Child Mental Health Series - Episode 2

May 16, 2024

Information

May 15

Working In and With Our Community

ID11685

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00:04And I just wanted to let everybody
00:06know the Pros for Peers webinar
00:08series is is a collaboration between
00:09the Yale School of Medicine and
00:11the Yale New Haven Health System.
00:14And it's brought to you by the
00:15Office of Academic and Professional
00:17Development and the Office of Chief and
00:19the Office of Chief Wellness Officer.
00:23So I'd like to really turn it over
00:25to Doctor Robert Rohrbach who can who
00:28serves as the Deputy Dean for for
00:30Professionalism and Leadership Development
00:31with the Yale School of Medicine.
00:34Doctor Werbach, please turn it over to you.
00:37Thanks so much, Peggy. One
00:39of OAP DS missions is to elevate well-being
00:41for for faculty and we're delighted to
00:44to welcome you today.
00:47As faculty and staff
00:48indicated in Wellness surveys,
00:49child mental health is a critical issue
00:51for members of both of our communities.
00:54We serve as caregivers at home
00:56and in the healthcare setting.
00:59We're really fortunate to
01:00have world renowned faculty
01:01at the Yale Child Study Center who
01:03can help us address this issue.
01:05I'm going to turn it over
01:06to Doctor Christine Olson,
01:08the Chief Wellness Officer for
01:10Medical Staff across the aligned
01:12clinical enterprise to introduce
01:13the Pros for Peers program and to
01:16introduce our host for this program,
01:18Doctor Linda Mays.
01:20Christine, thank you,
01:22Doctor Urbah Pros for Peers
01:24recognizes that we are surrounded
01:26by renowned experts in Wellness
01:28here at Yale all the time,
01:30every day.
01:30And we all have something to offer
01:32one another while fostering a
01:35culture of care and connectedness
01:37and strengthening pride and sense
01:40of belonging in our community.
01:42When our community identifies the need,
01:44as on the Wellness survey,
01:46we seek those experts to meet those needs.
01:49Previously,
01:50Pros for Peers brought you Sleep Week
01:53from the Yale section of Sleep Medicine,
01:56and you've indicated that your
01:58well-being would be improved by
02:00better knowing how to care and
02:02support the young people in your life.
02:04And so today for Mental Health Month,
02:07we are so grateful for the
02:09experts that we have here today.
02:10We look forward to this time
02:12together and it's a privilege
02:14to introduce Doctor Mays,
02:15chair of the Yale Child Study Center and
02:19our host for this program this month.
02:21Thank you so much.
02:24Thank you so much, Doctor.
02:25Really appreciate being here.
02:27And to add my welcome to all of
02:29you for joining for this second
02:31of the pros for peers webinars.
02:33And it's very appropriate,
02:34as Christine just said,
02:35to be doing this in Mental Health Month,
02:38but appropriate to do it actually
02:40anytime through the year.
02:41I'm going to introduce you to
02:43my colleagues very shortly,
02:44but I want to just tell you very
02:46briefly about the Child Study
02:48Center that we are a department
02:49in the Yale School of Medicine.
02:51We're focused on providing
02:52clinical care for children,
02:54adolescents and their families
02:56and and also on developmental
02:58science where we ask how children
03:00truly grow in their understanding
03:02of the world and the skills that
03:04they need to navigate that world.
03:06We have a very large educational
03:08program where we train the next
03:10generation of clinicians who will
03:11move our field field forward
03:13and we are multidisciplinary,
03:15have over 20 perspectives or
03:17trainings represented and our
03:19community is just over 500 people.
03:21You'll be hearing a lot about
03:23our clinical work today.
03:24And just to give you a sense,
03:25we serve over 3000 children and
03:28families annually through about
03:30over 60,000 scheduled visits.
03:33We've seen a tremendous increase in
03:35the need for our clinical services
03:37as has been true across the country.
03:40And it is also indeed true that
03:43children and adolescents are not
03:45only needing services younger,
03:46but also presenting with more challenges
03:50that require more intensive work.
03:53We provide our services much continuum
03:55from working in the home and community.
03:57You'll hear a lot about that today,
04:00consulting with pediatricians, seeing
04:02children in the hospital emergency room.
04:05Our outpatient services are inpatient
04:08units and we deliver care virtually as well.
04:11We're seeing about 1/3 of
04:13families now coming to us.
04:15As I mentioned, this is a national,
04:17a national concern.
04:19But what's most important that I hope
04:21you'll hear today was I introduce you
04:24to my colleagues is how we're really,
04:26truly trying to help children reach
04:28their fullest potential in our
04:30communities and how to help them
04:33again gain the skills they need.
04:35So my colleagues are going to speak
04:38about effective collaboration
04:39with our community providers,
04:41perhaps some barriers to clinical care
04:44that may impact getting to services.
04:46Indeed access is one of the things
04:49we think a lot about because it's
04:50it is quoted that 80% of children
04:53with mental health needs don't
04:55have access to care.
04:56And then we'll also talk about
04:58the impact of school based mental
05:01health services on children's
05:03education and and health.
05:05First you'll be hearing
05:06from Heather Maurizio.
05:07Heather is an assistant clinical
05:09professor in of social work followed
05:11by Taylor Collins who works in
05:13our in Home services,
05:15Roshani Treadwell who is also an assistant
05:18clinical professor in social work,
05:20Bridget Torres another
05:22assistant clinical professor.
05:24All will be talking really about
05:26the most sophisticated clinical
05:28work with children and families.
05:30And then to bring us home will
05:32be doctor Amanda Dettmer,
05:34research scientist is who is also
05:36working in schools and in school
05:38based mental health. So Heather,
05:40may I turn it to you to get us started?
05:43Yes, of course. Thank you Doctor
05:45Mays for the introduction and thank
05:47you all for having me here today.
05:49My name is Heather Morizio and I'm an LCSW.
05:52I've had the pleasure of being an ICAPS
05:54clinician for the past 7 1/2 years.
05:56Before I get going,
05:58I just wanted to acknowledge that
05:59the Yale Child Study Center has
06:01many in home programs that aren't
06:03necessarily focused upon today,
06:05but are too valued for their dedication
06:08serving families in their communities.
06:10The ICAPS program stands
06:11for Intensive in Home,
06:13Child and Adolescent Psychiatric Services
06:16that serves families and children 5 to 18
06:20years of age with acute psychiatric beads,
06:23our clients can be discharging from the
06:25hospital from intensive outpatient care,
06:28referred from a lower level of care
06:30like outpatient from a provider who
06:32has had ongoing concerns that place
06:35a child at risk for hospitalization.
06:37We focus our work really in four areas,
06:39so there's youth, family, school,
06:42physical environment and community.
06:43There are three phases of our work
06:46and three types of sessions a week.
06:49So there's family,
06:50individual and parent.
06:52These phases are clinically influenced
06:54by the therapeutic relationship
06:56which is really essential.
06:58It's essential in our model.
07:00We think relationships and we are relatable.
07:03Most of the children and teenagers and
07:05even a lot of the parents that we work
07:08with have significant life experiences.
07:10And with these experiences or layers of
07:13a person come the very real emotional
07:15responses that can then influence building
07:18relationships with others moving forward,
07:20whether it's with family,
07:22whether it's with providers,
07:24systems, schools,
07:25life experiences,
07:26shape how people and our
07:28families perceive the world.
07:30Ensuring today myself and some of
07:32the other colleagues and clinicians
07:34will be emphasizing upon the layers
07:37of trust needed to facilitate the
07:39work and to highlight the complexity
07:42of the work for me right now.
07:45Really focusing on this idea of
07:47like the in home piece to our work
07:49and inviting you to think and
07:51rethink this idea of community.
07:53Really existing solely as a place
07:55but really embracing the idea of
07:57the dimensions surrounding a person
07:59surrounding a family in motion as
08:02they are in motion with different
08:04aspects within their day.
08:05I have come to learn.
08:07Definitely realize as an in home clinician,
08:11I don't always like arrive at
08:13your home right.
08:14Not always knocking at your door,
08:15but rather I'm arriving where,
08:18when and how you are to
08:20meet you where you are.
08:21So this can be at anywhere,
08:23right?
08:23So having therapeutic sessions anywhere
08:25and some of my most recent endeavors
08:28target in a baseball baseball field,
08:30right.
08:32And then there's times too where I'm
08:34on the other side of a door with a
08:36teenager who has the door closed and
08:38they don't feel like coming out here.
08:41We we really meet families where they
08:43are within the lives that they live,
08:46how they authentically are.
08:48We are offered opportunities to
08:51physically be and access people places,
08:54the the people surrounding the family,
08:56the neighborhood in which they
08:58live and at times working towards
09:01in relationship with. Right.
09:03So we're building community with
09:05this can look like even a child
09:08like our work really finding an art
09:10class or a parent really working
09:12to find like his or her own job.
09:15This too creates other connections
09:17and connections that then impact this
09:19idea of what community is and how
09:22this person feels and interacts with
09:24in community within our model, right?
09:27So we have those three sessions,
09:28so we meet with a child,
09:30we meet with a parent and then the family.
09:32While these children go to schools,
09:34they have doctors, they have coaches,
09:36they have providers and just like parents do.
09:40So with building the relationship
09:43comes access to parents,
09:45providers with permission,
09:47meetings with other providers
09:48and that those are pieces of the
09:51family and the parents community.
09:53And with trust we really work with
09:57and connect to these different
09:59pieces of individual's lives
10:01to support the entire family.
10:03The trust piece cannot emphasize enough
10:06like but true true core trust by bearing
10:10witness with muddling through treatment,
10:13with moments that become
10:14even the bigger moments.
10:17Trust with like in which the family
10:19like lends to us then allows us as in
10:22home workers to really sit on their
10:24their on their floors and their homes
10:27and become acquainted with our communities.
10:30And I would love to pass it
10:32along to Taylor Collins,
10:33my colleague who will share more about
10:35the importance of treatment through the
10:37lens of the family systems approach.
10:41Thanks, Heather, and thank you
10:43everyone for giving us this space
10:45to share our clinical experience.
10:47My name is Taylor Collins,
10:49working as an LCSW with families
10:51and ICAPS for the past five years.
10:53One of my most salient takeaways
10:55is that child mental health
10:57problems don't operate in a vacuum.
10:59School systems, community groups,
11:01technology, peers and families all
11:03service contacts that ebb and flow in
11:06their influence on child mental health.
11:09ICAPS focuses on the convergence
11:11of these systems and particularly
11:13family patterns with a highlight on
11:16attachment and trauma informed care.
11:19Our family systems are one of the first
11:22micro environments we really experience.
11:24They serve as a foundational lens in
11:26which we begin to understand our world,
11:29how we communicate, behave,
11:31trust and we then take this lens and
11:34carry it with us throughout our life.
11:36Our work is to build a more complete
11:39picture of that family context with
11:42a multi generational perspective.
11:44We really zero in on the family patterns
11:48and parenting influences that might be
11:50overlooked if we just examine a child's
11:53mental health needs in isolation.
11:56For this reason,
11:57our practice aims to increase parental
12:01curiosity about their own experiences
12:03and as well as their child's.
12:06So this presenting problem that parents
12:09typically tend to notice in their
12:11children and then come to treatment to
12:13address those can be things like outbursts,
12:16conflict,
12:16impulsivity, defiance,
12:18really any types of mental health symptoms.
12:22And so with this in mind,
12:24we come in to treatment with them with
12:26a non judgmental presence to observe,
12:29build, trust and join with the family.
12:32Really learn and get to know them.
12:35Then through careful observation and
12:38built understanding help the families
12:41become attuned to underlying emotional
12:43needs and maladaptive family dynamics
12:46that might be hidden below these more
12:49observable surface level problems.
12:52Our parenting work uses therapeutic
12:54tools to aim a spotlight into
12:57unacknowledged trauma and family norms.
12:59Growing up, So what was your home like?
13:03What was normalized?
13:05What lessons about yourself and
13:07the world did you learn and then
13:10translate that knowledge into now?
13:12How are these patterns serving
13:14you and disserving you both as
13:16a person and a parent today?
13:17How are they impacting your child's
13:20mental health when there hasn't been space
13:23for introspection or self reflection?
13:25It can result in the meeting of our defenses,
13:28our coping mechanisms,
13:30and our socially learned habits,
13:31all forming this default way of responding
13:34to the world and responding to our children.
13:38While exploration of ourselves,
13:40our tendencies and their origins
13:43allows us to see alternatives and
13:45to expand our ability to respond
13:48differently to our world and interrupt
13:51any of these problematic patterns.
13:53So really we we want to
13:56encourage parents to say,
13:58hey wait,
13:59why am I responding to my child this way?
14:02Is this the only way to handle this?
14:05What's happening for my child
14:07emotionally when I do this?
14:09And what are my other options?
14:12As we understand patterns across generations,
14:15we then work to highlight
14:17with parents how this shift
14:19impacts their child and how
14:21they can work to create change.
14:23The gravity of this ask to shift the
14:25focus to the parent's self is really heavy
14:28as so many parents are already working
14:30their hardest to do the best they can.
14:33And at times we might be asking
14:35parents to practice labeling,
14:37organizing and being with their
14:40child's underlying emotions or
14:42taking space when heated to model
14:45regulation and to reduce conflict.
14:47And This is why meeting parents where they
14:50are in their process of self-awareness
14:52is a key part of our clinical process.
14:55At times, parents present with complex
14:58trauma histories or limited prior mental
15:01health care for their own unaddressed needs.
15:04Parents may not have had a felt
15:07experience of having an emotionally
15:09attuned response from a safe caregiver,
15:11and so this can mean asking parents to
15:13meet this seemingly impossible challenge
15:15of showing up for their children in a
15:18way that was never modeled for them.
15:20The therapeutic relationship
15:21can then serve as a reparative,
15:24secure attachment experience,
15:25acknowledging a parent's inner
15:27child by sharing the same warmth,
15:30safety and validation we want
15:32them to have with their children.
15:34Our objective is to improve child
15:37and adolescent mental health
15:39by encouraging curiosity,
15:41increasing self reflection,
15:43reducing conflict and supporting
15:45connection within the family.
15:47All of which helps to build trust,
15:48allow vulnerability and promote healing.
15:51And with that I want to pass it
15:53along to our our another one of
15:55our in home clinicians.
15:56Roshani.
15:59Thank you Taylor. Thank you.
16:00Thank you also for giving me this
16:03opportunity to share my experiences today.
16:06I'm Roshani Treadwell and I'm a
16:07licensed marriage and family therapist.
16:09I have been working at Yale Child Studies
16:13Center a little over 7 years and I I really
16:15enjoy working as an in home therapist,
16:18especially because I get to work in the
16:20community as a as a part of our work we
16:23build an understanding of our clients
16:25experience in a way that incorporates
16:27their characters including gender,
16:30sexuality, race,
16:31culture, and religion.
16:33All of what comes together to form
16:36each client's unique identity.
16:38We often collaborate with other providers
16:42as a part of the care we provide.
16:44The severity of the cases we treat
16:47cannot be effectively managed
16:49by anyone service provider.
16:52So we do need the support of all
16:54the providers to address multiple
16:57aspect of our client's life.
16:59Our family's life could be mental health,
17:01physical health,
17:03Daily living needs social support.
17:05So the moment we receive the referral,
17:08we begin connecting with other providers.
17:12Personally,
17:12I do believe that entire community
17:14play a big role in shaping each child's
17:17future and I I find collaboration
17:19helps me advocating for children
17:22families within their own unique
17:24community because they're not always
17:27able to advocate for themselves.
17:30This could be due to a negative
17:33experience in their life as well
17:35as the past and ongoing trauma.
17:38It is really essential to build meaningful
17:42trust and rapport with the whole family,
17:46but especially important when working with
17:49parents in the beginning of treatment.
17:51Building trust with families at this
17:54stage allow us to demonstrate our ongoing
17:57commitment to them throughout the treatment.
18:00We usually initial collaboration by
18:03collaboration by getting consent from
18:06the family and we seek to clarify
18:09our role as a liaison to all parties,
18:12especially maintaining confidential between
18:14parent and other providers such as schools,
18:19DCF, hospital, lawyers,
18:20food banks and even landlord.
18:23At times,
18:24we really need to learn about
18:26each family's history and the way
18:29that each family and how they fit
18:31in within their own community.
18:34We really ask about families
18:36experiences with other care providers,
18:38carefully noting both negative and
18:41positive responses to individualize our
18:44individualize our care for our families.
18:47This really fascinated the creation of a
18:50safe and supportive therapeutic environment,
18:52making family members more likely to
18:55open communication and build positive
18:57partnership with other providers.
19:02Most of our families comes
19:04with a deep rooted trauma.
19:05Acknowledging each family's unique
19:07trauma as part of our treatment
19:10increases the likelihood that the
19:12family will trust in our care
19:15and value our clinical support.
19:17One of the goal is to empower
19:20families to advocate for themselves
19:22within their providers and
19:25manage ongoing communication.
19:27However, at times we do face
19:30challenges working with providers
19:32who may not have a complete with
19:35both the families need or may not,
19:37may have their own biases or may not be
19:41aware of how the role that past drama
19:44plays in families reaction in treatment.
19:47As in home therapist ours,
19:50our role is so comprehensive that
19:52it gives us a big picture that most
19:56individual service providers may not have.
19:59I want you to imagine a parent to
20:02experience a significant amount of trauma.
20:06This parent will feel so vulnerable and
20:09not not feel that they can trust anyone.
20:14They will feel that no one can help them.
20:16Their responses and reactions are
20:19not always understood by others,
20:21which create challenges for families
20:24who receive multiple services
20:26in the in their community.
20:28Our most marginalized groups can
20:30feel negatively labeled and they may
20:32interpret experiences as rejection
20:34or rejecting or hostile which tend
20:37to minimize their trust in providers
20:40who are trying to support them.
20:43So it is really important and we
20:45actually model and roll favor
20:48effective communication looks like
20:50between clients and providers.
20:52We reinforces use of trauma,
20:54sensitive language that acknowledges
20:56and validate experiences which
20:58help families feel safer.
21:00We avoid blaming,
21:01shaming and anything that could
21:03be triggering or retraumatizing.
21:05Most importantly,
21:06we focus on our clients strength and
21:10encourage them to rely on their resilience,
21:13our focus in communication
21:16build improved understanding.
21:19Thank you for your time and you will
21:21be hearing from my colleague Bridget.
21:23Thanks,
21:23Rashawn.
21:25Hi, my name is Bridget Torres.
21:28I'm a licensed clinical social worker
21:29and have been a clinician and supervisor
21:32in the ICAPS program for nine years.
21:34I'm really, really excited to get
21:35the chance to talk to you all today.
21:39As my colleagues have already highlighted,
21:40community based services work to meet
21:42the needs of children and their families
21:45wherever they are with compassion, humility,
21:47collaboration and authentic connection.
21:51Many of the youth that access
21:53community based services like ICAPS
21:55have experiences that fall under the
21:57umbrella of complex trauma or repeated,
21:59pervasive interpersonal traumatic
22:00events that can impact their sense of
22:03safety both within their communities,
22:05their homes, and their caregivers.
22:08Many of these youth develop ways
22:10of coping and surviving,
22:11which makes sense at the time but
22:14become maladaptive over the years,
22:15including dissociation,
22:16self harm, suicidal ideation,
22:19and physical and verbal aggression.
22:21And as Taylor addressed,
22:23many of their caregivers have had
22:25similar experiences and developed
22:26their own ways of coping and surviving.
22:29And when we first meet many of our clients,
22:32they already have had experiences
22:34of inpatient hospitalization,
22:35outpatient therapy,
22:36and invalidating experiences
22:38with larger institutions,
22:40sometimes including our own.
22:42And again, so have so many of their parents.
22:47Making the extra effort to join with and
22:50understand is extra valuable when others
22:52have not attempted to build trust before.
22:55Building a strong,
22:56authentic relationship is key to creating
22:59a space where youth can do the difficult
23:02work of working through their emotions,
23:04finding ways to express them,
23:06making sense of their experiences,
23:08and then sharing this story and their
23:11narrative with their caregivers with
23:13the hopes that their caregivers
23:15can better understand them and
23:16begin to be a steady guide.
23:18As clinicians,
23:19we work to build epistemic trust
23:21with our clients and their families.
23:24This refers to the capacity for
23:26someone to trust in the knowledge
23:27that somebody else is imparting.
23:29When youth and their families have
23:31experiences of complex trauma,
23:33epistemic trust with anyone
23:35is difficult to build.
23:36Those who were supposed to protect them
23:39could not or were actively harmful.
23:41As clinicians, we have to be present,
23:43actively engaged,
23:44non judgmental and align our
23:46pace with our clients.
23:48And it is this trust that can help clients
23:50to continue to access care as they need
23:53it throughout the course of their lives.
23:55You've likely heard of the
23:57concept of a continuing of care,
23:58which includes preventative care,
24:00treatment, rehab, and maintenance.
24:02The needs of youths and their
24:04families are rarely as linear,
24:06especially as stressors can
24:08compound over time and generations.
24:11The intensity of support needed may
24:13wax and wane as youth transition
24:15through different developmental stages.
24:17And I know this isn't like big news,
24:20but growing up is very difficult develop.
24:22The task of becoming a person is hard,
24:26and the task of helping somebody grow
24:28up into a person is really hard.
24:30And for almost everyone.
24:32Life gets more complicated with time.
24:34The special kind of trust that
24:37families may develop with us,
24:39as in home clinicians and is actually an
24:42extended part of their communities can
24:45act as a long term stabilizing force.
24:48I and many of my colleagues have had
24:50the experience where we've worked with
24:52families and I caps, maybe worked
24:53with them in an outpatient setting.
24:55And then as needs change,
24:56something happens.
24:57They come back to us in I CAPS.
24:59And where there is that extra boost
25:02and support for the whole family until
25:05things have kind of gotten back to
25:07a point where they're regulated and
25:09maybe they come back to outpatient or
25:12move on for another community support.
25:19This connection, long term connection
25:20and understanding can help to build
25:23resiliency and youth who then have
25:25another stable figure to go to as needed,
25:27who can understand their home life
25:29in a different way and can serve as
25:32a bridge between themselves and their
25:34caregivers when they're at an impasse.
25:36There is so much power in human connection,
25:40in just being with each other and in being
25:43seen working in community with each other.
25:46That includes the providers,
25:48schools, caregivers,
25:49everybody that's around helps us all
25:52to access these essentials more fully.
25:54And thank you so much for your time.
25:57I'm going to pass it over to
26:00Doctor Amanda Demmer now.
26:01Thank
26:02you, Bridget. And wow,
26:03I'm just so honored to be included in
26:06this panel of my expert colleagues.
26:08I've already learned so much
26:10just by listening to you all.
26:13I'm thrilled today to build on what my
26:16colleagues have shared by discussing
26:18some of the research that we've done
26:20looking at the impact of school
26:23based mental health on students,
26:25educational and behavioral health outcomes.
26:28And as we've already heard,
26:30it really takes a village to raise children,
26:33and not just to raise them but as
26:35Doctor Mays mentioned at the beginning,
26:37to teach them the skills to
26:40thrive in their environment.
26:41And when we think about it, right,
26:43school is the place where our kids spend
26:46the majority of their waking hours.
26:49So this is really a prime opportunity
26:53to act on behalf of our kids.
26:57Now, I am not a clinician,
26:58so I I can't speak to personal experience
27:02in treating children in schools.
27:04But why I'm excited to share a
27:06little bit about today is the work
27:09that we've been partnering with,
27:11doing and partnering with a provider
27:14of in school mental health services.
27:18So in 2022, just a few years ago,
27:22we began this formal partnership
27:24with an organization called
27:26Effective School Solutions.
27:27Now this is an organization based in
27:30New Jersey and they began in 2009
27:33as a private therapeutic day school.
27:36So this was an out of district placement,
27:38right,
27:38for students who couldn't be
27:40served in their home district.
27:42And out of the services grew
27:44an idea from ESS.
27:45You know,
27:46why can't we take the same type
27:47of clinical programming that
27:49we offer out of district?
27:50Why can't we adapt it and offer
27:52it within the school walls so that
27:54students can stay in their district?
27:56That's really the ultimate goal.
27:58And thus thus was born ESS as
28:02it stands today.
28:04And ESS now serves over 6000
28:07students nationwide each day in
28:10over 120 districts in 12 states.
28:13And that includes Connecticut.
28:14In fact in Connecticut at our
28:17most recent analysis,
28:18ESS is serving over 600 students
28:21which is second only behind
28:23its home state of New Jersey.
28:26And So what we wanted to do in
28:28partnership with ESS that they
28:29hadn't been able to do yet was
28:32really start looking at the impact
28:34of their in school services.
28:35So what kind of services do they provide?
28:39Well ES S s mission is to provide
28:42high quality and cost effective
28:44clinical programming for youth K
28:47through 12 in district and this
28:49is for students with really the
28:51most significant emotional and
28:53behavioral challenges.
28:54So ESS follows a multi tiered
28:58systems of support and what this
29:01means in practice is that ESS
29:04provides in the school building
29:06both Tier 2 and Tier 3 services.
29:09So these would be programming that
29:13either offer moderate intensity care
29:16and crisis response for students
29:19at kind of the Tier 2 level or for
29:22really the most in need students.
29:24This would be intensive in school
29:27clinical support during the school day
29:30and these are really comprehensive
29:32wrap around services.
29:33So it includes on site clinical
29:35care from a a licensed clinician,
29:38behavioral programming both individually
29:40and in groups with other with peers.
29:44It also includes other services we that
29:46may not come to top of mind immediately
29:50like school avoidance interventions,
29:51family support.
29:52So families are brought into the schools
29:55as well to engage in therapeutic sessions,
29:58multiple layers of supervision
30:00across the school setting,
30:02clinical documentation and then
30:05crucially it also includes professional
30:08development and psychoeducation for
30:10the educators in the school building.
30:13And So what we found in our just the
30:16past couple years of working with ESS
30:18is that this type of programming and
30:21meeting students where they are during the
30:24day really has potential to benefit students.
30:29And we found this is true not only
30:32behaviorally but academically.
30:34And that's where I'm gonna start first.
30:35So we found that compared to baseline,
30:38which is the period of time,
30:39the marking period in schools before students
30:43were officially enrolled in ESS services,
30:45right.
30:46So compared to baseline,
30:48students saw a a significant
30:51increase in their GPA.
30:54And so for 65% of those
30:56students who enrolled in ESS,
30:57they either maintained or increased
31:00their GPA compared to baseline.
31:02And we followed this up with a
31:04sort of a fidelity analysis.
31:06So what we mean by fidelity analysis
31:09is we we recognize that school
31:11districts are not going to be able
31:14to uniformly implement ESS services
31:16for a variety of reasons, right?
31:19But in order to maybe try to
31:22prompt districts to adhere to ES
31:24s s highest standard of care,
31:26we conducted this fidelity analysis
31:29where we divided students who
31:31received in school mental health
31:34services to two groups.
31:35So the first of those was what we
31:38called a high fidelity group and
31:40this is where students were received
31:453 therapeutic sessions in the past
31:48two weeks plus one family session
31:52and that occurred for at least
31:53half the school year.
31:55Low fidelity were those students
31:56that received less than that and
31:58we found that for those students
32:00engaged in high fidelity programming,
32:02they they realized a greater
32:04than 30% increase in their GPA.
32:07We saw reductions in absences and
32:10disciplinary incidents as well.
32:12Crucially though,
32:13we also wanted to look at mental
32:17and behavioral health outcomes.
32:19And so post ESS enrollment in
32:21the 12 months following the start
32:23of these therapeutic services,
32:25we found that inpatient hospitalizations
32:28for these students is decreased by 56%,
32:30which is I think a staggering number.
32:33And the number of weeks these students
32:35needed to spend in higher levels of care,
32:38which is intensive outpatient
32:40referrals or partial hospitalizations,
32:43those were reduced by 35%.
32:46So this is really promising type
32:48of intervention that I think
32:50can work really strongly,
32:51really well in conjunction with
32:53the types of services that we've
32:55heard about already to provide the
32:57optimal care for our students by,
32:59as we've already heard,
33:01meeting them where they are.
33:02So thank you very much and
33:04I'm really looking forward
33:05to our Q&amp;A. Thank
33:06you so much, Amanda.
33:08Really appreciate everyone bringing
33:10us into such a rich discussion.
33:13There's some questions coming in,
33:14but I want to actually begin with,
33:17with one question that I suspect
33:20might be on everyone's mind and
33:24maybe well why don't I put the
33:27question out and and let any one
33:28of you begin to to think about it.
33:31So just thinking really practically,
33:33I know you work with many children
33:35who have a number of needs,
33:37but often times can be very, very upset.
33:40Could you just talk about what you've
33:42learned in your work that you would
33:44do if you're if a child was having a a
33:47meltdown and the adults around them,
33:49We're also feeling really overwhelmed.
33:52What are some of the strategies that you
33:54could give people to to think about?
33:57And Taylor, would you like to start?
34:00Yeah, sure. I I'd be happy to.
34:02I think this is a really human thing that
34:05occurs in our relationships and having
34:07things come up for us when we are the
34:11protectors and caregivers for children,
34:13one of the best things that we can
34:14do first is to practice, look inward
34:17and practice our own self regulation.
34:19Because if we bring our frustration or
34:23our intensity, our overwhelm into that,
34:25we are now taking that child's emotions
34:28and adding ours into that pot.
34:30And so the best thing we can do
34:32is to to do something to regulate
34:34ourselves and work on our regulation
34:36and then we can sit with them in
34:39that overwhelm that they're having.
34:40So that can be really just naming
34:43what we see and just being with,
34:46not trying to change it,
34:49not trying to minimize or shift,
34:51but just staying with.
34:52And that's a it's a really hard task
34:54to do I think when when everything is
34:57chaotic you might have multiple kids
34:59whether that's in the classroom and
35:00you're you're a teacher or whether
35:02you're in the hospital and you're
35:03with a family that's struggling
35:04or whether you are a parent and
35:07you're in the thick of things So.
35:09So looking in naming emotions
35:11and just being with is is really
35:14the best way to start.
35:17Great thanks. Any other
35:18anybody else want to add
35:24another question has come across
35:26the question answers about can
35:29we discuss the availability of
35:31services for non-english non Spanish
35:33speakers anyone like to take that
35:40just looking Bridget do you want to
35:43go I think it's a it's a everybody
35:47paused because I think it's a
35:48challenging question to the answer
35:50because they're the resources feel
35:53very limited a lot of the time.
35:55I know that for non-english,
35:58non Spanish speaking folks, which we have,
36:01we've worked with people in the community
36:04with different levels of English language
36:07ability and whose first language varies.
36:10And we do have access to translation and
36:14interpretation services and we've been
36:17able to provide services in that way.
36:21And I believe more recently we're now
36:23able to actually have an interpreter
36:26that can come to the homes with us.
36:28When we do do visits with families
36:31that need interpretation services,
36:33which I've used before and has been helpful,
36:38especially because often we're able
36:41to have the same person come as an
36:45interpreter and so they kind of get
36:47to know the family.
36:48But it it can,
36:49it can be a huge barrier,
36:51I think.
36:52And we do,
36:53we definitely need more people that
36:57are bilingual and in Spanish and
37:01and every other language because it
37:03would really be beneficial for us to
37:05sort of be able to help more people.
37:08I certainly agree. Anyone else want to add?
37:13Hi there. I think you're on mute. Yeah,
37:16I was just agreeing with Bridget
37:18and shaking my head very,
37:19very much so because it, yeah,
37:21I think it speaks to the need in
37:23the populations like our catchment
37:25area specifically serves too, right.
37:27So we're, yeah, it's Shoreline
37:29towns but we're in New Haven, right.
37:32And our catchment area really extends
37:34different ways and Spanish speaking
37:36communities and like Bridget you
37:37named as well it's not just Spanish
37:40speaking but yeah resources are
37:42are always needed in addition to
37:44clinicians who really can sit with
37:46and and and language that clients
37:48and families and and children feel
37:50best comfortable in speaking in.
37:53Thank you. I know that we also have
37:55partnered very effectively with
37:57our health system colleagues on
37:59increasing interpreter resources
38:00certainly for your in home,
38:02for all of our in home services but
38:05also for when children come or in the
38:07hospital or come to our outpatient clinic.
38:11So but it's absolutely a tremendous
38:13need and it's important that we
38:15also attend to the culture that
38:18families bring to us as well.
38:22Amanda, could I,
38:23could I give a question to you?
38:25Sure. Could you also talk about the,
38:29besides the obviously the
38:31information that you provided
38:33about the benefits to students,
38:35behavioral how,
38:36what are some other benefits
38:38that might be accrue from having
38:40mental health embedded in schools?
38:43Absolutely. What a couple of other findings
38:47that I didn't have time to delve into
38:50were those for a marginalized students.
38:53And so in our analysis we found
38:56that in those in that reduction
38:59of inpatient hospitalizations
39:01following ESS services that was even
39:04higher for LGBTQ plus students,
39:06it was a 62% reduction.
39:08And when we looked at weeks and
39:11higher level of care that ranged from
39:1451 to 68% for non white students.
39:16So when we're talking about equitable
39:19access especially for students who
39:21may be having difficulty for various
39:24reasons and getting the mental
39:25health services that they need,
39:27I think this is has really
39:29strong potential getting to meet
39:30these students where they are.
39:32Thank
39:34you. Well, what are the policy
39:37implications that you see for the.
39:40Yeah, so especially for other for
39:44providers or maybe primary care providers.
39:47You know, I think this is really a
39:50unique opportunity to strengthen advocacy
39:54efforts and really coalesce around
39:57this notion of it taking a village.
40:00And we really think that these
40:03data especially looking at the
40:05inpatient hospitalizations,
40:06higher level of care and how those
40:09were reduced following school
40:10based mental health services,
40:12we really think this has strong
40:14policy implication for you know,
40:16changing the way that health
40:19insurance providers will decide
40:21to reimburse services, right.
40:23And so right now as it stands,
40:26these same services could be provided in
40:28a building right next door to the school
40:31and be covered by health insurance,
40:34but they're not covered in the school.
40:36And we're really hoping that data like
40:37these might help change that eventually.
40:39And this is where we can really use
40:42strong vocal support for these kinds
40:43of services from our colleagues.
40:46Absolutely. Thank you.
40:47Another question has come in and
40:50maybe Rashani, this would be maybe
40:53you could address it or anyone,
40:56but can you talk about situations where
40:59other clinical clinicians biases might
41:02impact their support for families,
41:05especially as we're trying to
41:06think so much about culturally
41:08sensitive care and then doing that.
41:13Thank you. Yeah, I think most of
41:16the time our work is really try
41:19to help other providers to see
41:21the family in a broader view.
41:24Of course we need family's permission
41:27to especially get consent to see if
41:31like if we can support the providers
41:33to recognize the impact of trauma in
41:37families life and also like learn
41:39about what difficulties the the the
41:42client or the family or the child
41:44had in the past with the providers or
41:48just in general accessing services.
41:50It is really,
41:52really important providers take
41:55client as the expert on their life,
41:58just listen to them.
42:00I had AI had an example,
42:02a parent who was with the provider
42:05felt really invalidated because the
42:08provider looked in the computer
42:11and kind of like to took that as an
42:14expert on client's life trying to
42:16tell her you have this diagnosis
42:18you have to do this because of
42:20that and really didn't have.
42:22He didn't take the client view
42:24and she actually told me that
42:27I thought very powerful,
42:28no one can tell my story like I do.
42:31I have to tell the I had to tell
42:34the provider what actually went on.
42:38So I think it's really important to
42:39take the client centered approach,
42:41empower the client,
42:43focus on clients strength needs and let
42:47them make choices and support the growth.
42:51Also taking a holistic approach
42:53client to receive services with
42:55physical health and mental health
42:57other services and one of the most
43:00important thing that I also see
43:02providers can hold cultural biases on
43:05assuming that may things that impact
43:08the interaction with the clients.
43:10Some providers comfort level can be
43:14difficult for them to stay with the
43:17client when the client coming with the
43:20high anxiety or intense and become defense.
43:23I think those are the some of the
43:25things that we can address and
43:27support providers to understand
43:29so families can get the support.
43:33Thank you for that. Anyone else want to add?
43:36Yeah, thanks Rashawni.
43:37I think you did a a great job summing,
43:39summarizing that all.
43:40And I just kind of going on to
43:43what you said about providers.
43:44I think almost what we can do on our
43:47provider side is like the language
43:49that we use in describing and talking
43:52about our clients and the people
43:54we serve is incredibly important
43:55because you can set up someone when
43:57you're transitioning them to care
43:59a very different way by what you
44:01highlight and what you're showing
44:03about the case and what you're how
44:05you're thinking about another person.
44:07And so there's like stigma about diagnosis
44:10and and how things might present.
44:12And sometimes like you can look at a
44:15child in the referral we get of what
44:17they're described behaviorally as being
44:19like and and what their diagnosis are
44:21and their their level of medication.
44:23And then you meet this really sweet
44:26kid that's just has so many strengths.
44:28And I think what language we
44:29use in sharing and telling about
44:31things like our our clients to each
44:33other is really important.
44:35Absolutely appreciate that.
44:38We have another really practical
44:40question that if the student needs
44:42help at school how is that referral
44:45initiated is does it come by the school,
44:47by the primary care pediatrician,
44:49by the family?
44:51Amanda do you want to take that or
44:55I think I I may need a little more clarity
44:58by what they mean by help at school.
45:01I'm I'm gonna go on an assumption
45:03that this may mean they need
45:06therapeutic help at school. Yeah.
45:09So to the best of my knowledge,
45:13this is generally begun by, well,
45:19in the schools where these services exist.
45:23This is generally begun through consultation
45:26with I think all all parties, the family,
45:30the student themselves, of course.
45:32And then the maybe the school psychologist
45:35who would then refer them for an initial
45:39evaluation like an intake and then
45:41determine their eligibility for the in
45:44school intensive mental health services.
45:46So I hope that answers the question
45:49and if not please follow up. OK,
45:52so so usually by a person in
45:56the school in college, that's
45:57my understanding. Typically yes.
46:00But in in the schools in which
46:02the ESS services are embedded,
46:04the request may come for example
46:06from a parent, have the student
46:08be evaluated for eligibility.
46:13You know, for
46:13all of you, I think mental health and
46:16advocating for more what children
46:18need and more services on how you get
46:21better access to services is a is a
46:24is a challenge that we all share.
46:26And I guess I would ask you maybe
46:28to to talk of a little bit about
46:31how can families be involved and
46:34advocating for children broadly,
46:37but in advocating for the services that
46:39they want and need for their child.
46:49Yeah, I didn't mind getting going.
46:51And then I'd love to hear others,
46:53too, 'cause I think it,
46:54everyone brings in such like
46:57great perspective, you know,
46:58like everyone's kind of talking about,
47:00I know and like our model,
47:01like the first month or so,
47:03we're really working to gather
47:04a lot of information.
47:05We're making those calls.
47:07We're talking to pediatricians,
47:09we're talking to schools.
47:10But I think the most important people we
47:12need to be talking to are the families
47:14that we're sitting in the room with.
47:15You know and I think like we've
47:17all talked about parents are doing
47:19their best and figuring out also
47:22what needs they would like to have
47:24addressed are are always in the
47:25forefront and really pairing with them,
47:27joining with them if you will of you
47:30know for example like I'm thinking about
47:32school services from the lens of our work,
47:34right.
47:34So we might step into a the picture
47:37where kids really struggling in
47:39school you know academically,
47:40socially, etcetera and their
47:42classified maybe as regular education.
47:45So it's really sitting down with a kid,
47:46it's sitting down with a parent
47:48and it's like, hey,
47:49what has been your experience
47:51with working with schools,
47:52fostering relationships with schools
47:54and then working with parents too,
47:57to write a letter to have a school meeting?
47:59Hey, let's chat,
48:00let's see what's going on,
48:01what's working, what's not.
48:04And usually parents,
48:05parents know what's best and and we
48:08let them be in that seat, that's,
48:10that's the seat for them.
48:16I think I
48:17would. I would like to add sometimes our
48:21parents are not aware of the services
48:25and resources that are available.
48:28Especially thinking about the school when
48:30a child is refusing to go to school or
48:34child is having difficulties in the school.
48:36There are different services
48:38that available for parent,
48:39but parents get really anxious or parent
48:42get really frustrated because it might
48:44be because they don't have the trust in
48:47the system or trust with the providers
48:49or care that they may have received.
48:51In the past.
48:52Sometimes we had situations that
48:55parent actually decided to home school.
48:57I think educating them and supporting
49:00them to understand what services
49:02available for them is also very important.
49:07I think a very practical question
49:10for all of you working in homes
49:13you you well one thing is I it's
49:15would like you and in many ways
49:17to talk about you you see so much
49:19more in homes and you you've talked
49:21about that that kind of advantage.
49:23But I'm I'm really sure that you
49:25have to see a lot of children there
49:26who they don't want to go to school.
49:28They they prefer the safety of home or
49:31whole whole post of reasons and I think
49:35that that is sometimes a universal issue.
49:38So do you have some practical ideas for
49:41parents on how to address where their
49:43child does not want to go to school?
49:46Oh, what a challenge I think it's yeah,
49:54I'm, I, I welcome anybody to
49:56jump in here because this is,
49:58it's really tough right now.
50:00I feel like it's it's something
50:02that has been happening and is
50:04is like a perpetual challenge.
50:05But also since the pandemic started
50:09and students started school from
50:12home and then maybe never really
50:14fully transitioned in new schools
50:15gotten much more difficult.
50:18I think from a very big in like the
50:21most basic sense if the if your child
50:24doesn't want to go to school and
50:27they are spending a lot of time then
50:29on the computer or on video games
50:31or like how are they spending the
50:34time when they would normally be in
50:36school and kind of removing access
50:40to those things at the time when
50:44they would normally be at school.
50:47Because if if the difficulty is
50:48that it's preferable to do that.
50:50But I think often there's something
50:55going on under the surface of the
50:57school refusal and so I would I would
51:01also recommend working with a clinician
51:04either in you know an eye caps level
51:07of care and outpatient level to try to
51:10understand what is going on and what
51:12is kind of fueling the school refusal.
51:14Is it is it around bullying?
51:16Is it because they don't understand the
51:19work and it feels uncomfortable to do.
51:22Is it that school's over stimulating?
51:25There are so many different reasons that
51:28kids are not going to school right now.
51:31And
51:34it takes, it takes like the whole
51:36community to be able to help get them back.
51:39And including a clinician,
51:41including the school.
51:42There's a lot that you can do when
51:47there's some that you can do in terms
51:49of working with the school to help get
51:51the get your child kind of back in if
51:55they don't have any kind of services yet.
51:59You can advocate for something
52:01called a five O 4 plan,
52:03which is if your child has any
52:05kind of psychiatric diagnosis,
52:06they do qualify for a five O 4 plan.
52:09Parent can request this via writing
52:12and have a meeting with the school,
52:13and this is a kind of less formal
52:18way of getting additional services
52:21in place for your for your child.
52:23And that can include maybe like different
52:26ways that their work gets presented to them.
52:29It can include having 1/2 day or
52:32moving their schedule around in a
52:34way so that they're able to attend
52:37a class that's preferable in the
52:40morning and keep them there longer,
52:43spend more time with friends or
52:45be in classes with peers.
52:47And that's like that's an early step.
52:51I know everybody here has also
52:53worked with folks that are having
52:56trouble going to school,
52:57so if you had anything else you
52:59wanted to add, that would be great.
53:04Yeah. Bridget, you summarized it really,
53:06really wonderfully that there's so many
53:08things and the first thing we need
53:11to do really is understand what is
53:13that reason for the school avoidance,
53:16because it can come from all these
53:19different things going on at school
53:21that makes school stressful.
53:23It can also be things that are at
53:25home that might be driving it.
53:26So that can be a caregiver that the
53:29child's really worried about or has
53:31a really strong attachment to and
53:33has a hard time separating from.
53:34It can be a peer that also is not
53:37engaging in school somewhere else
53:39and they're communicating with and
53:41kind of there's a a cohort thing
53:43occurring there's it can be really
53:47really strong depression and and
53:49maybe needing medication support to
53:50get out of that because it's it's
53:53at a really strong level.
53:54So there's so many different reasons
53:56and the the best way to start is to be
53:59curious and create an open and safe
54:01space for that child to really share
54:03with you what's going on in their world.
54:06So you can kind of figure out
54:07OK now how do we tackle it.
54:08It's
54:11a fun work to
54:12ask you because you've all again
54:14been homes for with many children.
54:17Have you had a sense of the impact
54:19of the pandemic when children were
54:21off of spending more time at home
54:24or or school was very different.
54:26Would you would you have
54:28any comments about that?
54:34We can, I can jump, But unless OK,
54:39there's definitely been a
54:40large impact of the pandemic.
54:42And I think not only on
54:44kids but also on caregivers.
54:46It's kind of everybody from
54:48what I've seen going in
54:53in that and and Taylor references
54:56too of like for kids to be OK,
54:59parents also need to be OK,
55:02need to be working on
55:04understanding themselves,
55:05what's triggering them.
55:05And I think the pandemic was
55:07just an intensely stressful,
55:09scary time for everybody.
55:11And we were all trying to get
55:14by and for a lot of us and felt
55:18the lingering effects of that,
55:19like this mass deeply scary event are still,
55:26they're still present.
55:28So we've seen that parental
55:29stress has been up and that's
55:32impacted kids and vice versa.
55:34And even I think still there's the
55:41ongoing work of trusting the world again.
55:45For some people like it was very
55:50scary time and not to discount
55:53at the same time kind of all of
55:56the social movements that came to
55:59afford during the pandemic and that,
56:02I mean that's active.
56:04That's an active part of our work
56:05too of of thinking through the ways
56:07that identity and everything impacts,
56:12impacts a person's sense of safety.
56:14And yeah, so there's been pretty
56:18significant impacts. Yeah, Taylor,
56:20well, yeah, I think I think the pandemic
56:23also normalized disconnection, right.
56:25That was like actually called for.
56:27And so especially for children in this
56:30foundational time where you're working
56:32on building relationships and where
56:33like if you if you I guess just even
56:36thinking about like the world around us,
56:38what gives us like the lifeblood and
56:40feeds us and what gives us energy is,
56:42is community is like outside
56:44connections or hobbies or communities
56:47that like bring groups together.
56:50And when not having those was
56:53just this foundation for so long,
56:56I think it's really hard for people
56:58to transition back into that.
56:59So like one of the best things we can
57:01do is get involved, get connected,
57:03kind of shake some of that disconnection
57:06up because that's been something people
57:09have been suffering for a while now.
57:12Yeah,
57:12really, really agree.
57:13So we're just, we're at our time,
57:15want to thank all the presenters
57:17for joining and then doing this.
57:19Really appreciate it.
57:21And to remind everyone that we
57:22will have another one coming
57:24up next week where we will talk
57:26about parenting and transition,
57:28adults transitioning to parenthood.
57:31Look forward to your questions.
57:32Look forward to joining again.
57:34Thank you so much for coming
57:36together to think about children
57:38and families and to my colleagues
57:40for such rich presentations.
57:42Thanks everybody.