Family and Community Roles in Addiction Recovery | Counselor Continuing Education

Foreign. I'd like to welcome everybody today's presentation on the role of the family and community in prevention and treatment. I'm your host, Dr. Donnelly Snipes. And for those of you who didn't realize, you can actually hear a lot of the on demand content through Counselor Toolbox podcast. It's the same thing as just replayed on your podcast player if you don't have access to YouTube. In this presentation we're going to define family and community and explore skills and strengths to help prevent medical, emotional and behavioral disorders. Why do we talk about all of those? Well, because they all interact. It is important to understand that if somebody has chronic pain, it's going to affect their mood, it's going to affect their actions and reactions. It's important to understand if somebody is depressed or anxious, it actually does have consequences on their sleep and, and decreasing their pain tolerance and other things. So they are all interconnected. And so we need to make sure we are doing our best to help create an environment that a person can be as healthy as possible. According to the committees, and these are government committees that have gotten together evidence based prevention programs for schools and tools for teachers and parents. Tools enhance youth knowledge and the dangers of drug use as well as early intervention strategies for children with environmental and risk factors are essential. We need to have these evidence based prevention programs out there and available. Are they out there right now? Yes, they are. Are they available? Not so much. A lot of these programs, and I'm going to give you some examples as we go through, are very pricey to get into which and require a lot of education of the facilitators prior to them being able to facilitate. So that is a huge barrier that we need to figure out how to overcome. Anyhow, we need to identify or recognize that a lot of youth who are at risk for substance abuse, mental health and even physical health disorders, stress related health disorders, experience trauma of one sort or another. They may or may not have been in foster care, but foster care is a risk factor. They have likely experienced more adverse childhood experiences than the average person of, you know, four or more. We find is strongly associated with problems. And I have another video on adverse childhood experiences because I think it's important that we understand what they are, but we also understand that not all situations are created equally. For example, they identify divorce as an adverse childhood experience. Pardon me. And while that's true, and in some cases there can be very nasty divorces, in other cases the divorce itself may have been sort of a godsend because the relationship was so toxic. So we don't want to assume that just because somebody experienced this that it was necessarily traumatic to them. But it is. There are things out there that we know tend to be more traumatic for children. And developmental disorders also put people at risk for developing other disorders and struggling later in life. Fetal Alcohol spectrum disorders is one that we don't talk about enough. But adhd. A lot of people with ADHD experience rejection, sensitivity. They have difficulty functioning the same way in a neurotypical environment as a neurotypical person does, which adds a lot of stress and distress and can make them more prone to a variety of disorders. What are family and community? You know, that's. We say those terms, but do we know what they mean? Have we defined them? And in the video that I do on the sociological approach to addiction treatment, we talk about Broffen Brenner's socioecological model. And in community, we are including your neighborhood, the people that live on your street, on your block, the school that the child goes to, Social service organizations that serve your area, serve your neighborhood. Businesses that are in your community, whether it's somebody, a business that's right up the road or a business that's in downtown, in your city, in your very localized area, local media that is providing news and information and resources, hopefully to people in your area. The national media, well, yeah, they're not in your community, but they're in your house, whether you like it or not. A lot of people have the national media on in their house and you know, that's. We need to stay aware of things that are going on. But that also means that the national media impacts your proximal, your close environment. The Internet is the same way. It's there, it's in your face. And politicians now, a lot of politicians, we want to look at your local politicians particularly because they're more able to affect change at the local level. In the family, we include the biological mother, the birth mother, the biological family, and significant others that are non blood related. Not everybody grows up in a family where they are blood related. That's okay. We want to recognize that family is how people define it. Now, we're going to talk in a minute about some of the things that are important to consider in prevention, believe it or not, in prevention, that take place during the prenatal period. All right, I know I've got this in big letters here, but it's so important. I've worked for so many years in community behavioral health with well intentioned people who really, you know, their hearts are in the right place. But they take a very paternalistic attitude and they say, okay, these people need these resources in order to live a rich and meaningful life. What they're doing is saying, if I were in their shoes, these are the resources I need. We don't know what resources those people need. We need to ask them. We may know the problems. We know that trauma and aces and divorce and, you know, access to or exposure to drugs, either physically or environmentally, our risk factors. We know those are the problems, but we don't know the causes of the problems, the needed resources for that culture, for that community, and the reasons they're not using the current resources. And I'll explain that a little bit more as we go through. As I mentioned, during pregnancy, infancy and early development, there is a huge disease developmental window that children are at risk for developing problems. And those problems may not manifest until later in life or they may manifest then. But it's important to understand that even when the child is a fetus before birth, that child is impacted by the mother's stress in. If the mother is constantly stressed and dysregulating, the kid is constantly stressed and disregulating. Now, they may not, you know, emote yet, but their nervous system is being inundated with those surges of stress hormones which can lead to a baby being born with an already dysregulated HPA axis. We've demonstrated this in research. Poor maternal nutrition and anemia is one of the risk factors. Maternal smoking and alcohol and drug use is another risk factor. Okay, so let's talk about those real quick. Going back to what I said earlier, we know the problem. Poor maternal nutrition is the problem. Now, what's causing it? Is it because the birth mother does not know how to cook healthy food? She has no idea what proper nutrition looks like. She can't access proper nutrition because she can't afford it, or she doesn't have time to cook because she's working three jobs and. Or something else that I haven't even mentioned. So if we go in and we say, okay, you need to get good food, we're going to make sure that you have access to funds so you can get healthy food. Well, that's all well and good, but if she doesn't know what healthy food is or how to prepare it or doesn't have time, then no amount of, you know, assistance is going to really help her unless you have the assistance of somebody cooking it for her. So we do need to ask what's keeping them. We need to be curious about what's keeping them from having these successes. We also need to recognize that in some cultures, for example, food is very central to community and very central to the organization. And if we start saying, well, you need to eat these healthier foods and not eat these foods, you need to eat boiled chicken, not, you know, barbecued spare ribs or something, I don't know, that may be contributing to other problems. No solution is one size fits all. That's kind of my point. Maternal smoking, alcohol and drug use. Well, why are they using and why are they not using the resources that are currently available to help them stop? Why are they unmotivated and what might help them stop if they wanted to? Not all birth parents want to stop smoking. It's just the way it is. And we've got to acknowledge this. We can educate, but we can't force exper exposure to neurotoxic substances. Well, it may be by where they live, it may be by where the mother works. It could be due to a variety of different things. We need to educate them about ways they can avoid different neurotoxic substances to the best of their ability. Maternal depression. We know that postpartum depression is correlated with a lower IQ in the child. I know that that's harsh. But it is a fact that when the child does not receive the interaction and stimulus during this developmental window, as you know, birth to birth to three, that it significantly negatively impacts their learning abilities. Adrenal fatigue, low birth weight, low maternal weight, Pre. Multiple previous preterm deliveries. We still don't know what causes preterm delivery, so we don't even know the cause of that. But we know that what some risk factors are. We'll talk about those in a minute. Periodontal disease. Who knew? But yes, periodontal disease is a window or a tunnel for bacteria to get into the mom's system. And that can cause problems for the fetus. Where's that coming from? Do they not understand how to floss? Does it hurt when they floss? So they don't do it? Do they not have access to dental care? Lot of people don't. What's going on? And physical and emotional stress. Well, how's that for catchall term? What is it that's causing this person stress at this time? And what resources would be helpful to them? And why aren't they using the resources that are available? A lot of times the reasons are the resources are only available while I'm working, so. Or it's culturally inappropriate for me to seek out resources. Or I've tried before and it hasn't helped. It's just been a waste of my time or I can't afford it even if I have Medicaid or something or insurance that pays for it. I also have to pay for transportation, I have to pay for a sitter. I have to pay for this other stuff. It's just not practical. So all of these are obstacles. Not barriers, but obstacles to people accessing services that are available. And then as I mentioned, sometimes there may be services they need that we haven't thought of. We need to ask, what is it that you think would help you? Preterm births have increased from 8% to 12.5% over the past couple decades. We need to help people improve nutrition. No, there's a link between poor nutrition and preterm births. Prevent exhaustion when caregivers get exhausted, adrenal fatigue, not getting enough sleep because they're working two jobs or they're not in a safe environment so they can't rest. That contributes to stress on the body. And stress on the body can trigger preterm delivery. Identify and control bacterial vaginosis. This is something that occurs in 29.2% of women. So almost a third of women will have bacterial vaginosis and it may flare during their pregnancy. It is not something to be ashamed of it just this particular. Well, this 29.2% of people naturally either have a lack of lactobact bacilli bacteria or use antibacterial soaps to wash themselves and kill off that lactobact that that b good bacteria that can help protect the fetus. We know that bacterial vaginosis does contribute to preterm labor and we need to make sure that mother, baby, pre prenatal treatment programs are available that encourage people to come in and be seen in a trauma informed setting where the caregiver, the practitioner is empathetic and compassionate and doesn't start going well, why are you just now coming in? Why are you still doing this? Why are you still doing that? Where it feels like an interrogation or just a litany of accusations. Let's welcome the mom and say we are so glad you're here. Let's see what we can do to help you have the healthiest pregnancy possible. PERRY and postpartum depression lead to changes in sleep, appetite, weight, energy level and physical comfort in in women or all of these things lead to peripartum depression in women during pregnancy and postpartum and can cause significant emotional strain when a woman is not able to get good sleep because you know, the Baby's out to here, or the baby's just maybe only out to here, but it's sitting right on her bladder or kicking her in the, in the abdomen. It can be difficult to sleep. Hormones are all over the place when people are pregnant. Appetite changes. All of these things can be overwhelming and make it seem harder to deal with life on life's terms, which can lead to feelings of Perry and postpartum depression. But more than that, the hormone changes can significantly trigger depression in the perinatal and postpartum period for a lot of women. And we don't want to just dismiss it as oh, that's just baby blues. No, we need to take it seriously and say, hey, you are feeling depressed right now and let's look at the reasons. What might be contributing to your symptoms and what resources do you need? What can we do to try to help you out? Because even if it is not to the level of diagnosing postpartum depression, a caregiver, male or female, who is experiencing postpartum depression, and I say male or female because dads get it too, anybody in the household that is in charge of caring for this new baby is not going to get good sleep and it's going to have extra stress and are at risk for, for postpartum depression. So we need to look at what's going on and try to figure out for that person at that time what resources would be most helpful. If we can help the caregivers and the child bond in this early period, we can help them create this secure attachment. In this early period, the child is infinitely better off than if they are insecurely attached. Trust and mistrust during this early developmental period. Birth well, Even prenatal to 3 years old, maternal sensitivity and attachment is really important. Caregiver infant attachment is a well established influence on infants successful development. If infants and children are not securely attached, then they are perpetually anxious. When people are perpetually anxious, then they're in that fight or flight state which prevents them from effectively learning, which prevents them from effectively developing and growing the way they could because they're too worried about surviving and they're not focusing on learning. Home visiting is an intensive intervention that targets successful pregnancies and infant development. Early intervention is a tool that's out there in I think most every moderate sized or larger community. I'm not sure about the more rural areas, but they serve birth to three. And if there are any signs of developmental delay, the child can be referred to early intervention services and receive a whole slew of Services. My son was a micro preemie and was in this program, and it was just a godsend for us because he was, at one point he was seeing a occupational therapist, a physical therapist. And then we had our inhome caseworker that would come in twice a week to check in on him and assess what was going on to help him integrate and get caught up. Because he was born at 29 weeks, which means he didn't cook near as long as he should have in early childhood and childhood. If you think back to Ericson's stages of psychosocial development, the child is developing autonomy and initiative. The first stage is trust versus mistrust. Can I trust that you're here, that you're going to give me my bottle, that you're going to be responsive to my cries? And that's where that secure attachment is initially formed. When the child gets a little bit older, they're starting to go through autonomy and initiative. They're trying to start saying, that's when they start saying, no, I don't want to do that. Or they try to dress themselves. And it's important that we help parents figure out how to proactively support children during this phase so they learn how to take initiative, how to make decisions. You know, for, for a very young child who is wanting to start dressing themselves for daycare or for school, great, okay, well, we will leave the clothes in their closet that are seasonally appropriate and they can choose from those if they choose their, you know, best outfit that they use for going to grandma's one day, well, if you left it in the closet, it was a reasonable choice that they could have made. But if we give them controlled choices, then we're not having to say, no, you did it wrong. We, we're able to say, all right, I met. Might not have put the polka dots with the plaid, but good for you. And we want to support that and help develop a sense of self esteem and confidence. Aggressive social behavior typically begins to emerge during childhood. A key risk factor for progression of ex externalizing disorders is early aggressive behavior. If the child early, early on has difficulty controlling their impulses and we don't help them reign it in and figure out, when I'm angry, it's not appropriate to bite, I need to do this. If we don't help them start learning at that age how to regulate their urges in response to their emotions, then as they grow older and they have these strong emotions, then they will have progressively strong externalizing reactions. Harsh and inconsistent parenting practices often contribute to aggressive Antisocial behavior. If the parent smacks a child and says, don't hit, what kind of message is that sending? So that is one of those things. If the parent is always punishing and saying, you did it wrong, go to timeout, um, and not telling the child what right is, then the child's going to feel, you know, they don't know what to do. And that may cause even more stress and consternation. And if the caregivers are inconsistent, one day it's fine, you know, I'm just going to ignore it. It's no big deal. The next day I am going to, you know, take away your television for, or your iPad for three days. That's huge. So we need to help caregivers recognize the importance of appropriate and consistent parenting. Positive involvement with children. That means like actually getting down on the floor and playing with them and being curious, asking them questions. You're not going to love everything they do. I know I didn't love everything my kids wanted to play. I was never into playing tea things or with the little cars that my son used to like. You know, those were things that I didn't love doing. I tried, but I would redirect sometimes and I would say, hey, let's go to the park, or let's go outside and kick the ball or let's paint. And we would do things together that were proactive, that the both of my children, whichever one I was interacting with, the child liked, but and I also like. So I was creating an environment that was positive instead of only interacting with the child to correct, discipline, criticize. Positive reinforcement of desirable behavior also contributes to cooperative and pro social behavior. When they do something good, we need to make sure we remember to tell them, hey, that was good, awesome job. Instead of assuming, well, they did the right thing, why should they get praised for that? Because if you praise them for it, then they know it was the right thing and they'll do it again. Programs that target child maltreatment have the potential to prevent multiple mental, emotional and behavioral disorders and promote healthy development across several domains of functioning. Go figure. If we have a child who's getting maltreated, they're either being abused or neglected, which you know is going to completely disrupt that secure attachment. They're going to feel anxious, they're going to feel scared most of the time. Whether it's scared about where the, where their next meal is coming from or scared about, you know, what's going to happen when dad comes home. Doesn't really matter. They're scared and that is going to prevent learning. It's going to contribute to chronic stress, complex trauma, and emotional dysregulation, which later may lead to aggressive social behavior. Family poverty and material hardship is associated with increased parental depression. Guess what? When the parents are working two jobs and not getting a whole lot of sleep, hardly seeing each other, it's exhausting. And they may feel overwhelmed if they can't make their bills no matter how hard they try. So that is going to potentially increase depression. Mental ill illness, mental health issues in caregivers is one of those adverse childhood experiences. Increased spouse and parent child conflict is also a adverse childhood experience. And guess what? When money's tight and people are stressed out, conflict tends to rear its ugly head a little bit more often because people are on edge, they're stressed out. And ineffective parenting, which often is the result of the caregiver not being connected, not being attached to the child and able to respond in a helpful way to that child because they don't understand what the child needs. Sometimes the ineffective parenting is because the caregiver is. Doesn't have the skills. They have no idea how to deal with this. Okay, we don't know. We don't know what's causing the parents depression. We can guess, you know, if they're experiencing poverty and material hardship. We can guess what some of the things are, but we don't know what all of them are. Maybe they grew up in severe poverty and this is triggering what things that happened when they were a child. We have to ask and then we have to say, what is it that you need most? What is it that would most help you right now? Industry and identity is early adolescence, developmental period during which the prevalence of substance use, delinquency and depression begin to rise. Our tweens and our teens, psychological and behavioral problems tend to be interrelated. Most people don't act out behaviorally unless there is an underlying psychological issue. Behaviors. Communication behaviors may say, I'm going to do what I want. I don't care. Nobody's ever cared about me. Or they may say, I'm going to act this way because I'm terrified and this is the only way I know how to protect myself. Or behaviors may say, I'm going to withdraw because I don't trust anybody because it's never been a safe place for me. I don't know what the behaviors are saying. But it's important to understand that antisocial behaviors and aggressive behaviors have meaning. They are aggressive. They are a stress, behavioral stress response. We need to understand to what risk factors for behavioral problems in early adolescence? Family conflict and poverty. Increase in the rates of teasing and harassment. And middle school, so and, and in high school. But the, the child who gets teased and harassed more is going to feel less and less safe. And as they feel less safe, they're going to be more on edge. Significant physical changes. The child that develops faster than others or the child who has a sudden disability that is observable is. May get more teasing than other children. Social changes, including the transition from elementary to middle school. Now everybody does it, but it goes more easily for some children than for others. And increased concern about peer acceptance. Some children are super concerned about it. They are more at risk than children who feel confident in themselves, secure in their attachments with their families and their friends. And, you know, if everybody doesn't like me, no big deal. That's not common in early adolescence to hear that sort of attitude. But the children that have that attitude are much better prevented or buffered against substance and mental health disorders. Increased demand for autonomy. The children that start demanding that they have a later bedtime, that they get to do this, that they get to do that, and they're given that. The caregivers acquiesce to that tend to often be more susceptible to problems that stem from their peers. They tend to be more influenced by their peers partly because they're spending more time with them. Deviant peer group formation and aggressive social behavior, which contributes to social rejection and deviant peer group formation. If a child behaves aggressively, then a lot of the people are going to give them a wide berth and steer clear from them. And the people that do join up are people that either are submissive to that behavior or engage in that same behavior. I'm thinking gangs here, but we want to teach and encourage parents, teachers and after school care workers to use praise and rewards to reinforce desirable behavior. Use a trauma informed approach in understanding that all behavior is communication. If Sally's happy today, she's communicating something. If she's skipping down the hall, she's communicating something. If she's crying at her desk, she's communicating something. We want to replace criticism and physical punishment with redirection and mild consistent negative consequences for undesirable behavior. What I mean by that, instead of saying, that was awful what you did, you are a horrible person. Well, number one, no, separate the child from the behavior that was a bad choice that you made. And these are other choices you could have made. A lot of times children don't know or couldn't think of in the Moment what an appropriate response would have been. They went with what they knew. Instead of assuming that they know better and know how to implement those skills, we need to compassionately correct, let them know, okay, that's not an acceptable behavior. You know, I love you as a person or I like you as a person. That behavior is not going to be tolerated in this classroom or in this household. And what could you do otherwise? So we want to make sure that the child has options. Avoid that physical punishment, provide redirection with these are alternate things you could have done and mild consistent negative consequences. Timeout, brief loss of privileges that's appropriate to the developmental age, etc again, increase positive involvement with the children, such as playing with them. Oh my gosh, reading to them, and here's another one listening to them. Yeah, sometimes they have stories that just seem to go on forever and go off on all these tangents, but they're so excited to be telling us and if we can get excited, if we can try to engage with them, it means a lot to the child because the in the child's mind it says, hey, this person thinks I'm worthy of attention and time. Parent training and increasing positive parent child interactions is very important and parent child interaction training is actually a therapeutic approach that can be used. I have a very, very good friend of mine from college that specializes in teaching this, but basically it has a therapist observe interactions between the parent and the child and identifies problems where there may be negativity, where there may be obstacles to communication, to understanding, to bonding. Parent training and positive parent child interaction increase effective emotional communication skills. The child starts learning how to say I'm angry. This is why using timeout is also a positive thing because it helps the child understand that okay, this needs to stop and we're going to talk about it. I'm not rejecting you, I'm not kicking you out and I'm going to give you. We're going to talk about options. And it emphasizes parenting consistency. If whatever this behavior is is not acceptable on Monday, it can't be acceptable on Thursday or Friday either. So the caregiver needs to be aware and mindful and present. In a lot of my lectures I talk about the mnemonic for secure attachment, consistent, responsive, attentive, empathetic and safe prevent preventative interventions for divorcing families. There's a program called New Beginnings program which is designed to strengthen parenting, improving warmth and discipline, increase father child contact and non parental adult support and reduce divorce stressor stressors. The New Beginnings program recognizes that divorce is hard, doesn't matter how nicely the divorce is going. It's hard for the caregivers as well as for the children. And the caregivers are going to need some time for themselves as well. So there need to be respite places of other non parental adult supports that can provide breathers for the caregivers while they're trying to adjust to this new normal School Based the CDC Task Force on Community Preventative Services recommends the use of universal school based programs for preventing violence and improving behaviors in school. Well, yeah, universal means we teach them to everybody at every school. It's not a risk based thing. The Good Behavior Game is an elementary school universal intervention targeting classroom behavior. It starts at about $3,500. See, I told you. A lot of these great practices are out there, but they're expensive. The Good Behavior Game is a simple universal program to reinforce appropriate social and classroom behavior in elementary schools. Fast Track is a comprehensive, long term, multi level intervention for students at high risk of antisocial behavior and it starts at a price tag of $10,000. Guiding good choices is another program that I have actually implemented through a grant we got from SAMSA where I used to work. But again, every facilitator that is trained and got Guiding Good choices it costs $2,500. So unless you're getting a grant from somewhere, it may not be in the budget of the school or the treatment center or whatever. The Seattle Social Development Project is designed to reduce risk, build productive strengths in schools, families and children. Long term follow up revealed multiple positive effects on mental health, functioning in school and work, and sexual health 15 years after the intervention ended. This is not hyperlinked because I found a great article and a great research report on it, but I couldn't find it anywhere. If you know where it is, please share. Early Head Start is a federally funded extension of the Head Start program targeting low income pregnant women and families with infants that and toddlers. Those participating showed improvements on the Mental Development Index of the Bailey Scales of Infant Development. Children who participated in Early Head Start had larger vocabularies, lower levels of aggressive behavior. Guess what? They're able to communicate their needs instead of having to try to act out and externalize. Hm. Interesting correlation. They had higher levels of sustained attention, greater engagement with parents, and less negativity toward parents. Families with four or five of the following risk factors did not benefit from Head Start. It's important to understand not every intervention fits every person. No high school education, single parent, teen, parent receiving public assistance, which means they were financially struggling and not employed or in school. So I thought that was really interesting that early Head Start actually isn't effective for the families that you would think would be most at risk in preschool. The CDC recommends publicly funded center based comprehensive early childhood development programs. Preschool education has the positive effects of improving language skills. I know my son, when he was very little, didn't talk much and he would communicate what he needed. He got his. If he was thirsty, he would ask for a drink, but he wasn't putting together sentences when the book said he was supposed to. And of course I go by the book, so I'm freaking out. We go to the pediatrician for his checkup and I'm talking to the pediatrician who had eight children of his own. And he said, well, are you meeting his needs? Probably could have phrased that a little bit differently, but I was like, of course. And the doctor said, well then what motivation does he have to speak? When he needs to speak, he'll speak sure enough. Soon as he started preschool and he didn't have somebody basically reading his mind or knowing him well enough to respond without him having to communicate as much, he started talking and he pretty much hasn't been quiet since, God love him. So he's wonderful. But he's a perfect example of how when they get into preschool, they start talking a lot more because they have to in order to communicate with their peers and their teachers. Literacy was improved with preschool education partly because a lot of children don't have caregivers that spend a lot of time reading to them, they are in front of the iPad or the television or something else which is not reading. They may be learning some things, but they're not reading. And their general cognitive abilities improved because preschool teachers and preschool curricula encourage students to think, not just to passively play, but they're actually thinking and interacting and solving. High risk preschool prevention programs include home visiting, parent training and preschool education and have shown improved cognitive functioning, social emotional functioning and family functioning. Interventions directed toward children's early cognitive development are associated with long term improvements in multiple mental, emotional and behavioral problems. I've said it a bunch of times already and I'm gonna say it again. Adverse childhood experiences, things that happen in a child's young life that leave them feeling unsafe and powerless contribute to them having high levels of stress when, and think for yourself when you're under super high levels of stress. Are you able to learn very well? Are you able to, you know, study for something and actually get the grade you probably deserve on a test? Probably not. We don't learn as well, we don't remember as well, we don't implement as well because we are not in the, as Linehan would say, the wise mind. The child is always in the emotional mind and fearful. So whatever is contributing to their feeling unsafe and powerless, whether it's because they can't read and their peers can and they're getting teased, or because they don't know where their next meal is coming from, or because there's all kinds of drama and chaos at home, whatever the case, if we help them address those, we are going to help prevent problems. Early cognitive development is when the child learns how to downregulate, learns how to evaluate situations and get those facts in this context at this time, learns how to take other people's perspectives and think about things and problem solve all crucial skills for emotional intelligence. Child outcomes due to reducing poverty actually remain limited if all things stay the same. But this family that was impoverished now is not impoverished. We don't know if that the reduction of the stress that results from that fixes everything else. My guess would be no, because there are things that are ingrained over the long term. There are long term consequences of poverty, not just something that can be fixed. Several preschool classroom curricula are designed to improve teachers behavior management of classrooms by reducing child behavior problems and strengthening children's social skills or executive functioning or both. The promoting alternative thinking strategies or PATHS curriculum is one of those. In terms of the community, community members can influence legislation. We can get together if you've had kids, if you have, if you care about kids. You don't have to have a child in the elementary school to care about children, but you can work together to influence legislation. You can work with your senator representative, you can influence the school by volunteering at the school. For example, more eyes equals more safety. And I know it's sad to think that it has to be that way. But as the saying goes, kids will be kids. And kids can be really mean sometimes. So the more eyes that are available, the more parents that are there, the more people supervising the children, the fewer blind alleys exist for children to be bullied. Get involved with the pta. Advocate for children, advocate for school based counseling, advocate for health curricula, promoting practical health and wellness behaviors. Not just this generic curriculum that they have, but actual tools they can use to figure out what healthy nutrition is. You know, healthy nutrition, you have to read about what it is. And nutrition itself involves a fair amount of math, you know, quarter cup this, half cup that, measuring. There are a lot of different, what's the word I'm looking for? You know, math, science skills, a lot of different skills that nutrition can actually be folded into. So why is our curriculum so impractical? Advocate for practicality. Home economics courses, teaching basic life skills like financial management can be really helpful especially for teenagers and school life balance. My, my kids were homeschooled, so my experience has been with their friends who were in public school and their friends would have literally five, six hours of homework a night. They'd get home from school, do homework until 9, 10, 11 o' clock at night, go to sleep, get up at 6am which means, guess what? They were not getting the minimum amount of sleep and do it again. Okay, so many problems there, not getting enough sleep. And you know, all the busy work and school nutrition programs, making sure that kids have access to healthy palatable food at school, model healthy behaviors in the community, make sure that there's a commitment to, I guess a dry campus, no smoking or alcohol or drug use. At least no alcohol use to excess. I know there's going to be bars and stuff around but, but we want to show healthy behaviors. We want to promote healthy stress management. We can do this by teaching, we can do this by teaching our children in the family in Sunday school, at community centers, at school school by having messages that come out through the public broadcasting system in the different shows that they watch. Same thing with proper nutrition, good sleep habits and effective communication. We don't children learn more by from what we do than what we say. So if we're eating like crap, sleeping like crap and not communicating, guess what? That's what they're going to learn. Agencies and organizations can make prevention and early intervention services affordable and available in a way that people can access. One of the things that we did with our grant was we would go to the clubhouses of the various apartment complexes that we served in the communities that we served so the children could walk over and take part in the services without the caregivers having to transport them, without the caregivers having to take time off work. And while they were there they also got some homework help. Imagine that home visiting, community based multi component interventions providing services like family support, preschool education, child care, community development, and all of these things can be can help parents learn how to cope with the stresses they're facing and help children learn how to cope as well as. Intensive family preservation services is effective for families with maltreatment or neglect issues and social skills development. We need to remember that these services, even child care, can be provided either through a home visit or through community based interventions. The school community interventions have several elements in service training of school staff. If we want school staff to do something, we need to train them how to do it. We need to in the community, have a local task force to develop policies, conduct, conduct school wide fairs, seek funds for the school and conduct field trips for parents and children so there can be a local task force in the community that's supportive of the schools, not just the pta that can help promote some of these wellness behaviors and parenting training workshops at libraries at places that are neutral. Schools sometimes are not happy places for some parents. Churches again, sometimes not happy places for people. So picking neutral locations. Communities that Care helps communities identify and prioritize risk factors and implement tested interventions that address those factors in terms of the media and the Internet. This is emerging as a means to reach local communities beyond schools and families and the broader community as well. So we're helping educate even the people who don't have kids about the skills, tools, resources that are necessary for a happy life. Their extensive use by today's young people makes use of evidence based promotion and prevention interventions using these venues more attractive. And I'm working with a company right now that's looking at using some of these practices in in the Metaverse, which is really exciting. If the Metaverse kind of once it gets up to having photorealistic avatars and stuff right now it's. It doesn't feel very warm and fuzzy to me but. Studies of the impact of electronic media like television, computer assisted interventions and websites have also found positive effects in areas such as cognitive behavioral mood management skills, mental health interventions and smoking cessations. The National Institute for Health and Clinical Excellence in the UK has approved two computerized CBT interventions for depression and panic phobia disorders. The ecological approach to family intervention and treatment consists of parenting information provided through a family resource center. So you got to have one of those along with parent child homework interactions that encourage effective family management. So there's a family resource center that they get the information from from which actually can be online now. And parent child activities, I don't like the word homework. Parent child activities that encourage effective family management. It's based on an empirically based model of child adolescent problem behavior is family centered, addressing adult leadership and support in the change process is assessment driven, identifying intervention needs of that family and at that time targets social interactions with parents and peers, addresses client motivation to change as a core component so really increasing motivation in all five areas and utilizes a health maintenance model delivered in service settings that involve children and families somewhere that is neutral and comfortable and easily accessible. Many of the target risk factors of preventative interventions are interrelated and unfortunately trauma related. Both aggressive and withdrawn behaviors can co occur and when they do, it imparts a much higher risk than aggressive behavior alone. So when youth become aggressive and withdrawn, then they are kind of more of a powder keg if you will. Both risk factors are independently linked to concurrent and successive problems in concentration, attention and poor achievement. Depressive symptoms are also associated with poor achievement. We put so much emphasis on achievement on grades and when children start struggling for some reason they can feel very depressed, they can feel inadequate when, heaven forbid, they get held back, they can feel ostracized because they're not moving with their cohort. Externalizing behavior across different social fields and deviant peer group contact in middle school predict later juvenile arrest, drug use, and higher levels of risky sexual behavior. Many of the target risk factors are interrelated. Social skills training using cognitive components that alter perceptions and attributions can be very helpful. Instead of perceiving the entire world and everybody as dangerous all the time, the cognitive components would help address some of those distortions to help people feel safer and more empowered. The social skills training can help change behaviors to improve social relationships and help youth recognize the impact of their behaviors on others and develop awareness of alternative behaviors to achieve the same end and promote non social skills can promote non response to provocative situations. That doesn't mean you know well. It doesn't mean don't protect yourself. But in provocative situations where there may be anger, social skills training helps people use their words instead of their fists. Universal inter interventions that impact school structure and safety have been shown to help reduce aggression. If it's harder to get away with it, people are going to be less motivated to do it. Classroom Management Again, if there is more likelihood of negative consequences that the person perceives as negative, then they're less likely to do it. If when they get in trouble they get sent to the principal's office or they get a stern talking to, they may have been craving that attention or they may like being the class clown or disruptive because the other kids laugh and they get attention. We need to understand what their behavior is communicating and manage a classroom so everybody feels safe and empowered. And universal interventions that impact students relationships, self awareness and decision making skills also go a long way to helping them cope with those overwhelming emotions that we experience during childhood and adolescence. When puberty, all those hormones and everything and when that brain is still Forming. Remember, up until the age of 24, the thinking area of the brain, the prefrontal cortex is still forming. It's not fully functional yet. So the children are more impulsive. That's. That's just the way, literally the way they're wired. And they have fewer experiences and fewer tools to use to handle situations. So we need to help provide them through role plays and other things. Provide them skills and tools that can be helpful. Interventions can come from the media like news TV or athletes on tik tok or X or something that provide children and families snippets of information. If this is happening, it could be caused by this. Or if this is happening, here's a resource that may help you out. The Internet, through ads and websites, through podcasts, through teachers, through when the teachers use curriculum that are directly related to social skills and health and wellness. It's so much more practical because the children are learning what they need, whether it's reading or math or science. They're learning the skills that they need in that area, but they're learning it through a practical application. And teachers modeling teachers need to be able to model healthy social interactions and effective communication. Physicians, after school providers, parents, school based counselors and leaders, and I use that term loosely to be lay leaders as well as ordained leaders at churches, synagogues and mosques. All of these people or organizations or whatever you want to say are part of the community and they can all contribute. They all impact or affect the lives of the children that they come in contact with. Risk factors that seem to be cross cutting include trauma or adverse childhood experience based risk factors including lack of bonding, lack of a secure attachment, parental depression and family discord. And the other one is externalizing behaviors. That's not an identified adverse childhood experience, but it tends to be a consequence of adverse childhood experiences. So ultimately, as parents, as commun communities, as neighbors, we can look around and we can look in our little area and say in our little area, what do we need in our neighborhood, in our community in order to make it safer, healthier and more empowering? Thank you everybody for being here today. I saw a lot of people talking while I was. Or in the chat room while I was going. That's great. So I'm going to go back and review those real quick, see if there's any questions that they had. I appreciate you being with us, Tiffy. If you're still here. I agree with you, Teresa. We need to talk more about adrenal insufficiency and adrenal fatigue. I struggle with it and it is. It can be debilitating at times and exasperating. I'm so sorry that you just lost two teens in your neighborhood this week. That is. Wow. That's devastating. All right, everybody. It looks like. Up Chuck's already promoting my book. And I haven't even finished writing it yet. Gotta love it. Okay, everybody. Well, thank you so much for being here. Welcome back, Shyman. It's been a while. I am so glad to see you again. Have a wonderful day. Have a wonderful Valentine's Day, if you celebrate it. And remember, tomorrow in most places is half off chocolate. That's my kind of day.