand that attempting to
  • 01:38:09make connections between her feelings
  • 01:38:11and her experiences and her behaviors
  • 01:38:13can be organizing for her and at the
  • 01:38:16same time I've really honored the
  • 01:38:18commitment that they have made tetiana.
  • 01:38:21It's really been quite remarkable.
  • 01:38:24One of the things that's foundational
  • 01:38:26in CPP is really developing an
  • 01:38:29empathic therapeutic relationship
  • 01:38:30with both the child and the parent,
  • 01:38:34and this has been really hard work.
  • 01:38:36Not so hard with the grandma,
  • 01:38:37because we've, I think Rick
  • 01:38:40developed a very nice relationship,
  • 01:38:42but with Tiana it was very hard.
  • 01:38:45I saw her virtually that was that I met her
  • 01:38:48virtually and saw her twice a week once
  • 01:38:51with grandmother and once individually.
  • 01:38:54It was three months before
  • 01:38:55she called me by my name.
  • 01:38:57She would call me by the other clinicians
  • 01:38:59name or she would stop and say what's your
  • 01:39:02name again at the end of the session.
  • 01:39:04One day she said,
  • 01:39:05and I think some of you have
  • 01:39:07heard this before.
  • 01:39:08You are Dr Oldys mushy and sloppy.
  • 01:39:10I don't like you.
  • 01:39:11I don't ever want to see you again.
  • 01:39:14I said to her I knew how much she
  • 01:39:16missed Doctor Katie and she was sad
  • 01:39:18and mad that doctor Katie left her.
  • 01:39:20She responded to that by saying
  • 01:39:22she really didn't feel that way,
  • 01:39:24which she often does.
  • 01:39:25Protesting a little bit too much when it
  • 01:39:28really does hit a chord a few sessions later,
  • 01:39:31she went into her closet where
  • 01:39:33she regularly went.
  • 01:39:34When playing or talking about
  • 01:39:36something difficult.
  • 01:39:37Can I tell you something?
  • 01:39:38I think you are a super
  • 01:39:41girl and you're beautiful.
  • 01:39:42I said I think you're getting to know me
  • 01:39:45better and share all kinds of feelings.
  • 01:39:47So I think her comments really illustrate
  • 01:39:50her struggle with relationships
  • 01:39:53and managing ambivalent feelings.
  • 01:39:55I think her consistent weekly
  • 01:39:57connection to grandmother and our
  • 01:39:59capacity to be reflective about her
  • 01:40:02feelings and consistent in the limits
  • 01:40:04we set when she becomes dysregulated.
  • 01:40:06And she believed me.
  • 01:40:08He becomes dysregulated were very
  • 01:40:11organizing during the difficult times
  • 01:40:14of COVID with great joy in person.
  • 01:40:17Sessions began in May of 2021,
  • 01:40:19and what I've seen is a growing capacity
  • 01:40:23in Tiana to grow to play imaginatively.
  • 01:40:27Play is very much an important
  • 01:40:29component of child parent psychotherapy
  • 01:40:30because it's through imaginative
  • 01:40:32play that children learn how they
  • 01:40:35feel and make meaning of experiences.
  • 01:40:37And I'm just going to show you.
  • 01:40:39Some props,
  • 01:40:40these are her favorite babies and
  • 01:40:43dollies that she spends a lot of time.
  • 01:40:46Plain family kit.
  • 01:40:48Being a loving and caring mother
  • 01:40:50which makes me think there have
  • 01:40:52been times when she has received
  • 01:40:55that kind of care grandmother who
  • 01:40:56initially with the other clinician
  • 01:40:58didn't sit on the floor,
  • 01:41:00sat on a chair and watched Tiana
  • 01:41:03play is down on the floor engaged
  • 01:41:05in the play and following her lead.
  • 01:41:08The babies need feeding and bathing.
  • 01:41:11They go to the park.
  • 01:41:12They get ready for school.
  • 01:41:13They do a lot of eating and going to bed.
  • 01:41:16Her role shifts from being the
  • 01:41:18baby to being a little girl,
  • 01:41:20teenager an aunt and a mother.
  • 01:41:23The play has developed to
  • 01:41:26be more explicit about her fears and
  • 01:41:28traumatic things that have happened to her.
  • 01:41:30She worries about getting shot or
  • 01:41:32somebody coming to take her away.
  • 01:41:34If she hears a loud noise during session,
  • 01:41:37she played about a baby who was.
  • 01:41:39Left on the sidewalk by
  • 01:41:40the mother and a family,
  • 01:41:42finding her and taking her in.
  • 01:41:45Recently she played a mother of these
  • 01:41:48babies who was going away to get
  • 01:41:51married and Auntie was babysitting and
  • 01:41:53Auntie said I hope he does not hit you.
  • 01:41:56The baby gets in trouble.
  • 01:41:57This one gets in trouble for not
  • 01:42:00following the rules and has and
  • 01:42:02has to go to bed for being bad.
  • 01:42:04Babies are hiding in the basement because
  • 01:42:06a man is coming to get them grandmother
  • 01:42:09and I stay with her in this play,
  • 01:42:11helping her to expand and feel safe
  • 01:42:13enough to examine her underlying feelings.
  • 01:42:16And finally,
  • 01:42:17I think that we've also helped her
  • 01:42:20find ways of coping or discover
  • 01:42:22things that help her cope.
  • 01:42:24One of the things that she's been doing
  • 01:42:27doing recently is taking responsibility
  • 01:42:29for knowing how much time is left in
  • 01:42:32her session and plans for it so that
  • 01:42:35she can leave in a more regulated way.
  • 01:42:38Attending church has been very
  • 01:42:40organizing and I would say her
  • 01:42:42grandmother is very religious and
  • 01:42:44her other foster families have
  • 01:42:46participated in their church communities.
  • 01:42:49Singing and dancing are very special talents
  • 01:42:52that I'm II try to nurture in session.
  • 01:42:55And I hope will be nurtured
  • 01:42:56outside of this session.
  • 01:42:58She'll sing original songs during
  • 01:43:00sessions that have things on her mind.
  • 01:43:03I've learned that singing calms her,
  • 01:43:05and when I see her kind of revving
  • 01:43:07up at the end of the session to
  • 01:43:09maybe have a difficult time,
  • 01:43:10I suggest that she sings a song and she
  • 01:43:13will often sing a song to grandmother.
  • 01:43:15And here's an example of one
  • 01:43:17we don't have a family.
  • 01:43:20My family is in my heart.
  • 01:43:21I miss you every morning when you
  • 01:43:23take care of me and my sister.
  • 01:43:25In your heart is a big family.
  • 01:43:28I love you.
  • 01:43:28I am very happy to be with you
  • 01:43:30'cause you are so special special
  • 01:43:32and you were like a dream to me.
  • 01:43:34A very special dream and you are special
  • 01:43:37and a grandma that is special to me.
  • 01:43:40Certainly there is more work to
  • 01:43:41be done but I remain hopeful.
  • 01:43:44I want to thank you all and thank
  • 01:43:46you especially for all of the
  • 01:43:48continued support that you give
  • 01:43:50to us and and or center.
  • 01:43:53Thank you so much, Nancy.
  • 01:43:55So I just want to look at the clock
  • 01:43:58'cause I want to give everyone a chance
  • 01:44:00for some questions and discussion.
  • 01:44:02We have a a built-in break.
  • 01:44:05I think we can take a few minutes
  • 01:44:07for questions and then we'll come
  • 01:44:08back and take a little bit of time
  • 01:44:11from our concluding question session.
  • 01:44:13So are there any questions for
  • 01:44:15our our clinical presenters?
  • 01:44:18As a group, and I hope you've
  • 01:44:20given you a sense of the.
  • 01:44:22I'm just a bit of a sense of the range
  • 01:44:25of clinical work going on in the center.
  • 01:44:27Will open up for questions.
  • 01:44:38I think a car yeah.
  • 01:44:42Go ahead.
  • 01:44:44Can you hear me? Yes
  • 01:44:46Carol we can. OK
  • 01:44:48so I wanted to ask how old do
  • 01:44:51when you presented these cases?
  • 01:44:53How old were the children on
  • 01:44:55the spectrum? You know on
  • 01:44:56the age group with developmental.
  • 01:44:59Are there age limits or this specific?
  • 01:45:04Ways you work with different ages.
  • 01:45:07And do the children know that
  • 01:45:10is a time limit? Because
  • 01:45:12these children are the first people
  • 01:45:14that they could ever trust,
  • 01:45:17and do they know how?
  • 01:45:18If it's going to be 6-6?
  • 01:45:21Or how do you frame that for
  • 01:45:22them so they understand that?
  • 01:45:26So who would like
  • 01:45:27to take that? I mean, Tara,
  • 01:45:29do you want to address the
  • 01:45:30age range that we serve and?
  • 01:45:33Store in our outpatient in our youth
  • 01:45:37clinical services we serve children from
  • 01:45:40birth through their 19th birthday, so that
  • 01:45:44that's the range within those services.
  • 01:45:47And so we have a team that Nancy is on
  • 01:45:49that works with some of the younger
  • 01:45:50group and then from four and a half up.
  • 01:45:52We have our other team that the time
  • 01:45:55really depends on what what's going on and
  • 01:45:59and what the particular intervention is.
  • 01:46:03You know Carrie was talking about CSI,
  • 01:46:06which has a certain number of sessions,
  • 01:46:08so that's different than some of
  • 01:46:10the other work that we might do.
  • 01:46:11CPP might be the opposite and
  • 01:46:13take longer through the play.
  • 01:46:15It's really about what is
  • 01:46:17clinically indicated in that time,
  • 01:46:19and as we go along in treatment, we are.
  • 01:46:22We talked with the children and their
  • 01:46:24caregivers about where we're at every about,
  • 01:46:27every three months when it's the longer
  • 01:46:29term treatment about where we're at and
  • 01:46:32where we think we need to go in about.
  • 01:46:34How long we think it might be,
  • 01:46:35and so we're constantly having
  • 01:46:36that conversation with them and
  • 01:46:38revisiting what progress is.
  • 01:46:39Well,
  • 01:46:39if you have a very
  • 01:46:40young child, they don't
  • 01:46:42understand that I don't.
  • 01:46:43I don't know how you would frame it
  • 01:46:45so they would because when I worked
  • 01:46:48in the clinic they children drew a
  • 01:46:53picture of their is sitting in a car
  • 01:46:56going off the click, the cars going
  • 01:46:58off the Cliff and it was the end of
  • 01:47:00the treatment and I just wonder,
  • 01:47:02you know, with the short term.
  • 01:47:05Treatment how that?
  • 01:47:07Can be explained to them or how you would.
  • 01:47:12Handles that.
  • 01:47:14Well, Nancy, since
  • 01:47:15you are one of our younger child
  • 01:47:17experts, I wondered if you could
  • 01:47:19share your thoughts on this one.
  • 01:47:22I'm sure happy to come.
  • 01:47:26I think that certainly the the UM,
  • 01:47:29it's important to be explicit
  • 01:47:32upfront with the family about the
  • 01:47:35nature of the treatment and what
  • 01:47:38we're going to be working on.
  • 01:47:41And in child parent psychotherapy we
  • 01:47:43do a lot of gathering information from
  • 01:47:47the parents over several several weeks,
  • 01:47:51so that together.
  • 01:47:52But the parent we can form a
  • 01:47:55treatment triangle that talks about
  • 01:47:57what has happened to the child.
  • 01:47:59You know, if you think about Tiana
  • 01:48:02you you were taken from your mommy,
  • 01:48:04you've lived in a lot of foster homes.
  • 01:48:07How the child has responded to that.
  • 01:48:10You have a lot of temper tantrums.
  • 01:48:13You really lose control.
  • 01:48:16You have a hard time being a good
  • 01:48:18boss for yourself and this is
  • 01:48:20a place where we can help you.
  • 01:48:23Understand what has happened to you
  • 01:48:25and you can feel safe and whoever
  • 01:48:28is the parent in the in the CPP
  • 01:48:31with them you and Mommy or Ewing
  • 01:48:34and Grandma are going to work are
  • 01:48:36going to work on this together and
  • 01:48:38this is a place where you can feel
  • 01:48:40safe and you can learn about some
  • 01:48:42of the feelings you have connected
  • 01:48:44to being taken from your mommy.
  • 01:48:47And then that's a little kind of
  • 01:48:49simple and concrete, but we also use.
  • 01:48:53Animals or people to to show what you know,
  • 01:48:57show what the child's experience has been.
  • 01:49:00We try because of the young age.
  • 01:49:01We keep it simple and maybe don't you know,
  • 01:49:04certainly with Tiana,
  • 01:49:05we wouldn't address all of
  • 01:49:07her experiences at once.
  • 01:49:09You know we didn't.
  • 01:49:11We didn't talk about them initially
  • 01:49:14when she was for all of them.
  • 01:49:16I mean,
  • 01:49:17the big the big issue for her
  • 01:49:19was the removal from her mother.
  • 01:49:24So we have a. We have a couple
  • 01:49:27of questions in the chat,
  • 01:49:28so Jennifer is asking how to CPP
  • 01:49:32compared to using TF CBT with young
  • 01:49:35children who experienced trauma Carrie,
  • 01:49:37would you like to or Nancy
  • 01:49:38either won't take that. CPP
  • 01:49:41is and carry out.
  • 01:49:42I'll let you you go after,
  • 01:49:44but CPP is an intervention that's
  • 01:49:48meant for children zero to 6.
  • 01:49:52And TFCBT, I'll let you take over. Carrie.
  • 01:50:02So in TF CBT is a model that can be
  • 01:50:05implemented with preschoolers and older,
  • 01:50:08although a lot of folks really focus
  • 01:50:10on sort of maybe 6 year olds and up.
  • 01:50:12But it can be done with preschoolers
  • 01:50:14and older and this is a model that
  • 01:50:18it's a very phase based approach and
  • 01:50:20components based approach and really
  • 01:50:22focuses on and this kind of goes to
  • 01:50:24your question Carol about how do you
  • 01:50:28actually work with the younger kids?
  • 01:50:30This is really about.
  • 01:50:32The opportunity to predict if the
  • 01:50:34essence of the traumatic experience
  • 01:50:35is all about loss of control.
  • 01:50:37I couldn't control what's happening
  • 01:50:39to me or to a loved one.
  • 01:50:41In the case of domestic violence
  • 01:50:42that we want our treatment to be
  • 01:50:44all about reversing loss of control,
  • 01:50:46of putting words to symptoms,
  • 01:50:48identifying coping strategies to
  • 01:50:49bring those symptoms down and also
  • 01:50:51being able to predict treatment.
  • 01:50:53So here's what we're going to do today.
  • 01:50:55So you're right,
  • 01:50:57it depending developmentally.
  • 01:50:58Whether or predicting what we're
  • 01:50:59going to do today,
  • 01:51:00whether it be predicting the
  • 01:51:02overall trajectory of the model.
  • 01:51:04But the the treatments really folks?
  • 01:51:06TF CBT in particular focuses
  • 01:51:07on as well as safety aside,
  • 01:51:09bringing symptoms down and regaining
  • 01:51:11sense of control of symptoms first
  • 01:51:13and later getting to a trauma
  • 01:51:14narrative in the context of TFCBT,
  • 01:51:16I don't know if that answers your question,
  • 01:51:18Jennifer.
  • 01:51:19Thanks Carrie. So Tom,
  • 01:51:20I see you have a couple of questions
  • 01:51:23when I'm going to suggest that we gave
  • 01:51:25everybody a chance to take a brief break,
  • 01:51:28a 5 minute break stretch,
  • 01:51:30grab a glass of water, coffee, whatever,
  • 01:51:31and then we'll come back and start
  • 01:51:34our education part and Tom I will.
  • 01:51:36I will respond to your questions in our
  • 01:51:39and our question and answer at the end.
  • 01:51:42But thank thanks for people for
  • 01:51:43putting the questions in the chat
  • 01:51:45so it is 452 if we could be back.
  • 01:51:49Just it. This sounds so concrete,
  • 01:51:52but if we can be back at three
  • 01:51:54minutes or four and we will,
  • 01:51:56we will get started again.
  • 01:51:57So we're just taking a brief pause.
  • 01:52:23And for the answers, the questions
  • 01:52:25in the chat that were about DBT,
  • 01:52:28both Tara and Carrie had provided
  • 01:52:31some information in the chats.
  • 01:52:33So we now come into our education section.
  • 01:52:36Or are we probably should call
  • 01:52:38this more career development and
  • 01:52:40I'm really excited for you to have
  • 01:52:43a chance to hear these individual
  • 01:52:45stories from former colleagues.
  • 01:52:47Let me first turn through Doctor
  • 01:52:49Emily Olson, Emily.
  • 01:52:54Hello everyone. Uhm, good afternoon.
  • 01:52:58My name is Emily Olson and I'm currently
  • 01:53:01in my 6th and final year of training and
  • 01:53:04the combined child and Adult Psychiatry
  • 01:53:06residency and I'm delighted to have
  • 01:53:08the opportunity today to talk with
  • 01:53:10you a little bit about my experience
  • 01:53:13here at the Yale Child Study Center.
  • 01:53:16So just a bit about my background
  • 01:53:18and what drew me to Yale.
  • 01:53:19I was raised in Brooklyn,
  • 01:53:20NY and then I went to a small
  • 01:53:22liberal arts school in Ohio before
  • 01:53:24attending the MD PhD program at
  • 01:53:27Washington University in Saint Louis.
  • 01:53:28During my PhD I developed an interest
  • 01:53:31in using translational genomic
  • 01:53:33approaches to better understand
  • 01:53:35and treat psychiatric conditions,
  • 01:53:37but it really wasn't until my medical
  • 01:53:39school clerkships when I was working with
  • 01:53:42children and families that my clinical
  • 01:53:44passion for child psychiatry solidified.
  • 01:53:46So when I applied to residency,
  • 01:53:48I knew that I ideally wanted to
  • 01:53:50attend a program where I could start
  • 01:53:52working in child psychiatry early
  • 01:53:54and also continue my genetics work.
  • 01:53:56So I was especially delighted when
  • 01:53:59I found this woman integrated
  • 01:54:01residency program and this truly
  • 01:54:02is a one inch of a kind program.
  • 01:54:05And here I'm just showing you a
  • 01:54:07general schematic of how I've spent
  • 01:54:09my time over the last six years.
  • 01:54:10But essentially this program
  • 01:54:12combines three things.
  • 01:54:14Residency training in general.
  • 01:54:16Adult Psychiatry subspecialty fellowship
  • 01:54:18training and child psychiatry as well as
  • 01:54:21rigorous research training throughout.
  • 01:54:24The entire six years.
  • 01:54:25So for someone like me,
  • 01:54:27who was the spy ring to be a physician,
  • 01:54:29scientist and child psychiatry,
  • 01:54:31this was really an ideal program.
  • 01:54:33The leadership of this program is also
  • 01:54:36incredibly supportive and I'm just
  • 01:54:38showing a few of the many key people here.
  • 01:54:42So my first two
  • 01:54:43years, the majority of my time was
  • 01:54:45spent seeing patients in Pediatrics,
  • 01:54:46neurology, and psychiatry,
  • 01:54:48and during this time I honed my clinical
  • 01:54:51skills and these early experiences
  • 01:54:53also gave me a sense of some of the
  • 01:54:55important unanswered questions in
  • 01:54:57their field and during this time I
  • 01:54:59became especially interested in two
  • 01:55:01significantly under study conditions,
  • 01:55:03TRICHOTILLOMANIA and excoriation disorder.
  • 01:55:05Individuals afflicted with these
  • 01:55:07conditions often spend hours a day
  • 01:55:09pulling or picking at their hair skin,
  • 01:55:11which causes significant distress
  • 01:55:13and impairment.
  • 01:55:14But there are no first line pharmacologic
  • 01:55:17treatments for either condition,
  • 01:55:18which really highlights that we
  • 01:55:20need to have a better understanding
  • 01:55:21of the underlying biology.
  • 01:55:23But I was surprised to find that there
  • 01:55:25were no state of the art large scale
  • 01:55:28genomic studies for either condition.
  • 01:55:30So I went to my mentors,
  • 01:55:31Tom Fernandez and Michael Block with
  • 01:55:33this idea of conducting the first DNA
  • 01:55:36sequencing study in these conditions,
  • 01:55:37and with these conditions,
  • 01:55:39and with their guidance,
  • 01:55:40we developed the TAB study.
  • 01:55:42And here is a picture of
  • 01:55:43our recruitment table,
  • 01:55:44and this was at a meeting back in.
  • 01:55:45April 2018,
  • 01:55:46for individuals who had these
  • 01:55:48conditions in San Francisco,
  • 01:55:51and you can see that we have all the
  • 01:55:53supplies to collect saliva for DNA and
  • 01:55:56to collect our clinical assessments.
  • 01:55:58But when I took this picture,
  • 01:55:59I was a little nervous.
  • 01:56:00I honestly didn't know what to expect,
  • 01:56:02but shortly after this photo,
  • 01:56:04we enrolled our first research participant
  • 01:56:06and over the three days of the meeting,
  • 01:56:08we were able to enroll over 50 families
  • 01:56:11and individuals who had these conditions.
  • 01:56:14I was really moved by the support
  • 01:56:16for this research and hearing
  • 01:56:17their stories compelled me to
  • 01:56:19continue this line of work.
  • 01:56:23Over the next four years,
  • 01:56:24I expanded the TAB study and
  • 01:56:26also led other genomics projects.
  • 01:56:28I have now analyzed DNA sequencing data
  • 01:56:31from hundreds of individuals and families
  • 01:56:33to help to understand the genes and
  • 01:56:35pathways that lead to these conditions.
  • 01:56:38My hope is that this work will
  • 01:56:40identify new treatment targets.
  • 01:56:42But it's important to note that I have
  • 01:56:44only been able to do this because of the.
  • 01:56:46Because of my protective research time,
  • 01:56:48which was made possible by grants and
  • 01:56:50donations to the Yale Child Study Center.
  • 01:56:52I've also continued to develop my
  • 01:56:54clinical skills because I also want
  • 01:56:56to be a practicing child psychiatrist
  • 01:56:59and this model of simultaneously
  • 01:57:01working with patients while conducting
  • 01:57:03research is incredibly powerful
  • 01:57:05because there's a constant feedback.
  • 01:57:07I find that my clinical work informs the
  • 01:57:10research questions I ask and my research
  • 01:57:12findings also improve our clinical work.
  • 01:57:16On a more personal
  • 01:57:16note, I want to add that during my training
  • 01:57:19I also became apparent to two kids.
  • 01:57:21This experience has been wonderful
  • 01:57:23in many ways, and it's also further
  • 01:57:25solidified my commitment to the
  • 01:57:27work that we do here at the center.
  • 01:57:28And just as the center has helped so
  • 01:57:30many children and families that we've
  • 01:57:32heard about just in the last session,
  • 01:57:33they've also been incredibly
  • 01:57:35supportive of my own family.
  • 01:57:39I'm now in my last year of training and
  • 01:57:41I'm in that process of transitioning.
  • 01:57:43Unfortunate that I recently received
  • 01:57:45a strong score on an NIH grant,
  • 01:57:47a career development award which
  • 01:57:49really builds upon the work that I
  • 01:57:51mentioned to you today at the TAB study,
  • 01:57:53and my hope is to be able to continue
  • 01:57:55this work as a faculty member
  • 01:57:57at the Yale Child Study Center,
  • 01:57:59which, over the last six years has
  • 01:58:01become my academic home.
  • 01:58:03With
  • 01:58:03that I just want to thank UM, all
  • 01:58:06my funding and everyone who's supported me.
  • 01:58:11Thank you so much.
  • 01:58:12I'm really how I would just say
  • 01:58:14that we share your hope so.
  • 01:58:16So let me turn to Karthik.
  • 01:58:19Gotta be Roman kartik.
  • 01:58:25Right, uh, I'm Karthik I'm
  • 01:58:26the other six year along with
  • 01:58:28Emily and usually I give a talk about
  • 01:58:31my interest in the neuro developmental
  • 01:58:33trajectory of schizophrenia.
  • 01:58:34But being at the end of my training,
  • 01:58:36I thought it would be a great opportunity
  • 01:58:37to talk about my own developmental
  • 01:58:39trajectory and the essential role.
  • 01:58:40The Child Study Center has had
  • 01:58:42in helping me develop my voice.
  • 01:58:43And really being someone that,
  • 01:58:45in this trite saying of
  • 01:58:46bench to bedside lesson,
  • 01:58:47that I really strive to try to do.
  • 01:58:49And it's only recently have
  • 01:58:50been able to do that at
  • 01:58:51the CHILD Study Center.
  • 01:58:53Alright, and so prior
  • 01:58:55to coming to Yale,
  • 01:58:56I did my MD PhD on the West Coast
  • 01:59:00and during my Graduate School time.
  • 01:59:01I studied very early brain development.
  • 01:59:03I was really interested in the
  • 01:59:05intricacies of gene regulation.
  • 01:59:06How do you turn on a gene at the
  • 01:59:08right place in the right time?
  • 01:59:09This is just a figure from one of my
  • 01:59:11papers from grad school and actually just
  • 01:59:13came out and then it's an overwhelming
  • 01:59:15slide 'cause it's a lot of data.
  • 01:59:17It's a lot of information
  • 01:59:18and I absolutely loved it.
  • 01:59:19I'm a little transcription factor nerd,
  • 01:59:22I think, however.
  • 01:59:24I was struggling at the end of grad
  • 01:59:25school of how I could translate this work
  • 01:59:27into something clinically meaningful.
  • 01:59:28How could I actually help patients with this?
  • 01:59:30So I put that concerned aside and went
  • 01:59:33back to Medicine Medical School and
  • 01:59:34finished my last two clinical years.
  • 01:59:36Wow, those during those last two
  • 01:59:38years that I realized I love child
  • 01:59:39psychiatry working with children
  • 01:59:40that have always enjoyed and I was
  • 01:59:42really struck by children and their
  • 01:59:44resilience as well as how much they
  • 01:59:46struggled and at the same time I
  • 01:59:48realized the patients that really
  • 01:59:50struck me and really drew me in
  • 01:59:52where patients with schizophrenia,
  • 01:59:54which is traditionally the purview
  • 01:59:56of adult psychiatry.
  • 01:59:57So when I went onto the interview trail,
  • 01:59:58I got advice from people that
  • 02:00:00really respected that I shouldn't
  • 02:00:02do child psychiatrist.
  • 02:00:03Stick to adult psychiatry as that would be
  • 02:00:05better for my clinical interests as well as.
  • 02:00:07More supportive of my basic science
  • 02:00:09research and so my last interview was
  • 02:00:11at Yale at the at the SONET program,
  • 02:00:13and I was really excited to
  • 02:00:14learn about the program.
  • 02:00:15As Emily mentioned,
  • 02:00:16it's one of these unique programs
  • 02:00:19that integrates adult child
  • 02:00:21psychiatry along with research,
  • 02:00:23and it was really great to talk to
  • 02:00:25people that were current trainees that
  • 02:00:26as well as mentors that integrated both
  • 02:00:29that did basic signs that did research
  • 02:00:31as well as seeing patients that did
  • 02:00:33someone something that didn't have
  • 02:00:35very much experience with previously.
  • 02:00:36And so I was really excited to get into the.
  • 02:00:39Program and so.
  • 02:00:40Over the first couple years I was
  • 02:00:43able to work with adults with
  • 02:00:45schizophrenia both in the acute setting,
  • 02:00:47the emergency room and including page.
  • 02:00:49They were actively psychotic,
  • 02:00:50as well as the inpatient setting
  • 02:00:52and the outpatient setting,
  • 02:00:53but addition had the unique opportunity
  • 02:00:55to work in a young child inpatient unit.
  • 02:00:58And during that time I met a couple
  • 02:01:00of children that were just starting
  • 02:01:01to hear voices that were on this
  • 02:01:03very scary pathway to schizophrenia.
  • 02:01:05And that was something that
  • 02:01:07really resonated with me.
  • 02:01:08And this is the population I really want to.
  • 02:01:09Work with
  • 02:01:10at the same time. I was also
  • 02:01:12working in the laboratory of Doctor Nets,
  • 02:01:14Aston in that lab I was really
  • 02:01:16interested in understanding
  • 02:01:17how the front of the brain,
  • 02:01:18the prefrontal cortex, develops,
  • 02:01:20as well as how it evolves.
  • 02:01:21The prefrontal cortex is greatly
  • 02:01:23expanded in humans as well as
  • 02:01:25special properties that are thought
  • 02:01:26to underlie our unique capabilities
  • 02:01:28in complex social behaviors. But
  • 02:01:30these same unique changes in the human brain
  • 02:01:33may underlie our risk for
  • 02:01:35Neuro psychiatric disorder.
  • 02:01:36So while I was doing my second stint on
  • 02:01:39Winnie one as a fellow sister my 4th year,
  • 02:01:42I stumbled upon this really exciting finding,
  • 02:01:44which is displayed here.
  • 02:01:45Just summarizing it.
  • 02:01:46Basically what we found was disruption
  • 02:01:49of development of the prefrontal cortex.
  • 02:01:51So think the second trimester of
  • 02:01:53pregnancy could produce the exact same
  • 02:01:55circuit deficits described in patients.
  • 02:01:57Adults with schizophrenia, for example.
  • 02:02:00This is an image of a five day old
  • 02:02:02mouse brain and what you see on the
  • 02:02:03right is the connection between the
  • 02:02:05front of the brain or the medial
  • 02:02:07prefrontal cortex and the thalamus.
  • 02:02:08You see this thick bundle of connection.
  • 02:02:10It's a very important circuit
  • 02:02:12for memory cognition,
  • 02:02:13but in the mutant mouse
  • 02:02:14where we disrupted genes,
  • 02:02:16a certain set of genes,
  • 02:02:17we saw a huge reduction of connectivity
  • 02:02:19and this is something that's been
  • 02:02:20described in adults with schizophrenia
  • 02:02:22as well as inpatients or prodromal
  • 02:02:25adolescence that are starting to
  • 02:02:27have mid like the initial symptoms of
  • 02:02:30schizophrenia prior to conversion to
  • 02:02:32psychosis and these findings as well
  • 02:02:35as my clicker experience had really
  • 02:02:36coalesced into my future plants,
  • 02:02:37right?
  • 02:02:38I really see a way of integrating
  • 02:02:39my basic science.
  • 02:02:40Interesting to something clinical,
  • 02:02:42but I'm hoping to study is how
  • 02:02:44can disruption of second trimester
  • 02:02:46pregnancy and this so well established
  • 02:02:48point for example during famines
  • 02:02:50or pandemics or any type of stress
  • 02:02:53during pregnancy.
  • 02:02:53There is a massive increase of the
  • 02:02:56risk of schizophrenia 20 years later,
  • 02:02:58so I'm interested in understanding
  • 02:02:59what's going on in those twenty
  • 02:03:01years from that initial genetic
  • 02:03:02or environmental stressor to that
  • 02:03:04later diagnosis.
  • 02:03:05Schizophrenia,
  • 02:03:05I think if we can understand
  • 02:03:07what's going on those 20 years,
  • 02:03:08we can possibly prevent
  • 02:03:10schizophrenia completely.
  • 02:03:10Which is my big long term goal.
  • 02:03:13I couldn't have done this research and
  • 02:03:15had this experience anywhere else,
  • 02:03:16so I'm so grateful to be at
  • 02:03:18the Yale Child Study Center.
  • 02:03:19I'm excited to continue this, hopefully here.
  • 02:03:21Just like Emily said as well.
  • 02:03:23And of course,
  • 02:03:24I'm thankful for everyone that was involved.
  • 02:03:26This test in lab,
  • 02:03:27all our collaborators, all the funding.
  • 02:03:29Some of my work that I'm going
  • 02:03:31into really trying to create better
  • 02:03:33models of psychiatry was funded
  • 02:03:35by the Alan Sipka Foundation.
  • 02:03:37Starfinder pronounced that as
  • 02:03:38well as everyone that was involved
  • 02:03:39in the solar program.
  • 02:03:41The child space,
  • 02:03:41and they've been so supportive
  • 02:03:42the whole way through.
  • 02:03:44And as I said,
  • 02:03:45I'm really grateful for the opportunity,
  • 02:03:46thanks.
  • 02:03:51Thank you so much Karthik.
  • 02:03:54May I turn to doctor Kareem Abraham?
  • 02:04:21You're on karine.
  • 02:04:23I thank you for this wonderful
  • 02:04:25opportunity to share with you. My story.
  • 02:04:27My name is Kareem and I'm an earth
  • 02:04:29scientist and child psychologists.
  • 02:04:30Here Child study center.
  • 02:04:32The overall goal of my research
  • 02:04:35is to understand brain networks
  • 02:04:36related to emotion regulation,
  • 02:04:38impairments and child mental health
  • 02:04:40that can inform clinical interventions.
  • 02:04:43And with the ultimate goal of improving
  • 02:04:45the life of children and their families.
  • 02:04:48So my story really begins with a handshake.
  • 02:04:50Well at least.
  • 02:04:52Pre COVID several years ago
  • 02:04:54and shaking hands was a norm.
  • 02:04:57I remember that day quite well because
  • 02:04:59I was at the Seaver Autism Center Mount
  • 02:05:01Sinai drives in my graduate research,
  • 02:05:03and at the time I was a doctoral
  • 02:05:05student in clinical psychology.
  • 02:05:06In my research focused on understanding brain
  • 02:05:09regions important for social functioning.
  • 02:05:12Here I'm showing you some of the
  • 02:05:14main findings where children who
  • 02:05:16receive social skills training showed
  • 02:05:18increased activation in a region
  • 02:05:21called the medial prefrontal cortex.
  • 02:05:23When interpreting ironic scenarios and
  • 02:05:25viewing faces with different gaze directions,
  • 02:05:27so even at this very early stage
  • 02:05:30of my career,
  • 02:05:30this really sparked my interest to
  • 02:05:33understand how brain activation
  • 02:05:34changes following treatment and how
  • 02:05:36this can be leveraged to develop
  • 02:05:38better and even more focused clinical
  • 02:05:40treatments for child mental health.
  • 02:05:47So it was again.
  • 02:05:48It was a raining day and I remember
  • 02:05:50thinking it's actually perfect day for
  • 02:05:52catching up on reading and paper writing.
  • 02:05:54Then my graduate mentor found me and
  • 02:05:56invited me to join her at grand Rounds talk.
  • 02:05:59She emphasized that his right at
  • 02:06:01my alley and that the speaker was
  • 02:06:02from the L Child Study Center,
  • 02:06:04but she didn't really provide
  • 02:06:05much more detail,
  • 02:06:06leaving it quite mysterious,
  • 02:06:08and I will also admit I actually
  • 02:06:10did not ask for more detail.
  • 02:06:12I guess a part of me actually like this.
  • 02:06:14Spence so we braved the rain.
  • 02:06:16I went to this Grand Rapids talk.
  • 02:06:18It was about two to three slides into this
  • 02:06:20talk when I knew that this was the research
  • 02:06:22I imagine myself doing in the future.
  • 02:06:24It had everything it was patient,
  • 02:06:25oriented with a focus on neuroscience
  • 02:06:28and neural response to treatment.
  • 02:06:30I was also really fortunate to have
  • 02:06:32the opportunity to join my advice
  • 02:06:34or needing with the speaker.
  • 02:06:35After the talk,
  • 02:06:36the speaker was actually Doctor
  • 02:06:38Dennis Super Dulski, shown here,
  • 02:06:39who is a faculty at the center.
  • 02:06:41Here we shook hands.
  • 02:06:43We had a great conversation about our shared.
  • 02:06:46Interest.
  • 02:06:48Uhm?
  • 02:06:49So I would later go on to complete
  • 02:06:52my graduate training in cognitive
  • 02:06:53behavioral interventions and NSS
  • 02:06:55lab and then a T32 postdoctoral
  • 02:06:58research scholarship directed
  • 02:06:59by Doctor Michael Crowley.
  • 02:07:01Were Dennis served as my primary mentor.
  • 02:07:04But during my postdoc,
  • 02:07:05Dennis played a vital role in
  • 02:07:07really fostering my collaborations
  • 02:07:09with neuroimaging experts who
  • 02:07:11are now my Co mentors,
  • 02:07:13which has been crucial for
  • 02:07:14my training and leading to a
  • 02:07:16research award from the Yale
  • 02:07:18Center for Clinical Investigation.
  • 02:07:22So now as a junior faculty,
  • 02:07:24my research focuses on brain networks,
  • 02:07:26underlying emotion regulation,
  • 02:07:27impairments across child
  • 02:07:29psychiatric disorders,
  • 02:07:30and one aspect of my work focuses on
  • 02:07:33understanding brain connectivity and
  • 02:07:35developmental disorders such as autism.
  • 02:07:38Another aspect of my research focuses
  • 02:07:40on understanding impairments and brain
  • 02:07:42structure as well as sex differences
  • 02:07:44in structural and functional networks.
  • 02:07:47So my research is really multi
  • 02:07:48modal because it merged his
  • 02:07:50information from both structural.
  • 02:07:51And functional imaging to understand what
  • 02:07:54goes awry and these neural connections
  • 02:07:56related to mental health conditions.
  • 02:07:59More recently,
  • 02:08:00another aspect of my research leverages
  • 02:08:02was called Network Neuroscience,
  • 02:08:04which allows us to understand long
  • 02:08:07range neural connections across the
  • 02:08:09entire brain called the connectome.
  • 02:08:11We've also applied this connector modeling
  • 02:08:14method to understand childhood aggression.
  • 02:08:18And with the support of a child study
  • 02:08:20center Pilot Research award and grant,
  • 02:08:22this has allowed me to add
  • 02:08:24new aspects to my work.
  • 02:08:25And understanding the temporal
  • 02:08:27dynamics of these neural connections
  • 02:08:30which we can use to identify
  • 02:08:32distinct brain States and test how
  • 02:08:34disruptions here are linked to emotion
  • 02:08:37regulation impairments in children.
  • 02:08:38So I'm very thankful to have met
  • 02:08:40Dennis and to be at a place where I
  • 02:08:42can focus on the three things that
  • 02:08:44I loved most in my research career.
  • 02:08:46Neuroscience,
  • 02:08:46mentoring and teaching students.
  • 02:08:49And maintaining my skills as a violinist.
  • 02:08:53Actually, I'm also founding member
  • 02:08:54of the Send string quartet here.
  • 02:08:56The Child Study Center,
  • 02:08:58which is named after Dr.
  • 02:08:59Milton Son who was a child
  • 02:09:01psychiatrist and the second
  • 02:09:03director of the Child Study Center.
  • 02:09:05I'm also extremely thankful to doctor
  • 02:09:07Linda Mays for her immense supporting
  • 02:09:09guidance on this path and to illustrate
  • 02:09:11the dedication and support from
  • 02:09:13Dennis and the Child Study Center.
  • 02:09:15I would like to share with you a review
  • 02:09:17or comment from my recent NIH career
  • 02:09:20work grant that I think captures this.
  • 02:09:23So the reviewer writes that quote
  • 02:09:25the candidate referring to me and the
  • 02:09:28project received exuberant support
  • 02:09:29from all mentors and leadership
  • 02:09:31at the Yale Child Study Center.
  • 02:09:33By the way,
  • 02:09:34this is actually the first time I've
  • 02:09:36ever found myself quoting a grant viewer.
  • 02:09:41So to think that my path was influenced
  • 02:09:44by attending a 45 minute grand
  • 02:09:46rounds lecture New York that led
  • 02:09:48me here to the child study centers.
  • 02:09:50Really quite amazing and
  • 02:09:52perhaps even serendipitous.
  • 02:09:54So I'll leave you with one of our
  • 02:09:56favorite lab pictures of Doctor
  • 02:09:58Dennis Ucode Ostian myself,
  • 02:09:59reviewing emerging data together.
  • 02:10:01Thank you.
  • 02:10:04Thank you so much, kareen,
  • 02:10:06we should we should have the sense string
  • 02:10:10quartet actually virtually play as well.
  • 02:10:13May I turned to Doctor Carol Thompson Felix?
  • 02:10:23OK, are you able to see my slides?
  • 02:10:26Yes, they look great. Awesome so
  • 02:10:29good afternoon everyone.
  • 02:10:30My name is Tara Thompson Felix
  • 02:10:32and today I'm excited to
  • 02:10:34share with you my experiences
  • 02:10:35as a trainee
  • 02:10:36here at the CHILD Study Center.
  • 02:10:39So sometimes a simple email
  • 02:10:41can change the course
  • 02:10:42of your life
  • 02:10:43and this was the case for me
  • 02:10:45when I was a junior in college. I
  • 02:10:47reached out to a world renowned scientist
  • 02:10:49here at the Child
  • 02:10:50Study Center and expressed my
  • 02:10:52interest in learning a little
  • 02:10:53more about research. Shortly
  • 02:10:56after joining the lab, I became a
  • 02:10:58postgraduate research associate at
  • 02:11:00the Child Study Center and received
  • 02:11:02funding to develop my skills
  • 02:11:04as a scientist. This experience solidified
  • 02:11:07my interest in epigenetic research.
  • 02:11:09I then continued my training at
  • 02:11:11medical school and also at residency
  • 02:11:15and after completing
  • 02:11:16my adult psychiatry
  • 02:11:18training at Temple University,
  • 02:11:19the Child Study Center was my number
  • 02:11:21one choice for the
  • 02:11:22next phase of my training. My fellowship.
  • 02:11:25This was because I could see how
  • 02:11:28the educators at the CHILD Study
  • 02:11:30Center prioritized the professional
  • 02:11:32as well as the personal growth
  • 02:11:33of their trainees. So obtaining
  • 02:11:36a PhD while completing
  • 02:11:38my clinical training
  • 02:11:39with something I had
  • 02:11:40hoped that I could achieve,
  • 02:11:41but I wasn't sure if it would be
  • 02:11:44possible and when I discussed
  • 02:11:45this idea with my mentors here
  • 02:11:46at the CHILD Study Center,
  • 02:11:47they made the seemingly
  • 02:11:49impossible possible.
  • 02:11:50So I'm now enrolled
  • 02:11:53in the investigative
  • 02:11:54medicine PhD program
  • 02:11:56and receiving a financial
  • 02:11:57support through a competitive Federal
  • 02:11:59funding award here at the Child
  • 02:12:01Study Center. I feel supported
  • 02:12:03not only as a scientist,
  • 02:12:05but. Also, as a clinician and as
  • 02:12:07a mother with two young children
  • 02:12:10and so coordinating all of this
  • 02:12:12would not be possible without
  • 02:12:13tremendous support for my program.
  • 02:12:16So during my clinical supervision I got
  • 02:12:18advice and guidance about my clinical cases,
  • 02:12:21but also a lot of support and advice on
  • 02:12:24affordable childcare options and financial
  • 02:12:27support available to me as a Yale fellow.
  • 02:12:29This support is so critical to
  • 02:12:32scientists like myself who are just
  • 02:12:35embarking on their research. Here's
  • 02:12:37another amazing part
  • 02:12:38of being at Yale
  • 02:12:40is the opportunity to
  • 02:12:41work with world renowned
  • 02:12:42leaders in the field. So an example
  • 02:12:45of this is I will be working
  • 02:12:46with Nobel laureate James Rothman for one
  • 02:12:49of my PhD courses this fall and Doctor
  • 02:12:53Rothman's work provided new insight
  • 02:12:55into the mechanisms
  • 02:12:56responsible for cell signaling
  • 02:12:58for my PhD. My advisor, Kieran
  • 02:13:01O'Donnell, is a renowned leader
  • 02:13:03in pregnancy, mental health
  • 02:13:05and how this shapes child brain.
  • 02:13:07Development these opportunities have
  • 02:13:09allowed me to pursue
  • 02:13:10my scientific passion of
  • 02:13:12trying to understand how the prenatal
  • 02:13:14environment shapes child development
  • 02:13:17and to do so in one of the best
  • 02:13:19environments in the world.
  • 02:13:21So how then how is the
  • 02:13:23environment communicating
  • 02:13:24with the baby forming
  • 02:13:25in the womb? This
  • 02:13:26is something that fascinates me.
  • 02:13:29How does this stress response of
  • 02:13:31the mom get through to the baby?
  • 02:13:33And how can we get real time information
  • 02:13:35on how the baby is affected?
  • 02:13:37This is fundamentally a question
  • 02:13:39about communication and through my PhD
  • 02:13:42program I'll be able to investigate
  • 02:13:44a novel signaling pathway that
  • 02:13:47involves these tiny little cellular
  • 02:13:49packages called exosomes. These exosomes
  • 02:13:52are released from most cells
  • 02:13:53in the body and were previously
  • 02:13:56thought to be waste products
  • 02:13:57of the cell. Now we're learning
  • 02:13:58that they play a very critical role
  • 02:14:01in maternal fetal communication
  • 02:14:03and general communication
  • 02:14:04between cells. Through
  • 02:14:06this work we hope to better
  • 02:14:08understand why and how prenatal
  • 02:14:10stress effects child development.
  • 02:14:12By doing this, we hope to find ways to
  • 02:14:14identify and help those children who
  • 02:14:16are likely to be affected. Please
  • 02:14:19come to my poster to learn more. I
  • 02:14:21want to say a special thank you to my Co
  • 02:14:24fellows members of the O'Donnell lab and
  • 02:14:27to leadership from my fellowship program.
  • 02:14:29The T32 training and
  • 02:14:31Investigative Medicine program
  • 02:14:33and also a special thank you to
  • 02:14:35the associates for supporting
  • 02:14:36the Faculty Development Fund. Thank you.
  • 02:14:42Thank you so much Terra.
  • 02:14:44May I now turn to Doctor Chen Reyes?
  • 02:14:55Can everyone see my?
  • 02:14:57Perfect your great great so
  • 02:14:59I'm here to share about how
  • 02:15:01I raised the child at the
  • 02:15:03Yale Child Study Center.
  • 02:15:04In addition to my own children,
  • 02:15:05I'll explain all these acronyms in
  • 02:15:08a bit. So I my journey is rather
  • 02:15:13unique and like different
  • 02:15:14from my colleagues. I traveled all
  • 02:15:16the way from Manila to New York City
  • 02:15:20during my PhD in applied
  • 02:15:22developmental science.
  • 02:15:22I was always enamored by the
  • 02:15:24idea of using science in
  • 02:15:27the service of society,
  • 02:15:28so it's really about using
  • 02:15:29science to improve practice. But
  • 02:15:31in order to improve practice,
  • 02:15:33how do you inform policy to
  • 02:15:35sustain it? And so luckily there's
  • 02:15:38such a thing. As the Yellow Child
  • 02:15:40Study Center, the Zigler Center
  • 02:15:42in Child development social
  • 02:15:43policy unit that Ed Zigler was
  • 02:15:47a childhood hero
  • 02:15:48of mine. When I
  • 02:15:49saw it was just amazing to you know,
  • 02:15:52you know for someone who comes from
  • 02:15:54across the ocean to be working at
  • 02:15:56someone's lab and working with
  • 02:15:58tremendous people, so to speak.
  • 02:16:00So I started working with
  • 02:16:02Doctor Pia Brideau who's
  • 02:16:06now at UNICEF
  • 02:16:07working on Global E
  • 02:16:08Early childhood development policy.
  • 02:16:11When she left
  • 02:16:12I I worked alongside Dr.
  • 02:16:15Walter Gilliam and his work
  • 02:16:17on preschool expulsions,
  • 02:16:18and both these vendors have really
  • 02:16:21encouraged me to dream big and have
  • 02:16:24supported me throughout the years.
  • 02:16:28You know to develop
  • 02:16:28my own career
  • 02:16:30path and I've always been dissatisfied
  • 02:16:34with the way we're measuring the quality
  • 02:16:37of how teachers foster social emotional
  • 02:16:40skills in early childhood classrooms. Like if
  • 02:16:43we were to believe what other measurement
  • 02:16:46tools are telling us, which is
  • 02:16:49we're actually doing really good in
  • 02:16:52the early education field in terms of
  • 02:16:54how we're supporting young children,
  • 02:16:56social and emotional development? I know that
  • 02:17:00that might be quite the stretch,
  • 02:17:01and so we developed
  • 02:17:03the climate of healthy interactions
  • 02:17:05for learning and development
  • 02:17:06or the child tool. It's
  • 02:17:11preliminarily a measurement tool,
  • 02:17:13and it serves as a lens or organizing
  • 02:17:16framework for assessing
  • 02:17:17the quality of interactions that
  • 02:17:20foster children. Social,
  • 02:17:21emotional and holistic development.
  • 02:17:24It's comprised of nine dimensions
  • 02:17:27that make up this healthy environment.
  • 02:17:29Correct price price.
  • 02:17:30Antiquorum developmentally
  • 02:17:32appropriate practice the
  • 02:17:33equitable treatment of children.
  • 02:17:35We focus on things not just on verbal
  • 02:17:37behaviors but a non
  • 02:17:38verbal and para verbal behaviors.
  • 02:17:40We focus in addition to adult child
  • 02:17:43interactions. We look at adult
  • 02:17:44to adult interactions.
  • 02:17:47And all these and the scores
  • 02:17:49are placed along a quality
  • 02:17:50spectrum of mental healthiness,
  • 02:17:53and we actually have data showing that
  • 02:17:55scores and the child are associated
  • 02:17:58with teachers adverse childhood
  • 02:18:00experiences. So those
  • 02:18:02teachers who experienced
  • 02:18:04adversity in childhood having
  • 02:18:06an incarcerated parent and
  • 02:18:07experiencing emotional abuse,
  • 02:18:09we found that their scores as
  • 02:18:11teachers of young children were
  • 02:18:13actually lower on the child tool.
  • 02:18:15We also have emerging evidence
  • 02:18:17showing that. For
  • 02:18:18some, the child predict end
  • 02:18:20of year, teacher turnover and
  • 02:18:23something that's a little more
  • 02:18:25exciting. But it's also emerging
  • 02:18:26is that we're showing correlations
  • 02:18:28between scores and the child
  • 02:18:30and English language Learners
  • 02:18:32language proficiency test scores.
  • 02:18:34So it's really, really exciting.
  • 02:18:36But the real power behind the
  • 02:18:38child tool is its utility,
  • 02:18:41and specifically in early
  • 02:18:42childhood mental health consultation. So
  • 02:18:44mental health consultation instead of pulling
  • 02:18:46out a child with severe
  • 02:18:48challenging behaviors. Out of the
  • 02:18:50preschool and bringing that child
  • 02:18:52into the clinic, what we're doing
  • 02:18:54is we're pulling
  • 02:18:54out the mental health professional
  • 02:18:57out of the clinic and into the
  • 02:18:58child's program, and so they use
  • 02:19:00the child tool as as an organizing
  • 02:19:02framework for their consultation. We found
  • 02:19:05in a recent
  • 02:19:08study that was published
  • 02:19:10that child informed
  • 02:19:12early child mental health consultation does
  • 02:19:15work, and what's powerful
  • 02:19:17about this study is that.
  • 02:19:19Not only did we find effects
  • 02:19:21on the children who prompted
  • 02:19:22the need for services
  • 02:19:24in the first place, but
  • 02:19:25we found a horizontal diffusion
  • 02:19:28of effects such
  • 02:19:28that it affected all the other
  • 02:19:30children in that classroom,
  • 02: