The Brain Architects – Center on the Developing Child at Harvard University
Healthy development in the early years provides the building blocks for educational achievement, economic productivity, responsible citizenship, strong communities, and successful parenting of the next generation. By improving children’s environments, relationships, and experiences early in life, society can address many costly problems, including incarceration, homelessness, and the failure to complete high school. But if you’re a parent, caregiver, teacher, or someone who works with children every day, you may be wondering, “Where do I start?!” From brain architecture to toxic stress to serve and return, The Brain Architects, a new podcast from the Center on the Developing Child at Harvard University, will explore what we can do during this incredibly important period to ensure that all children have a strong foundation for future development. Listen to the trailer, and subscribe now!
The Brain Architects Podcast: Extreme Heat & Early Childhood Development: A Discussion on Rising Temperatures and Strategies for Supporting Development and Lifelong Health
May 21, 2024
In April 2024, we hosted a webinar where we explored the science from our latest working paper, Extreme Heat Affects Early Childhood Development and Health. The Center’s Chief Science Officer, Dr. Lindsey Burghardt, joined by Dr. Kari Nadeau, Chair of the Department of Environmental Health at Harvard’s T.H. Chan School of Public Health, brought the latest research and insights from the field to discuss the intersection of heat, early childhood development, and health equity. They also discussed actionable solutions to benefit children, caregivers, and communities now and in the future. The webinar discussion has been adapted for this episode of the Brain Architects podcast.
Cameron Seymour-Hawkins: Welcome to The Brain Architects, a podcast from the Center on the Developing Child at Harvard University. I’m Cameron Seymour-Hawkins, the Center’s Communications Coordinator. Our Center believes that advances in the science of child development provide a powerful source of new ideas that can improve outcomes for children and their caregivers. By sharing the latest science from the field, we hope to help you make that science actionable and apply it in your work in ways that can increase your impact.
In April, we hosted a webinar where we explored the science from our latest working paper, Extreme Heat Affects Early Childhood Development and Health.
The Center’s Chief Science Officer, Dr. Lindsey Burghardt, joined by Dr. Kari Nadeau, Chair of the Department of Environmental Health at Harvard’s T.H. Chan School of Public Health, brought the latest research and insights from the field to discuss the intersection of heat, early childhood development, and health equity. They also discussed actionable solutions to benefit children, caregivers, and communities now and in the future.
We’re excited to share this conversation on today’s episode of the Brain Architects.
Now, without further ado, here’s Rebecca Hansen, the Center’s Director of Communications, who will set the stage for our conversation.
Rebecca Hansen: Hello, everyone, and welcome. We’re very happy to have you all with us for today’s webinar, Extreme Heat and Early Childhood Development: A discussion on rising temperatures and strategies for supporting development and lifelong health. Whether you’re joining us for the first time or have been a regular at our webinars here at the Center on the Developing Child, we are very happy to have you with us today.
So, today’s webinar is grounded in the first working paper from the Early Childhood Scientific Council on Equity and the Environment. The council is a multidisciplinary group that synthesizes and communicates about emerging science that can help to improve our understanding of how influences from the broader environment affect early childhood development and also lifelong health. The council’s first working paper, published earlier this year, focuses on the many ways that heat can affect development, including its impact on young children’s biological systems and how it can amplify the effects of systemic inequities.
The paper offers strategies to mitigate the impact of extreme temperatures and points toward actionable solutions for cooling the communities where children live, grow, learn, and play. And we look forward to diving into these strategies throughout today’s conversation.
So, without further ado, I am going to introduce our panel, starting with a note that while we had hoped to be joined today by Dr. Gaurab Basu, he was unfortunately unable to be here. We do have with us Dr. Lindsey Burghardt, who is Chief Science Officer at the Center on the Developing Child, where she develops and leads the center scientific agenda. She is also founding director of the Early Childhood Scientific Council for Equity and the Environment and leads their efforts to synthesize and communicate about the scientific mechanisms related to how children’s environments shape their development. Dr. Burghardt engages regularly with diverse stakeholders and audiences, with the aim of making the science both accessible and actionable. She is also a practicing primary care pediatrician in the community outside of Boston.
Dr. Burghardt is joined today by Dr. Kari Nadeau, who is chair of the Department of Environmental Health, and John Rock, professor of climate and population studies at the Harvard T.H. Chan School of Public Health. Dr. Nadeau is a practicing clinician specializing in allergy, asthma and immunology in children and adults, and she has published over 400 papers, many in the field of climate change and health, for more than 30 years. She has devoted herself to understanding how environmental and genetic factors affect the risk of developing allergies and asthma, especially wildfire induced air pollution. Her laboratory has been studying air pollution and wildfire effects on children and adults, including wildland firefighters. Dr. Nadeau is also a member of the Early Childhood Scientific Council on Equity and the Environment. And we are very happy to have her here with us today.
And with that, I will turn it over to Dr. Burghardt to begin our discussion.
Lindsey Burghardt: Thanks, Rebecca. I’m so excited for this conversation today. Thrilled to have Kari here with us. I’m just going to start by setting the stage a little bit for why this feels like such a timely and important conversation. And then we’ll dive right in. You know, I think many of us have recognized from our own experiences that temperatures are rising around the world. And, you know, science is confirming we’re having record setting heatwaves that are happening more often and they’re lasting longer than they have ever before. So I think with these increasing temperatures and with the increased frequency of these events, it makes this topic really timely and important because it’s something that’s already affecting kids and their caregivers today. And we know that excessive heat impacts kids development, both in the moment, but also potentially across their lifespan. And the good news is that there’s a lot of solutions that already exist and that communities are putting into effect already with really good results. So we’re going to talk today about how extreme heat affects development, the potential effects in pregnancy and throughout early childhood, and then get into some of those actionable solutions and thinking about how heat works to affect development. We really know that it starts with an understanding that environment influenced all children’s development by shaping the exposures and the experiences that they have. And this developmental environment is really the full range of exposures and experiences that they have in places where they live and learn and play and grow. And so what’s surrounding children is quite literally shaping their biology. But importantly, you know, these experiences and exposures can be positive or they can be negative. So environments can have exposures and experiences that fuel positive development, things like really strong foundational relationships with their caregivers and access to green space and breathing clean air. Or they can be more negative or potentially derail development. So things like extreme heat or breathing toxic air from wildfire smoke.
So climate change is coming in and it’s creating and shaping changes to this environment of exposures and experiences. And it’s really important to understand, too, that these effects are not only direct on their biology, like breathing in their toxic wildfire smoke, but they’re also indirect and that things like extreme weather events and flooding can cause displacement that then places enormous stress on caregivers, which then has an important effect on those foundational relationships. And when it comes to climate change, this is just the first in a series of conversation that we’re hoping to have about how climate change is shaping developmental environments. And today we’re going to talk about Heat and, Kari, it’s just so amazing and special to have you join this conversation as just really an expert and really thoughtful thought leader in this space. So thank you.
Kari Nadeau: Thank you. I’m so excited to be here. I’m a pediatrician. I’m a parent. I’ve lived and dealt with heat stress myself as well as climate change. So I’m really happy to be here. As the department chair of Environmental Health, we work a lot with climate change in the global environment, and so our health is inextricably related to earth cell and we need to really focus on early development of children.
And today, I’ll talk a little bit about how heat, specifically heat stress affects children, because now with climate change here on our planet, every child born today will suffer from at least one severe weather condition associate of climate change and most likely that will be heat. You, I’m sure, all heard on the news that last summer was the hottest summer on record for our earth and unfortunate it will likely be the coolest summer on record for our in the future.
So we not only have to talk about solutions today, but we absolutely must talk about how those solutions affect children and pregnant women and how it affects the early development of the child. So I’m excited, Lindsey, for your wonderful seminar today and happy to answer any questions from you as well as from the audience at the end.
Lindsey Burghardt: Yeah, Thanks, Kari. And actually, I am going to hopefully intersperse. We’ve got so many amazing questions that really helped to guide how we shaped the discussion today. And one question that I get a lot that came up quite frequently from the audience when it comes to heat is what do we mean? Like when we say extreme heat or excessive heat, What does that mean? How are people thinking about definitions and how do we kind of start from a common understanding?
Kari Nadeau: Yeah, that’s a great question. So when we talk about heat, especially in babies that tend to have a lot of extra tissue around, especially with children who are moving around and toddlers who are on the move, typically what we call heat that could affect them physically, mentally, in a in a way that’s not good for their bodies is 85 degrees Fahrenheit. So that’s what people think above, which if you’re exercising and moving a lot, it can actually be a problem for your health. So 85 degrees Fahrenheit is really where we keep the thresholds.
Lindsey Burghardt: Yeah, that’s super helpful. And I think, you know, the next question that usually follows is what about places where it’s been warm for quite a while? You know, how do we think about heat differently? You know, if you’re somebody listening in from someplace like Boston, that’s typically more cool and dry. How do we think about Heat and children’s the way that they’re going to experience is increasing temperatures differently or the same as a child who has always lived or whose family has always lived in a place that it’s typically more humid or hot.
Kari Nadeau: Right. So as we all know, we grow up in areas of the world with certain cultural habits. And we also make sure that our children are part of those cultural habits as a family. And those are good things. We’re part of that overall environment to take care of the next generation. And with that, for example, in Boston, we tend to have colder weather in New England.
But the problem with 85 degrees is if it’s in April versus July, where we’re prepared in July to have warmer weather, people already have their clothes out, their shorts are bathing, suits have pools open. But in April, not so much in the middle of Boston. And so people are used to having colder weather. So therefore, they’re going to dress their children and dress themselves up with warmer type layers of clothing and so that’s a problem because part of dealing with heat physiologically is to evaporate our sweat.
And if we can’t evaporate our sweat, especially for babies and toddlers, because they’re not just little adults, they have different ways of evaporating from their skin because they don’t have as much skin surface area. So it’s actually more dangerous for children not to be prepared for these high temperatures in areas of the world that they’re not used to.
That, for example, in Switzerland, there were places in the Alps that had absolutely no air conditioning ever. They just didn’t have it because they never thought they need it. And two years ago, they had summer conditions of greater than 100 degrees Fahrenheit and people were not ready. So the children had terrible heat, stress and exhaustion just because people aren’t ready.
And so we need to when you think about preparing the rest of the world, you’re right. There are places in the global majority and near the equator that are used to heat, but they’ve already adopted the methods to be able to deal with heat that I’ll talk about later on today, because those are methods that have been central to the ecological knowledge of that community that now we have to be humble and listen to so that we ourselves can take the same steps to protect our children.
Lindsey Burghardt: And that makes so much sense too. And thinking about like, you know, we’re used to something in July that we’re not prepared for in April or even in October. And I think in Boston in particular, we experienced this when it came to our schools and our early care and education settings, which by design were made to keep heat in, you know, and are not adapted then to kind of handle those higher temperatures at times of the year where children are more accustomed to spending time inside.
So I’m excited to get into that, you know, a little bit later on. So can you talk about, you know, under the skin, how does our body respond, you know, when temperatures increase and how is that different? How is the response different? As you mentioned, it really young children, especially infants who have different physiology.
Kari Nadeau: Yeah. So on one side, when we deal with stressors, our body handles stress in some similar ways.
So there’s just a certain pathway that when we deal with early life stressors, it’s similar with heat. There are and pathways that are very similar to other stress pathways. So what I like to think about is these types of life stressors that affect children, especially early on. So and the reason we know so much of this biology is because unfortunately animals out in animal husbandry and agriculture have dealt a lot with heat stress and so have their babies.
And so we know a lot about mammals and how babies have to deal with heat stress. And so biologically, what will happen, especially even after three exposures of heat waves of 85 to 100 degrees Fahrenheit, where you’re dealing with overheating for more than two days in a row. With that in mind, we’ve seen that these proteins called heat shock proteins, can get activated.
And the reason I don’t want you all to have to know the molecular mechanisms here, but the important thing is this it’s real, it’s documented. We’ve documented in animals, we’ve documented it in human babies. Key proteins get activated. And why is that important? Because these are stress or proteins that are meant to keep everything stable, to keep everything happy in our blood.
The minute that they get stressed, the minute that the heat goes up, then unfortunately, they start to activate a pathway that inflames our body. And inflammation is not good. I hope that none of you have to suffer through inflammation, but it can result in disease, it can result in autoimmunity, it results in allergies, it can result in gut problems and skin problems.
So when our immune system is not happy, it’s not good for a baby, good for a toddler. It’s also the heat itself. Those heat shock proteins are in the brain, so they can also affect cognition and mental health. So unfortunately, our human body is not meant for high amounts of heat. And you could say, well, we learned that the human body stays at an equal temperature and that when we have a fever, we have heat.
And when children have a fever, they deal with high amounts of heat. That’s true, but it’s not continual. It’s not for five days constantly, for example. And if you don’t hydrate, if you don’t have opportunities to try to decrease that heat, that’s what can lead to trouble. And what we’re finding is that that can be irreversible in babies and toddlers because they’re so sensitive to heat
Lindsey Burghardt: And those huge shock proteins themselves to have important functions.
Right. Like they protect your hemoglobin, like other things that are really important in making your other body systems again. And so it’s sort of this really interconnected series of effects, it seems like.
Kari Nadeau: Yeah, that’s right. So these heat shock proteins are kind of nannies and caretakers for other things in your blood and kind of they’re patrolling the universe to make sure everything else stays really stable and the proteins don’t turn into denatured proteins.
And what why do I say denatured? Well, if everyone has basically cooked an egg or made egg whites into a whip, they know that if you whip things up, that egg white can actually turn into a foam. And that’s what I mean. If you heat up the human body too much, especially in children, your other proteins start to turn into foam and that’s not good.
So these heat shock proteins are meant to take care of that. And when they’re disrupted, when they’re too hot, they can’t. So it leads to big problems.
Lindsey Burghardt: And it’s amazing that we understand that cellular level, you know, where when we think about heat, especially in these sensitive groups thinking about even before birth. Right. What are the effects of heat on pregnancy and pregnancy outcomes Because those of us who think about young children, you know, think about how early brain development really starts and how we can both understand the impacts and then think about protecting groups that might be especially sensitive to heat.
Kari Nadeau: Yeah, let’s talk about that. That’s really important because as we think about the ways that heat affects infants, toddlers, early development, it really does start a lot of the times in utero. And looking at maternal health is critical. When a woman is pregnant, her heat exchange is different. And for us that remember being pregnant, you get hot much faster because your metabolism is higher.
You’re pumping out much more blood than another typical person that’s not pregnant. And you’re also carrying a lot more weight. And so that’s hard to release heat as well as other people that aren’t pregnant. And you’re also taking care of another, you know, sort of whole organism. And so with that, in mind, people that are pregnant have much more sensitivities to heat.
So when I talk 85 degrees Fahrenheit, we actually don’t know the threshold for pregnant women. But we do know that pregnant women are exposed to heat waves, for example, a hundred degrees more than three days in a row. And if they haven’t been given or afforded the ability to get inside, to hydrate, to be in cool rooms, that can lead to prematurity of the child, that can lead to, unfortunately, sometimes premature deaths of the baby and can lead to health issues of the mother herself.
So with blood pressure changes and other aspects to her health, that needs to be taken care of right away. So heat has a direct effect on pregnant women. And importantly, we don’t know enough about how that affects the child that’s born after delivery. And so people are watching that. And we’re following a group now, for example, in the Central Valley in California.
But it is important to follow because we need to see to what extent that heat effect and as a woman who’s pregnant affects also her child.
Lindsey Burghardt: And I think, you know, many people may be familiar with this idea of heat stress or heat stroke in older people or in, you know, children who are athletes. And we kind of can conceptualize that. But there’s also really important effects of heat on our youngest children in terms of their behavior and sleep and their learning. Can you speak a little bit to that?
Kari Nadeau: Sure. It’s really important to know that our bodies were really meant to be at around 75 degrees Fahrenheit outside. We might be 98.6 degrees Fahrenheit inside our body, but that’s not what we like outside.
And so especially children, you know, they can get cranky. Adults sleep so well, it’s really hard because they’re metabolizing so fast. Infants also have that nice layer of fat. Typically, it’s hard for them to go to sleep and it’s hard for them to stay asleep because they’re constantly trying to cool themselves. So it’s really important to develop methods by which to make it more comfortable for early child development as well as infants and babies and toddlers.
So with that in mind, knowing that that age group is much more sensitive, there’s a lot of downstream issues that happen. If you’re cranky, if you can’t eat as well, you’re just don’t feel hungry. You also don’t want to play outside as much. Those are types of interactions that are really important for the cognitive development of any child in early development.
The other problem is that we know that in early child development, every degree Fahrenheit increase on the outside environment can actually lead to a 1% decrease in test scores. Now, we’re not scoring the average toddler. We know that in terms of tests, but it’s important to know that it affects the brain and affects how the brain is going to function.
And so, again, our body is not meant to be in greater areas than 75 degrees Fahrenheit to optimally. We don’t want to have to work in that type of temperature or develop in that type of temperature that’s higher than that. And when it does get higher, our brain literally does not function as well. And we have data on that for children.
Lindsey Burghardt: And I think, too, as a mother, I can remember having three small children and how sort of my own behavior and ability to regulate my own emotions changes in a room that’s, you know, 98 degrees and humid and how that affects the foundation. Our relationship, when I show up for those young children, you know, it’s stress on me that translates to my ability to be present and provide the things that are so important for child development.
And I’ve learned, too, that. Is it true that, you know, we all of us need a subtle drop in temperature to facilitate sleep onset? And so for you and when we don’t have that, you know, you mentioned trouble falling asleep and having more frequent waking is true of children. And then also the adults who are having more disrupted sleep who can then, you know, be available in a really different way the next day, you know, feels important. And we think about, you know, oh, sorry, go ahead.
Kari Nadeau: Now, you’re absolutely right. We’re trying to create the best environments, indirect and directly for our children. And adults don’t get good sleep, which oftentimes happens when it’s hot. You’re right. We use just the lower temperature to be able to just fall asleep for any of us on this earth.
But I do worry about this because indirectly, heat and living in high areas where there might be violence, the violence actually increases outside and inside the household. And children, unfortunately, are sometimes the victims of this violence or see it, and it’s very stressful to them. So it affects how we behave as adults and it also affects some other behaviors that are irreversibly damaging to children.
Lindsey Burghardt: And I think, you know, so many of the what we know about how heat changes behavior and leads to increase and in different types of violence, as you mentioned, is getting more measured and available in adults. I think it’s more difficult to measure. I think we haven’t yet, but it would be really interesting to understand how heat really affects the behavior of toddlers and young children, because I think it makes sense that their ability to regulate their own emotions is going to be maybe even more sensitive than ours.
And we know that this is something that’s affecting adults. So we can only assume that it’s going to affect kids, you know, as much, if not more. And, you know, our conversations about sleep and behavior got me thinking about like where children spend a lot of their time. And I think in particular, many infants spend much of their sleep time and they’re you know, they’re early learning time in early care and education settings, including those that happen in in-home settings.
So how do you think about what we need to be thinking about in terms of adapting to increasing temperatures both indoors and outdoors when it comes to those particular settings?
Kari Nadeau: Yeah, I think so many of our children, especially if they’re in nursery schools or in daycare settings, we need to make sure that on the whole we can create better structures to deal with this heat all throughout the world in the U.S..
So let’s talk about that because that’s important. We talked about climate change. We’ve talked about heat stress. There are ways to mitigate and adapt to climate change that include biodiversity, vacation, that have fantastic acts, children and how they’re growing. So part of those solutions in daycare centers, in schools, at our own homes can include bio vacation, could include green and real green.
And the reason that’s important is because part of the simple ways to help decrease heat exposure is to offer shade. So let’s just talk about what are some of the really typical things that one can use practically at home or at a nursery school or at a daycare center to just help to reduce heat? Number one, if it’s going to be hot outside, please make sure you monitor the NOA Web site websites that we can provide you links for.
There are also provided, I believe, Wendy, in the report, the report from the star. The developing child is fantastic, by the way, and I hope everyone will read it because it offers such great resources to citizens. And I’m really proud of it because there’s so much science in it that can really be tangibly used right now in real time.
So what does this mean? Let’s talk about solutions on the individual level for heat. First, go to shade. If you’re outside, seek a shaded place. If you’re inside, make sure that it’s shady, not in some sun exposed area. Seconds If there’s no air conditioner, there’s no central air feature that can cool the room, then get a fan, get a bowl of ice underneath that fan.
And that can reduce the temperatures up to five degrees Fahrenheit quickly in any given room. And so those are some low cost ways to really make sure that you can introduce a cooling system into an area, especially with children running around that want to play, that want to be interactive. The other thing is to get cool, wash clothes and make sure that any skin exposed take away as much clothes as you can, but just cool off the skin because that’ll help it evaporate.
Better humidity can also reduce the likelihood of evaporation, so anything that we can do to decrease humidity is good. So. So getting that skin cool will allow it to evaporate more as well. And then finally, making sure that the children are hydrated, the babies are hydrated and the people taking care of them are hydrated. So all of these things are simple, easy steps to do.
The first step, though, is monitor and monitor. Well, now, most cities, most places around our country, at least in the U.S. and many places around the world, have alert systems to let you know if there’s going to be a heat wave. And that’s important because then we can start getting ready. And so I give a list of things to prepare for on the individual basis.
But these are things that can also be done on the public scale to scale it up across any given area that’s affected by a heat wave.
Lindsey Burghardt: And I love the fan and bowl of ice tip. I can just like picture and almost feel how that will cool a room and it’s something that, you know, is potentially accessible to a lot of people.
Now. We’ve been learning a lot and I think there’s a big range of programs that are doing some incredible work. You know, places like the NC State Designs Natural Learning Initiative that are thinking about how to bring greenspace and outdoor environments to children for a number of reasons. And you and I have had conversations before, and I would love to kind of talk about it here about how these natural learning environments, particularly with really young children in these early care and education settings, have such cobenefits, both when it comes to our biology, sort of what happens underneath the skin and then what happens in a range of benefits for children’s development and learning and kind of social emotional health. So can you speak a little bit to those? And also the benefits that it has in terms of lowering temperature because it’s one of these when you start listing off all the great things that this does, it really just seems like a win win win win.
Kari Nadeau: It really is. And in all humility, we’re learning a lot more about the winds that seem to be exponential in value, especially to young children.
So let’s talk about that more. So then it’s important for the audience to know that a lot of people now are studying this concept of natural outdoor exposures, especially in children. And there’s a whole sort of system now, both adults and children called natural capital, the investment that we take in nature and how we can get exposed to it more purposefully so that we can help ourselves.
It also decreases heat when we’re in nature with trees and of course plants themselves. They can emit carbon, but they also sequester carbon. So there’s a lot of things about plants. Let’s talk first about the good things for our brain with plants and with greenery. So we know that one of the great benefits of being outdoors not on a screen that shows outdoors, actually being outdoors and walking and making mental pictures and photographs, wonderful things outside with our children and being able to make sure even in infants to get outdoors and inhale and be part of nature, that really helps cognitive development.
There are many studies now to show that that helps stimulate your brain. Children do better overall in tests once they get exposed to the outdoors, even for an hour in between recess, they go outside, get exposed to green, not cement tops, but green. In the case of this study that was done in Australia where children in nursery schools got exposed to green during an hour after during their school recess.
And they actually did better coming back in with such a similar controlled study. So with all that in mind, green is good for the brain, especially infants and developing bright green is also good for tactile learning. And when people have done studies on nursery schools that have green grass and dirt compared to a typical playground, that does not that just has rubberized mats, the children that are exposed to the dirt and play around in the grass, that only do they learn more and they’re more academically aware of things later in life.
But in addition, they get microbiome, they get good bacteria established in their gut that actually helps their immune system. So a study was done in Finland compared to a controlled group with all other measures controlled for, and they found that the children that were playing more in the dirt were exposed to grass and trees, that they had a different microbiome system in their gut and that that actually helped their immune system.
And they had and that was measured by how well they responded to vaccines. So this is really important. This is a win win, win, win win cognitive development, tactile development, good microbiome in the gut, good immune system, and then good protection against infections.
Lindsey Burghardt: Yeah, and it’s lowering temperatures at the same time. It’s amazing. And I love this space because it really feels like a place or whether you’re in philanthropy or policy or already in an early caring education setting like that feels like that’s something that we can do to kind of bring all of these cobenefits into these settings. So it feels like a real place for hope.
Kari Nadeau: Absolutely it is. It’s I am very hopeful and there are many more people doing work on here with rewilding environments, making sure that in that process of greening we green schools and green nursery schools first, that we prioritize that because we know how important that is for developing children.
Lindsey Burghardt: And so when we start to think about how we target some of these investments or our attention to make sure that we’re, you know, creating the greatest benefits for children, you know, through, you know, things that you’ve taught me and other members of the council are really kind of built in understanding that heat is not affecting all groups of children equally. And really, there’s so many factors like your socio economic status, your nutrition, living conditions, where you live geographically, what your stages in development. You know, these things all shape the way that children experience heat and the types of heat that a types of effects that he can have on their development. So can you talk a little bit about how heat, you know, sort of amplifies some of these other more systemic inequities and how heat, these effects of heat can be compounded in areas where air quality may already be more of a challenge?
Kari Nadeau: Right. I’m really glad that at the Center for the Developing Child, you know, you brought us all together in a council to talk about these difficult things and they’re complex, but that doesn’t mean we should step away from them. It means we need to really focus in and understand them better, understand how to prioritize solutions and I’m glad that your center you’ve exactly done that.
And so kudos to you for being able to have a webinar like this and being able to have systematic ways to approach difficult conversations. And one thing that we’re learning with climate change is it’s really been the x ray and to our soul of health inequities extra into the soul of a lot of communities, especially those including children of color, those including children that get displaced to do climate change.
We have over 200 million people displaced every year to climate change associated events, and about a 90% of those displaced are women and children. So we need to think about how this affects children on the long term scale and specifically heat, because it is so directly related to climate change. But like you said, when you have heat and you’re already incredibly exposed to things like air pollution, if you live in a community of color, unfortunately, you’re going to have a higher risk as a child to being exposed to toxins.
And that’s unfortunate because of something called red zoning and redlining that were part of our real estate practices. Now they’re not. But still we have communities that are highly exposed, inequitable. And so what happens is if you have heat stress, if you’re already exposed to air pollution or toxic chemicals, which happens a lot in our underserved, marginalized communities, people of color, people that necessarily have been discriminated against in our country and traditionally, unfortunately, Native Americans and original peoples across the world, those children really have some of the worst statistics for being able to deal with heat because they have underlying issues.
And unfortunately, we also have an issue around nutrition and good nutrition practices. And for many communities where they might not have access to healthy food, there’s a lot of obesity and that very much affects how people respond, especially children, to heat stress. So with all of that in mind, we need to really think about the most vulnerable, the most and actively exposed, because if we can’t help them as children, as toddlers, as babies, then who are we as a society?
Because it’s those children we should be focusing on first because they are going to need the most help. And so a lot of work is being done. And so I’m hopeful that the your report is coming out. You talk about these and exposed children and some of these vulnerable communities that we really need to make sure we understand and understand the multiplying effect of these exposures over time, not only in any given day could a child be exposed to heat, air pollution, drought, perhaps a vector borne disease or an under stress event in it for their mental health?
But in addition, it compounds over the course, like you said, over time. So they have a higher chance of having these issues. But I’m hopeful that their solutions now the EPA is putting out heat risk indices for children, especially those in what we call these communities that are in exposed environmental justice communities. Also, the CDC has a new heat, red heat risk index.
So you can go online as members of the public, search the Internet and go to the EPA, your Center for the Developing Child report, as well as the CDC, the center basically the Center for Disease Control. And of those information packets, you’re going to find a lot about heat stress and how to help communities. And I’m really grateful that our government has this systematic ways to help the public now.
Lindsey Burghardt: Yeah, it’s really amazing. I think the amount of attention that this topic is getting and how children are being brought into the conversation. I think even a couple of years ago there maybe weren’t this type of robust, you know, sources of information that they say with heat. And now I think the EPA resources and thank you for the kind words about our report, but just kind of getting these this information out to people who are taking care of young children everyday feels really important.
And I sort of have heard you kind of draw out our top name almost like three real levels of solutions, right? Sort of like we need to take some immediate actions to keep people safe when these heat waves happen. And but we also need to think about how are we adapting our systems, our services, our infrastructure, Because as you said, you know, this was the coolest summer and that we’ll see going forward.
So how do we, you know, adapt to that new reality? But then also, you know, and it got to this, I think, a little bit when it came to the early care and education settings, like how do we stop the reasons why the planet is warming so much in the first place by decreasing our reliance on fossil fuels and, you know, decrease our greenhouse gas emissions.
So, you know, thinking about those three levels of solutions, is there anything that you’ve learned from your work with workers in California or in other places about how we can think about solutions, particularly in urban heat islands where temperatures are much higher? And can we think about applying those solutions to children and to pregnant individuals?
Kari Nadeau: Yeah, I think there are a lot of solutions now and I’m really grateful.
So when we talk think about climate change, so many of our solutions have immediate effects on heat, and that’s great because we want to stop warming our planet. It’s not good. We see so many issues around that warming of the planet with drought, with wildfire smokes, with water insecurity, with food insecurity. Heat plants don’t like heat either. Yeah.
So we want to make sure we think about the whole Earth. This whole concept of one health, planetary health, animals, plants, everything. Heat especially affects them. And so there are ways to adapt to heat, like I talked about with on the individual levels, but on the on the other levels of adaptation and planting more tree canopy, for example, in cities, the urban heat islands are real.
Many people feel that when they’re in the inner city, Chicago or in a city Harlem or inner city, New York City, they’re going to have degrees up to five degrees Fahrenheit, more in some of the heat islands compared to, let’s say, rural areas. So that’s real. And so what’s happening now is people are realizing, again, thanks to that whole concept of natural capital, planting trees in cities, especially, and children are going to basically benefit from these tree planting exercises, plant trees up to increasing tree canopy by 30%, decreases premature deaths by 30%.
That’s incredible. And it reduces temperature by 1.3 degrees Fahrenheit. That’s great. That’s substantial. That helps maintain good health, that decreases the risks of heat stress and heat stroke for not just children, but also for everyone. So and that’s a 30% canopy increase. Could you imagine? 50%. So and then the trees will also help absorb carbon. And the most important thing for those of you have allergies to trees.
It’s actually not going to increase allergies. And that’s also if you plant mixed sex trees, you reduce allergies. And so it’s very cool that we see so many benefits of these systematic ways that cities and communities can actually push for these policy changes. They are happening around the country. In front of you on the phone, please talk to your town councils about increasing tree canopy and plant in the right trees.
And I’m happy to help in any way. I’ve done a lot of work with different towns and planting trees. The other thing that people are doing more and more is actually using cooling paint. So if you use white paint on roofs or even green roofing, having natural roofs like grass and other things that are happening more in cities like Paris or just planting sort of spruce up, that’s done very much in certain cultures that white roofs and sod roofs, solar panels also reflect light so that that rooftop does not absorb light.
So solar panels, white roofs, green, real green grass streams, for example, they all help a lot reduce the absorption of that heat. And then there’s new technologies coming out for cooling sidewalks. We’re doing that in Springfield, Massachusetts, for example. Now, there’s also examples of cooling pumps that you can install into your home and you don’t need to leave the home.
These are low cost methods. And importantly, is talked to your local council, talk to your state, because nowadays states actually give subsidies for air conditioning, for cooling pumps, for offering access to cooling rooms, for example. I know that’s maybe not as easy as having cooling places in your own backyard or your own home, but there are no public cooling rooms available, especially in areas of the country that deal with heat stress.
And then finally, public places are being offered as ways to cool, cool areas. Now, we are still missing a lot for schools. We need to do a lot more directed work for public schools and private schools for children and nursery school. So I think when we wrote our EPA report for the Children’s Protection Committee, we did say we have to systematically make sure that on the public side that we reduce temperatures in these key areas that are taking care of children.
So We’re on the road to these types of practices. But I’m really glad to see a lot of cities starting to adopt them now.
Lindsey Burghardt: Yeah, You talked a little bit about heat pumps. So if somebody is new to the concept of a heat pump, can you explain a little bit about kind of what that looks like, why it may or may not have advantages over air conditioning and then for both of those technologies, you know, one thing that people ask me about a lot is, you know, we have this very old building. It’s it would take a lot of investment to think about. You know, the EPA, I know, has done a lot of thinking about cost effectiveness and what that actually means in terms of investment versus benefits. Can you speak to that at all?
Kari Nadeau: Yeah, I’m not a heat pump expert. I mean, people think heat pump, they’re like, oh, well, you’re making heat for me.
That’s true. The same pump in the wintertime can make heat for you. In the summertime can make cool. So it’s I call it a pump and so they can install this in homes. I’ve seen them they are at the current time they can be very energy efficient so they don’t take as much energy as let’s, say, an air conditioner, which is good because we want to decrease the use of greenhouse gas energy components, increase the ability to use renewable energies and heating pumps are one of those systematic ways of being able to adapt to more renewable energy devices.
So overall, what, for example the city of Boston is doing, as well as other cities around the country, as well as communities, not just cities. They’re looking at these pumps because they’re more energy efficient. You can install them into your home now without a lot of issues and without disrupting normal living. And they don’t require as much energy, let’s say, as air conditioners do, because people probably no air conditioners use some toxins that then get emitted into the environment and they’re actually really bad for greenhouse gases.
And so we want to make sure that the very same solutions that we’re using for cooling do not turn into solutions that actually turn out to be worse for our environment and can start to increase change. So that’s where the pumps are actually really helpful. But if you have any other suggestions.
Lindsey Burghardt: No, no, no. I found it like so amazing when I first learned about it, because you hear a pump and you sort of think that it’s going to like, I don’t know, work off of some type of, you know, coolant like the air conditioners do.
But they actually in the winter, it’s kind of amazing dry heat out of the air even when temperatures are well below zero. I think the state of Maine has done this at scale and they actually warm many environments, you know, much more evenly in the traditional cooling methods. And then at the same time, you know, they’re able to draw in the summer months that energy and that heat out of the air and actually put it back into the earth in a way that it’s also, you know, cooling to the to the degree of air conditioning is without those negative effects of the greenhouse gas emissions.
I think, you know, many times when we learn that air conditioning may actually not be great for the environment, but, you know, if you had the ability to put some type of air conditioning in a place where children sleep or where children live and you can lower that temperature, I think we’ve learned that the effects on learning actually are really important when you lower those temperatures and that there’s significant costs associated with the learning losses in the days lost in school.
And that actually even though you have to invest it, put that money into air conditioning, you’re sort of regaining, you know, the losses that would have happened in so many other ways because of heat. And I think when it comes to young children, especially that ability to like, play and explore and just be curious and be able to move around your environment comfortably is so intangible and hard to measure.
But thinking about how to get these technologies into places where young children spend time feels, you know, so important. So I love that you Yeah. I mean, it’s great just to think about that. There’s solutions at so many levels that really, no matter where we sit, you know, we have to, you know, we can start to think about, you know, what we can do to make these make environments more comfortable for kids.
So, you know, if you had to think about if you were working in an early parent education setting, if you were in a school, you know, we’ve talked about a couple of different temperature numbers and ranges today. Is there you could wave a magic wand and say, I would love for these little infants to be able to play and live and sleep at this temperature in these toddlers. Is there a range that you think is helpful for the audience to know about?
Kari Nadeau: I think 70 to 75 is helpful. I think that that gives us leeway. But, you know, that’s where we’re coming down now. But obviously we want to know what’s harmful so that we don’t get to those temperatures. And that’s like 85 and above and all of this comes conditionally with making sure you’re hydrated, making sure that there’s humanity and dryness differences.
So with all that in mind, though, Lindsey, it is so important to try to be that change. Now with this information. I hope that your audience will take it forward on the individual level, but also to knock on the doors of your town council, to knock on the doors of your local government and say, hey, you know, can you give subsidies or cooling pumps for certain neighborhoods?
Can you make sure that they’re in schools? Can you make sure that we deal with good aeration? You know, just a little bit of wind will help with evaporation and will help reduce temperature a lot. So I hope that all of these things that we’ve talked about today will be helpful to your audience. But it’s important that we as a community really advocate for children, for infants, for toddlers, because we as adults, I think that is our a privilege to be able to make sure that we can take care of everyone on this planet, especially those that are early in life.
Lindsey Burghardt: Yeah thank you. And I learned so much every time I have a conversation with you about this. I wish that I could be like taking notes and talking so I can go back and learn more about all these great things. Is there anything that you would give us sort of a take away or, you know, a final recommendation for people who really want to bring this home?
I love the thought about coming to your lawmakers, coming to your local government. Is there anything that you would put forward as, you know, something that gets you up and into this work every day with hope and forward looking?
Kari Nadeau: Yeah. Thank you so much and thanks for everyone for joining. I am very hopeful that we can, through bio diversification, through getting access to more natural environments, actually help our children, especially in early development.
And I also am very hopeful that because there’s areas of the world that are dealing with extreme heat greater than 40 degrees centigrade, greater than 110 degrees Fahrenheit, this is happening more and more in the news. These are areas that I really do hope we can also think about. How are those children affected and what access can we make sure immediately we can provide to them for healthier lives.
Lindsey Burghardt: Yeah. Thank you, Kari. This is terrific. We’re so grateful for your time and your expertise and for everything that you’ve taught us today. So I’m going to turn it back over to our host. And thank you all for joining us. We hope to see you again at a future conversation.
Kari Nadeau: Thank you, Lindsey.
Rebecca Hansen: All right. Thank you so much, Dr. Burghardt and Dr. Nadeau for this wonderful conversation today.
I also just wanted to quickly note that we have several additional webinars in development for later this spring and summer where we’ll talk more about different aspects of the developmental environment and other topics related to early childhood development. So please be sure to follow us on social media and subscribe to our newsletter to receive updates and find registration information.
We’re so grateful to have you with us and we hope you enjoy the rest of your day.
Cameron Seymour-Hawkins: The Brain Architects is a product of the Center on the Developing Child at Harvard University. You can find us at developingchild.harvard.edu, where we’ll post any resources that were discussed in this episode. We’re also on Twitter @HarvardCenter, Facebook at Center Developing Child, and Instagram @DevelopingChildHarvard. Our music is Brain Power by Mela Collective.
A Place to Play: Moving Towards Fairness of Place for All Children
May 02, 2024
In March 2024, we continued our Place Matters webinar series with our third installment: “A Place to Play: Moving Towards Fairness of Place for All Children.” During the webinar, we explored the power of play in supporting early childhood development, as well as the importance of ensuring that children and caregivers have access to safe green spaces, like parks and playgrounds. Our panel of experts discussed how access to safe, stimulating, and joyful play space is not equally distributed across communities, along with strategies to work toward building a future where all children have a safe place to play. The webinar discussion has been adapted for this episode of the Brain Architects podcast.
Panelists
Leah Anyanwu (Moderator) Programme Specialist, Children on the Move, Children’s Learning and Development, The LEGO FoundationCynthia Briscoe Brown Atlanta Board of Education Seat 8 At LargeKathy Hirsh-Pasek Professor of Psychology and Neuroscience, Temple University; Senior Fellow, Brookings InstituteLysa Ratlif Chief Executive Officer, KABOOM!Le-Quyen Vu Executive Director, Indochinese American CouncilMelissa Rivard (Webinar Host) Director of Engagement Strategies, Center on the Developing Child at Harvard UniversityCameron Seymour-Hawkins (Podcast Host) Communications Coordinator, Center on the Developing Child at Harvard University
Cameron Seymour-Hawkins: Welcome to The Brain Architects, a podcast from the Center on the Developing Child at Harvard University. I’m Cameron Seymour-Hawkins, the Center’s Communications Coordinator. Our Center believes that advances in the science of child development provide a powerful source of new ideas that can improve outcomes for children and their caregivers. By sharing the latest science from the field, we hope to help you make that science actionable and apply it in your work in ways that can increase your impact.
In March, we continued our Place Matters webinar series with our third installment: “A Place to Play: Moving Towards Fairness of Place for All Children.” During the webinar, we explored how play and a family’s access to safe green spaces, like parks and playgrounds, support early development. Our panel of experts discussed how access to safe, stimulating, and joyful play space is not equally distributed along with strategies to work toward building a future where all children have a safe place to play. We’re excited to share part of this conversation on today’s episode of the Brain Architects podcast.
If you’re interested in in seeing some examples of community-led solutions to address gaps in play space equity presented by Lysa Ratliff of KABOOM and Kathy Hirsh-Pasek of Playful Learning Landscapes, we encourage you to head over to our YouTube channel to view the full webinar recording.
Now, without further ado, here’s Melissa Rivard, the Center’s Assistant Director of Innovation Strategies, who will set the stage for our conversation.
Melissa Rivard: Welcome and thank you all so much for joining us today. It’s really gratifying to have so many of you showing up for this really important topic. So thank you. I’m Melissa Rivard, Assistant Director of Innovation Strategies and I will be your host today. This webinar is part of a series of webinars that the Center on the Developing Child has hosted to examine the ways that a child’s broader environment, including the built and natural environments, as well as the systemic factors that shape them, play a role in shaping child development and health beginning before birth. Our focus today, the importance for all children to have access to stimulating joyful and safe places to play, is prompted by our focus on fairness of place as well as a desire to highlight a long standing collaboration between the Center on the Developing Child and the LEGO Foundation, and our shared belief in both the power of the early years and in the power of play to positively impact lifelong learning and health. Our moderator for the conversation is Leah Anyanwu. Leah is a program specialist at the LEGO Foundation, where she supports the Foundation’s early childhood portfolio with a focus on children displaced due to conflict and climate. Leah is a passionate educator and advocate with over a decade of experience working in education with a focus on early childhood and education systems reform. Along with Leah, we’ll be joined for this discussion by a phenomenal group of panelists who bring a wide range of expertise related to this topic. Kathy Hirsh-Pasek is a professor of psychology at Temple University and a senior fellow at the Brookings Institute. She served as president of the International Congress for Infant Studies, was on the Governing Board of the Society for Research in Child Development and is on the board of 0 to 3. In 2010, Dr. Hirsh-Pasek founded Playful Learning Landscapes with her colleagues, an initiative that reimagines cities and public squares as places with science infused designs that enhance academic and social learning opportunities for young children. And we have Lysa Ratliff, who is CEO of KABOOM!, a national nonprofit that works to end play space inequity. Lysa is a leading national advocate for equitable access to play spaces, has been invited to speak at several White House events and engages with members of federal, state and local public offices advocating for and creating opportunities for kids to play across the nation. We’re also joined by Le-Quyen Vu, who is Executive Director of the Indochinese American Council in Philadelphia, a nonprofit working to empower disadvantaged and minoritized groups and newly arrived refugees and immigrants in their community to achieve social, economic and educational advancement and mobility. And Cynthia Briscoe Brown, a member of the Atlanta Board of Education, Seat 8 at large who’s been instrumental in passing a number of policy initiatives, such as the historic Equity Policy, the Atlanta Community School Parks Initiative and the Atlanta Public Schools Center for Equity and Social Justice. Without further ado, I am so pleased to hand the baton to you, Leah.
Leah Anyanwu: Thank you and welcome, everyone. I am so excited to hear from each of our panelists about the critical work connected to play equity and for this conversation, which centers the power of play and the importance of safe and quality play spaces. Our aspiration at the LEGO Foundation is that children become creative, engaged, lifelong learners who thrive in a constantly changing world by experiencing the benefits of learning through play. The scientific evidence around the power of play is clear and growing. In short, play is essential, everyone. Not only is play the best way for children to learn and to thrive, but play builds the foundations of lifelong learning and fosters holistic development. We’re here today because there is so much opportunity for children, families and communities when it comes to play and creating spaces that invite and enhance it at the community level in policy development and in the work that brings each of us to this conversation today. Yet we have a long way to go towards ensuring that the opportunity for quality play is equally accessible to all children, families and communities. To quote the Place Matters paper that Melissa just mentioned, “just as dimensions of the built and natural environment have been designed over time, they can be redesigned to support healthy development.” Throughout our conversation today, we will share insights from research and the field about ways to redesign, to rethink and to rebuild in pursuit of creating environments that support all children’s copy development. Now, without further ado, let’s get started. And I really want to invite Kathy to really focus first on the why. So, Kathy, good to have you here. What does this science tell us about why play matters for children, particularly young children? And how is play connected to learning and what kinds of play and characteristics of play are particularly important?
Kathy Hirsch-Pasek: All right. You got it. And thank you so much, Leah. Well, we created Playful Learning Landscapes because we agreed with you Leah and we agreed with the work going on at Harvard that it was time to transform cities and villages and towns into family friendly spaces that were inclusive and that were infused with learning. So what I’m going to share with you today are not really just play spaces. It’s not like going to the playground. They are every day spaces that are infused with the science of learning and social learning that can be built right into the architecture. We build everything that we do on what we call our three part equation. The first thing is that when you go into a city, you need to know who your audience is. You need to be consistent with the cultural beliefs and the community values. So we start there. And then on top of that, we add a series of characteristics that define how human brains learn. And it just so happens that those same characteristics define play and playful learning. You have to be active, not passive, engaged, not distracted. It has to be meaningful. It has to not be disjointed. Has to be socially interactive. It has to change a little each time and be iterative. And finally, it should be joyful. That’s the how of learning how brains learn. And then the science of what children learn is the 6Cs. You know, in a world with AI we need to learn reading and writing and arithmetic, but we need to go beyond it. Can we collaborate and can we communicate well. Do we know our content? Do we have critical thinking? Do we have good–here you go–creative innovation, which is going to be very important. And then we want to know if you have the confidence to give it a try, which helps to feed grit and perseverance. There’s a whole lot of science to back this work up. And that you can use this equation for digital media, for places and for school building in ways that will help kids grow in a playful way.
Leah Anyanwu: Thank you, Kathy, for that framing, I want to bring Lysa into the conversation. Lysa, KABOOM!’s mission is to end play space inequity for good. Can you tell us how you define play space inequity and share what you’ve learned about the scope of the issue? And what are you and others doing at the policy level to try to address it?
Lysa Ratliff: Sure. The big question and I want to start by thanking Kathy for grounding us in such beautiful space, because what we see through those examples is that we have solutions. We are working against a solvable problem, and for Kaboom! we define play space inequity as a lack of access to and a sense of belonging and which is important. Quality play spaces due to the affect of systemic racism in communities across the country. And for anyone who’s been following the report, the play Place Matters report or the webinars, I would encourage you to go back to Dr. Lightsey-Joseph’s conversation where she laid out the historical policies that we are all trying to navigate today, and for Kaboom! Within that broader context, our focus is centered on kids. We care deeply about our children and we prioritize public space. And so we focus our efforts on play spaces and the surround sound that needs to happen so that kids have more access to and more quality time in play spaces so that they can benefit from all of the things that happen when kids go out and play on quality spaces. What we’ve learned about the scope. There’s just four really big categories that we’ve discovered through some work that we did that was funded by Colorado Health Foundation, and we worked with our partners at NC State and the College of Charleston, where we see those same patterns of inequities that Dr. Lightsey-Joseph was talking about and things like the achievement gap, the access to healthy food and health care coverage, all of those things. They also apply to play spaces. And so the four different areas are 1) distance matters and we hear a lot of conversation around the ten minute walk and the accessibility to play spaces and making sure that it is the easy option and that play spaces are within the communities that we need to work in. The challenge is that low income and communities of color and even rural rural communities are more likely to have limited access to play spaces where they live and learn. This is not just in their community, this is in their schools. There are schools without play spaces at scale and in parks just across the board. There is not easy access to play spaces and public spaces for kids and families to go. So that’s one critical piece. The quality of those spaces is also something that we’re concerned about. And so even when they do have access to places, it tends to be lower quality. It tends to be in communities of color, half the size as in communities that are predominantly white. So there’s less space to be able to play in and there’re worse physical conditions and lower play value. So we all know that kind of repetitive play is important and being able to not just go out there once and play, but time and time again to go out and discover new things is really important. That all has to do with quality. Neighborhood, again, you know, when we’re thinking about inequities, low income and BIPOC communities are more likely to have limited access to play spaces because of neighborhood factors like transportation and personal safety concerns. And so community cohesion and coming together and making sure that the community starts to really bind together as a community through public space will also help us address the barriers to kids going out and play. And then finally, history. You know, I’ll kind of end with this piece with where I started is that our communities are still shaped by racist historical practices like redlining. Our public spaces, our schools are a reminder that not so long ago they were segregated space. People are still alive that lived in segregated space. And I can’t share it here because I don’t have license to the photo. But I would encourage people to look at the Gordon Parks photo from 1956 called Outside Looking In, and it shows a group of young black kids looking through a fence into the most beautiful play space you can imagine. And yet they weren’t allowed to play in it. That residue is still what we’re dealing with today. Those kids in that photo are probably still alive. Some of them are probably still alive today. So we’re not talking about that long ago. So that history that we have inherited is also affecting how we work today . In the fifties, what we were also seeing is infrastructure being developed that went straight through thriving black communities like our highways and freeways, all of this backdrop is really the barriers that we have to make sure that we are acknowledging and problem solving around to make sure that we solve in a way that addresses the systemic issues, but also allows us to work in a systematic way so that our future is better than our past. You talked about policy, or asked about policy. And so to that part of the question, doing so much, so much and we’ve only really leaned into policy and advocacy and government affairs works since like 2019, 2020. And in that time we’ve moved in light years. You know, we think that our policy and advocacy work and the influence that we have there is as important as the spaces we build, because that’s where we’re going to stall and stop the perpetual issue of that historical racism has created in our public space and the allocation of resources. And so in the policy work, we see play space inequity as a historic challenge, which stems from an intersection of local and state and federal policies that were rooted in a racially biased ecosystem and decision making. And so we have to work at all of those levels. At a local level, we’re working with our partners on data. We are very committed over these past years to really understanding through data where play space inequity exists, and so a resource that we can bring to our local partners is giving, providing them with that data and letting them overlay it with their own data as a road map for the work and also as a tool to help prioritize. Oftentimes you see in local systems that they work against the pressure of who’s talking loudest and who’s asking loudest. And so by having that data as their baseline for prioritizing their budgets, which is also a little bit of a policy document, because budgets are saying where money and resources are going to go, it helps our state or our local partners prioritize historically, disinvested spaces. That state work links to our federal and That local work links to our federal and our state work. Because so often the resources that go into the local system come from the state or the federal government. And so we work a lot at the certainly at the federal level where we are in a couple of layers. So we are working across the board, not just specifically on play space issues, but advocacy efforts around things like the rural development and the farm bill and looking for greater flexibility in that CDBG program because we know those fundings, those funds are going into local budgets. And so making sure that we are a champion for prioritizing equity in those spaces and then even some of the work we’re doing with the administration is to support the implementation of the 40 initiatives. And then finally, two other points on the policy work at the state level. We’re also working to advocate for things like recess, mandatory recess. And I was horrified to learn that California is the 10th state, which is a state we just worked on with Governor Newsom to pass a mandatory recess bill, but it’s only the 10th state in our country that has mandatory recess. So we have work to do there. But it’s alarming to know that we’re not even mandating recess in the majority of our states. The last thing I’ll say about our policy and advocacy work is it’s not work we can do alone. And so we’re part of a lot of coalitions. We helped co-found Coalition called the Nonprofit Infrastructure Coalition. We did that during the pandemic when there was funding being decided around infrastructure and making sure that we were part of mobilizing the sector to advocate for equitable allocation of resources when a lot of money was going to come out from our federal government. And then two other notable coalitions we’re a part of is the Percefra Place Coalition, which advocates for greater investment by the federal government in civic infrastructure. And then finally, the Outdoor Alliance for Kids, which is really looking at promoting legislation and policies that make it easier for kids to access outdoor recreation and play. And so a lot there, but a lot of history and the partnerships that we’ve been able to build make it really easy for us to lock arms and make the kind of progress that we could have never made alone.
Leah Anyanwu: Yeah, Thank you, Lysa I mean, there’s so much to unpack here, but I’m going to ask you and you can maybe just in one minute, can you share KABOOM!’s general approach to design and creating play spaces and briefly summarize the project that can be will be speaking about this.
Lysa Ratliff: Yeah. Okay. This is a challenge. So data collection, I mentioned that data collection is recently we have we know that we cannot solve playspace inequity if we do not know where playspace inequity exists. So we’ve made deep investments in data. So that data piece, the partnering with others, what Kathy was talking about, community voice and making sure that we are responding to what the community identifies as their needs through the team that we have here, and more importantly, local partnerships that are connected to community on the ground. We work with Le-Quyen who will hear from. We recognized a couple of years ago that we cannot keep working one project at a time, but we’ve got to look at more system level partnerships and working with peer organizations. So in places like Atlanta, we’re locking arms where Children in Nature Network, Atlanta Public Schools, Transfer Public Land to utilize the data that we’ve collected to re-envision what a school yard can look like. Nature elements, sports elements, learning outdoor classrooms. you’re not just looking at a play infrastructure, but you’re looking holistically at that school campus as a place to grow food, as a place to have multiple activities and so the Oakland work that we’re doing as part of our partnership with the Learning Play Foundation in Oakland Unified School District, where we’re transforming 25 schoolyards throughout Oakland by the end of 2026.
Leah Anyanwu: Thanks, Lysa. I’m so sorry to interrupt that you have so much wisdom on this call and so many examples to share that I know we’ll share links to the theory of change and the project so folks can continue reading. I just really want to make sure we have time to pick up on one of the essential themes that you and Kathy spoke about, which is community involvement and leadership. And so I’d love to bring Le-Quyen in and Le-Quyen–can tell us what does community led look like in the Literacy Rich Neighborhood Initiative and the literacy tree installation, and how do you ensure that community members involvement is truly meaningful? How did involving the community make a difference in terms of design and the use of space? Le-Quyen, over to you.
Le-Quyen Vu: So just to be clear on the record, none of us knew that we were. Lysa probably didn’t know that we were funded by KABOOM!, and Kathy probably didn’t know that this project was her brain when I started picking her brain, before we responded to the Funder who was asking for us to submit our idea so that that just to put it out there. The Center did not invite us because we were linked together. It happened that way. So, so to me when we got this project, so we are the literacy agency, We work with adults, we work with children. Family literacy is part of what we do. We are not an architecture firm, so I am entering into a territory that is new, that is born to me. So the thing that I that I have to ask myself was how do we get the community to this space that we tried to transform? Who knew we who are the people who will be using it, and how do we get these folks to take ownership? We talk about that all the time, but how we go about doing it is different. So that was a question that would just make me lose sleep when I heard that I got the funding because that’s huge. So I realized, okay, we have to approach this, the community, as partners. We have a job to do and these are the folks that will help us finish the job. So I always said this we have to approach this as we have a product in that we’re not selling anything, but we have something to sell. So the people who are using the space are our customers. So we need to go do that. We need to involve them from the beginning. We need to do the research at that. Lysa did her work, Kathy did her work. So our job is to take that work and bring it to the community in a way that is going to create a result that everybody’s happy. So that’s basically it. So we came in with a blank piece of paper. We wrote the proposal with 20. There’s a goal, this thing that we achieved, but we didn’t have a definite picture of what that looked like. We said what it looked like would be from the community. But he has other goals. So we went in there from the beginning before we submitted the proposal, we went to the community and asked them, we are going to do this. Would you be partner with us? Would you be interested in us doing this? So even before we submit the proposal, we went and asked them. So everybody was asking us, Yes, yes, yes. And then when we got the funding, it was easy to go back and say, So we got the funding. You said you want us to do this, so let’s do it together. So that’s basically what it is. And then us in the process of working on this project, I realized there are a culture differences between institution between government and between the community who live in the neighborhood. And our job–everybody knows what they want the two and know what they want coming together and connecting those two things together. They don’t speak the same language. Good thing that English is my second language, so that come naturally for me to be like, okay, we’re going to have to connect these folks. So we along the way, we basically played the role of a mediator, the peacemaker, the coming okay, here’s what people said. Here’s not what people said. And then coming and bringing people together. And that’s how we started that project and that’s how we the people decide where they want the space, the kit, these know what it looks like and everything was from the people. We went back we invited the university students. We invite the people to take the classes, the design class together, the community committed to ten weeks of 3 hours of every hour, every week to work as a student to design this whole thing. So the first phase was we got the William Penn Foundation to do that tree. The second–there are more– they the community wants a lot. So we were able to get KABOOM! to fund the other piece that the community wanted. So it’s an ongoing project.
Leah Anyanwu: That’s what it sounds like Le-Quyen sounds like, you know, it’s very participatory and you’re always adapting and adjusting. And I mean, you touched on something that I would love to bring Cynthia in to kind of build on, and that’s, you know, a similar question, but from the policy perspective. So Cynthia, if you can just share briefly, you know, can you outline the work that you’ve done to make play more accessible for all children in Atlanta? And I know you’ve done a lot of work in this space, so perhaps you can just share, you know, a bit more broadly and then focus briefly on the Atlanta Community Schools Parks Initiative.
Cynthia B Brown: Absolutely. And thank you for asking. As Lysa said a few minutes ago, history matters. And in Atlanta in particular, where Atlanta public schools, it has a approximately four out of five of our students are on free or reduced lunch, and well over eight out of ten are students of color. We deal with racial and socioeconomic inequities that are baked in for centuries. We have schools which have no walk zones. It’s too unsafe for children to walk from their home to the school. We have schools where two thirds of our students are transient. Atlanta is a city of neighborhoods. And and so we still have neighborhood schools, attendance zones where we believe that schools really are the the beating heart of a community, the social center of a community, not just a place for children to go for instruction, but for wraparound services, for health centers, for food pantries, for clothes, closets. We have parent centers where parents can come and use wi fi and and computers to apply for social services and apply for jobs. We have parenting classes, so we really think of a school as the beating heart of the community. We want that entire school property to be a learning rich environment. And so when we had the opportunity to work with KABOOM! And the children and Nature Network Trust for Public Land, the city of Atlanta, we needed to find a way to to to build a structure for that kind of partnership. What we are really talking about here is a new kind of public private partnership where where we tackle big problems, problems that are h onestly too big for any one of us to solve and and we are able to do that because we don’t care who gets the credit. Our equity policy that the Board of Education passed in 2019 is the foundation of this. It’s the driver of everything else we’ve done. Because what it does is require the superintendent to eliminate inequities in every decision, every dollar, every program, every initiative, every thing we do in Atlanta, public schools coming out of that is our student outcomes focused governance work, which uses data to drive all of our decisions based on student outcomes. And so the data that we get from the Atlanta Community School Parks Initiative allows us to make the argument that student outcomes are affected by play spaces because we’re given that information that allows us to to to use the policy as a lever to drive direct action. Finally, we, we then use the policy. I never like to say we do anything top down in Atlanta Public Schools, but we can use this top down policy. The the this I believe statement that the board makes in a policy to drive bottom up engagement so we can put in a policy that the that the superintendent will consult with the community will develop an engagement plan and then fully and faithfully implement that plan before we before we make any major decision. That’s been an effective way for us to integrate this play space work to to build learning rich environments and to to get the community involved. Because like Le-Quyen’s project, this is very community based. Our children and their families, our employees design the projects that we then implement. I’ll also say that building relationships is critical. We have a mayor right now who declared this past year is the year of the Youth–an APS alum himself. He has declared that he wants Atlanta to be the best place in the country to raise a child. And so we’ve received additional assistance by building relationships with the mayor’s office, with the city council, with the Department of Parks and Recreation that have resulted in some very tangible results, including a joint use agreement between Atlanta Public schools, the city and this consortium that the Atlanta school, the Atlanta Community School Parks Initiative, so that we can open our school yards, our spaces in our schoolyards to the community to allow them to to enhance added rich, what we are doing at the school and also in the community. We have intergenerational spaces in those in those schoolyards. They are safe, they are clean, they are welcoming, and so they are enhancing and adding to what we do in the classrooms.
Leah Anyanwu: Thank you, Cynthia. So Le-Quyen I’d love to hear from you. What were your lessons learned about how community involvement can make a difference in the design and the use of the space?
Le-Quyen Vu: Community involvement would help us maintain the space, would help us advocate for funding. When we did this work, we were ambitious and we thought that little money we have can do three things. We ended up with able to do only two. The community. Engagement was able to make the case to the state and get the money from the state to do the other area. So that’s what community engagement and community engagement also mean that they will look out for this space is is it to maintain a lot of time, We built these places, we make it beautiful, but funding ended and then we don’t have a means to continue maintaining it. That is what what is meaning is meaning that this place will continue to be used. This place will continue to serve its purpose and they will continue to maintain.
Leah Anyanwu: Right. So really getting to the sustainability bit. And that’s really helpful. Lysa, can you also share your lessons learned about communicating the problem of play space inequity and what moves policy and decision makers can take if they want to make play more accessible for all children?
Lysa Ratliff: Yeah, I mean, I’ll just boil it down to at the end of the day, we are having human conversations about our most precious humans. And I, you know, when you use words like historical disinvestment, racial equity, racism, it can become emotionally charged. But for us, we’re talking about a human issue and we’re talking about a human issue as adults who have a responsibility to care for our kids. And that just crosses all walks of life. And so for us, particularly in our policy and advocacy work, we’ve been able to show up in a very nonpartisan way to problem solve. The work that we’re doing in Uvalde, Texas, where we have quite literally locked arms with the community there, we have gone to the Hill with them and advocated across You know, Democrats and Republicans who are really looking at space and equity as something that can be solved as an example to solve bigger issues. And so at the end of the day, just my my advice there is that we’re just talking about human issues and our responsibility as adults to care for our babies.
Leah Anyanwu: And this is a human issue, right? Like we can set aside our differences. At the end of the day, we are all set up for success when our children can thrive. Thank you for that. Kathy, a question we received is around examples or suggestions of ways to create opportunities for quality outdoor play in communities that might have fewer resources. Can you share for one or 2 minutes just any examples or suggestions that you might offer?
Kathy Hirsh-Pasek: Yeah, absolutely. The first thing I’ll say is that I totally agree with Lysa and Cynthia about the wonderful work that you guys are doing and how it’s really a team sport. And so there are a couple of things I’ll say about resources. The first is in the work that we do, bus stops have to be built, transit centers have to be built. There are budgets in cities and communities for these things to be built. So as I said, well, ours are play spaces. They aren’t really they’re just your average bus stop. They’re just your sidewalk. They just happen to be the library. And there is money for those amenities. So the cost to people in the community is zero. Okay. And we have found that if you go to the cities and you say, wow, the next time you put in this bus stop, the next time you put in this sidewalk, let us be a part of it and they will let us do it. And as Le-Quyen knows, Philly’s been really, really good about that. And even put a person who focuses on playful learning in the mayor’s office. So sometimes it takes that. And that also helps with the kind of coordination that Cynthia talked about. All right. One more piece to that is that, you know, you can do fancy things with the government or can do not fancy things. So I always talk about it as the champagne or the beer level. And all of those are available in the projects that we’ve done. And one that I did in the country of Colombia. And I have never, ever experienced poverty like I saw in the place that I was at in this one, this one school area in Colombia. And how did we put in place a learning landscape? We used cardboard, we painted it different colors, and we used chalk because with chalk I could draw on a floor, I could draw on a sidewalk. So sometimes it’s as easy as chalk. The examples I could show you that we went into, you know, supermarkets and change signage. The whole project cost us $65. So I wouldn’t worry about the cost. There are many ways to do it. I think the bigger issue is what you just talked about last time, that it really does involve listening and hearing as Le-Quyen told you so beautifully, so that the community has ownership you don’t and that you work with all the people who need to be around the table, which includes policy people and people from the Parks Department and people from the city, or it won’t get done.
Leah Anyanwu: Thank you, Kathy. And I love that charge that, you know, play can happen with nothing. I remember being a child and we were just playing outside. We would just make up stuff. So we don’t always need, you know, fancy playgrounds. Can we just have some creativity? Recycled cardboard, plastic bottles, rocks, tires. The sky is really the limit. So we are we are nearing the end of the hour, which is hard to believe. And thank you all for such a rich conversation. Before we close out, I’d love for each of you to share one positive note to leave our audience with. So perhaps that’s an outcome from your work, a development in your community, or finding from your research that we can take with us. So we’ll start with Le-Quyen then hand it over to Cynthia, Lysa and Kathy close us out.
Le-Quyen Vu: I would say persistence and partnerships. Those are the two things that I take away from this project.
Leah Anyanwu: Thank you Le-Quyen.
Cynthia B Brown: Mine is similar to that and that is never give up. Five years ago I would not have believed that we could be accomplishing what we are in Atlanta. And and the other word of advice I have is find champions, find a school board member who you can who you can rope in, who you can get excited about your project. Find a city council member, find a nonprofit CEO and and build those relationships so that together you can accomplish more. You can solve big problems in a way that none of you can do individually.
Leah Anyanwu: Thank you, Cynthia.
Lysa Ratliff: Hey. Ditto. There’s always a solution. And really, in looking at creating a better path in the future to, have a solutions mindset. And that’s how we’re getting stuff like this done. All of us work together in some way, shape or form on this panel. And so we’ve been committed to each other and to finding solutions to problems. And the more that we do that, the more results we’re going to see, like the ones Kathy shared with us at the beginning.
Kathy Hirsh-Pasek:: I’m going to end with, believe. If you can dream it, you can do it. If you really feel it in your heart. I have seen people from the community of Philadelphia, Santa Ana, Chicago, people who you would never believe could rise to the occasion and make dreams come true for their community. Make inclusive spaces where every child can grow and can thrive with their parents, with their grandparents, with their friends believe, If you can imagine it, it is possible.
Leah Anyanwu: Well, thank you for that. I think we have time for one last question before we close out. And that would be, you know, what advice do you have for folks about the best ways they can advocate for quality play spaces in their communities and what resources might you recommend? And anyone can take that one.
Kathy Hirsh-Pasek:: Well, I’m happy to jump in again. As I said, it depends what you want. You know, the resources can be beer or they can be champagne and they can come from parks departments or they can come from city government. There’s so many ways to do this. If you have a dream that you want to fulfill, write us and we’ll help you get there.
Cynthia B Brown: I’d second that and that is that that I think anyone working in this space is including myself, is happy to share what we’ve learned. In fact, the one of the most exciting things to me about the Atlanta Community School Parks Initiative is the chance to create a model which we can then replicate in communities across the country. So if if you are interested in this kind of initiative, if you want to hear more, please reach out to us and we would be excited for the opportunity to work with you in your community.
Lysa Ratliff: The last thing I’ll add is find your people. Find your people. There’s people everywhere. All you got to do is just look up and listen and gravitate towards the people who are ready to get things done. That’s certainly how all of us are making progress is just finding the problem solvers, right?
Leah Anyanwu: Oh, I was taking so many notes. Le-Quyen, Cynthia, Kathy, Lysa. Thank you. Thank you. Thank you for the work that you do each and every day to ensure that children can access safe and quality play spaces. Thank you all for the work you do and thank you to all of you who joined us in the audience today. I hope you are leaving with actionable insights that you can integrate into your work. Back to you, Melissa.
Melissa Rivard: Thank you so much, Leah, and to all of our panelists. What an incredible conversation. I just want to add my thanks to Leah’s for all of you and sharing your insights and your inspiring work today. And thanks to our audience for attending. Also, please stay connected to the Center’s work through our website and the newsletter for more on this topic. And of course, visit Playful Learning Landscapes and KABOOM!’s websites to learn more about their work, and have a playful day. Everyone, thanks so much for being with us.
Cameron Seymour-Hawkins: The Brain Architects is a product of the Center on the Developing Child at Harvard University. You can find us at developingchild.harvard.edu, where we’ll post any resources that were discussed in this episode. We’re also on Twitter @HarvardCenter, Facebook at Center Developing Child, and Instagram @DevelopingChildHarvard. Our music is Brain Power by Mela Collective.
Understanding Racism's Impact on Child Development: Working Towards Fairness of Place in the United States
Feb 15, 2024
In December 2023, we continued our Place Matters webinar series with our second installment: “Understanding Racism’s Impact on Child Development: Working Towards Fairness of Place in the United States.” During the webinar, Stephanie Curenton, PhD, Nathaniel Harnett, PhD, Mavis Sanders, PhD, and Natalie Slopen, ScD, discussed their latest research, exploring how racism gets “under the skin” to impact children’s development and how it contributes to unequal access to opportunity in the places where children live, grow, play, and learn. Together, they explored ways to dismantle systemic barriers and work toward solutions that promote healthy child development. The webinar discussion has been adapted for this episode of the Brain Architects podcast.
Cameron Seymour-Hawkins: Welcome to The Brain Architects, a podcast from the Center on the Developing Child at Harvard University. I’m Cameron Seymour-Hawkins, the Center’s Communications Coordinator.Our Center believes that advances in the science of child development provide a powerful source of new ideas that can improve outcomes for children and their caregivers. By sharing the latest science from the field, we hope to help you make that science actionable and apply it in your work in ways that can increase your impact.
In December, we continued our Place Matters webinar series with our second installment: “Understanding Racism’s Impact on Child Development: Working Towards Fairness of Place in the United States.” During the webinar, Doctors Stephanie Curenton, Nathaniel Harnett, Mavis Sanders, and Natalie Slopen, discussed their latest research, exploring how racism gets “under the skin” to impact children’s development and how it contributes to unequal access to opportunity in the places where children live, grow, play, and learn. Together, they explored ways to dismantle systemic barriers and work toward solutions that promote healthy child development. We’re excited to share this conversation on today’s episode of the Brain Architects podcast.
Now, without further ado, here’s Tassy Warren, the Center’s Deputy Director and Chief Strategy Officer, who will set the stage for our conversation.
Tassy Warren: Hello. Welcome to today’s webinar. Understanding Racism’s Impact on Child Development. Working towards fairness of place in the United States. We’re so excited to bring you into this conversation. Whether you’re joining us for the first time or are a regular to the Center on the Developing Child, thank you for being here today. This webinar is part of our Place Matters Webinar series. The series is designed to expand upon our Center’s recent work on how influences from our environments, particularly the built in natural environments, play a role in shaping early childhood development beginning before birth. Throughout this series, we’re highlighting scientific and community expertise and offering strategies to work towards fairness of place and to create the conditions that will allow all children to thrive. Today’s conversation will explore the intersection between policy, systemic inequalities, racial disparities, and children’s healthy development. We hope that you’ll gain insights that are helpful to you in the work you do in support of children and families. And thank you to everyone who submitted questions when registering for this event. We received hundreds of submitted questions, so we’ll be asking some of those questions in the second half of the conversation. Of course, we will not have time to address all the questions that are submitted or we would be here for days. But we were really intrigued going through all of the questions that were submitted. And we appreciate the thought-provoking ideas that you all brought to mind for us. So we will be thinking about how those questions can inform future conversations.
So I am really excited in just a second to hand it over to Dr. Stephanie Curenton, who we are incredibly lucky to have leading this conversation for us today. Dr. Curenton is a professor in the Education Leadership and Policy Studies department at Boston University. Wheelock College of Education and Human Development and is the Director of the Center on the Ecology of Early Development, or CEED.
CEED’S research and initiatives serve to inform policies that promote equity and justice for racially and ethnically minoritized children in the context of education, health and community. She is joined today by an outstanding panel of researchers Dr. Nathaniel Harnett, Dr. Mavis Sanders, and Dr. Natalie Slopen. Dr. Harnett is Director of the Neurobiology of Affective and Traumatic Experiences Laboratory at McLean Hospital and an Assistant Professor in Psychiatry at Harvard Medical School.
Dr. Harnett’s research is focused on understanding the neurobiological mechanisms that mediate susceptibility to trauma and stress related disorders. Dr. Sanders is a Senior Research Scholar of Black Children and Families at Child Trends, where she leads in applied research agenda that advances racial equity and social justice. Before joining Child Trends in 2021, Dr. Sanders served as a professor of education and affiliate professor in the doctoral program in Language, Literacy and Culture at the University of Maryland, Baltimore County.
Dr. Slopen is an Assistant Professor of Social and Behavioral Sciences at Harvard T.H. Chan School of Public Health. Dr. Slopen is a social epidemiologist, and her research focuses on social and contextual factors that shape childhood development and inequities in health. Now, I’ll let Dr. Curenton share more about herself and kick off our conversation.
Stephanie Curenton: Hello, everyone. I am honored to be here to moderate this conversation and to represent CEED as well as Boston University. As Tassy was saying, our work at CEED specifically focuses on understanding how racism impacts Black children’s growth and development and ways in which families use their cultural assets and social capital to protect themselves from the harm of racism.
And we know that this conversation we’re having today is critically important because racism operates on multiple levels and it impacts young children throughout all levels of their biology, their social development and other ecological systems. And in the prenatal phase and the first years of life, they are the most sensitive developmental period. So it’s really critical to understand how racism exerts its impact on the health and growth of prenatal children and infants and toddlers.
As a scholar myself, I’ve been investigating and doing work on the topic of racism in young children’s learning for decades. By the fall of 2024, CEED, along with our partners at Equity Research Action Coalition, will be publishing a special issue for Early Childhood Research Quarterly on this topic, featuring researchers from a variety of disciplines and highlighting the work of several junior scholars.
So the scientific evidence is clear, and it’s growing that racism imposes unique and substantial stressors on the daily lives of families and caregivers. And understanding how these stressors affect child health and development provides a compelling framework for understanding and protecting young children. Such frameworks are the Rise Three Model, for which I’m a coauthor with Dr. Iheoma Iruka.
It presents new ideas about how communities, policies, programs and funding streams might confront and dismantle inequalities and build a stronger future for all of us. But we’re here today because there is so much opportunity ahead of us at the community level, at the policy level, and in all the work that brings each of us to this conversation today, as the Center on the Developing Child wrote in Their Place Matters paper that was published earlier this year.
It says just as dimensions of the built and natural environment have been designed over time, they can be redesigned to support healthy development. So throughout our discussion today, we will share ways to redesign, rethink and advance forward in pursuit of creating environments that are anti-racist and can support all children’s healthy development. And with that, I’m so excited to be moderating this conversation with Nate and Natalie and Mavis.
And I’m going to start the conversation with Nate. So, Nate, can you share what you’ve observed in your recent research in early childhood emotional health? Specifically, how have you observed the effects of racism on children’s brain development and how. And how were you able to expose a direct relationship to structural racism in your findings?
Nathaniel Harnett: Yes. Thank you so much, Dr. Curenton. And thank you very much for having me. Just to set the stage for answering that question, you know, my lab is really interested in understanding how we identify and prevent the development of things like trauma and stress related disorders. And we know that the stress that people experience during childhood really plays a role in the development of those disorders.
And we know that there are these really strong racial disparities between the amount of stress that people are exposed to where Black and other racially, ethically marginalized individuals are exposed to a disproportionate amount of stress. And so what we’ve been trying to do is to understand how the places in which children are growing up is related to the developments in brain structure and function and how that might play a role in later development of PTSD.
And so one of the more recent things that we’ve done is we looked at data from this large scale longitudinal study of child development called the Adolescent Brain and Cognitive Development Study. This is a study in about 10 to 12000 kids that started when they were about 9 to 10 years old. We were looking at the volume of gray matter of different brain regions that we know are really important for emotion, learning and memory.
These include things like the prefrontal cortex, really important for attention and top down regulation of people’s emotional responses. And then regions like the amygdala and hippocampus, which are really important for expressing that emotional response, that fear response to something stressful. And what we found was that if you look at the brain volume of white children compared to Black children, you see that Black talent show, this decrements in gray matter volume of these different brain regions.
But what’s really important is if you look at the environments that they’re growing up in, if you look at the amount of income that Black children have or their parents have, if you look at this thing called the area deprivation index, it’s way of looking at the amount of resources available in these different environments. If you look at the amount of conflict that’s happening in the homes, there really strong racial disparities in all these different areas where Black children are really living in these areas that have much more deprivation, There’s much more conflict in the homes, there’s much lower income across those in all of those things are related to gray matter volume in the study. And so once we go through to address your question of how do we actually expose this direct link, once we go through, we try to normalize these mathematically, when we try to account for all of those, you really don’t see strong racial differences in gray matter volume anymore. This is really important because we also look to see how are the volumes of these regions tied to PTSD symptoms even at nine and ten years old.
And so you wouldn’t expect large symptoms of PTSD. You wouldn’t expect many people to reach the level of the disorder. And you don’t see that. But you really still see even at nine and ten differences in the severity of PTSD symptoms, differences in the levels of trauma, exposure at nine, ten years old between white and Black individuals. And once you sort of normalize when you sort of equalize the environment, the places that they’re growing up in, you really see these sort of normalizations of brain volume, too.
And so we’re really thinking about how do we address this question that the webinar is about this sort of aspect of place and how that’s really toward kids are growing up so that we can help to alleviate some of these brain differences that we see that are going to have a role in how these individuals develop into the future.
Stephanie Curenton: So this is just absolutely fascinating. I was taking copious notes here, and I can’t wait until we get to the question and answer session to talk more. But at this point, though, I want to give Natalie a chance to talk about some of her recent work that is centered on racial disparities in the physical and mental health of young children.
So, Natalie, can you tell us about your research and how you’re finding links to inequitable experiences and opportunities, particularly as it relates to inequalities in the places where caregivers are raising their young children?
Natalie Slopen: Yes. Thank you so much for having me here and for the opportunity to share the work that I’m doing along with my students. So my research is focused on understanding how inequitable experiences of opportunity for healthy development that are shaped by our systems and structures affect healthy development and contribute to inequities that we see across socioeconomic position as well as across racial and ethnic groups with marginalized, racial and ethnic children from marginalized groups, often displaying worse outcomes early in the life course.
And we know that these differences emerge over time. So, you know, health is rooted in childhood. And so it’s really important to understand the systems and structures that are in place very early on affecting children in their families so that we can identify where and how we can intervene. And so I have been working on research across a variety of topics, thinking about what are different systems and structures that children interact with that are relevant to their health in the earliest years of life.
And one of the areas very relevant to today’s topic is housing. And one of the areas that I’m interested in is also in neighborhoods. And so I thought I could give an example of a study that I published this past year related to neighborhoods that connects to the topic for today. So this was a study that we published in Pediatrics, and we drew on a large national data source called the Mortality Disparities in American Communities.
And what we did is we connected information about over a million children in the United States coming from the American community surveys, linking it to information about the neighborhoods that they were living in. So here we were using a neighborhood measure called the Child Opportunity Index. And then we followed the children were followed with death record data for 11 years.
And so what our study found was that residing in neighborhoods with lower opportunity based on this measure of the Child Opportunity Index was associated with increased risk for mortality for children as well as for their parents. And so we felt as though it was important to document the intergenerational consequences of neighborhood settings and the importance of implementing place based policies to reduce the inequities that children experience that will have consequences as time goes on.
And so that particular study that I’m talking about was focused on outcome of mortality. But there’s a huge literature documenting the role that inequitable neighborhood environments, how across many dimensions of social, emotional, behavioral development in children and then health outcomes that we see as individuals age over over the life course. So that’s an interesting area of work. And one of the topics that I’m very interested in is how we best measure neighborhood context for health.
So there’s a lot of leading, you know, a lot of popular measures of neighborhood environment. And I think there’s a lot of open questions about which is going to be most useful for us and in which context. So some measures may be best when we’re thinking about how to decide where to implement certain programs or policies, whereas other may be useful, you know, for research purposes.
And so I think there’s a lot of open questions that we can answer using science about the best ways to conceptualize what the characteristics of neighborhoods matter most for children. And then finally, another topic that I’m interested in has to do with heterogeneity or variation in the way children respond and to their environments, thinking that that can help us to understand how to develop interventions that can close gaps in outcomes to lead to more equitable health and development for all children.
Stephanie Curenton: Well, again, just some really compelling research and just really, really, really interesting and compelling, somewhat a little sad too. So I will turn it over to Mavis. And Mavis, you and your team of researchers recently developed an interactive tool that allows users to such as users, such as policymakers, practitioners or researchers, to browse a decade of literature on the effects of protective community resources, and with the aim to explore how these resources can mitigate the impacts of risks faced by children and youth, including racism, as one of those risks.
So during your review of this extensive body of work, can you share more about some of your key discoveries?
Mavis Sanders: Absolutely. Thank you so much, Stephanie. Thank you for the invitation to this conversation. Just to provide a bit of context. My coauthors and I, including Jennifer Winston, Shana Rochester and Dominique Martinez, that I definitely want to give a shout out. We have been engaged in a process since I arrived at Child Friends to develop a research agenda which we sort of collectively throughout the organization decided would acknowledge the diversity in the Black community be strengths-based, be systems-focused and solutions-based as well. And we went through a three step process, and I believe that there will be a brief in the chat box to identify what went through this three step process to identify the research priorities. So you can imagine it was a large option, a large number of options that we could have pursued.
And so what we decided through this three step process is to focus on Black family, cultural assets and community protected resources. My colleague, Chrishana Lloyd, will be focused on Black family cultural assets and I am focused on protective community resources as part of that process. We are engaged in a systematic review of protective community resources and how they relate to child and youth development.
We had 3000 studies. Initially we were able to reduce those to about 300, and so of studies that went before a review, and then we reduced further to 172 settings. So your bibliographic tool that you reference includes information for those 172 studies that users can filter based on either the risk of participants or the age of the participants, or the type the type of protected community resource people are interested in.
And so for this discussion, because we’re talking a lot about mental well-being and cognitive development and so forth, when we look at those outcomes and this also feel terrible about things like community cohesion and support. Rise to the top is being consistently significant across this very diverse body of literature. So I want to put that out there. This is really hard to come to, drawn any absolutes.But there is a preponderance of evidence that suggests that community role models and mentors positive peer support, school connectedness and engagement in community based activities as well as neighborhood amenities, all contribute to the positive mental health of young people and that they can mitigate some of the risk. And I think that’s what Natalie was talking about. That’s in communities and what that suggests to me is that relationships matter, but also the spaces for people to gather and build those kinds of relationships that were so important to young people’s development. So I’d be happy to talk about that further as this conversation unfolds.
Stephanie Curenton: Yes. I’m going to ask you another question, Mavis, about your work. Your team released a brief in November that was called Black Children and Youth can Benefit from focused research on protective community Resources. And in that brief, you stated several neighborhood amenities and services that were associated with that health and safety. Can you name some more of those specifically?
Mavis Sanders: Yeah, absolutely. When we and Natalie talked about this as well, the constraints that we have as researchers by the measures that we have. Right. But we are improving in those areas. Neighborhood amenities specifically, which is one of the areas that we found to have a significant and positive relationship and association with Black children’s flourishing and development. One of those, you can think of those amenities as parks, recreation centers, libraries, sidewalks. So people who are familiar with the National Survey of Children’s Health are familiar with that sort of neighborhood amenities measure that includes those. There are also some studies that are really interesting around walkability of a city. So how is the city sitting out to promote walking as a mode of transportation? So you look at, you know, public transit location as how buildings are laid out, the lighting that is available. All of those things. And so we also published one brief where we looked at flourishing and flourishing was just looking at individuals’ ability to stick to a particular topic or a particular task and to have their ability to control their emotions and those kinds of things. And we found that young people who had access to all four of those neighborhood amenities, sidewalks, green spaces and parks, libraries and rec center were more likely to flourish or to have those sort of mental health indicators of flourishing than children who did not have access to those amenities. We also found out another study suggested that young men who work in cities with walkability so young Black, male, adolescent were less likely to report being involved in physical violence of any sort when they lived in cities or neighborhoods with higher walkability skills. So those are two of the sort of space-based or, you know, built environment elements that would seem to make a difference in the outcomes that we’re interested in for Black children.
Stephanie Curenton: Yeah. Again, this is just so the research that all of you are talking about is just really, really emphasizing the importance of place and the importance of relationships within the context of spaces and places. So it’s just fascinating to me. I’m going to circle back to Natalie now and ask you, Natalie, about the Child Opportunity Index and how you use that in your work. So specifically, can you share with us more about this tool and how that tool in particular might help us better understand health disparities in places where children live and grow?
Natalie Slopen: Okay, so the Child Opportunity Index is a measurement tool that was developed by Dolores Acevedo-Garcia and her colleagues, notably Clements, know IQ is a major contributor there as well. They’re based at Brandeis University, and they developed this measure as a way to think about the opportunities that are available to children in various communities across the United States. So it’s an example of a police station measure that’s aiming to evaluate or quantify resources and opportunities, specifically as related to children’s well-being and future prospects. So there are other place based composite measures of advantages or disadvantage that exists. And yet we mentioned the area deprivation index as an example. There’s the social vulnerability index. There’s really a host, there’s an environmental justice index.
But this is the only one that I’m aware of that I’ve seen in the literature that’s really tailored and designed to think about those aspects of the environment that matter for child development specifically. So it’s thinking about quality of education and health care, neighborhood characteristics of the built environment such as those that Mavis had just mentioned, like walkability and safety and other essential elements of neighborhoods and communities.
And so this measure is used by many different types of individuals and organizations. It’s very well designed to highlight disparities in access to opportunities across different demographic groups and across geographic areas. So this can help people to think about, you know, which contexts really require certain types of investments or interventions and where we may see the greatest impacts of investments for improving outcomes among them, perhaps underserved communities. And so the data is, you know, we have this data nationally across the United States, and it’s been being used by researchers as well as a lot of different public health departments at this time.
Stephanie Curenton: Great, great. So happy to learn, too, that that was built here in Massachusetts. That’s very great. I’m going to switch to talking about the implications for you all’s work and I’m going to open it up to each of you. So I know that it’s hard for researchers to come up with policy recommendations or community strategies specifically because we are scientists and researchers by training. But can you think about your research and how it informs strategies to support child development at either that community level or that larger systems level? And I’m going to circle back to Nate and let him start.
Nathaniel Harnett: You chose the one that it’s hard to answer. So I think that, you know, for us in the brain imaging field, it’s sometimes hard to think about how does showing picture pictures of the brain to people really help with this type of thing and how do we address policy? But I think that one of the benefits of the work that we do is that we really can show these effects very strongly. It’s one thing when you ask people, you know, do you think that discrimination has an impact on well-being? And you can get in this argument of, oh, is it perceived as the best thing? And we can actually look at the brain. We can actually look at what happens when you keep people in these impoverished environments. I think that’s really powerful.
We’ve done a bit in terms of reaching out, both to talking with individuals at the Center For and Behavior with Transition and thinking about how do we actually talk to people in positions of power, people who are making laws, people are making policy and actually showing them the data to just say, look, this is a real thing. We can really see it in the people that we’re looking at.
It’s not something you can really get away from, you know, And I think that there are other things that we thought about in terms of what are the actual policies that we can do. And I think, you know, one thing that I’ve said in the past is like, well, we know that even though there’s heterogeneity, the results, even things like cash transfers are associated with changes in brain, they vary reliably in some ways associated with changes in mental health and behavior.
And I think that part of the reason you see these heterogeneity is in some of the findings is for the exact reason that we’re talking about here. Right. And that the place that people are growing up and the actual structures themselves also need to change to help to facilitate this bettering of child development and ultimately sort of healthy adult functioning in the future.
Stephanie Curenton: What about Natalie or Mavis? Do you want to follow up on that?
Mavis Sanders: Sure, I’ll jump in. I think it really speaks to the need for researchers not to conduct their research in silos, to think about these research policy practice kinds of partnerships and being intentional about building those. Also, I’ve I feel lucky to be a part of an applied research center where we really are thinking about solutions, but also working in tandem to evaluate interventions like Nate just mentioned, to be able to show effects both short term as well as long term.
And I think it also speaks to the need for funding to support that kind of work and not only those short term evaluations, but those long term evaluations. And so really helping folks be present to seeing over a period of time and also to support the establishment of databases that allow this research. All of that is so important.
And we see how this research can also translate into positive practice. I love the sort of rebuild effort that’s going on in Philadelphia. We can talk a lot about that. But it is the sort of outgoing mayor, and I guess they’re part of their legacy to rebuild the libraries and the parks and the rec centers that are in Philadelphia.
Hundreds of billions of dollars have been invested, has been very community center, where the community has a say in the type of amenities that are provided to communities and the importance of those spaces not just for what we think about, but for afterschool programing, for family reunions, for all of these things that we know sort of benefit both children and families.
And I believe that there’s a video clip that will be there to talk about rebuild to a certain extent. But these are the kinds of large scale initiatives, policy initiatives that can take place when policymakers and practitioners and advocates, as well as researchers are in conversation to say this matters, this type of investment is absolutely necessary to address the disinvestment that has occurred in Black communities and other underserved communities.
And I think sometimes when we question the importance of our voices, but I think it absolutely is necessary in tandem with advocates and practitioners.
Stephanie Curenton: And I think that’s very, very well said. Did you have anything you wanted to add to that question? Natalie?
Natalie Slopen: No, please feel free to move on. I think that was really comprehensive and I appreciate Mavis bringing in this notion of collaboration with with Cost Communities, because that’s really what we need to be doing to have tailored and effective approaches. And I think also being like recognizing that evaluation for some of the types of programs that we’re talking about is really hard and may may not be able to follow a randomized trial. But we need to to think broadly and creatively about how to build the evidence about what works.
Stephanie Curenton: So I’m going to start this next question with you, Natalie. And this question is about mindset shifts. So we’ve been talking about changes to spaces in the built environment, but can you talk to us and share your ideas about what mindset shifts or adjustments we really need to consider in the early childhood field and which mindset shifts would be informed by your research?
Natalie Slopen: That’s a hard question. So I think that, you know, there’s been so much change and progress in the field of early childhood over the past several decades, and I think that there is now tremendous appreciation and focus on inequities, which is wonderful and a lot of attention to how we can take an anti-racist approach to understanding and addressing inequities in a way that we haven’t seen in the past. And that’s thanks to a lot of people’s work across a lot of different disciplines. I think we see changes in psychology and social work and public health, but it’s really coming from a lot of people focused on early child development, which is great. I think we have a long way to go to understand how to situate everything that we understand about an eco bio developmental model of child development within our thinking about upstream causes. And so while personal relationships matter, personal relationships are situated in an ecosystem and we we want to take a structural approach so that we can be as effective for as many people as possible. So I think that might be somewhat of a mindset shift. It’s not saying that relationships don’t matter because of course they do. But if we can shift our mind to think about what can we do at the higher upstream policy level to allow for the types of relationships we typically study, you know, are helpful to children to play themselves out.
So what can we do upstream to create opportunities in for children to have the healthiest context possible would be the mindset shift that that comes to my mind is continuing to push to think about upstream determinants.
Stephanie Curenton: Yeah, so I love what you just added here. You just articulated it that this is what we’re talking about now. This research is really about space and place. It’s upstream, right? It’s it’s a really good example of how to think about the work that’s important and upstream. So it’s fascinating. I’m just learning so much here with you all today.
I know that at this point we have a good amount of time for some questions from the community and we have some here that Tassy and her team have already curated. And I’m going to start with one and I’ll just open the floor. And whoever is interested can just respond to it. So one question is, what does the research show us about the different types of impacts that racism has in early childhood education and poverty, what they have in early childhood development? What similarities do we see and what differences do we see about the different how the different types of racism affect young children? And I’m assuming by types of racism, they’re talking about structural, interpersonal, internalized, etc..
Mavis Sanders: I’ll jump in and say from our systematic review of the literature on protective community resources, what we found was that even though we looked at a decade of research, right, so from 2012 until 2022, so research that was published within that sort of last decade went nowhere in 2023, ended in 2020. And I think one thing we identified some gaps in is in that report that you referenced earlier, Stephanie, that we need more in group for group specific types of studies because right now so much of the research and I understand researchers who are trying to be published in the top journals of their particular field, they actually will rely on a lot of survey data or data that includes diverse population of participants so that they can sort of draw and generalize the findings. Right. But when we do that, we give up something, right? So there’s no perfect study. You know, there are pros and cons to all kinds of approaches, and that’s reason we need a mix of studies, because at this particular point, we don’t have a lot of specific studies, and it’s hard for us to sort of talk about what this means, like the impact of racism, for example, the impact of anti-Black racism on young people, how that differs across, you know, region of the country, across socioeconomic status. There are so many very specific questions that we don’t know the answer to because we haven’t had that type of research. And then by the same token, we can say what supports, you know, youth versus young children’s development. And when we start talking about youth, we look at sexual and gender identity and how that has different effects and affects the experiences of young people differently.
All of these become questions that show that even though there is an abundance of research, that we have been constrained by measures a lot of it we’re using quantitative survey designs that can limit the kinds of questions that we can ask and the measures that we’ve had in the past. I mean, just thinking about the different types of racism, that’s a fairly current conversation. And so people are just beginning. So I wish that we could say more. But I think one thing that we can say is in this literature, there are large gaps and so we need to embrace the importance of those very group specific questions and encourage researchers to go ahead and do it. And I don’t think that there’s been the same level of permission to do those kinds of studies in the past. But we know their importance and we need to give each other and ourselves and various researchers who are coming into the pipeline permission to conduct those kinds of research.
Stephanie Curenton: Yeah. So I echo and support everything you’re saying and just this idea of how we need to expand and diversify our research and just in terms of measures, in terms of samples, in terms of quality data versus quantitative, I think that that is a really good, thoughtful and big agenda for how we move forward and in a way that can answer these questions.
So it’s great. I’m going to ask this question from an audience member, which I think is really interesting, is which one point about racism’s impact on early child development? Do you do you wish that we as researchers or the public policy makers practitioners that we understood more? So let’s think about one point.
Natalie Slopen: The one point that comes to my mind is I think that there is could be often a misconception that the consequences of experience. Well, first of all, I think people hear the word racism, and very often the default thought is interpersonal experiences of racism and not thinking across different levels. So, number one, but I think that there’s a conventional thought that the damage would be psychological or emotional without thinking about the broader span of consequences. There are implications of the range of types of racist experiences that people have interpersonally and within their day to day experiences in systems and in structural environments that affect cognitive development and social development and how the physical health is impacted. As Nate talked about, sleep, the whole range of developmental outcomes that we study are beginning to be studied in relation to a variety of forms of racism and we shouldn’t underestimate that the pervasive impacts that it can have.
Mavis Sanders: That is a hard question because we know how pervasive the effects have been, right? So I would cheat and I would, you know, try to at least two come to mind, top of mind. And one is the relationship between racism and economic violence. Or when I talk about economic violence, again, drawing from the domestic violence definitions of obstructions to economic mobility and opportunity, because in that way we see the interface between racism and poverty and economic disinvestment in communities and all that means for children’s well-being, their health and the environment. So that’s one thing. But I think also importantly, how racism and this pervasiveness of American society leading to representation in education, the effect that that has had on one’s identity development and young children’s identity development, what we see that in terms of youth and what we’re seeing in terms of research, where young Black and young adults, Black youths feel less tied to Black identity than previous generations.
And what does that mean for young Black children as they develop in the society that is still characterized by anti-Black racism? When young Black children do not have a sort of positive racial identity? And how do they then begin to understand the system that they’re in and how do they navigate the this? So the effects of racism not only on racial identity, no children and their whole identity, their personhood, but also is the association with economic deprivation and violence in the United States. So those would be two things.
Nathaniel Harnett: Yeah. So I’m also going to cheat in answering this question because I think that the question itself really dovetails nicely with both Dr. Slopen’s and Dr. Sanders answers to what is the mindset shift We’re going to we need to have this sort of field, and especially for those of us in neuroscience, I think it’s really important to recognize that we really haven’t done that much in terms of trying to understand this sort of intersection of racialization, socioeconomic deprivation and violence that children are exposed to.
We spent a lot of time thinking about how environmental deprivation or exposure to different threats the environment might affect children in general. We’ve done two decades of work looking at all of this, but in terms of acknowledging or accepting that the experiences that say, Black or white children might have are different as a result of this sort of socio historical or cultural pressures that’s been placed on the environments that people now grow up in.
There’s been very limited to do with that. And also going back to Dr. Sanders point, and it’s something that our work is trying to move to, We haven’t done a good job of it. We’ve focused a lot on group differences and potential contributors to that, but we haven’t explored or begun to scratch the surface of what’s happening within groups. What might be different for individuals who are still exposed to these high levels of racism that come from less socioeconomically disadvantaged areas. What’s the sort of impact on the brain? And again, we know again, it’s been almost 100 years, maybe more, figuring out these regions are really important for emotion, really important for different psychiatric disorders. And if we really want to have a full understanding of what the consequences of stress are, what the consequences of racism are, and what the sort of brain basis for disorders are, so we can make these generalizable, actionable treatments for the entire system in the United States. We really need to figure out what’s happening there, especially in child and how this sort of intersection between racialization and these threat and deprivation, other aspects of thinking about childhood development are intersecting to achieve those goals.
Stephanie Curenton: So I have a quick follow up question for Mavis. When you were talking, did you say that children nowadays have a less of a attachment to their Black identity than in prior years decades? Can you talk more about that?
Mavis Sanders: I have to send you the poll. And so I don’t want to share the source, but I’m almost sure what the source is about. But as I said, it’s documented now and so I will soon that link. But yes, they were just looking at across generations in terms of identification with one sort of racial identity. And we know that young people, I think younger than 30, have a different level attach of attachment than previous generations.
And I will make sure that I send that study so that it can be added as a resource for participants moving forward.
Stephanie Curenton: Yeah, that’s really interesting. Compelling. I see a lot of little shocked emojis floating up the, you know, with that. So yes, please. Sure. That we all get that. I have another question that I’m going to go to here. Okay. And I again, I’ll throw this out to anyone. How do you think we can ensure that future research contributes to this dismantling of racial inequalities and of building those conditions for a success? How do you think future research what do you think future research needs to do? And for everyone, as a field, not just you.
Mavis Sanders: I would say that Nate has, you know, sort of laid it out and that Natalie has also laid it out in terms of, you know, group specific studies, in terms of new questions and the development of new measures, the actual full use of the existing measures that are out there around economic opportunity and the opportunity index scale that Natalie was talking about using a variety of approaches, engaging with community to see about community questions. What is important in those communities. We talk about research, policy, practice partnerships and research. So I think all of those, you know, those are at least four areas in terms of the approach to who has a say in the types of questions that we’re asking and answering. You know, what type of supports and funding are available for us to do these specific kinds of studies and vehicles for publication. And then for those who are in higher ed and academia, whether or not institutions of higher education are also valuing these that our promotion and tenure ratings are also valuing them. And so that as people do this type of research, they’re not fearful that they will be able to advance in their chosen field in academia. It really means that we have to start bringing all of these insights into the conversations because we know this research is important, that there are so many institutions and systems that are in place that may limit people’s opportunity to engage with this.
Stephanie Curenton: What I really love about you all as panelists is that you are all coming from different perspectives, right? So it’s sort of really interdisciplinary and I think that’s a strength. When I talked about the ECRQ. special issue, also, it’s interdisciplinary. And I’m wondering when we think about research for the future, I’m wondering if there could be some way in which instead of approaching these questions as individual scientists, can we approach things as a collaborative right so that we can go deeper?
And I just think that that is such a good, proactive way to allow the science to advance. And I’m hoping that people can hear funders, federal agencies, I’m hoping that they can hear this as well, and really see the power of what we can learn when we have an interdisciplinary group working on issues. We have about 5 minutes. I’m going to give you all each some time to do a take away message. And so the takeaway message is please share a positive outcome or a development in your work related to communities, policies and research that we can take with us. So an idea that we can leave with us that will help us sort of fill and empower to learn and grow, continue this work. So what’s a positive you want to leave with us?
Mavis Sanders: Well, one positive that I have is that it seems to be a convergence that I’ve seen around advocacy groups, policy groups, researchers that understand the importance of disentangling the effects or highlighting the effects of systemic the way systems organization affect outcomes and not just reporting outcomes, but really trying to help people understand the context in which those outcomes are produced. And so that’s moving us forward in the conversation. So we’re not reporting just, oh, there’s a gap in academic achievement between Black children and white children, and we’re talking about the institutional aspects of of underfunding education and relying on text, you know, property, poverty, tax based or whatever. And they have long term effects of economic inequity, of educational and economic inequities to lead to these outcomes. So the importance of contextualizing these findings so that we take our research gains for the systems that produce them rather than the individual, I think is really important. And it seems as though I feel as though there’s much more support for that and and almost an expectation of that. And so we can hold on to that and push that that I think that that helps us to to change or create those kinds of environments that all children deserve and to thrive.
Stephanie Curenton: I love that. What about Natalie and Nate? What are what is your takeaway or positive takeaway you want to leave us with?
Natalie Slopen: Well, I feel very encouraged about the attention that we see across the different disciplines. Thinking about early childhood to context, I think there has been this shift that we’ve all observed over the past decade that has made it almost an expectation to be thinking about across topics and I think that our data sources are catching up and we have more and more opportunities, let’s say, where researchers who rely on large federally funded cohort studies, for example, they are collecting more information that allows us to study both risk factors, but also protect of factors, which is an incredibly important future direction as well. And so I think that we have increasing opportunities to take a very comprehensive look at social environments that shape child development, both positive and negative. And also to take a multi-level perspective, which we know is going to be really important for figuring out upstream strategies for intervention.
Stephanie Curenton: Yeah, okay, great, great. What about you, Nate?
Nathaniel Harnett: I think you are. Both of these are great. I wish I could just answer that, but I’ll try to come up with something unique very quickly. You know, I think for me, I’m not unaware of the sort of story that neuroscience has played and the way in which people will use biology to justify a lot of, let’s say, racist behavior. And the way that sort of structuralism, the institutions that we have, it’s been very, very encouraging to see more people pay attention to this. And you know, really get the data to show that it’s not this sort of ingrained brain thing. It’s the systems that we develop as the structures that are in place that are contributing to altered development and playing a role. That is true. And I think this sort of increased recognition, having the data to really emphasize this is just been really positive for me. Yeah.
Stephanie Curenton: I tell you, I am so filled up with knowledge and encouraged as a scientist by, this conversation with you all, I really feel as though we need more conversations like this. We just scratched the surface here and I it’s been so lovely meeting you all. And I want to say that I hope we can continue this conversation in meaningful ways.
And I want to thank you for being part of this panel and bringing your knowledge here in this space. And I thank you on behalf of Harvard and the Center on the Developing Child. I thank you on behalf of Boston University and and CEED. And I look forward to continuing these conversations with you all.
Cameron Seymour-Hawkins: The Brain Architects is a product of the Center on the Developing Child at Harvard University. You can find us at developingchild.harvard.edu, where we will post any resources that were discussed in this episode. The next webinar in our Place Matters webinar series is on March 5th at 12pm EST—stay tuned to our social channels for more details. You can find us on Twitter @HarvardCenter, Facebook at Center Developing Child, and Instagram @DevelopingChildHarvard. Our music is Brain Power by Mela Collective.
A New Lens on Poverty: Working Towards Fairness of Place in the United States
Jan 24, 2024
In the fall of 2023, we kicked off our three-part Place Matters webinar series with our first installment: “A New Lens on Poverty: Working Towards Fairness of Place in the United States.” The webinar discussion featured the work of Mona Hanna-Attisha, MD, MPH, FAAP, whose research uncovered the water crisis in Flint, H. Luke Shaefer, PhD, co-author of the new book The Injustice of Place: Uncovering the Legacy of Poverty in America, and their groundbreaking new program, RxKids, an innovative effort to address child poverty and improve health equity. This conversation, moderated by our Chief Science Officer, Lindsey Burghardt, MD, MPH, FAAP, has been adapted for the Brain Architects podcast.
Amelia Johnson: Welcome to The Brain Architects, a podcast from the Center on the Developing Child at Harvard University. I’m Amelia Johnson, the Center’s Communications Specialist. Our Center believes that advances in the science of child development provide a powerful source of new ideas that can improve outcomes for children and their caregivers. By sharing the latest science from the field, we hope to help you make that science actionable and apply it in your work in ways that can increase your impact.
In October, we kicked off our three-part Place Matters webinar series with our first installment: “A New Lens on Poverty: Working Towards Fairness of Place in the United States.” During the webinar, Dr. Lindsey Burghardt, our Chief Science Officer, moderated a discussion between Dr. Mona Hanna-Attisha, whose research uncovered the water crisis in Flint, and H. Luke Shaefer, co-author of the new book The Injustice of Place: Uncovering the Legacy of Poverty in America. The resulting explores how the qualities of the places where people live are shaped by historic and current policies, which have created deep disadvantage across many communities with important implications for the health and development of the children who live there. We’re happy to share these insights with you all on today’s episode.
Now, without further ado, here’s Rebecca Hansen, the Center’s Director of Communications, who will set the stage with a brief overview of the webinar series.
Rebecca Hansen: Alright, hello, everyone. My name is Rebecca Hansen, and I’m the Director of Communications here at the Center on the Developing Child. And I’m very excited to welcome you all to today’s webinar, A New Lens on Poverty: Working Toward Fairness of Place in the United States. This webinar is the first in an ongoing series designed to examine the many ways that a child’s broader environment, including the built and natural environments, as well as the systemic factors that shape those environments, all play a role in shaping early childhood development beginning before birth. In this series, we will explore various environment tool influences from both scientific and community-based perspectives, including strategies to work toward fairness of place and improve existing conditions to allow all children to thrive. I want to thank everyone who submitted questions for our panelists today. We received hundreds of questions, and we will turn to some of those in the second half of the conversation. And with that, I am excited now to hand it over to Dr. Lindsey Burghardt, who is the Chief Science Officer at the Center on the Developing Child and a practicing pediatrician in the community outside of Boston. Lindsey, I will pass it over to you to introduce our panelists and get the conversation started.
Lindsey Burghardt: Thanks, Rebecca. And thanks to everybody who took time out of their day to join us here. And before I introduce our fantastic panelists, I’m just going to start by giving some context and some background for our conversation, and then we’ll jump right in. And I think we’ll have a great conversation together today. So earlier this year, the National Scientific Council on the Developing Child published their 16th working paper and they called it Place Matters: The Environment We Create Shapes the Foundation of Healthy Development. And that working paper laid out a framework for how the child-caregiver relationship is critically important and just as important as it’s ever been. But in shaping early childhood development. But that relationship doesn’t exist in isolation. And the places where people live affect what they’re exposed to. And that in turn affects maturing biological systems. And those effects can be positive or they can be negative. And that’s what we mean when we say that Place Matters. So the physical environment that surrounds children, their built environment, their natural environment. Both of those are shaped by human actions, including very intentional decisions around policies that shape the environments where kids live and the quality and the conditions in the environment where children live. They’re not evenly or randomly distributed. They’re shaped by and they’re deeply rooted in public policies and social history that we’ll talk about today. So for many families, both these historical roots, as well as present day policies and decisions being made, are resulting in really an uneven distribution of risk and opportunity in neighborhoods and in the places where families are raising young children. So I am thrilled just completely thrilled to introduce two really special guests who are going to talk more about this today and who are really deeply committed to reshaping children’s environments to support their healthy development. Dr. Mona Hanna-Attisha is a fellow pediatrician. She’s an activist and author. Just an amazing person who leads an innovative program called Rx Kids, which aims to address child poverty and health equity. And it does it through unconditional direct cash payments to residents of Flint, Michigan, during pregnancy and throughout the first year of their child’s life. Our other panelists, Dr. Luke Schafer. among many things, is the Hermann Amalie Kohn Professor of Social Justice and Social Policy at the University of Michigan’s Gerald R Ford School of Public Policy and the inaugural Director of Poverty Solutions. And he’s partnering with Mona to launch Rx Kids. Luke has a new book that came out this summer, The Injustice of Place, and it provides what I think is a really sweeping understanding of extreme poverty in the United States. And it puts a new lens on poverty, I think, because of the unique multidimensional measures, Luke, that you used in the book, as well as the way that you engage the communities when you are conducting research for the book. So Mona and Luke, welcome. I’m really excited to have you here.
Mona Hanna-Attisha: Thank you so much for having us.
Lindsey Burghardt: So the two of you are working in really close collaboration with the community in Flint to address poverty in really actionable ways. And what I’m hoping today and what we talked about before when we prepared for this webinar was really focusing on the innovative approach to solutions that you guys have taken and so that those who are listening can apply anything that resonates in their own contexts. Sound good? Awesome. All right, let’s do it. So first question for Mona. We have some international listeners and some who may not be as familiar with maybe how your really specific engagement in this area got kicked off and your work related to the Flint water crisis and you really helped to shine a spotlight on a key example of how community disadvantage and underinvestment influence exposures that shape children’s developing systems. Can you talk a little bit about how you became involved in the water crisis in Flint, what you learned and kind of where things stand today? Awesome.
Mona Hanna-Attisha: Thank you for that question and thank you for having us. We’re so excited to be here with all of you, almost 500 people to talk about solutions. And in order for us to really move forward and to make a better world for our kiddos, I think we so often have to start by looking back. So I can share a little bit what happened in Flint and my role. And it’s really it really starts by looking even further back. And I think that’s where kind of Luke is an expert in terms of kind of a history that got us to where we are today in terms of disadvantage. But Flint was at one point like a place of prosperity and opportunity. The birth of the UAW, which is in the news right now, that there’s a historic strike in the 1930s that really put Flint on the map. And autoworkers were demanding prosperity, very similar to what they’re demanding right now. And there was Flint kids striking alongside their parents. And there’s a Flint kid that was holding a sign in the 1930s. It said, give us a chance for better food and a better life. And that advocacy, that resistance that enabled really the beginning of the UAW and the birth of the middle class in America. And that started in Flint. And things happened in the environment and investment and public health and education and community schools and, you know, infrastructure, all this stuff that made Flint a place of prosperity, that translated into improved opportunity and improved health for the people that lived there. The history that followed in Flint is not unique to the communities across the nation. It’s a history of disinvestment. Automation. Globalization. Plants closed. Jobs were lost. Exploitation of workers. Systemic racism that made certain neighborhoods specific to African-Americans because of redlining and blockbusting and chronic disinvestment from, you know, state and federal government, which made Flint kind of this a bleeding city with the loss of population. And really every disparity that you can think of. And even before the water crisis that made growing up in Flint toxic like in so many of our communities, a kid in Flint, you know, their life expectancy is, you know, 15 to 20 years less. And a kid in another part of our county, this is once again not unique to Flint, but the census tract that you grow in the place, the environment, the conditions, the history, the geography, the hierarchy all predict how you end up. Flint was near bankrupt, lost democracy was taken over by emergency management. Like so many cities in our state at that time, anti-democratic law pushed through by our gerrymandered legislature, and that took away democracy, accountability and the decision was made to change our water source. It was from the Great Lakes to Flint River water without proper treatment, and that caused corrosive water to flow through our drinking water infrastructure and that corroded our pipes, which had lead in them for a year and a half. The people of Flint, a predominantly poor minority community, were drinking lead laced water. That’s how I got involved as a practicing pediatrician in Flint to do the research to uncover what was happening to our kids and really since then have been on this path to recovery. But it is an emblematic story of what happens when you live in a place that has been chronically disinvested, that does not prioritize the health and development of our children. Literally, the address of our children predicted whether or not they were going to drink poisoned water. So maybe an extreme example of what happens, a consequence of growing up in a certain place, but once again, not unlike so many communities across this nation.
Lindsey Burghardt: And, you know, I think for Luke, Flint really represents this example, as Mona articulated so beautifully, of a community that has been disadvantaged in so many ways and the sort of that theme of underinvestment. And Luke, in the book, I was really fascinated when you wrote about this concept and developed this index of deep disadvantage, which is something that I had not heard about before in the context of understanding poverty. So I’m wondering if you can kind of describe the index and share more about how it can deepen our understanding about the circumstances of a community, especially as it pertains to young children.
Luke Shaefer: I think that the index really tries to pick up on the themes that both of you have already started describing. One is that when we think about something like poverty, it really is often a matter when we’re really thinking about it’s a matter of compounded disadvantage. So in my field, we often think of poverty as a lack of income, not having enough to meet your basic needs. But I think when we all think about it, we think about income. And that’s clearly really important. But we also think about health. and those vast disparities that Mona was describing, you know, huge differences in life expectancy in fairly small levels of geography. And I think we think about social mobility. So we think about the possibility if you grow up or what are your chances of rising to the middle class. And so the index, the first thing the index really did was try to bring income, poverty, income, health and social mobility into conversation with each other. And it turns out we can learn more about a community. We can actually find communities where poverty is very high, but social mobility is also pretty good. Or communities that have longer or shorter life expectancy than we think. And it just really enriches our understanding and I think gets us closer to what we’re talking about. The second thing that the index does is say it tries to shift the focus from the individual to the community. So Mona described like huge, like decade plus long differences in life expectancy and like small geographic spaces and like, how can we how can we explain that the same is true with social mobility. So there are places in the United States where if you grow up poor, you are just as likely as anyone else to rise to the middle class. And then there are places where if you grew up poor, you’re likely to be poor as an adult as well. So how do we understand those geographic differences? So we brought all of those factors together and put them into a Machine Learning technique called principal component analysis. And we’re able to rank all the counties in the United States in the 500 largest cities on a continuum of disadvantage based on income, health and social mobility and it created a map for us and just to reiterate the evidence from this that support is exactly what both of you were saying. Once we had that map, we started comparing it to other maps and we could see like huge parallels. The most stark one was a map of enslavement in the United States from 1860, where we compared our map of deep disadvantage, a concentration of deep disadvantage to a map of the concentration of enslavement from 1860 and could see not just some correlation, but like really just a high level of correlation between the very gradation of those maps. So that really takes the onus off the individual. How can it be an individual’s fault when communities have been bifurcated and divided in these ways, not just for a decade, not just for a few decades, but well over a century? I think we have to start thinking about solutions in a very different way.
Lindsey Burghardt: Thanks for bringing the solutions early. So, Mona, from your experience, like how does this disadvantage, you know, and it’s so deep as you’ve described and kind of through these generations. How does it show up in children’s environment and how does it impact their health? Because, you know, we know that this starts before birth and it can show very early in life and things like low, low birth weight, which Luke talks about in the book, too, is a marker of, you know, disadvantage early in life. So how do you observe that in practice? How is it showing up in your work?
Mona Hanna-Attisha: Yeah. Lindsey That’s a great question. And as a fellow practicing pediatrician, you know, we see it in our patients, we see it in their bodies and we see it in their blunted potentials. One of my favorite quotes, someone said as a pediatrician, we are the ultimate witnesses to failed social policies. You know, it’s these inaction and policy or certain actions that that make our kids sick. And, you know, and once again, implicate their entire life course. I’m going to share one quick story. The last time I testified before Congress, you always have to tell stories. They don’t listen to science and facts as much as long stories. And I and I told them a story about a patient, a kiddo who and who had seizures and developmental disorders and all these problems because he had drunk, you know, from the leadline in his house during the water crisis. But then I didn’t just talk about the kid. I traced it back to his family history. So his grandparents moved to Flint in the 1950s as part of the Great Migration North. So look at the policy because of Jim Crow racist, you know, laws and lynching and oppression, his family, you know, fled the South and came to Flint like, you know, Chicago, Detroit, all these other places for a chance at equality for them and their children. And they stayed in Flint. The ups and downs and their grandkid, their great grandson, was now sick because of policies not just the acute policy of our water switch, but also these historic policies that have made it hard for people to be healthy. And that’s just an example of how it’s kind of the multigenerational impact.
Lindsey Burghardt: Yeah, absolutely. And can you talk for those who may not be specifically familiar with exposures like related to water in particular, and like, how does that show up? I mean, can you explain like how that can matter even before birth?
Mona Hanna-Attisha: Yeah. So important. Yeah. Like most environmental exposures, they often don’t show up acutely. So lead is known as a kind of a silent epidemic. We we don’t see acutely the consequences of lead exposure like like many environmental exposures. Yet we see their manifestations, their, you know, their impact years, if not decades later. So my book is called What the Eyes Don’t See, and it’s because of that we don’t see lead in water. We don’t see a lot of the contaminants in there yet Once again, they manifest later causing things like cognition issues, behavioral problems, early exposure to things like lead and other neurotoxins cause things like hypertension, high blood pressure that’s been linked to, you know, early dementia and gout and kidney disease and a whole slew of lifelong consequences because of an exposure in early childhood. And also, like you said, also prenatally, a lot of these toxins in our water and in our in the rest of our environment also cross the placenta and affect the developing child. So we know that exposure in this kind of critical, you know, prenatal infancy window as these, you know, hazardous kind of life course altering impact.
Lindsey Burghardt: Yeah, I really appreciate how well you articulated that because I think that’s especially what’s frustrating in practice is that some of these implications and effects of environmental exposures that we see, they are like invisible and they’re delayed. So the implications of being, like you said, exposed to lead in utero or as Luke describes in his book, the implications of being born with a lower birth weight, we tie that I think, sometimes to these very individual actions when really there’s things that are surrounding us and shaping our biological systems from the earliest days of development that are very much not based on individual actions. People’s systems can be shaped for better or for worse by what surrounds them as they’re developing. And so I think I heard you say once, and it has stuck with me on such a deep level. I wish I could prescribe away poverty. And I think that’s one of the times that I knew that you were going to be like a force in this field, is that that connection is so important. And I think that getting that message out about how poverty impacts and how the impacts of things like systemic racism affect not only, you know, how well children do in school, but their health throughout their life, cause it’s so important. So thank you both for being the spokes people that you are and for kind of getting these messages out in the articulate way that you do. And I want to pivot to Luke now and talk about, you know, your team found that some of these places of deepest disadvantage were actually dominated by rural communities. And I think there’s often this counterpoint or kind of counter assumption that poverty can be worse in cities because of things like high cost of living and high concentration of people. And we sometimes, I think, erroneously assume that rural communities might have lower levels of inequality which you actually found is not the case. So can you kind of talk about why these assumptions were wrong and how you kind of found poverty to exist in different contexts and how that played out?
Luke Shaefer: So I think borrowing from Bryan Stevenson I’ll mention that I think we’re best at understanding the problems that we’re most proximate to. And so most scholars and folks who are thinking about poverty are, you know, more clustered in urban areas. And so I myself had been, you know, all of my time that was working in the field in places like Chicago and, you know, in in urban areas in Michigan. And so it’s easier to just see, you know, certain challenges, high cost of living being one of them. Right. We can see sort of how much housing is costing. We can see that public transportation systems maybe don’t work as well as they should. And so we can follow our nose there. In this book, we tried to take a data driven approach to zero in, and we wanted to go to the most disadvantaged places in the country based on income, health and social mobility. And as you mentioned, I when we looked at that top 100 places in the United States, we loaded in every county, in every city. You know, the 500 largest cities gets you down to cities of maybe 50,000 people. It was disproportionately rural. There actually only nine cities in that hundred most disadvantaged places. And in a place like Chicago, it wasn’t even in the 600 most disadvantaged places. And then we went to these places and really got to know a subset of them, the ones that we write about in the book, but also spent time getting to know other communities. And it looked right to us. Right? We felt like this sort of visual audit validated that. So the thing is that like when you are more proximate, the problems, you can understand their downsides, but you also don’t understand some of the signals of those things. So we have a high cost of living in some parts of the United States in urban centers, is often connected to the fact that there are better services in those places. So maybe the health care system doesn’t work as well as it should, but it’s there and people have access to a health care system. Maybe public transportation doesn’t work like it should, but there is some public transportation in the rural communities, which also, you know, I think surprises some folks. Many of these rural communities are predominately communities of Black Americans or Latin Americans, of course, out West and Native American lands. And there might not be any hospital at all or no health care system to speak of. And there certainly is no public transportation. And so there’s cost of living differences, which we’re used to. Thinking of them as a challenge also represent things which are differentiated in terms of private philanthropy. We see, you know, hugely more dollars go into low income Americans in urban centers than in rural areas because that’s where the money is and people like to give to their communities. And then so much of the what’s available, the federal government to work on these community problems is actually driven by contracts or grants. And what does that require? That requires very talented folks who can write those grants, which you often don’t have, in very, very poor rural communities that you might have in an urban community. So once again, I think when we sort of delve deeper, when we really try to understand places and we, you know, we can come away sort of with a deeper understanding of what’s going on, what are the challenges that different communities are facing that that we might not have any connection to at the start?
Lindsey Burghardt: Well, thanks. Luke, let’s shift a little bit and talk about Rx Kids because I think this can feel very overwhelming. And when I heard about Rx Kids and I saw the potential for this solution, I got so excited because here’s a chance for like public policy to really influence child health and development in an incredibly positive way. So this is the first prenatal and infant cash allowance program in the country, is that right?
Mona Hanna-Attisha:: The first universal one. First universal–okay. All right.
Lindsey Burghardt: So, Mona, can you talk about how your experience has kind of led you to this program, like how it works? How did you come to Rx Kids? Yeah.
Mona Hanna-Attisha:: So, so the water crisis happened in Flint, and, you know, we had this population wide exposure to a neurotoxin also just kind of the trauma of the injustice. So we have been working around the clock to mitigate the impact of the water crisis and really promote the health and development of kids. And our work has really kind of focused on that early childhood window. We have two brand new childcare centers, huge expansion of early literacy, Imagination Library, Reach Out and Read nutrition, prescriptions, home visiting programs, trauma informed care, the expanded Medicaid, early intervention. The list goes on and on of the awesome that we have been able to put into place in Flint. But caveat, these are things that should have been there already and these are things that all kids need. They need food, they need education, and they need health care as a basics. But we didn’t have them before and we’re still kind of struggling to maintain them. And a lot of that what we have been able to put in place really relies on families to do more, you know, sign up for this program, go to this class, read to your kids, you know, feed them healthy, come to see me as a clinician. And that’s all good. But it makes me feel guilty like I am. I have been tired of asking the oppressed to do more. We talk about the kind of this concept of resilience, like why should my patients have to be more resilient? Because we as a society fail to build resilient communities. And when you understand what it means to grow up, be born into and grow up in poverty, like Lindsey, you said, I’ve wished so many times the ability to prescribe away poverty, like when I’m holding a little newborn in my hands and doing all the things I’m doing, the vaccines and the growth and development and the back to sleep and feeding and all this up, I wish I could change their zip code so that they do not have to grow up in poverty. And I was kind of sick of shrugging my shoulders and I’m like, Well, hold on, let’s do something. We can do something. We do big, hard things. Let’s do something. So I called Professor Shaefer over here, who is a child poverty expert, helped bring forth the expanded child tax credit for the nation. And I’m like, Do you want to work with me on a child allowance for Flint? He didn’t say no. And, you know, since then, we have been developing this program, which has become Rx Kids. It is a prescription for health, hope and opportunity. And starting in 2024, we will be prescribing every pregnant mom unconditional universal cash allowance and mid pregnancy, and then every baby an unconditional universal monthly cash allowance from birth to 12 months of age. This has never been done before. It’s city-wide scale. It’s launching. I see all the hearts and I’m so excited because now I’m. Sure the loving is hard and. Perfect because this is launching on Valentine’s Day. Because as much as we are trying to alleviate poverty and address economic instability, we are sending a strong message of love. This is how we are supposed to care for each other. This is about loving our moms and babies, seeing them and hearing them and walking alongside them during this really critical mom infant period, which not only is so important developmentally, but turns out to be the most economically vulnerable. Families are the most poor perinatally. So we’re launching in February. We’ve raised a lot of money. We still have about $15 million to raise. So anybody feel free to contact me if you want to give us money or, you know, anybody really rich here wants to support us, go to RxKids.com But we are launching in January and our hope is to do this for five years of moms and babies. And, and maybe I could pivot to Luke and who can tell us more about kind of the science of child allowances globally and domestically, if that’s okay, Lindsey.
Lindsey Burghardt: Please, yes!
Luke Shaefer: So in prior work that I had done, I had focused on very, very poor families in the United States. And actually this increase in families without any money. So in the United States, families might have access to food assistance through like food stamps or maybe even work that can provide for that. But what does it mean that they have money to be able to buy toothbrushes or toilet paper or diapers or pay the rent if you’re facing eviction or food? And so as we were thinking about what to do about it being policy scholars and wanting to get to solutions, we also knew that the old casual birth system that we had in this in the United States was a very stigmatized program. It was a program that just made families answer many, many stigmatizing, invasive questions. It has a long history of it being administered in structurally racist ways in the United States. So we wanted to look for a different model. But luckily you don’t have to start from scratch. There is this incredible movement across the world for child allowances or sometimes they’re called child benefits. And the logic starts from a very different place, which is raising kids is expensive and society has a reason to come alongside parents and support parents in that work. And one way to do that that empowers families is to provide cash to pay the utility bill or to buy diapers or buy the crib. And so we’ve seen this over and over again in country after country, provide a small amount of money. Sometimes that’s $250 per kid, maybe $300 per young kid and every time countries adopt this, child poverty plummets and food hardship plummet, and kids do better on so many different metrics. So in the United States, this seemed like pie in the sky a number of years ago, and my colleagues and I started talking about it, but it became a reality in 2021, where we did this through the expanded child tax credit. And families for six months, really received a monthly amount to support their kids in a way that they saw was best. And we saw child poverty fall to an all-time low. Millions of children lifted out of poverty. We saw food hardship fall to an all-time low. We saw improvements, research papers, finding improvements in the mental health of parents. We saw one of the things I thought was most interesting was credit scores actually hit their all-time high. At the end of 2021, the number of Americans with bad credit fell to an all-time low. So, so many markers of financial health and it wasn’t extended. There still is a lot of support in Washington for it, but it did not become a permanent reality. And we just saw new child poverty numbers where child poverty more than doubled. And we have millions and millions of kids back in poverty after having been out of it. But there is still interest. And I think it showed what was possible for as a country that we could follow other countries on this. And so when I got Mona’s call, I couldn’t have imagined a call I would want to have gotten more to try to keep this in the public imagination and be a part of Flint actually leading the nation and saying like, this is how we should care for our families with kids, because we would have loved to done it for every kid of every age. But those numbers got really, really big, really quickly. So as I learned from my pediatrician and new pediatrician colleagues, like how important that first year of life is, and before that, babies brains doubled in size. And so much of what happens in that first year affects the life course. There’s a new paper in the quarterly Journal of Economics that finds an extra thousand dollars during that first year of life, has a substantively increase in earnings like relationship with people’s earnings in their thirties. So we’re talking about decades later and that it pays for itself. So this program is going to be laser focused on that first year of life in that prenatal period. And another thing that I really love about it is linking health care providers. So, you know, there’ll be lots of ways into the program but the primary way is for poor families to, you know, expecting moms to go to their prenatal doctor’s appointment and be prescribed cash along with all of the other advice that they’re receiving. And so we, you know, think and believe that it’s going to deepen the relationship between provider and family. So we’ll have the positive impacts of money that can help with your core expenses that families have, as well as a deepening of relationship with providers. And we hope maybe a re-envisioning of the social contract since this is so different from really any other type of program that we have in the social safety net.
Lindsey Burghardt: I love that and I love that tying it to your prenatal care and your prenatal provider and thinking about that model of a program like Reach Out and Read where parents don’t need to go to another different place and answer another set of questions and make a new relationship. When they already have one that for many they hold dear and as a trusted source of information. So I just think that deepening of that relationship is an incredible part of this program. And I think you talked about this a little bit with some of the effects that maybe we wouldn’t anticipate it with the program. Right. Like credit scores increasing, are there things that you’re thinking about looking at as outcomes that might not necessarily be tied immediately in our conscious, like thinking about implications for parents or children’s mental health in childhood or other kind of downstream implications of not having to feel this kind of burden of poverty.
Mona Hanna-Attisha: Maybe I’ll talk about some of the wellbeing ones and talk about some of the community measures that we’re excited about. So we’re going to look at wellbeing, so we’re looking at measures of happiness and hope for themselves and their children, looking at the measures of dignity and trust, agency and empowerment. So I’m in addition to, you know, lots of health outcomes and, you know, prematurity and low birth rate, maternal morbidity and mortality, mortality and NICU admissions and well-child visits and health care utilization and postpartum depression. So there’s a lot of health stuff, but through surveys, we’re going to look at these well-being measures, which I’m excited about. And then this is a universal program. So in addition to kind of self-report, we’re going to also be leaning on administrative population level data. So maybe Luke can talk about some of the exciting things that a community level which is really novel for this, for this kind of project that we’re going to look up.
Luke Shaefer:Yeah, I’m super excited about the sort of deepening of the relationships and seeing, you know, one thing we often see in my field is, well, you know, an organizational start, a new program that they think is really great and nobody will show up in. You know, they’ll think, Oh, we need to market it more. We need to make sure people know about it. Somehow with cash transfers, people show up. It is something that they value. So it’s a way to sort of build that relationship. So I’m excited to see if the cash transfers increases, you know, prenatal visits, does it increase things like nurse home visits after the fact because it’s building the relationship, sort of welcoming us into a conversation. And I’m really excited about child welfare outcomes. So that very first year of life is like a shock. I think it’s the biggest shock in terms of child maltreatment and kids being placed out of home. And so there is a new study out about the Alaska Permanent Fund and what it means to get benefits from that. That’s really a basic income that Alaskan residents have. And so this new paper looks at families that got that during that infant period and sees huge reduction in child welfare reports and out of home placements. Pretty incredible. And there’s yeah, there’s another you know, one thing that people are often interested in is around like alcohol and tobacco or drug use, you know, worrying that maybe folks will use cash in the ways that society deems wrong. And the research has been really interesting on that. So all of the places where we studied that there’s never an increase in substance uses. In some places there’s actually a decrease in those things. So the cash transfers are related to reduced alcohol, and tobacco, for example, maybe as a result of reducing stress, means that families are less likely to feel like they need to rely on substances. And then what we can do with this that we can’t do with any study that, you know, a pilot for a couple hundred is what Mona was alluding to of looking at the community level factors like does this help to rebuild trust in government and just money circulating through the community. So we’re talking about 9 million extra dollars that is going into the hands of Flint residents. And all of the research suggests most, if not all of that is going to be spent locally. And maybe this is going to be a more effective economic development strategy than some of the top down type approaches that we’re more often using.
Mona Hanna-Attisha: The rebuilding of the social contract work, I see this also as a way to restore democracy and more trust and faith in government. And I think we might see that in improved voting rates and civic engagement. So that’s something else that we’re looking at.
Lindsey Burghardt: So I can imagine that like people who are listening would really like to kind of look into your play book and get an idea of how you’re able to do this. I can’t wait to be able to share some specifics about how you kind of got the program to life. How did you get it written into the state’s budget? So, you know, can you share kind of any tips for people that might be listening and interested in applying this to their own contexts?
Mona Hanna-Attisha: Absolutely. So from the onset, our intention was to start this in Flint, but really to share this. That’s why we’re so excited to be here today. So this is expensive. So we need about $11 million a year to do this. 9 million are the direct cash transfers. And once again, we want to do this for five birth cohorts, five years of moms of babies. So our goal has been to raise $55 million. We received a very, very generous grant from philanthropy from the CS Mott Foundation, a $15 million match grant very early. Other foundations also came in, a mix of family and local and state and national foundations. But our most exciting funding has come from the state of Michigan, and this is our pathway towards sustainability and scalability. And it has come as a redirection of TANF, which is the Temporary Assistance for Needy Families. This is the cash welfare system, and I’m going to send it back to Luke because he’s an expert here. But this is super exciting. This enables other communities to do this. This is what’s really kind of getting the attention nationally and is the playbook.
Luke Shaefer: And the United States in 1996, we thought that we reformed welfare to be a work first and time limited cash welfare program. But it turns out what we did was create a very flexible block grant. So this is a chunk of money that’s 16.5 million at the federal level that goes down to states. In Michigan, we get about 750 million of that in this TANF funding. And all the states can choose to use this for cash assistance where they provide a small amount of money to families every single month. And if they do that, they have to do a lot of reporting. There’s lots of requirements. They can actually get into trouble if they don’t do things right. Or if they want to they can not provide cash assistance and use the money for any number of other things as long as they can justify on paper that it fits one of the core purposes of TANF that includes, you know, taking care of kids in their own home, but also things like promoting marriage or reducing out of marriage births. So what states have figured out over time is that they can actually use the money in ways that they were probably already spending otherwise. And so we’ve shifted the money to all sorts of things. Lots of states pay for their child welfare, their foster care system out of it, Lots of, sort of, using the money to deal with administrative costs. And in Michigan is not out of line with where a lot of other states are. Of their 750 million that the federal government spends then and the state puts in another 100 million or so, only about 55 million actually goes to cash assistance to families. So that’s 6% of the total amount to a much bigger chunk goes to things like the child welfare system or in the case of Michigan college scholarships, that mostly go to higher income families because we were short on our college scholarship budget. So Rx Kids what it does is say, let’s bring some of that money back to, you know, what was really the intention of the original program as 6% is not an appropriate amount of this block grant to be spending on cash aid. But let’s do it in a fundamentally different way. Let’s do it with dignity. So, you know, cash welfare programs of TANF always require like an income test, and families have to apply. They have to really prove that they’re not just poor, but they’re really, really poor. In this case, we’re going to use TANF to support families who are low income, but all families are going to be eligible because by making every family in Flint eligible, we actually cut off the stigma that having that income tax can have on families who don’t have enough. Right. We’re no longer saying you get this money because you can’t handle, you know, your own needs. We’re saying raising kids is expensive and society wants to come along and support you in that work. It turns out people that are well above the poverty line, have trouble paying for diapers or trouble paying the rent or paying for child care. So it makes a lot of sense. So we’ve just been so excited to see the level of interest that this has driven from other states. We’re hearing from people in all sorts of other states that want to talk about this. I think in part by focusing on this first year, we sidestep some of the general, you know, the typical questions about, you know, does this become a life cycle? Is this a dependency? Is it going to impact, you know, our work in the long run? We’re talking about really focusing on this first year of life when families are the poorest, when kids are developing at like breakneck speed and using this money in a dignified way, not just to help families meet their basic needs, but also to try to send them a very clear message that you are cared for and we want to be a part of helping you do this job that you think is, you know, the most important thing that you are doing.
Mona Hanna-Attisha: I can just add you have Luke and I, but this this work, like all good work is done, has been done in a humble partnership with our community. And that we have a group of moms and dads and kids that have been really driving this work and where this kind of originated and that that’s part of Flint’s story. If you remember Flint’s a story that lost democracy so central to our recovery and our path forward is the role of participatory democracy and self-determination. So from the logo design to how much money to our Valentine’s Day party and who’s going to perform it, maybe Beyonce, maybe so all of this has been driven by our parents, by moms and dads in this work, which I think is, you know, which is kind of central to all public health work and working communities.
Lindsey Burghardt: And that’s amazing. It’s actually the perfect segue to our questions. We got over 100 questions from the webinar registrants from all around the world. And one of my favorites, because I’ve heard you talk about this is really how you were incorporating that lived experience and community perspective in the in your work. And I just think to hear you talking about bringing back like the joy and the dignity and centering those in this process just I think is amazing. And we’re going to jump into a couple of questions. We have a few minutes here to just hear from what our registrants wanted to know more about. And there are several questions that kind of got into the education and early education space and thinking about applying, Luke, like what you kind of learned on the road about schools in the education context, to think about how we can think about solutions to funding to support these places, you know, schools and early childhood centers to address issues related to poverty and kind of what strategies and recommendations would you both give school districts to help center the importance of place? Sorry, there’s a couple questions in one.
Luke Shaefer:Actually I’ve just been writing about this, so the very first thing that I mentioned is it’s worth it to look at the history of places and figure out why schools are so unequal. So one of the favorite parts for me of my book is a passage about segregation as academies that cropped up in a lot of the communities that we’ve studied over time where, when Brown v Board came down, communities were able to ignore it for a while, and then finally they weren’t. And they had to integrate public schools and the research is very powerful that integrating public schools had a huge positive impact for Black American schoolchildren and no negative impact for white schoolchildren. But communities going in the opposite direction and the segregation academy sometimes pulled over like all of the resources from the public schools and basically replicated in many ways the system we had before. So looking at that history, I think is really critical. I think it can help us understand like what are the solutions that would actually work, how could they be circumvented? So what do you do with that? One strategy that I have actually become very interested in is just raising the pay of starting teachers. So this has a really nice evidence base around. We just we paid teachers who do incredibly hard work almost nothing. And so, you know, to keep that up–again, it’s not just the money and being able to survive, but it’s the signal that we send to people who want to go into the teaching profession about how we value it. So the evidence is sort of in that first few years of teaching: if we could raise those salaries, we would attract more people, we would keep them for longer. And if you can have mandates across systems that, like everybody is raising their teacher salaries, it’ll impact the poorest schools the most.
Mona Hanna-Attisha: But we need to raise early childcare teacher salaries even more. They are paid so little. And if we respect the science that we all understand that this is the most critical time in a child’s life, we know these are brain builders We need to be paying them Ph.D. level salaries. I mean, it just it needs to follow the science and they are absolutely undervalued. So, I mean, that would be one of my recommendations. But also really thinking about the education system a lot earlier, you know, why is a school, you know, grade K-12? Well, why doesn’t it start at age three or, you know, age one? So really respecting the science and thinking about the importance of the–prioritize the importance of early education.
Lindsey Burghardt: Yeah, I couldn’t agree more. And I think, you know, Luke, you mentioned that there’s like economic perspective now looking at kind of the cost benefit analysis, even like focusing on young children very early when they need it most. And I think to us as pediatricians and for people who are deeply immersed in this work, it just makes total sense. But I, I hope that we can continue to build the kind of arguments for what really feels like science that our grandmothers told us that makes the most sense: if you take care of young kids when they’re very small, you can get them off to a good start and sometimes better to get it right the first time, I think, although it’s never too late, of course.
Mona Hanna-Attisha: So I know you have a bazillion questions, but I’m going to I can’t not share my favorite quote, so
Luke Shaefer:I know you’re going to.
Mona Hanna-Attisha: So, we’re launching on Valentine’s Day, remember, because this is about love, and it’s Black History Month. And it’s also Frederick Douglas’s, self-proclaimed birthday. And he his quote about prevention is my favorite quote and really kind of what I live by. And he has said: It is easier to build strong children than to repair broken men. And that is the work that we are all doing every day. It is building strong children, our health care system, our education system, our criminal justice system, you name the system. It’s reactive. We fail to prevent we fail to invest in our kids and we go on and Band-Aid and pay the consequences. So it is easier to build strong children than to repair a broken man.
Lindsey Burghardt: Yeah, it’s beautiful and I think to your point, we can hold up each of these systems and look at how they are considering or not considering very young children’s welfare and their impact on the youngest citizens. And I don’t think that we do that in a universal enough way. And thinking about bringing in folks to the table in zoning and urban planning and environmental protection who do not consider themselves early childhood advocates or people whose work influences early childhood, when in fact it has a profound influence on children and families. And I think you both are just doing such important work and connecting the dots. And you know, the last question that I’ll raise that came from audience that I loved, and I swear it was not planted: if science is so clear about how exposures like pesticides in lead and water affect brain development, you know, how have these things become so partisan in their communications? And how do you address that in your work to achieve the kind of mindset shift that allowed you to get something like Rx Kids off the ground? Like, how do we kind of approach these conversations to demonstrate to a variety of audiences what science tells us about supporting young kids?
Mona Hanna-Attisha: There’s a lot in there, and I’m just going to, you know, I think we have to keep sharing the science. And as we’ve done a little bit today, we have to continue sharing the stories about why this is important. I think very often we share a lot of bad news and we share we catastrophize, especially with all the issues facing children and climate change. And, you know, the list goes on–gun violence. And I think like you have done today, I think it’s important to share the solutions and to share kind of the community driven, you know, hope and the practical way that we can do this. We are at a place right now, this science denial place, not by accident. And we have to look at the history. Special interests and corporations have made it be this way. They have purposefully weakened regulations, disinvested in public health. Everybody, you know, go read about one of my heroes, Harvard’s first woman, professor Alice Hamilton, who fought against these industries and, you know, against the lead industry and General Motors and all these special interests and was silenced. And that really kind of set forth this paradigm that we work with today that has allowed for the unchecked use of so many bad things that hurt kids because the upper hand is always industry and corporations and profits and it’s not kids. So we have to learn that history and then we have to kind of, you know, keep electing people who understand that and respect that and will fight for kids.
Lindsey Burghardt: Beautifully said. So closing thoughts from the two of you. So if you had to give advice for listeners, people who want to pursue public policy changes like what the two of you have worked so hard for in their own communities, what advice would you give?
Luke Shaefer:I guess I would encourage people to start with listening. You know, I have found that my book that we talked some about today, all of the chapters were not things that I really expected to write about going in. But as we got to know communities, we really started to talk to families that drove our research agenda. That really drives the agenda of my research center here. And so we have to be willing to look at things like in our book, we have a chapter on government corruption, we have a chapter on community violence, and then tie it to the history and really be mindful that the challenges that face us today did not appear out of thin air. And if we really understand where they came from, we can do better at figuring out where to move forward and then come to positive, concrete solutions and celebrate them when things happen. You know, positive change can happen in the incredible distance that we’ve come on lead pipes being replaced all over the country is really remarkable. And so we have to understand our challenges and celebrate solutions.
Lindsey Burghardt: Love it. Mona?
Mona Hanna-Attisha: I would just say you make all kinds of friends, those of us who live in who do this work often hang out with folks that are very similar to us. And I never thought I’d hang out with a social scientist policy guy to be able to do this. But we need to make all kinds of different friends. The tent of folks that care about kids is broad, and I think if that tent– as big as we can make that tent–the more likely that we will be able to achieve the outcomes that we hope to see.
Lindsey Burghardt: I love it. Every time I talk to the two of you, I feel so inspired and buoyed to go out and think about this more. And you gave me so much to think about and reflect on and consider in our work at the Center. We partner with other organizations as well but everybody who’s listening feels the same way is that thank you so much for making the time, for being here, for being the advocates that you are for young children, for all the work you’re doing in Flint and beyond.
Mona Hanna-Attisha: Thank you for having us.
Lindsey Burghardt: So I’m going to turn it right back over to Rebecca Hansen from the Center to close us out.
Rebecca Hansen: Alright, Thank you, Lindsey. And thank you again to our panelists for a really wonderful conversation. As Lindsey said, this has given us so much to think about and great ideas to apply to our work, and we’re really grateful for your willingness to share your expertise with our community. And lastly, I just want to say that there is so much more to come in this webinar series. We are working to bring more conversations like this one to you in the coming months. we’ll be sharing more about the next webinars in our series, including a conversation examining the impact of racism on child development. So please stay tuned on our social media channels and subscribe to our newsletter so you can stay up to date on additional activity in the series. So thank you again to you, all of you, for coming and I hope you have a great day.
Amelia Johnson: The Brain Architects is a product of the Center on the Developing Child at Harvard University. You can find us at developingchild.harvard.edu, where we will post any resources that were discussed in this episode. The next webinar in our three-part Place Matters webinar series is on December 11th at 12pm EST—stay tuned to our social channels for more details. You can find us on Twitter @HarvardCenter, Facebook at Center Developing Child, and Instagram @DevelopingChildHarvard. Our music is Brain Power by Mela Collective.
In June, we hosted a webinar about our latest Working Paper, Place Matters: The Environment We Create Shapes the Foundations of Healthy Development, which examines how a wide range of conditions in the places where children live, grow, play, and learn can shape how children develop. The paper examines the many ways in which the built and natural environment surrounding a child can affect their development, emphasizes how the latest science can help deepen our understanding, and points towards promising opportunities to re-design environments so that all children can grow up in homes and neighborhoods free of hazards and rich with opportunity. Corey Zimmerman, our Chief Program Officer, moderated a discussion around these themes between Dr. Lindsey Burghardt (Chief Science Officer) and Dr. Dominique Lightsey-Joseph (Director of Equity, Diversity, Inclusion and Belonging Strategy) which has been adapted for this episode of the Brain Architects podcast.
Tassy Warren: Welcome to The Brain Architects, a podcast from the Center on the Developing Child at Harvard University. I’m Tassy Warren, the Center’s Deputy Director and Chief Strategy Officer. Our Center believes that advances in the science of child development provide a powerful source of new ideas that can improve outcomes for children and their caregivers. By sharing the latest science from the field, we hope to help you make that science actionable and apply it in your work in ways that can increase your impact.
In June, we hosted a webinar about our latest Working Paper, Place Matters: The Environment We Create Shapes the Foundations of Healthy Development, which examines how a wide range of conditions in the places where children live, grow, play, and learn can shape how childre
During the webinar, Corey Zimmerman, our Chief Program Officer, moderated a discussion around these themes between Dr. Lindsey Burghardt (Chief Science Officer) and Dr. Dominique Lightsey-Joseph (Director of Equity, Diversity, Inclusion and Belonging Strategy) which we’re happy to share with you all on today’s episode. To access the full Working Paper and related publications, please visit our website at developingchild.harvard.edu.
Now, without further ado, here’s Corey Zimmerman.
Corey Zimmerman: Hi, everybody. Welcome. I’m Corey Zimmerman. I’m the Chief Program Officer here at the Center on the Developing Child, and today we’re going to be discussing a paper, the name of it is Place Matters: The Environment We Create Shapes the Foundation of Healthy Development. This paper was written by our National Scientific Council on Developing Child and was released earlier this year in March.
We see this webinar as an opportunity to begin to understand a broader frame for thinking about what influences early childhood development, the role that inequity plays in influencing the environment children are in, and third, some early thoughts on new actors or sectors that might be called upon given this broader frame, to be able to join us in our collective effort to improve outcomes for all children and their families.
Okay. With that, let’s get started. It is my pleasure to introduce you to my two colleagues, Dr. Lindsey Burghardt, who is the Chief Science Officer here at the Center on the Developing Child. And then second, Dr. Dominique Lightsey-Joseph, who is our Director of Equity, Diversity, Inclusion and Belonging Strategy here at the Center. Okay. So we’re going to start with a brief overview of the Working Paper, Place Matters from Dr. Burghardt.
Lindsey Burghardt: Thank you again, Corey, for that introduction. And thanks to all of you today who took time out of your day to join us and to hear about this new working paper from the National Scientific Council. So the overall focus of this paper is really to broaden the frame of how we’re talking about early childhood development and health. And we’re going to look upstream today and consider all the different factors that influence how kids develop.
So we all experience this continuous influx and flow of influences from our environments, and they begin before birth right in the earliest days of the prenatal period, and they continue throughout our lives. And these influences include the environments of relationships and those environments–that environment of relationships–is just as important as it’s ever been. And children also experience exposures and influences from the physical environment that surrounds them and their caregivers.
So particularly the built and natural environments. And there are a really wide range of conditions in places where children live, learn, play and grow, and all these conditions have the ability to get under the skin and affect the developing brain and also other biological systems. So the immune system, the microbiome and the metabolic system, among others. And beginning before birth, these environmental conditions are shaping how children develop and that, in turn, has the ability to shape their lifelong physical and mental health.
So the built and natural environments and the systemic factors that shape them, like policies that influence where people are able to live and how resources are distributed, interact with each other and they interact with a child’s social environment in really deeply interconnected ways. So this is really what we mean when we say that place matters. So every environment is infused with a combination of influences, and these influences can have positive or negative effects on health and development.
And it’s also really important to recognize that level of exposure to risk and access to opportunity for children are not distributed equally. So in 2004, the National Scientific Council on the Developing Child described the effects of early life experiences on the developing brain and its first working paper called Young Children Develop in an Environment of Relationships. And over the two decades that followed, this concept really helped to make the case for caregiver-child relationships is sort of the active ingredient in how environments can influence the architecture of the developing brain. So the environment of relationships includes the presence of responsive relationships, the presence of significant stress and adversity, caregiver well-being, social connectedness, community support, faith and cultural traditions. And so more recently as our understanding of how early the early origins of health and disease have advanced, we’ve also really started to understand how early experiences affect multiple developing biological systems beyond the brain. So thinking about the immune system, the metabolic system, the respiratory system, and actually how these systems are interacting with each other and shaping each other as well as the brain. So the environment of relationships again, is just as important as it’s ever been, but these environments–that environment or relationship–it doesn’t exist in isolation; it exists in the context of is much broader environments that include the built and natural environments that surround children.
Exposures from the natural and the built environments also directly shape the development of biological systems inside the body, and they interact with adult-child relationships in a really deeply interconnected way. And these exposures can be positive or negative, and they can include things like air quality and temperature that children breathe, the purity and availability of their water supply, their ability to access safe green space and healthy housing and whether or not they’re exposed to things like environmental toxicants.
So we can take the example of lead is one that many people are familiar with. So lead is one factor in the built environment that connects to safe and healthy housing, connects to clean water supply and to exposure to toxicants. And we’ve known now for a really long time that lead is harmful to children’s development, particularly in the prenatal period and in the earliest years. And lead is still a challenge for a lot of families that today that are still dealing with this and the ongoing situations in Flint and in Jackson speak really clearly to this issue. So the presence of lead in children’s drinking water directly influences and affects their development, and it also shapes the environment that their caregivers are in with the burden and stress that it puts on them. So if there’s lead in the water supply, caregivers often have to seek out alternatives, and it’s typically at a cost, they may need to find in time for additional doctor’s visits and follow up. And all this can cause stress on them, and that can impact their ability to be in a caregiving relationship. So when we look at an environment, one that provides lots of positive influences is more likely to support children’s healthy development, and just as an environment that provides or imposes more negative influences is going to be more likely to result in disease and in poor health outcomes.
So let’s widen the frame one level further, because there’s also these really broad systemic influences that play quite a powerful role in shaping the environments our children live. So these systemic influences are going to shape children’s development directly and they’re going to shape them indirectly through their influence on a child’s environment of relationships and their built and natural environments. And these influences include things like current and historic public policies, systemic racism and intergenerational poverty, among others. So it’s really important to acknowledge that conditions in our built and natural environments are not experienced equally among children. They vary widely and the adverse effects of systemic racism in particular have deep historical roots whose impacts continue to the present day and many present-day policies continue to perpetuate these inequities and their ongoing effects. So there’s an example that we’re going to dive deeper into a little bit later on in redlining. And redlining strongly influences where many children of color live today. And although this practice is now illegal, it has modern day implications like the home appraisal process that continues to shape the environment where young children grow. So increasingly, data that has been provided that shows deep analysis of these differences at the community level. And there’s one that’s provided by the Childhood Opportunity Index, or COI, that’s cited in the working paper. And then we’ll again talk in more detail later on. But the COI demonstrates that in the United States, neighborhood opportunity is highly segregated by race with black and Hispanic children having access to significantly less neighborhood opportunity than white children.
So let’s shift a little bit now to talk about the timing, which is so important. Well, it’s really clear now that it’s not just our genetics and it’s not just our environment, that influence health and development. It’s both. And the influence that our genes and our environment have on our health is also really depends on the time during which we have certain experiences or exposures. And people differ in their sensitivity to influences from their environment at different points throughout their life course. And children’s biological systems in particular have different periods when they’re really sensitive and more sensitive to various environmental exposures and influences, even within the same biological system. So one example is the developing microbiome in our gut, which is very sensitive to influence from the built and natural environments around the time of birth and in the first few years of life.
So in general, the sensitivity of the brain and the other biological systems that we’ve talked about is typically greater in the prenatal period than it is in early childhood. And in general, young children are more sensitive to influences from their environment than older children who are in turn more sensitive than adolescents. And in general, adolescence will be more sensitive than adults to many environmental exposures, and this is really important when we consider the importance and the impact of environmental exposures because of a greater sensitivity in early childhood.
When an exposure happens during a fetal development or in early childhood, it’s going to have a very different impact and potential effects than if that same exposure happened later in life. So when we think about it, actually the first place where a child’s development is affected by place is the intrauterine environment during pregnancy. And during fetal development,immature biological systems are developing a very, extremely fast pace and their development is powerfully shaped by the environment around them. And these systems read the conditions in the womb as predictors of what they’re going to encounter after birth, and they sort of adapt accordingly. And so because these systems are still differentiating, they’re still becoming specialized and figuring out what they’re going to be, the exposures can result in really different outcomes depending on the time during development when they occur.
And we can take a look here at the example of air pollution. So air pollutants can be absorbed in a variety of ways and can cause problems in developing organs and entire organ systems. But the nature and the severity of any potential effects will be different depending on the time during childhood and during development when the exposure occurs.
So, for example, in the prenatal period, exposure to air pollution is associated with things like adverse birth outcomes in prematurity and in low birth weight. And in early childhood exposure to air pollution is a known risk factor for a variety of health effects, including asthma and children who are exposed to higher rates of outdoor air pollution during the first year of life may have diminished functional lung capacity as teenagers. So this is only one example of how the nature and the extent of an exposure that occurs very early in life may not even be fully apparent for years or even decades later.
So let’s talk a little bit about climate. So climate and our changing climate is a really important factor in how children experience place. So we’ve talk today about how environment shape development and health, and we’ve discussed that what surrounds us quite literally shapes us.
So let’s go back to thinking really broadly about what’s surrounding and shaping children in their environment. We talked about the quality and the temperature of the air that they breathe, the purity and availability of their water supply, their ability to access safe and healthy housing, their ability to access nutritious foods and the quality and density of the buildings in their neighborhoods. So climate is modifying the environment where these kids are living in a number of ways, it’s increasing the temperature of the air that’s surrounding them and making that air less pure. And it’s altering the availability and purity of the water supply, and that’s making housing less predictable through displaced men and through increasing energy costs. And it’s making nutritious foods for many children around the world even more scarce.
So climate is changing children’s environment and it’s doing it unequally across groups. Let’s just take a moment to look at heat as an example. So higher temperatures actually lead to a really wide variety of negative outcomes on development and health, including adverse birth outcomes like prematurity and low birth weight. It can have impacts when it’s experienced even in early childhood on academic achievement that can persist for many years later and heat increases the effect of air pollutants which are known to worsen conditions like asthma. So more heat will intensify the effects of air pollution and we’ll see more problems with asthma as a result. And heat is increasing in all children’s environments all over the world, but it’s not increasing equally among communities. So urban areas that already have a higher density of buildings, already are experiencing higher temperatures and have less green space, are going to be more impacted than suburban or rural areas. And the disparities then, in exposure to heat and the intensified effects of air pollution are going to be different depending on where you live and how you’re experiencing our changing climate. And as a result, we’re going to see a disparate impact in the contribution to disparities in rates of diseases like asthma that are already based on where children live.
So we feel that the implications of this really rapidly growing science on this front are clear. Understanding the really powerful effects that the natural and built environments have on the early foundations of health and development is calling for increased attention to really important influences that fall well beyond what we all consider the traditional boundaries of the early childhood field. So this demands that we have to incorporate a more intentional early childhood perspective within the current concerns of things like urban planning, rural development, environmental protection, climate change, anti-discrimination policies, many others. And doing this requires that a much broader range of policy domains must work together to address racist and other discriminatory policies, and we have to achieve greater equity.
All communities have aspects of their built and natural environments that have been designed through intentional decisions made over time, and they can be redesigned to support healthy development. And supporting healthy development is still very much about encouraging and supporting caregiver-child relationships, and it’s also about bringing communities, businesses and governments to work together to assure a supportive and healthy environment for all young children with particular attention to the built and natural environments that are currently falling far short of that goal.
So working together across various policy domains beyond the early childhood field and sector, we can reshape environmental influences with a science informed lens and a shared goal of achieving fairness of place so that all children can grow up in homes and neighborhood that are free of hazards and rich with opportunity.
Corey Zimmerman: All right. Thank you, Dr. Burghardt, for that overview of the paper. So many rich insights. I’m actually really excited to dive into this more now with you and Dr. Lightsey-Joseph. Thank you. All right. That was a great overview. And now we’re going to shift into the panel part. So, Dr. Burghardt, this first question is going to be for you.
You mentioned that every environment is infused with a combination of influences and that those influences can impact children in positive and negative ways. And I was wondering, can you give us an example of an environmental influence that has an important impact on children and families? But maybe that’s not something that we typically think of as related to early childhood development.
Like, help us dimensionalize a little bit. What would be an example?
Lindsey Burghardt: Yeah, thanks for the question, Corey. So one of my favorite examples here is green space. So our knowledge of the health effects of green space is really increasing as we’re learning more and more of the science behind how green space exposure affects health and development in children. And we have a growing body of science that’s demonstrating that the benefits of access to safe green space around the prenatal period has a variety of benefits and a variety of health outcomes in children.
So later on, benefits to the immune system and benefits really on children’s mental health in a number of ways. And there’s also a really growing and exciting deepening knowledge about how green space can offset some of the more negative environmental exposures that I spoke about, like heat and air pollution. So, you know, as we talked about earlier, children are experiencing the built and natural environment really differently based on where they live. And right now, children’s opportunity to access green space is not equal. But I think that given the robustness and the rapidly growing science in this area, around the really wide range of benefits, this kind of disparity of place is one that really demands greater attention. And in particular when when it pertains to green space. There’s also, I think, really interesting and significant what we call co-benefits when we think about bringing together in conversation and action children’s health and their environments.
So, for example, if we’re decreasing concentrations of air pollution, including through ways like increasing green space, then we can improve the air quality that children are breathing and potentially make problems like asthma less likely to occur. And these types of interventions, as we spoke about earlier, they’re really needed most in communities that have the lowest concentrations of green space right now and also the highest rates of asthma.
Corey Zimmerman: So many thoughts. That’ sparking so many different ideas, and that’s an example that’s close to my heart as well. So I really appreciate that one. Dr. Lightsey-Joseph, I want to bring you in. I want to ask about this concept of fairness of place that Dr. Burghardt mentioned. And I was curious if you could tell us a little bit more about the social history that’s led to this unequal distribution of environmental influences.
Dominique Lightsey-Joseph: Sure. Thank you for having me today, Corey. And good to see you, Dr. Burghardt. Yeah, sure. I can answer that question for you. I think in understanding the unequal distribution of environmental influences, we have to name the historical practice of redlining in the U.S., which is a policy in the thirties by the Federal Home Owners loan Corporation, in which neighborhoods, particularly those that were populated by Black residents, were color-coded based on perceived financial risks or real estate investments. And those areas that were color coded red were seen as the riskiest and the most undesirable neighborhoods. And this process resulted in these communities being systematically denied vital services and opportunities for economic advancement in this country. And despite the Civil Rights Act of 1964, the Fair Housing Act of 1968, which officially outlawed redlining, the economic disparities that resulted from these discriminatory practices persist.
An example of this would be, there was a 2020 report that was conducted by the National Community Reinvestment Coalition, which found that 74% of neighborhoods initially redlined in the ‘30s remain economically disadvantaged today. And this is characterized by lowered home values, higher rates of poverty and things of that nature. And I’d be remiss if I didn’t say that the impact of redlining, it doesn’t just end at financial implications. They stretch deep into the health and environmental qualities, too. And as Dr. Burghardt mentioned earlier, we can take Flint, Michigan, for instance, which is discussed in the paper, and the city’s water crisis, which subjected a predominantly Black community to dangerous levels of lead exposure has roots in the long term consequences of redlining. It was that facilitated segregation of that city all of those years ago that resulted in this higher concentration of poverty and exposure to these environmental hazards.
In comparison to, you know, other neighbor of neighboring areas in the state. So to really answer that question, Corey, I think the influence of redlining has pervasively shaped the socioeconomic and environmental contours of our neighborhoods, and consequently, it has defined the environments where kids are raised and the opportunities or lack thereof, they have to grow up healthy.
Corey Zimmerman: Thank you for sharing that. And I want to pull it forward now and ask you a follow up question, Dr. Lightsey-Joseph, around the Child Opportunity Index that Dr. Burghardt mentioned earlier and is in the paper, I think that’s a way of kind of quantifying also some of the ongoing pieces that you’re talking about. So, the Index lays bare the many ways in which disparity of place continue to exist across communities today. And I was curious about what this powerful dataset has to offer us as we think about how to create health promoting environments for all children. So I was curious your thoughts about that.
Dominique Lightsey-Joseph: Yes, the Child Opportunity Index, or the COI, it really does lay bare the fact that these disparities across communities exist. And I think it quantifies it to your point in a way that there’s that felt anecdotal knowledge of it, but to see it in the form of the COI, I think is invaluable. So it’s a tool that really does help us to understand these disparities across communities. And it uses a range of indicators, as Dr. Burghardt said earlier, within the educational, health and environmental domains, that really examines the conditions that are vital for children’s healthy development across neighborhoods in the U.S. And one of the most significant insights by the COI is that the substantial disparities in child opportunity are often racialized in nature between different neighborhoods, cities and regions. And for example, in the 100 largest U.S. metropolitan areas , a turn of the decade analysis of the COI, found that Black children are 7.6 times more likely than white children to live in neighborhoods with substantially lower opportunity to grow up healthy. And Latine children are about 5.3 times more likely to live in neighborhoods with lower opportunity. And so the COI beyond that, right, it allows us to identify these environmental disparities across neighborhoods within the same city as well.
So as you both know, I’m a transplant from California, has deep roots out there. And there’s a neighborhood in West Fresno that has consistently been ranked as one of the neighborhoods most burdened by population in the state of California. And subsequently it ranks really low on the COI as well, due to the high air pollution and the limited green spaces. But in contrast to that, neighborhoods with a higher ranking within the same city, literally across the tracks, right, often have less pollution and more parks and playgrounds. And I think the data that is offered by the COI is really this powerful resource, right? That not only allows us to identify these spaces, but it also allows us to address these disparities so that they can inform where these targeted interventions and resource allocations in neighborhoods that require more attention to infrastructure and investment is necessary.
And I would say that it’s important to note that neighborhoods in Flint, like we mentioned a few times and Fresno, are still impacted by being redlined all those years ago, the environments in which our kids live, grow, play and learn, they were not fixed, and these outcomes are not inevitable. They are the products of decisions that have been made over time and they can be reimagined and restructured.
And so I think it’s the responsibility of us, like researchers, government officials, advocacy groups, policymakers, just to name a few. But it’s our responsibility to really work collectively with community leaders to invest and restructure these built environments. I think we have to work together. That’s the only way that we’re going to be able to support healthy development for kids, regardless of their race, their ethnicity, or their socioeconomic status.
Corey Zimmerman: I love that. This is a product of decisions that have been made over time and we have an opportunity to redesign. And I find such power in that. There’s such agency actually in that this is changeable. We can do this differently. And so, Dr. Burghardt, I want to actually ask you, with that lens in mind, there is an opportunity to redesign neighborhoods in communities to support healthy development. And I was curious, can you say more about your you had a last point in your presentation that was around the extended role for actors in other sectors outside the traditional early childhood field. So I wondered if you could expand on that a bit.
Lindsey Burghardt: Yes, absolutely. Thanks, Corey. And I think I’m going to +1 what Dr. Lightsey-Joseph just said. And that I think for me, like the thing about the COI that really stands out is her point that she made about the geographic proximity and the starkness of difference. Like I feel that we can’t emphasize that point enough. If you look at cities like Milwaukee, I think is a good example of one where literally adjacent to each other some of the highest levels of opportunity in the state and the lowest opportunities in the country right next to each other. And I think that it just highlights that that intentional decision making of where to allocate and distribute resources is a really stark example. And if you check out the, if anyone’s interested, you can go to the website actually and learn a lot about the COI in your particular area. And you can it kind of translates, I think, to what we experience and know from our own experiences. So I’m not adding anything more eloquent than what Dr. Lightsey-Joseph said, but I think just a really, really valuable tool when we’re thinking about where we can invest and where we can focus on health promoting environments.
So, to get back to your question, Corey you know, in the beginning of our time together, I talked about broadening this list of policies that we’re thinking about as affecting the foundations of early childhood development and lifelong physical health and mental health. And the list I gave is by no means exclusive. But I think that looking at things like environmental protection, climate change policies, in particular, mitigation, housing, urban planning, zoning requirements, which helps to redress things like redlining, economic development, criminal legal reform and the criminal justice system and anti-discrimination policies. We can bring decision makers from all these different sectors to the table, even though they haven’t traditionally considered their work perhaps as impacting childhood development and lifelong health. We can again think about how all of the decisions we’re making–literally, every one–is affecting childhood health and development, and I think many people who are here today are already doing that in their work. But it’s thinking about who else can we bring in and who else can we share this messaging with, because we can make a child assessment, you know, impact assessment in every policy and program that we do. We should be looking at every single decision we make, even the ones that on the surface you think, well, there’s no way that that could affect children. Most people here could explain how it, in fact, would. So everything from minimum wage laws to zoning laws, they will affect children’s development, they will shape those environments and those environments will shape children’s health and development. And we really need to demand that kids are considered and that the impact on them is considered when all of these decisions are made.
Corey Zimmerman: Okay, so we have reached the point in the session, I feel like I should readjust my chair somehow, like we’re going to switch into the Q&A session now. So we’re going to switch over from the questions that we have sort of prepared and now respond to questions that have come in through the through our social media channels, through registration links. So a big thank you to Dr. Lightsey-Joseph and Dr. Burghardt for your responses so far and for your upcoming now next set of thoughtful responses also. Alright, the first one I’m going to start with is this one. It’s for you, Dr. Lightsey-Joseph, given what we’ve been talking about. And the question is, can you talk more about how and connect this to how does this align with protective factors and resiliency? Curious your thoughts about that.
Dominique Lightsey-Joseph: I love that question. So in these neighborhoods, right, there, there are these strong community-based organizations and social support structures that already exist, and they have long been providing emotional support, the practical help, the collective strength and resilience, which in turn nurtures the well-being and empowerment for the kids and families residing in these respective communities. And I think acknowledging these protective factors is important because they are invaluable for sure. I also think it doesn’t negate the need to confront and address the systemic injustices that have resulted in such disparities and made resilience so necessary in the first place. So these protective factors are present and they, to me, serve as a really good starting point from which we might begin to foster a healthier and more equitable environments for these kids. And so I think, to Dr. Burghardt’s point earlier about, you know, approaching this from a holistic perspective and looking at all of these other sectors, that we have to come together and work collectively to restructure these environments, but the approach in how we do that should be guided by the insights and the experiences of those within the communities and not merely outside speculations, assumptions or perceptions of the challenges.
So while we might use data to help us identify where these areas are, I think pairing that information with an approach to the wider systemic challenges and keeping it community-led and community-guided can really give us a real shot at transforming these opportunities that are available to kids on a national scale.
Corey Zimmerman: All right. I’m going to keep this going. Dr. Burghardt, this next question is for you. And you touched on this a bit earlier, but I think this is an opportunity for us to go deeper. And this is a topic that I care a lot about, and I swear I didn’t plant this question. Somebody else actually submitted it. And so the question is, how does the impact of climate change on the built in natural environments shape the foundations of development? And I’m excited to see this question, too, because I think there’s a lot of energy in this space right now. So I’m curious for you to add a little more thoughts from what you did earlier.
Lindsey Burghardt: Yeah, thanks, Corey. I appreciate the chance to come back to this topic and to talk more about it. You know that I share this passion with you, but I also think it’s a real opportunity for those of us in the early childhood field who kind of understand how there’s all these different influences, how they affect children’s health and development, to bring to conversations into the same space that maybe aren’t happening as much as they could right now. So climate change and children’s health are two things that I think once we can kind of explain the connections between the two make a lot of sense, but aren’t necessarily intuitive, especially for some of those sectors that I mentioned before, that kind of sit outside of what we consider the traditional scope of the early childhood field. So when we think about how we can tell the story, we’ve discussed today how children’s environments shape their development and health, and we know that environments affect development and that climate change affects each of the environments that we talked about today and that it does so unevenly across these different groups. So climate change, again, is modifying in many, many ways, both the built and the natural environments where children are living. And heat is one example that we discussed, but there are many others. So if we think about the availability of a pure water supply and access to nutritious foods as other examples of things that are impacted by climate change. So if nutritious foods are less available, for example, this can directly affect children’s developing biological systems, especially in the prenatal period and early childhood. So when we take what science has already demonstrated and what we already know about the importance of nutrition or lack thereof in the prenatal period in early childhood, and then we think about how that’s modified and changed by climate, it becomes a really clear and compelling story about why this is a really important issue that’s going to affect–and is affecting today–children’s development and health. And then things like natural disasters and flooding are going to increase the number of families who are displaced from where they live, and that’s going to significantly alter the physical environment that surrounds those children and it’s going to directly affect their developing biological systems as well. And so while climate change is an urgent issue that’s affecting how children are experiencing place, there’s also in this space a really wide solutions space that’s already available to us now at every level from high, broad, reaching goals also to more immediate things that many of us may have a potential to act on fairly quickly. And there’s actually a really big, what we call co-benefit that exist when we look at climate change and early children’s development and health in the same space. Because many of the solutions that we all know about that promote early childhood development, healthy development, are also climate promoting policies and programs like access to green space and decreasing air pollution by decreasing fossil fuel combustion. All of these things are really good for children and they’re really good for our climate. There’s a strong financial case that we can make here too, so there’s good research that’s demonstrated that for every dollar we put into decreasing greenhouse gas emissions, for example, we see up to almost at least $6 gained in child related outcomes. So that’s pretty compelling and maybe something we can take out into the field when we have these conversations.
Corey Zimmerman: So much richness there. I really love the like as we think about place matters and then how climate modifies place and why that is such are and see and attention and this idea of co-benefits that there are solutions that are good for the planet and good for helping us reduce the effects as well as are good for children and their outcomes.
So we can spend another hour there. But that’s not what this webinar is for. Okay, let me keep going in questions. Dr. Lightsey-Joseph, this one is for you. This is a theme we’ve been touching on throughout and it’s sort of expanding beyond early childhood. But this one is particularly about how can government agencies and nonprofits reach influential leaders like business to advocate for young children?
Dominique Lightsey-Joseph: So I think this in the same vein as Dr. Burghardt’s presentation earlier, at the time of our start together, I think the key to reaching influential leaders like those in business is to first recognize that there is this intersectionality of children’s lives, and so the environments that they are growing up in are influenced by so many sectors outside of just the early childhood arena. So really anybody, everybody can contribute from their respective domains and it’s going to take that kind of a holistic approach—there’s that term again–to you know, to make this change happen. And I think to answer this question more directly, I might use what we do at the Center as an example. So we have the knowledgebase on early child development as it relates to the brain, and we do the work to turn that scientific information into practical action, and we develop partnerships to engage with leaders–some within ECD and some outside–and we address what we bring to the table to their respective contexts. And then that enables those leaders to go out and advocate for and restructure programs and policies that favor children and families within their own unique contexts.
And so from my perspective, I see advocacy being more about more than just persuading others to act. It’s equally about investing that time into empowering one another to act. And I think the aim of government agencies and nonprofits should be to provide open access to our insights and our resources, develop outreach tactics that are content-specific and relevant. And I think we need to partner with leaders with respect for their unique contexts. And when we approach these leaders, we need to make sure we’re not approaching them merely as benefactors of our resources. They are our partners in doing this important work.
Corey Zimmerman: I love that, there’s so much–like it’s a two way interaction here—like, what do we bring and how do we engage together in this world. There’s so much. I think it connects actually in some ways to this next question that we have. The next question is for you, Dr. Burghardt, and it’s asking about what are possible changes that schools can make? So now coming at it from kind of a different lens and different set of partners. What are possible changes that schools can make to have a positive impact on healthy development? And maybe there are some particular calling out of early care and education centers to within that. But the question asked first about schools.
Lindsey Burghardt: Yeah, it’s a good question and it’s tough because, you know, most schools are already taking on like really substantial, really difficult efforts to meet the basic needs of a lot of students and teachers. So how we think about talking about adding in and layering in things like place-based support in those spaces, I think really has to be done in alignment with the needs and the priorities of people who have been working and are working in that space for a really long time to make schools the health promoting environments that they are. And I think, as in any program or policy domain, it’s really important to call out what Dr. Lightsey-Joseph said, and involving and working with the community who is there and affected and in those schools to understand what the needs are and what their priorities are, whether it’s related to air quality in schools, to high temperatures in classrooms, or to access to clean drinking water. And one resource that I do refer to that I think is useful for some concrete tools is the Environmental Protection Agency has a website they created with Office of Children’s Health Protection and it has really specific recommendations about how to pursue, and different options for pursuing, health promoting environments and specific categories within schools. It even has a list, I think it’s called Top Ten Ways to Make Your Schools Healthier, and it has a really specific breakdown of each item in the list that contains action steps and kind of a guide for how to approach these things that can seem very kind of large and overwhelming to tackle on an individual level. And the list has things like, you know, items that are indoor and outdoor air quality, radon, you know, lead in drinking water and how to approach–if you’re interested–you know, each of these different factors. I think we can also think about on green space the issues that we talked about earlier and thinking about if there’s local context or opportunity to bring green space to children’s learning environments even, and especially the early care and education environments too. You know, we know that there’s benefits to having children access green space. And if they’re able to do that locally in their school environment, I think that’s really potentially powerful.
Corey Zimmerman: Thank you. And I think there’s so many creative solutions out there right now, too, around how to schools and that outdoor learning environments and what they’re being able to do and it’s a great resource. Thanks for sharing about the EPA one. I think we have time, I think for two, maybe three questions we’ll see here. So the next question, Dr. Lightsey-Joseph, is kind of touching a little bit on what we’ve talked about earlier, but how might we use data better to identify neighborhoods for higher investment and what needs are most prevalent so we know where? I’m curious on your thoughts.
Dominique Lightsey-Joseph: One: yes, data critical. It’s a critical role in informing policy decisions and identifying neighborhoods in need for that higher investment. And we’ve been talking about it, as you said, with the COI being one example, which we’ve been discussing. But I want to pick up too on what Dr. Burghardt was saying, in terms of looking at the data on environmental conditions of neighborhoods, I think that has a really rich–it’s a really rich data source that we can tap into as well. And that could include looking at the data on pollution levels, access to green spaces, quality of housing, just to name a few. And we know from these studies, right, that children growing up in these areas with high levels of pollution or limited access to green spaces are more likely to suffer from health related issues like asthma and have lower levels of physical activity. We can also look at access to health resources such as primary care providers, nutritious food options, because those are critical to children’s physical development and overall well-being. And I think there’s also data out there on social determinants of health, such as poverty rates or employment opportunities, that that can also be critical in understanding the challenges faced by neighborhoods. And I think cross-referencing all of these data points on top of one another might be the way that we can identify those neighborhoods that are most in need of investment. A neighborhood that might run low all of those indicators I mentioned would be a prime candidate for some form of or community-based participatory intervention. And I know that’s a mouthful: community-based participatory intervention. But I say that because it goes back to what I said earlier. It’s not just about identifying where these neighborhoods are. Any interventions would need to involve and partner with the communities and the local organizations who are already doing this work to really understand those specific needs and strengths within the context of the neighborhood.
Corey Zimmerman: I love that. So many pieces that are connecting to what we’ve been talking about. I want to draw out–this question’s for you, Dr. Burghardt–and just one particular dimension actually, of what we’ve been talking about, about where there’s inequity and actually and there’s a lot of data. I was wondering if you could talk about–So this is a question that had come in and it was curious about can you address the unequal exposure to air pollution and talk some more about that?
Lindsey Burghardt: Yeah, I think it does. It’s a nice question too. I think it ties together some of the points that Dr. Lightsey-Joseph was just making. I’ll put out there first, you know, we use the term air pollution a lot. Air pollution really means a bunch of different things that are put out into the environment that are harmful for human health and development. But it’s generally a mixture that comes largely from fossil fuel combustion. So we can think about things like cars, busses like manufacturing sites and the amount of air pollution that a child is exposed to depends on where they live. So children who live closer to highways or roadways, closer to transportation depots or near manufacturing or combustion facilities are going to be exposed to higher rates of air pollution than children who live further from these sources. And we’ve discussed throughout the hour that where children live is impacted by historical policies like redlining and modern-day policies that kind of perpetuate where people are able to live and what type of neighborhood opportunity they’re able to access. But in neighborhoods that were previously redlined, and Dr. Lightsey-Joseph explained this very well earlier, there was an inability of the residents who live there to accumulate wealth by getting favorable mortgages or access to high paying jobs. And through that inability to accumulate wealth, they were therefore unable to gain as much political power to oppose the building of things like highways and transportation hubs, manufacturing sites in their neighborhoods. And so many of these air pollution producing factors are more commonly situated in neighborhoods that were previously redlined. And so, as a result, children who live in these areas are exposed to more air pollution than children who live farther from highways, manufacturing sites, transportation terminals. And that translates to a difference in the rates of things like asthma and other diseases that are caused by–or can be influenced by–exposure to air pollution. And we see higher rates of asthma in children who live and previously redlined neighborhoods than children who have access to neighborhoods with lower rates of air pollution. So it’s very clearly influenced by where you live.
Corey Zimmerman: There’s some sobering facts in there, just sort of pieces you were sharing and lots of reactions. All right. So last question. I’m going to squeeze one last one in here. This one’s for you, Dr. Lightsey-Joseph. It’s a question around how do you–how do we think about promoting change and do that in a way that keeps in mind people’s cultural norms, whether those are regional or local, but just thinking about how to promote change while keeping in mind those cultural norms.
Dominique Lightsey-Joseph: That is such an important question, Corey, for so many reasons. I think was sticking out for me is is important is an important question because there are so many well-meaning institutions that do run the risk of perpetuating a savior complex if their solutions aren’t representative of the communities that we’re trying to serve. And so what is being asked speaks to that importance of respect and understanding that change should never mean dismissing the ways people have lived for generations, but rather promoting change should involve working within those cultural frameworks to improve conditions in ways that really do resonate within the community.
And I think for sustainable change we’ve been talking about, you know, throughout our time today, we need to first understand and respect the context of these communities we’re engaging with. And this can be achieved in a number of ways, whether it’s active listening, engaging in learning opportunities of community-building relationships, collaborating with our communities, our members across different events. It’s really about amplifying those voices and insights rather than imposing our own. I think we also need to recognize that there is not a one-size fits-all approach to problem-solving solutions that work in one context or in one neighborhood might not work in another. So we have to really develop these framework targeted strategies that align with the specific realities of a respective community. And then I think the last thing I would say is it’s really about building capacity and empowering communities too, by providing access to the knowledge that we have. So the goal is to make sure we’re respectful of the cultural aspects in these communities while promoting and supporting programs, conditions. And I think to achieve this, our approach has to be rooted in empathy, respect and most importantly, not most importantly, but also very important is partnership.
Corey Zimmerman: What a great note to end on. All right, I’m pulling forward the theme that there are these universal concerns and ways we can use data that really having an approach that’s rooted in empathy and respect and partnership. And with that, thank you. A nd we wish you the best in your continued work supporting children and families.
Thank you for all that you’re doing. I’m really thrilled to be on this journey with you. Thank you.
Tassy Warren: The Brain Architects is a product of the Center on the Developing Child at Harvard University. You can find us at developingchild.harvard.edu, where we will post any resources that were discussed in this episode. You can find us on Twitter @HarvardCenter, Facebook at Center Developing Child, and Instagram @DevelopingChildHarvard. Our music is from freemusicarchive.org.
In April, we hosted a webinar about the recently released IDEAS Impact Framework Toolkit—a free online resource designed to help innovators in the field of early childhood build improved programs and products that are positioned to achieve greater impact in their communities. During the webinar, we provided an overview of the site and had the opportunity to hear from two organizations in the field about how they leveraged the toolkit and its resources to shape their work: Valley Settlement and Raising a Reader. This episode of the Brain Architects podcast features highlights from the webinar. If you’re interested in hearing a full walk through of the toolkit by the Director of our Pediatric Innovation Initiative, Dr. Melanie Berry, please head over to our YouTube channel to view the full webinar recording.
Panelists
Aeshna Badruzzaman, PhD (Moderator) Senior Project Manager for Instructional Design, Center on the Developing Child at Harvard UniversityMelanie Berry, PsyD Director of the Pediatric Innovation Initiative, Center on the Developing Child at Harvard UniversitySally Boughton, MNM Director of Development & Communications at Valley SettlementAndres Garcia Lopez, EdM, MBA Senior Project Manager, Center on the Developing Child at Harvard UniversityKarla Reyes Program Manager of El Busesito Mobile Preschool Program at Valley SettlementMichelle Sioson Hyman Senior Vice President, Programs and Partnerships at Raising a ReaderCorey Zimmerman, EdM (Podcast Host) Chief Program Officer, Center on the Developing Child at Harvard University
Corey Zimmerman: Welcome to the Brain Architects, a podcast from the Center on the Developing Child at Harvard University. I’m Corey Zimmerman, the Center’s Chief Program Officer. Our Center believes that advances in the science of child development provide a powerful source of new ideas that can improve outcomes for children and their caregivers. By sharing the latest science from the field, we hope to help you make that science actionable, and apply it in your work in ways that can increase your impact.
With that goal in mind, the Center recently released the IDEAS Impact Framework Toolkit—a free online resource designed to help innovators in the field of early childhood build improved programs and products that are positioned to achieve greater impact in their communities. The Toolkit is self-guided, self-paced, and provides a structured and flexible approach that facilitates program development, evaluation, and fast-cycle iteration, including resources to help teams develop and investigate a clear and precise Theory of Change.
In April, we hosted a webinar about the toolkit, where we provided an overview of the site and had the opportunity to hear from teams at several organizations in the field about how they leveraged the toolkit and its resources to shape their work. We’re excited to share those discussions with you here on this episode of the Brain Architects podcast. If you’re interested in hearing a full walk through of the toolkit, by the Director of our Pediatric Innovation Initiative, Dr. Melanie Berry, please head over to our YouTube channel to view the full webinar recording. You’ll also hear from Dr. Melanie Berry during the Q&A portion.
The full IDEAS toolkit we’ll be talking about today can be found at ideas.developingchild.harvard.edu. And now, without further ado, here’s Dr. Aeshna Badruzzaman, the Center’s Senior Project Manager for Instructional Design and the moderator for our panel discussion.
Aeshna Badruzzaman: Hello, everyone. Welcome. My name is Dr. Aeshna Badruzzaman. I am a Senior Project Manager for Instructional Design at the Center on the Developing Child at Harvard University or HCDC, and I’m part of the development team of the IDEAS Impact Framework Toolkit. And today, I’ll be your host. So, you may hear me come off mute, and help guide presenters, and I’ll be facilitating our question and answer period. So, we are so pleased to be talking to you today about this resource. The IDEAS Impact Framework was born out of more than a decade of the Frontiers of Innovation Initiative or FOI. And some of you may have been partners in that effort. So, while our team no longer offers live training on the framework, we are so excited to be introducing it to you as a free open access resource. And we really hope that this format is going to help make IDEAS accessible to innovators in the field of early childhood development moving forward. The framework was developed in partnership with the University of Washington College of Education, and the University of Oregon Center for Translational Neuroscience. With support from the Gates Foundation, The Lego Foundation, Porticus and the Hemera Foundation. I encourage you to check out our history and acknowledgments page of the toolkit for more information about our various collaborations and supporters throughout time as well.
Now I’ll go ahead and introduce our first set of speakers from folks at Valley Settlement. We have with us Karla Reyes, who is the program manager of the El Busesito mobile preschool program at Valley Settlement, which is a nonprofit that works to create opportunities for the Latino community in the Aspen to Parachute region of Colorado. Karla joined Valley Settlement in March 2015, as a preschool teacher for El Busesito until June 2021 when she took on a leadership role. And we also have Sally Boughton who is the Director of Development and Communications at Valley Settlement, a nonprofit again, serving the rural Aspen to Parachute region Colorado with six to generation programs designed by and for local Latina immigrant families. And Sally has been with Valley Settlement for over five years and began managing the organization’s evaluation function in 2021. Thank you so much Karla and Sally look forward to hearing from you.
Karla Reyes: Good afternoon, everyone. Thank you for inviting us to share our work with you all and how we have used the framework. I’m going to talk a little bit about it, we’ll see the program and how I kind of started. The idea that it will succeed though began in 2011. We had two bilingual and bicultural community organizers, who met one on one with about 300 families from the Aspen to Parachute region of Colorado. And they learned about their lives and the barriers that they faced within our community. One of the findings from the initial listening tour was that only 1% of Latino children in our community were enrolled in preschool. We also learned that three of the biggest barriers for families to participate in preschool programs were language, cost and transportation resulting in lack of access. Now we have all this information. And we started thinking creatively of different ways that we could bring more access to preschool education to our community. I have also seen those one of the first two generation programs that we launched in Valley Settlement to address the needs of preschool education. And throughout the years Valley Settlement has continued to learn, evolve and co-design programming to respond to community needs. Now, our program has four mobile preschool buses that have been retrofitted into small preschool classrooms. We have two teachers on the bus, and we serve eight children at a time, we provide families with about five to 10 hours of free preschool education. We have about 96 children that we serve annually between 40 to 50 children graduating at the end of the school year and moving on to kindergarten. And currently right now we serve different five different neighborhoods within our community. And we strive to build close relationships with families. So, our program really is designed to meet families at where they are, are at and start breaking down those barriers. We host family nights; we have home visits with our families. We have parent teacher conferences; we have different ways that families can volunteer within our program. We provide a lot of materials for families to use that home so that they can do home activities and homework packets with their students. And we really try to engage with the families. So, each one of our teachers speak Spanish, is bilingual and bicultural. So, this really allows that bond and that relationship to build with each one of our families. I’m going to hand it off to Sally Boughton, and she’s going to talk a little bit more about how we’ve used the framework.
Sally Boughton: Thanks, Karla. So, several years ago, we started working with the team at Frontiers of Innovation to refine and evolve our evaluation practices. This work included creating theories of change for each of our programs, researching and recommending observational assessments to measure participant progress towards our program targets and outcomes, and creating implementation guides for our programs to detail the critical components of our work and ensure that future staff can implement programs with fidelity, while still continuing to listen to and evolve alongside families. Since the early days of our programming, Valley Settlement has invested in evaluation to measure understand and strengthen the changes that children and families create in their lives through our programming. Working with the team at FOI really brought this to the next level. Over the last few years, we’ve been working to be more inclusive and participatory in our evaluation process. So now our entire staff gathers for three days every summer, in what I call an evaluation retreat, where we review our annual program data as a team and then try to answer those questions ¿qué? ¿por qué? ¿Y ahora qué? or as the toolkit outlines: What does the data say? Why? Why might the data say this? Or what does that mean? And finally, now what do we do to tweak or change in our evaluation approach or in our programming, based on what we see in the data? Our teams then create action plans to outline those changes that they want to make. We’re usually tweaking one or more program components for the upcoming year. On day two of the retreat, teams then go in and refine and evolve their theories of change. So, we really see that theory of change as a living document that breathes and grows alongside our programming. They identify what targets and outcomes they’re interested in measuring for the coming program year. And then after that evaluation retreat, we work together with our evaluation consultant to refine our measurement tools. And then I always try to call out and highlight that I am in the minority of Valley Settlements. Our staff are largely of the community that we work with. Most of our staff are immigrants or children of immigrants, many have grown up in this community, or immigrated to the community as adults with young children. And so, they have those shared lived experiences with the participants in our programs. And many of our staff have actually been former participants in our programs. Having the entire team participate in this process is incredibly valuable. It really places the experts in the work our staff in the evaluator seat, and we gained so much more by having that inclusive, participatory process. And we’re really so grateful to have our work shared in the online toolkit because, you know, I am not an expert in the IDEAS framework by any means. And that’s kind of the whole point is that it’s very usable, you can go in, you can click through this toolkit, you can see how it all is structured and works. And it just makes for a really kind of manageable, useful process that you can engage in. Thanks so much.
Aeshna: Thank you, Karla, and Sally, really appreciate you taking the time to share your experiences with us. Now we’ll hear from folks from Raising a Reader. So Raising A Reader supports families to build, practice and grow reading routines at home. Their award-winning evidence-based program helps caring adults set their children up for success by creating shared reading routines, fostering social emotional learning, healthy family relationships and learning skills needed to thrive in school and beyond. And first, we’ll hear from Michelle Sioson Hyman, who is Senior Vice President, program and partnerships. And in her role, Michelle is responsible for overseeing program development, growth and impact. And then we’ll hear from Andres Garcia Lopez, who is a Senior Project Manager at the Center on the Developing Child. And in his role, he’s coached many early childhood development entrepreneurs, including Raising a Reader in developing strategies to maintain their science-based impact, while scaling their ventures. Welcome Michelle and Andreas.
Michelle Sioson Hyman: Thank you so much for having me. I’ll start with a brief overview of Raising a Reader and how we’ve used the framework and then fundraising, engaging some conversation. So Raising a Reader is a national family engagement and early literacy organization through our network of affiliates and partners across 34 states and both rural and urban communities. We engage and support parents and the other caring adults in children’s lives help strengthen the bonds with their children, while building critical early reading and social emotional skills. So along with our award winning multicultural and multilingual book collection, we provide easy to use materials and guides that are really designed to make the most of that shared reading time in the home. So our work really does begin though, with partnering with local agencies who become members of our affiliate network, a community of practice in which we can share best practices and build connections. And we provide professional development, technical assistance and capacity building support to this network of affiliates and partners, who really work across the intersection of systems, supporting children and families at the various points throughout their educational and developmental journey. So that’s, you know, in ECD, K, 12, Health and Human Services. And we’re really able to meet families in the spaces and places where they are involved in how the framework has really impacted our work was that we were introduced to Andres. And the framework is a really critical inflection point in our history. So we’re over 23 years old and Raising a Reader had 39 independent evaluation that prove the success of our Classic Red Bookbag Program and its impact on improving and sustaining home literacy environments. But one thing that we realized through our work with Andres was that there were critical aspects to our work that we weren’t capturing in our theory of change. And just maybe I’ll stop there, and then we can chat. Does that work?
Andres Garcia Lopez: Sounds good. That works. Michelle. Thanks so much for that overview. And I’m so excited to be part of this panel, and it’s an honor to share it with you, Michelle, and with the Valley Settlement team. So I’ll just add a few things. I was working with Michelle as part of a fellowship that the Center partners with the Promise Venture Studio. And as was mentioned before, the theory of change on the IDEAS framework really helps you think about what are the key ingredients that my organization in my program works on or provides to families and
or maybe two partners that get to the targets that that move the needle towards my outcomes. One thing that was different about Raising a Reader was that they weren’t with partners. So I wanted to mention that sometimes the IDEAS framework can be, and the theory of change could be flexible, and adaptable to meet your needs. Originally, there are three columns in the theory of change. But we’re working with Michelle, we thought we should have an extra column because they wanted to look at how working with partners and affiliate organizations, what their strategy is that was doing racing, a reader was getting into the targets in partners and affiliates and how that was getting to the outcomes with families. And that was a key component on identifying precisely the actions that get to the targets and the outcomes. And I’ll pause there so that Michelle can share more about the specifics of what some of those strategies were and how that helped the organization.
Michelle: Thanks, Andres. Yeah, so one of the things including that additional column that Andres was talking about, it really helped us think through, how are we really building that educator capacity? And how are we really providing professional development around early childhood development. And another aspect to it is that we knew we did it all the time. And we had stories about how we did it all the time. But using the theory of change, the framework to really make it much more precise, is really helping us think through how we are doing it. And so, it also helped us think about how our program is impacting early relational health through strengthening healthy family bonds. And so, it really has made us to be better poised to effectively test and evaluate how we are doing this work and what isn’t what is not working.
Andres: Thank you, Michelle. And one comment that I add, as we have about 90% of the participants that are now in the webinar are new to the to the framework, sometimes you may use the framework as a program developer, or somebody who’s implementing a program like your shell, but you could also use it to help other organizations like the way I have used it as part of the center in the developing child, or as promised venture studio has also used it with social entrepreneurs in their organization, the framework is really helpful in helping you think through your impact strategy. I mentioned a brief comment, if you’re familiar with other frameworks that innovators use, like the lean startup or business model canvas or other ones, it these helps you think through in a very clear way, in a simplified way, what are your strategies and how I am I get into the outcomes. And because of its it’s simple, and it can fit in one page, it also facilitates communication, communicating internally and externally, with the families you work with, with their funders, potential funders and with potential partners. But I’ll pause there.
Michelle: One more thing I just wanted to add about the framework is how it really helped us think about our innovations and new programming to into our theory of change and help facilitate that fast cycle iteration. Because it’s over the last few years, we’ve developed to new programs and explored how we were success and exploring how we can integrate technology into our programming. And we didn’t have that we didn’t have that in our previous theory of change. And so being able to build that into a using the framework to build that into our theory of change, thinking about the evaluation, how do we get that feedback loop? It was really beneficial and helpful for us as we’re continuing to innovate and develop new programs to
Andres: Thank you, Michelle.
Aeshna: Thank you so much for sharing your experiences. And we’re going to go ahead and pull some questions from the chat. And we will start with kind of a somewhat broad question. And that came from Aaron Soto. Is that are there any prerequisites for an organization to implement the ideas framework? And it was Melanie, you might want to speak to this?
Melanie Berry: Sure. I would say there aren’t necessarily any standard prerequisites. But I do think having worked with a lot of different organizations around this framework, there are some conditions that set you up to be more or less successful or effective using the framework. One thing I would say is it’s important to have all the right people at the table. So, I mentioned that one of the principles of the framework is co creation and this idea that, you know, bringing together a group of people who have multiple perspectives on the program can be really valuable and that might include leadership, people who are responsible for developing or implementing the program, people who will lead on the evaluation or research efforts, but equally, importantly, you might invite people to contribute who have a role in actually delivering the service working directly with kids, families and caregivers. And better yet invite a representative from the community that you serve to be part of this process. So that’s the first piece is just having the right people at the table. And then the second thing I would say is timing can be important. So this framework is really designed to help you prepare for a fast cycle iteration process. So to prepare for a round of collecting data, reviewing that data, interpreting and analyzing it and making sense of it, and putting what you learn into practice. So the timing there can be important, you know, are you set up and prepared to actually put this plan into action? Do you have the resources you need? Is everyone bought in? Etc? Yeah, and having the authority to put what you learn into practice. So if you’re implementing a program that was developed by someone else, do you have sort of the leeway to make changes to how you’re implementing that program based on what you learned? Or are there kind of more strict parameters around how you implement that program?
Aeshna: Thanks, Melanie. The next question we have came from Nicolas, and it says a question for Miss Reyes from El Busesito. Were there any outcomes or benefits that happened unexpectedly from developing this program? i.e. unintended consequences that happened, which you did not expect, yet?
Karla: Yes. So there, it’s that’s definitely been a learning curve, we’ve definitely had to modify and just evolve the program. One of the biggest changes that we’ve made just recently is changing the program from a five-hour week model, where children receive two and a half hours of preschool twice a week, to offering five hours of preschool twice a week. So in total, they’re receiving 10 hours a week. And this really came from listening and taking the time to listen to parents and hear what their needs were, for years, or parents had been asking for more time on the bus, we’re really trying to make an impact on how many children we served. And like I said, we have, we have the capacity to serve 96 children in our valley. So that’s 96 children that otherwise wouldn’t be receiving preschool, you know, in a traditional preschool setting. And we’ve noticed recently, we’ve had a decrease in our enrollment. So it’s been a little bit harder to enroll children into our shorter classes. And I think that has now impacted our school district and our other centers that have grown their capacity in their centers, which was the ultimate goal to get more children into preschool and enrolled. So we’ve now looked at how we can because we’re mobile, we can now take our program and start serving communities that don’t have that access. So it’s, it’s been playing out lately, that we’ve noticed these trends.
Aeshna: Thank you. And actually, I just realized that this question is, the way it got segmented in the question answer section, I didn’t realize that the Nicholas who asked the question has the same question for folks at Raising a Reader. So were there any outcomes or benefits that happened unexpectedly from developing the program?
Michelle: Sure. So I’ll say that we have had 39 independent evaluation that showed, then we knew that Raising Reader helped improve home literacy environments, and which is like increased shared reading time, increased duration, and frequency, improve the number of books in the home. But one thing that we were hearing from folks was, oh, well, it’s helping me build confidence and supporting my child’s early learning in the home. It’s really providing a sense of comfort and support for our families, this daily really reading routine. And so creating a new theory of change, with coaching support from Andres, to really make a much more precise, we were able to build those kinds of things into our theory of change, which then led us to improving our measurement tools, so asking specific questions so that we could actually get some more data around, While their stories are great,it’s also helpful to have our surveys also reflect some of that more quantitatively as well.
Aeshna: Thank you, Michelle. And we have one question here. This asks if someone could speak to how this theory of change framework can inform logic model use and development, ensuring that the information is complimentary and not duplicative for programs who choose to create both types of resources.
Melanie: I’m happy to field that; I get asked that question a lot. From what I understand. Those two terms theory of change and logic model are often used actually interchangeably in the field. And there really isn’t solid consensus on how the two are similar and different. The best guidance on that that I’ve found is that logic models tend to be more standardized, they often include inputs, activities, outputs, and then short term and long-term outcomes are variations on that theme. And they’re really, their descriptive theories of change, are a bit less standardized. So if you Google the term theory of change, you’ll find many, many, many different approaches to theory of change. But in general, they’re intended to be causal models that really explain how and why the expected changes come about. That’s one way of thinking about that, then logic models are more descriptive and theories of change are really intended to be explanatory causal models. Honestly, in practice, I find that they’re, you know, when someone asks you for a logic model or a theory of change, you really have to follow up to ask what they mean, specifically what they’re looking for there. Because I think expectations vary widely. Our approach to theory of change is really, it zooms in on the point of service delivery, or the point of contact with kids, families, caregivers, and follows that through to the ultimate outcomes that you’re hoping to see, which are typically child level in the field of early childhood. And it can be really helpful to set you up to make a plan for gathering data to better understand whether you’re having the impact that you’re hoping to achieve. I hope that’s helpful. Sally, do you want to add to that?
Sally: Yeah, so I actually have a real-life example of how we’ve used both at the same time. So we recently worked with the team at Mathematica to create a Two Gen logic model, they did a project with different to join organizations across the country. And so we have been using theories of change for years in our programs and our six different programs to really identify, you know, what is the what are our strategies? What are the targets? What are the outcomes we’re trying to have in each of our programs, so it’s kind of granular, and then we worked with the team at Mathematica to create this, like, what is our whole organization do? And what is the whole change we’re trying to make in the community in in children and families. And so having that overarching logic model, that our theories of change then kind of feed up into, you can see how they, how they interact, how they’re incorporated in that larger logic model has been just really interesting, but we’re not duplicating. So we don’t have like a logic model and a theory of change for each of our programs.
Aeshna: Does anybody else want to speak to that before I move to the next question? Okay. So we have a question here from Eric Marlowe and asks, In your experience, I think this could be open to anyone here. How long are the typical iteration cycles? How long do you recommend evaluating and adapting elements of a given program so that changes are made neither too soon? nor too late?
Melanie: I can take a first pass that then I’d be curious to hear from our colleagues at Raising a Reader and Valley Settlement, if I understood correctly. So that was the question. Like, how often or how long does it take? Or maybe a little bit of both?
Aeshna: My interpretation was a little bit of both.
Melanie: Okay. I think so the way this question gets asked to us often is how fast is fast cycle? Like, are we talking something you can do in days, weeks, months, years? And the answer there, I think is unfortunately, it depends. It really depends on the nature of the program, or service or product that you’re looking to evaluate and improve. If it’s, let’s say, a 10 week parenting group, then a single cycle could take, you know, you’d want a couple of months to plan and prepare, to identify to develop your theory of change to identify your questions to figure out your study design, figure out the tools you want to use prepare for data collection, then obviously, you need the 10 weeks to go by where you’re actually delivering the program to kids and families. And then you’ll need some time afterwards to analyze interpret and make sense of that data.
But that timeframe is obviously going to be really different if it’s a program that’s implemented on a school year calendar, for instance, or if you develop something like an app or a website that families can engage with, as they choose, and maybe dosage and engagement looks really different from parents or parents. So there’s no right answer for how long a cycle can take, you really just need to be thoughtful about what you’re hoping to learn. And then in terms of how often, I think that really varies, again, from organization to organization, and what the appetite and bandwidth is to engage in this kind of iterative learning. I know that valley settlement, for instance, has really built this into your kind of culture and your routines as an organization. And it seems like you’ve developed a really nice kind of annual rhythm. So maybe I could pass the baton to Sally and, Karla, to talk more about that.
Sally: Yeah, so as you say, Melanie, we really do our evaluation on an annual basis. So we most of our programs happen during the school year. We do pre and post surveys, we also do pre mid and post TS GOLD assessments for Busesito preschool. And then we really we do the bulk of data analysis in June and July. And then every July, we gather and do that evaluation retreat with our entire team. And then in August, we’re kind of refining our evaluation and planning the next evaluation cycle. But what I will say is that when we’re piloting new initiatives, we are trying to be a little more like eyes on as the as the initiative is happening. So for example, we worked a few years ago to implement a Child Development Associate course, for family, friends and neighbors, providers, and also for high school students who are Spanish speaking. And we were we were doing little pre and post assessments throughout at the beginning and end of kind of each section of the quarter module. Just to understand like, was our approach working? How could we pivot and adjust. So as we’re piloting new things, we do try to be a little more rapid, if you will, I would just echo the same thing that we do have an annual, like an annual cycle, I guess, where we do an annual evaluation, annual check in with our affiliates is what we call it. And then we do have a couple of pilots right now where we are calling them mini learning phases. After each learning phase, then we’ll take a look at the feedback and then see what tweaks or what modifications we need to do to improve the program. And then we have our second learning phase, and things like that.
Aeshna: A quick follow up from Nicolas to this question was so does that mean that the theory of change is different with each iteration?
Sally: So we definitely like we can evolve our theory of change every year, we go in as a team and look at the strategies and say like, you know, are you are you still doing these things? How are you doing them? You know, we definitely change and evolve in our programming, we’re not doing the same thing every year, because programs, neighborhoods, communities change and evolve. And we learn new things every year. So we do go in and tweak our theory of change every year.
Michelle: And I’ll say we just revised ours so we haven’t changed it. But one thing I think it is helping us think about though, as we are developing our program, how to stay focused on what it is that we really want to do. Because there are so many needs, and we serve so many different communities that have different needs. How do we stay true to this theory of change that for our mission, and things like that, so it really helps us identify are clearly like, where is our most unique impact and helps us stay there and not kind of stray just because there might be a funding source over there or something like that.
Melanie: I’ll just add that. It’s a great question. And it gives us the chance to underscore that. Absolutely. A Theory of Change can and should evolve over time, as you learn. So we call them living documents, right? It’s not a one-time exercise that you do, and you make a PDF of it. And it’s done. It’s a living document that you come back to after every round of learning. And you say, you know, what did we learn? How can we refine our theory of change? How can we refine our actual program or product or service? And how could we refine how we’re gathering data and learning going forward?
Aeshna: Thank you. So now we have a question from Megan Crystal, asking if we have any examples if we know of any state level policy or programs that have used this framework.
Melanie: I have a couple that come to mind. So a while back as part of the Frontiers of Innovation Initiative that Aeshna mentioned, there was a project team who implemented a video coaching program to support childcare and early learning professionals. And that project was done in partnership with the State Department of Early Learning. And this framework was used to sort of articulate theory of change for that approach, and to actually work with partners at the University of Washington to craft the evaluation plan. So that’s one example. And then another more recent example that comes to mind is our Center worked with partners at the Massachusetts Department of Early Education and Care to create an initiative wide theory of change, actually, similarly for an effort underway to bring early care and support organizations to build the capacity of actually childcare directors across the state. So we worked with them to create an initiative wide theory of change. And then each organization who was providing that service, use that initiative, wide theory of change as a template and kind of tailored it for their particular approach. And I think that’s still being used right now, as the initiative continues to kind of facilitate learning and improvement over time. There might be other examples, but those are two that come to mind.
Aeshna: Thanks, Melanie. Does anybody else-
Melanie: Can I squeeze in one more just in case folks are looking for examples. We worked with an organization called TOPS, which is based in the Netherlands. And they provide if I’m remembering correctly, services to families with newborn children. And I think that’s actually like a nationwide program that’s used ideas to drive towards greater impact. And there are resources or references about the tops program in the resources section of the toolkit. I think there’s a research article there that talks about their experience.
Aeshna: Alright. Great. Thanks, everyone. I was hoping we might have time for one more question, but actually see that we’re pretty close to the end there. So I just wanted to thank you all for joining us. thank our panelists for sharing your experiences and your learning, we really appreciate it. And thank you all so much for joining, we really, really hope that this resource is useful for you all, and we wish you the best in your continued work, supporting kids and families.
Corey: The Brain Architects is a product of the Center on the Developing Child at Harvard University. You can find us at developingchild.harvard.edu, where we’ll post any resources that were discussed in this episode. We’re also on Twitter @HarvardCenter, Facebook at Center Developing Child, and Instagram @DevelopingChildHarvard. Our music is Brain Power by Mela from freemusicarchive.org.
These days, resilience is needed more than ever, and one simple, underrecognized way of supporting healthy and resilient child development is as old as humanity itself: play. Far from frivolous, play contributes to sturdy brain architecture, the foundations of lifelong health, and the building blocks of resilience, yet its importance is often overlooked. In this podcast, Dr. Jack Shonkoff explains the role of play in supporting resilience and five experts share their ideas and personal stories about applying the science of play in homes, communities, and crisis environments around the world.
Panelists
Andres Bustamante, Assistant Professor, University of California Irvine School of EducationLaura Huerta Migus, Deputy Director, Office of Museum Services at Institute for Museum and Library ServicesLynneth Solis, Researcher and lecturer at the Harvard Graduate School of EducationErum Mariam, Executive Director, BRAC Institute of Educational Development, BRAC UniversityMichael Yogman, Pediatrician, Harvard Medical School, Cambridge Hospital
Sally Pfitzer, host: Welcome to the Brain Architects, a podcast from the Center on the Developing Child at Harvard University. I’m your host, Sally Pfitzer. Our Center believes that advances in science can provide a powerful source of new ideas that can improve outcomes for children and families. We want to help you apply the science of early childhood development to your everyday interactions with children and take what you’re hearing from our experts and panels and apply it to your everyday work.
So in today’s episode, we’re going to get serious about the topic of play. For children, play is a fundamental building block of child development, but its role in supporting resilience is often overlooked. And after the past few years, we surely need resilience now more than ever! For me, as a former preschool teacher, I’m especially excited about this episode and speaking with today’s experts, because I’ve seen first-hand how important play is for young children’s development. But what can science tell us about it? And what can be done to support more play in everyday life, even in crisis contexts? In this podcast, we’ll dive into the science of play and resilience, and then we’ll explore how people are using that knowledge to support child development around the world. To explain the science, we’ll start with Dr. Jack Shonkoff, Professor of Child Health and Development and the Director of the Center on the Developing Child at Harvard University. So Jack, what do we mean by resilience and what do we know about how people develop it?
Jack Shonkoff: What we mean by resilience is that we’re talking about the ability to do well, the ability to cope, the ability to overcome hardship, or adversity, or threat to your well-being. So the key about resilience is it doesn’t occur in a vacuum.
Resilience is something that you actively build, and you build it in the context of relationships in an environment that helps you learn how to cope with challenges, cope with stress, cope with hardships. And it starts very early. It starts in infancy. And infants need to have some sense of participation in that.
But also, you don’t do it totally on your own. You need the support and the security, when you’re a baby, of adults who basically help provide a manageable environment in which you can learn resilience. So, if stresses and threats are overwhelming, they can overwhelm the system. And you don’t really get a chance to build resilience. If every time something happens that challenges you, somebody jumps in to protect you, that’s not good for you either because you have to build that yourself.
So the environment has a lot to do with how you develop resilience and skills, but so does your own activity on the environment, your own sense of being a player rather than just a receiver.
But no two children are the same, even children in the same family, growing up in the same environment. From birth, children differ in how adaptable they are. If you go into a newborn nursery in a hospital, the nurses who work there can tell you about how those babies are all different from each other. Some kids are just more easygoing, constitutionally. Some kids roll with the flow, a little bit easier than others. So in a sense, we don’t all start off with the same way of reacting to stress or hardship.
Sally: That’s great. And thinking about how resilience is built, are there specific building blocks that you need to think about? In this case, could you talk a little bit more about how play might support those building blocks?
Jack: Play, by definition, is an interactive process or a kind of self-directed process. It’s not by chance that all children, regardless of where they live in the history of the species, use play as a way to develop skills. It’s the way children learn to master their environment. And they learn to try things out. They test things. They test limits. It’s driven by curiosity, and it’s driven by an inborn drive to master the environment.
And if you think about what resilience is all about, resilience is mastering your environment. It’s building the skills to be able to cope, building the skills to have strategies, to deal with your own reactions, be able to have some control over what’s going on around you. And none of that would develop as well as it does if you depended on just being taught how to be resilient. No. Your ability, your natural ability to play, is one of the most important strategies that we have developmentally to build resilience in the face of adversity.
Sally: So, what is the science that underlines this connection between healthy development and how play supports it?
Jack: God, there are mountains of science that help us to understand the process of development. And three principles, three concepts, just continue to stand out among all of the research, evidence, and knowledge we have about development. And they are the keys to healthy development.
The first is the importance of supportive relationships. Children develop in an environment of relationships. So, supportive relationships are critically important for healthy development. The second is the need to reduce significant sources of stress—not eliminate stress, but reduce stress, so it’s manageable. And then the third is building core skills, the kinds of skills that are needed for just about anything that we’re expected to do at any point in our life. So these are the core skills that are the building blocks of learning, and behavior, and good health.
And if we put those three things together—supportive relationships, reducing sources of stress, and building core skills—they are essential for us to understand not only how resilience develops over time, but also what an important role play occupies in that process. Particularly in a young child, there is this sense of trying to figure out what the world is all about. So core skill development, which is essential for building resilience, is very much tied into the ability to learn actively through play and through interaction with others.
There has been so much research done on resilience in a variety of circumstances, trying to understand what is it that explains how some children overcome adversity and do well in spite of hardship and threats. The one thing that comes out in just about every single study is whenever there’s evidence of resilience, you can always identify at least one very important relationship that was critical to the development of resilience. Very often, it’s a parent. It doesn’t have to be a parent. It can be another member of the family. It doesn’t have to be a family member. It could be a neighbor. It could be a preschool teacher. It could be a child care provider. It could be a coach. It doesn’t really matter who it is. It certainly doesn’t have to be a blood relative, but there has to be at least one relationship that basically provides a scaffold in which children develop the skills to be able to cope themselves.
That’s the ultimate answer to the question of, can you build your own resilience? The answer is for all the studies that have ever been done, no, you can’t. You can’t become resilient yourself. You can’t will yourself to be resilient. You have to be able to be supported by at least one nurturing relationship.
If we look across the incredible range of experiences and conditions that children grow up in, the principles remain the same. Children are all busy actively mastering their environment, regardless of what that environment is. The challenge is to understand what’s individually different about each child and what is the nature of the environment in which the child is living. And everything else is just figuring that out based on basic principles of what science tells us about development.
Sally: So Jack, you spoke earlier about how play helps build resilience. I’m wondering if you could you give us an example of what that might look like at different ages—for example, what would it look like for an infant?
Jack: What play is about is early on, beginning in the earliest of infancy, really, shortly after birth, is if you think about what babies do, and once babies become attuned to the people who are caring for them, it’s the kind of thing that gets everybody all excited—the eye contact, the beginning of a smile, the cooing, and the vocalizations, and all that stuff that elicits back and forth, serve and return interaction between very young infants and adults. The vocalizing back and forth, the smiling, the looking around and then looking at the same thing, and then handing something, and grabbing it, and giving it back. And, all of those very simple interactions early on are playful interactions.
And then, as you move out of the very earliest of infancy and get into the second half of the first year, when babies become more mobile, and they’re rolling over, and then they’re crawling, being able to reach for things, and grab things. You find the right balance between allowing the child some room to do things in a protected environment and also initiating some things with you. So you initiate interactions. You respond to interactions. You let a child move around. You put stuff out on the floor for a child to play with. And sometimes, hopefully, you leave the child alone in a safe place and let the child explore.
All of this, a lot of people may not think of that as play. They may think of play as more organized kinds of activities. But that is the beginning of play. It’s the beginning of active learning, discovery, curiosity, trying things, learning from what happens when you do something, action and reaction, all that stuff. And then, as you get older and you start to play more organized games, play peekaboo, play Simon Says with a child that’s a little bit older, play all these kinds of games that have rules attached to them, rules about taking turns, rules about following instructions, all of this, board games as kids get older, and then as they get into the school age years, organized games, sports, more challenging board games, again, now most people would say, oh, yeah, that’s like play. That’s what play is all about. But it started much earlier, and it started with the foundation that was all about discovery, creativity, exploration, learning.
In the best of all worlds, play doesn’t end until you die, because play is a way of thinking and engaging with the world. Play is one of the most important vehicles for having some sense of mastery and control over the world that you live in, which is getting us very close to the definition of what resilience is all about. It’s not being able to just deal with predictable things that you’re expecting and you’re prepared to cope with, but being able to deal with anything that life sends your way.
Sally: Could you talk a little bit more about how play might actually support health? What are we learning from our current research?
Jack: This is a really important question and a really important expansion of how we think about play. It’s easy to understand that most of the conversation and most of the thinking about play for the last, let’s say, last 20 years as we’ve been learning more and more about the science of early development is it naturally connects to learning and behavior. It was very brain-focused.
But it’s not just the brain that’s developing. It’s the immune system and metabolic systems. Just like the brain is experience-dependent, the immune system is experience-dependent. It’s learning about different bacteria and viruses that are out there and it’s exposed to. And as a result of that, the immune system is building resistance to those infections early on and preparing you for better physical health. And the same thing with metabolic systems. A well-regulated environment every day is affecting all of these systems. And a dysregulated environment or a highly stressed environment, as it affects the immune system, can cause increased inflammation, which is part of the stress response.
And early behavioral regulation, it leads to more health-promoting adult behaviors, less likely to engage in risk-taking behaviors, less likely to engage in addictive behaviors, problems with smoking, problems with alcohol, problems with risky physical activities that get you into trouble.
So the link with play—there’s no question that somewhere down the road over the next 10 to 20 years, we will all have an understanding that playful learning and the role of play in building resilience is as much about physical and mental health as it is about early learning and school achievement.
Sally: You’ve given us so much to think about, as always, Jack! Thanks so much for your time and being here with us today. When we come back, our panel is going to give us some examples of how they’re putting that science into action.
Musical interlude
Sally: Okay, so we’ve learned a bit about how play affects our biology. Let’s bring it out of the lab now, and into our daily lives. Most of us think about play happening in child care and on playgrounds, but play can honestly happen anywhere! In our next segment, I’m so excited to talk to our panel members, who have lots of examples to share. Joining us on today’s podcast, we have Andres Bustamante, who is an assistant professor in human development in context at the University of California Irvine. Thanks for being here today.
Andres Bustamente: Thank you, Sally. It’s such a pleasure to be here.
Sally: Also on today’s podcast, we have Lynneth Solis, who’s a researcher and lecturer at the Harvard Graduate School of Education. It’s so nice to talk to you today, Lynneth.
Lynneth Solis: Thank you, Sally. It’s a pleasure to be here.
Sally: And also on today’s podcast, we have Laura Huerta Migus, who is the deputy director of the Office of Museum Services at the Institute of Museum and Library Services. Nice to see you today.
Laura Huerta Migus: So happy to be here, Sally.
Sally: Lynneth, I know you’ve looked at research on play and how it helps to build resilience in a lot of different places and contexts. How might opportunities for play look different in some of these different contexts?
Lynneth: The interesting thing is that we see play supporting children’s coping with stress and developing resilience in all kinds of contexts. So you may find it in a simple drop-off at preschool. So that can be really stressful for a child. What we have seen is that children that are allowed a few minutes between drop-off and the start of the day to play on their own or with peers, depending on their choice, actually show reduced levels of stress, both behaviorally and biologically.
But we also can think about other settings with children being exposed to prolonged adversity, like war or being in a refugee setting, where having the opportunity to play, for example, in play groups with caregivers or with other children gives the children an opportunity to create bonds with their caregivers and with other children. And it gives them opportunities to practice some of the coping skills to deal with the difficult emotions and effects of prolonged stress.
We’ve also seen it in situations where children have hospital stays or hospital interventions, which, again, can be very foreign for children, can be very stress-producing. And when health care staff use play to introduce to children what the procedures might be, to give them some space between the introduction of these procedures and the actual medical intervention, what we see is that children show reduced levels of stress prior to the medical intervention but also post the medical intervention.
So their ability to reduce the stress after coming out of that experience also seems to allow them to regulate their stress levels more quickly and more effectively. And so what we see is that both cross-culturally but also in different types of settings, play can be very beneficial for children and for the adults and caregivers in their lives.
Sally: That was the perfect tee-up, Lynneth. Thank you. Laura, what are some examples you’ve seen that encourage play that were created by museums and libraries? I think that’s a really interesting place to be thinking about how play is happening.
Laura: Yeah. Thanks for that, Sally. So it actually builds quite a lot on what Lynneth was telling us about the evidence. So the practice of children’s libraries and children’s areas being interactive, sometimes looking like mini children’s museums for example, having “making spaces” or craft spaces is a relatively new pursuit that is now pretty mainstream practice in library design.
You’ll see the same in museums. Obviously, we have children’s galleries. We have children’s programming, even children’s tours in mainstream museums. And, of course, we take it to the extreme in museums. We actually have children’s museums, right, the entire museum that’s designed with the child’s needs and development in mind.
We also think about playful experiences, like story times. And story times that are starting for the youngest families and the youngest children to help build that sense of playfulness but also helping parents build great relationships with their babies from day one in enriched environments. And then we’re helping to be part of really a public education effort in helping to teach caregivers—so not just parents, but any adult caregiver, which could also include educators—about the value of play as learning and how important it is for child development.
Sally: Laura, I was really struck by that phrase, you said it was a public education effort. And that was making me think, Andres, of your work, thinking about engaging community. And I was wondering if you could tell us a bit more about how you engage community members authentically to help devise playful learning opportunities.
Andres: Yeah, absolutely. So I’m part of a larger project called the Playful Learning Landscapes Initiative, which was started by Kathy Hirsh-Pasek and Roberta Golinkoff—who are my mentors and close collaborators. And that project is all about designing everyday spaces, spaces where children and families naturally go and naturally spend time. You can think bus stops, parks, grocery stores, doctors’ offices, laundromats, anywhere where families go in their everyday routine, and trying to enrich those spaces with play and learning value. Because, like our other guests Lynneth and Laura have shared with us, that has so much value. Those interactions and that play time is so enriching for kids.
We are partnering with a local community organization called SAELI. SAELI stands for the Santa Ana Early Learning Initiative. And we’re partnering with SAELI in order to design public spaces so not only that they have the learning value and stay true to what developmental science tells us about what creates high-quality learning situations, but also so that they reflect the community’s values and goals and strength and culture.
And this is really important because it can have a big impact on the way that families interact and engage with the sites and really build a sense of ownership, which can really increase learning value and also longevity and usability of these sites in the community. And so SAELI has over 200 members, and it’s local parents, it’s teachers, it’s school administrators, it’s local politicians, it’s community organizing and nonprofit organizations.
And so all people coming together to promote enrichment activities and supports for families with kids 0 to 9. And so through this partnership with SAELI, we’ve held design sessions where we have about 40 mothers from Santa Ana come in and just share their vision for their community. So we have them tell stories about their childhood and their experiences growing up, sometimes in other countries or sometimes here in Santa Ana, and what they did in those spaces. What did they do at the bus stop? Or what did they do at the park? Or how was it going to the market or the grocery store? And then from those stories, we’re able to distill themes and commonalities across families’ experiences and then try to represent those experiences in the designs that we create. And then we actually have families build stuff, so we’ll bring arts and crafts kits and have them actually build out a bus stop or a game for the park.
And so families end up sharing these really special stories and games that they played as kids and that now they want to play with their kids and show other people in their community. And these games are so rich with learning value. And so it becomes this situation where we accomplish all the goals that we wanted to from a science perspective about making learning situations that create these high-quality caregiver-child interactions, but are deeply embedded in the community’s lived experiences.
Many of our families are from Mexico, and they talked about how the abacus was a really common tool for them to learn math. And so we’re going to make a bus stop that has a giant abacus. And so kids can count things and engage in math conversation while they wait for the bus. And it’s a way that we’re really building on families’ strengths and experiences of like, this is how they learned math, and so they’re really equipped to communicate math and engage in this activity with their kids.
Another game, another bus stop idea was a Loteria bus stop. So Loteria is a really popular local game. It’s kind of like bingo. You spin a wheel and then you get a symbol. And then we’re going to make a bus stop that has a big version of Loteria. And then when you get a symbol, you flip it, and there’s different activities that kids and families can engage in that are play-oriented but have a learning value. I think that there’s going to be a real deep sense of ownership, because the families are the ones who really created these designs.
Laura: I just wanted to respond, Andres, to something really important about those examples that you gave. And that often when we’re talking about children and children’s learning and play, we talk about children as if they are isolated and they’re experiencing these activities on their own or in a child-only environment.
And we know how important play can be for strengthening or building really positive adult-child relationships and what you’re talking about here in terms of identity development and cultural identity building and generational transmission of knowledge. And I just think that that’s really important, at least also think about play as not just for the child but for the child and everything around and everyone around the child. It’s good for everybody.
Sally: Very true, and it seems to me that we all need play now more than ever, especially given the past couple of years!
Laura: Families have gone through trauma on a large scale over the last two years. And I think there’s a really important moment right now where, as a country, we have the opportunity to say we know what is important for our children’s well-being and for their recovery.
Lynneth: Play allows children to deal with uncertainty. So what it allows children to do is to pivot, to adapt, to follow different paths, depending on what’s happening right in front of them. So it’s an iterative process. And those skills that are developed over time are the building blocks of those coping mechanisms that are important when children are exposed to uncertain situations, like a pandemic, et cetera. And the interesting thing is that this is also true for adults.
Laura: Some of the most impacted families and children in the pandemic were our youngest children, so pre-academic years, children 0 to 4 or 5 years old, whose parents and caregivers were essential workers, and who tended to also be in our lower socioeconomic strata. Those families and children lost access to most of their learning and care supports and were very isolated in their homes. So many of us were, but you think about a restaurant or service worker with a two-year-old and what that first year of the pandemic looked like. Virtual learning doesn’t work for a three-year-old.
One of the innovations that we saw, in the children’s museum world in particular, was the development of learning kits—very simple sets of materials, tangible materials, that were focused around fun and playful activities. Quite often, they were just small prompts to elicit pretend play and guided play between adult and child.
What we heard from hundreds and thousands of parents was that they wanted these kits. They needed materials to engage their children away from screen time and in ways that were meaningful and that gave the parents confidence and power to engage their children in something joyful in a time of incredible stress. Hundreds of thousands of these kits have been disseminated by hundreds of libraries and museums. And the need is still there, and the want is still there. And so I think that tells us something about how families feel like play is a critical part of their toolkit, their resilience toolkit.
Sally: Thank you for those thoughts; they’re so important. We’ve talked a lot about the connection between resilience and play as it relates to learning. I’m wondering, though, are there also connections between play and other kinds of development? For example, we’ve been thinking a lot about health and social-emotional skills..
Lynneth: Something that is important to understand about the connections between play and all sorts of developmental outcomes for children is that not every single play experience leads to all the outcomes. So what do I mean? That there are certain types of play that are particularly supportive of health outcomes, for example. So you might think about more physically active play that might have children practicing both fine and gross motor skills or games that might have them be, again, physically active, may help reduce stress, which is also associated to biological responses to stress that can be harmful to the body.
On the other hand, if you think about social-emotional skills, dramatic play, pretend play, storytelling are types of play that can be associated with outcomes that are about understanding emotions, knowing how to name emotions, knowing how to respond to others and their emotions, regulating how to interact with others in a positive way.
So it’s not that children should only be engaging with object play and building and learning mathematical skills or that they should only be engaged in dramatic play and developing language and social-emotional skills. But that, actually, it’s sort of the toolbox of opportunities for children to engage in different types of playful interactions with peers, with friends, but also adults, as we’ve heard from the other panelists.
Laura: I really would like to “yes, and” what Lynneth said about the different kinds of play. Especially as you’re thinking about yourself as a parent or an educator or a policymaker, there’s often wanting the answer of, what kind of play is the best? And so I think emphasizing the notion that all kinds of play is the best is so important.
And also acknowledging why different communities are going to take different approaches, because the needs are going to be different. The affordances, what’s available, what matters is going to be different from family to family, community to community. And that’s a kind of diversity and flexibility I think it’s important for us to also embrace.
Lynneth: A question we often hear is, should this be free play or guided play? Which one is the most beneficial? And I think going along with this idea of all kinds of play for different types of outcomes is the idea that free play, children being able to play uninterrupted, being able to focus, being able to set up their own challenges and figure out problem-solving strategies is incredibly important for children.
And, as we’ve also discussed in the podcast, that the interaction with others—so the added support, the added scaffolding from educators, from parents, from other adults in children’s lives—can also help expand the types of opportunities that children have to learn and to develop skills through their play. So it’s important to know that adults helping to shape play is not necessarily a negative thing.
And it’s always in relationship to what is the interaction, how are we making these interactions with children the most valuable to both allow them to take risks and build autonomy and independence while also feeling supported in their environment?
Andres: I absolutely love this conversation about different kinds of play. And I really appreciated something that Laura said, which is that in each community, this might look different. And I think that’s the beauty in this idea of designing with the people who are going to be, at the end, using the space.
And so, for example, in our work in Santa Ana, a huge theme that came through from all of our families is this idea of transmission of culture intergenerationally. You know, whether it’s their language or their culture or their customs or their childhood games, they feel like their kids are not always getting their full experience of their community.
That might not actually be a top priority for every community. But I think that’s why if you design with the people who are going to be in the space, it’s so powerful. And you end up tapping into these really valuable ideas that are really going to motivate people to use these play spaces and create the kind of rich learning that we really want to see between kids and families.
Lynneth: I love what Andres and Laura have shared about working with communities. When I think about involving communities and creating playful experiences for children, there’s three questions that I like to think about. One is, what is working here? What’s already good? And what’s most meaningful?
Both Andres and Laura have shared examples of this. How do we work with communities to say, when we think about play, we don’t want to impose an already packaged program or set of activities. What we want to learn is, what’s already working for you? What’s already meaningful for you? And how does this continue to celebrate your history, your family relationships, community relationships, and the values that you have for the children in your community? So I really, really appreciate this conversation.
Sally: Thank you all so much, this was honestly such a treat – I love hearing all of your perspectives. So thank you!
Musical interlude
Sally: So next up, we have an expert on one really important kind of setting that’s all too often overlooked: humanitarian settings for refugees. There are millions of children in these settings worldwide and they need playful experiences as much as any child. Well, fortunately, there are some very committed people working on just that, and today I’m delighted to have a chance to speak with one of them. Her name is Erum Mariam and she’s with the BRAC Institute of Educational Development. I’m so looking forward to our conversation today, Erum.
Erum Mariam: Thank you, Sally. Looking forward to this conversation with you today.
Sally: So I know that you and the BRAC Institute, as well as your partners from Sesame Workshop and other organizations, have done a lot of work bringing play to humanitarian or refugee settings. Could you tell me a little bit more about what you mean by humanitarian settings?
Erum: Sure. I’ll be speaking from my experience of the Rohingya context today. Rohingya started coming in in 2017. There were thousands and thousands of Rohingya who were coming over from Myanmar and coming to Bangladesh to a place named Cox’s Bazaar. It’s the largest refugee camp in the world, and with about almost a million people.
So I will be talking about people who have been displaced from their own country. And in this case, it’s really very, very sad because they came away after the genocide in Myanmar. And there were women with infants and toddlers. They came with the most essential belongings, their families. And then they went into shelters, which were absolutely very temporary, with bamboo and then plastic sheets on top. And then after that, they moved more into what looked like housing. But these houses are of two, three rooms and made of bamboo as well as sheets. And that’s the humanitarian setting.
Sally: Wow. Could you give me a sense of how many children in particular are in this kind of setting worldwide, and maybe give us a glimpse into what that situation might look like for a child in particular?
Erum: I think, worldwide, the amount of displaced population is somewhere around 82 million. And out of that, believe it or not, it’s thought that about 42% are children. That’s around 34 million children we are talking about. It’s a really big number of children.
And what it’s like for children, I mean, one day, I saw this, I observed this, and it has really stayed with me. That there was a child who was about two years old, and she was with the mother. And the mother was given some—they were getting relief materials, and the mother got biscuits. And I saw that the mother took a piece of stone and the packet, and she was crushing the biscuits. As she crushed the biscuits, and it became powder, and she took the powder, and she was feeding the child. And then she was taking some for herself. Because you know, there were days that they wouldn’t get meals. And so even in the extremely difficult situation, I saw that mothers and parents tried their best for the children.
After that, when I observed that they got some kind of housing, we could see parents trying so hard to get a sense of normalcy, to give a sense of normalcy to their children in a very, very difficult situation. So I would see moms and dads getting water, moms cooking, dads getting bamboo to make the house stronger, parents drying their chilis and other things on the rooftop. And so just to give that sense of normalcy to everyday life in a very, very difficult situation.
Sally: I can imagine in these moments, where people are struggling to have access to food and water, that play might be something that’s lost. And in some cases, rightfully so, right? You need to make sure you’re treating these more immediate needs. Could you tell us a little bit more about why play should still be considered important in these settings?
Erum: Sure. Play does have this power of creating a very nurturing environment. And play of course has so much to do with relationships, because when children play, there is a relationship there. There is a caregiver or even their older siblings also in that space. When there are these situations of real deprivation, of so much of trauma, and if we can have these situations where there is nurturing and there is stimulation, I think that’s really fantastic for the children, that there are these opportunities for child development.
Sally: Erum, I love that you highlighted that responsive relationship with an adult or sibling. I think that’s really critical in terms of developing resilience. Could you give me an example of how these playful approaches might be integrated into these settings?
Erum: Yes, absolutely. In 2017, when we were there in the camp, and one day we were at a center. It was a child-friendly space, and the children were there. And we went in and we said, what do you want to show us? Show us anything that you really want to show and you’re proud of. And the children all got up and they were chanting a rhyme.
And believe it or not, Sally, when the children were chanting, we found that community members, they came and they surrounded the center. And they surrounded the center because with the chanting and with the children clapping and chanting, there was a connection with the community.
So we started exploring the Rohingya culture. We asked the children, what did you do when you were in Myanmar? And they showed us the most fascinating physical play. We asked the children, what do you like drawing? And they showed us motifs which were different. Children even as young as age two were able to hold the crayon. And they had really good fine motor skills. And so they were showing us the motifs of art.
We explored, we were exploring with the caregivers. We asked what is it that they had that belongs to the Rohingya culture. They showed us designs of cloth that they used to have in every household that would hang under the ceiling. The caregivers, the community members, they told us stories which were very much about the Rohingya culture and history.
As we developed this content, we spoke to child therapists. And the child therapists, they told us that, don’t you see what you have done. What you have done is you’ve been working on learning through play, but what you have really done here is healing through play.
And so they said that the two elements that you have been able to bring out is you have given so much emphasis on the children’s voices that they could say—they could tell you that this is what we did, this is what we like, this is what we play, and things like that. And the second was that we respected the Rohingya culture. And the Rohingya have beautiful play. And their play is really about coordination and balance. And they were bringing that to us and to the world.
Sally: Incredible. I really loved it when you were talking about both respect for the culture and how they play, as well as respect for children as autonomous and humans that have their own beliefs and ideas and creative thinking, too. I think that’s a really powerful mix. I’m wondering if you could tell us a little bit more about how this pandemic that we’re experiencing has affected your work with the Rohingya?
Erum: Once there was the lockdown and there was restricted mobility, parents of course had to step up. And that meant that every child’s home had to be, had to have an environment which was so very stimulating for the child.
So every week we would call the mother for 20 minutes. For the first 10 minutes, we would speak about her mental health issues. Was she having any kind of difficulty? How were the days? Is there anything that she wanted to speak to us about? And the next 10 minutes was about the playful approaches with the child. And so the child and the mom and the facilitator who was calling on the phone. And so this was, the next 10 minutes was about the chanting, the rhymes that the children love doing, and also some physical play that would be possible under those circumstances.
This was something that was totally emerged from COVID. And what we have found is when we looked at all the data and the results of the 20-minute phone call, we found that this has shown so much of improvement in the children’s communication and language, in children’s social-emotional development and cognitive development. So those are results that we’re extremely excited about. And so we look forward to much more.
Sally: That’s thrilling. And I feel like this thread that’s gone throughout this interview is around listening and how important that’s been for you and your organization, and how that’s meant that the resources you provide are so much more targeted. And that’s beautiful.
I have one last question for you. The needs for international refugees seem really huge and daunting. And we were wondering if you could share a little bit more around how might listeners of the podcast take action, or any feelings you have around hope that you’d like us to end on.
Erum: Yeah. My experiences with working with the refugees have shown that those who are displaced, their experiences are so hard. And so they live under such harsh realities. But what I have found is that their spirit is so—they have so much resilience. And there’s so much spirit for them to go on.
Because at the end of the day, we go back to our lives. But the people who are living in these conditions, they go on, and they find normalcy. They find aspirations. They find dreams. They find—under the most difficult of conditions. So the best we can do is just keep on supporting. Whatever opportunity we get. Whenever there’s a chance for any kind of resources, contribute there. So any opportunity to be there to amplify the cause and be a part of the solutions for the humanitarian settings.
Sally: Thank you so much for your time, Erum, I really enjoyed our conversation. And for listeners, we’ll post resources and information relating to the support for children in humanitarian settings on our website, which is developingchild.harvard.edu. When we come back, we’ll wrap up with a pediatrician’s important prescription for parents.
Musical interlude
Sally: And we’re back! After so much emphasis on what societies and communities can do, we wanted to close with something really practical that everyone could do. Joining us on today’s podcast, we have Dr. Michael Yogman who’s a pediatrician and faculty at Harvard Medical School and Cambridge Hospital. It’s so nice to talk to you today, Dr. Yogman.
Michael Yogman: Thank you so much for inviting me.
Sally: One thing I didn’t say in my introduction is that you are actually the founder and driver of an initiative of the American Academy of Pediatrics; it’s called Prescription for Play. The idea is to encourage pediatricians to actively prescribe play for children to support their healthy development, and then to give them some tools and resources for the kinds of playful interactions they might suggest to parents. Could you tell me a little bit more about what the Prescription for Play initiative is, and where did it come from?
Michael: I spent about six years as chairman of the board of the Boston Children’s Museum. I was also chairing a committee of the American Academy of Pediatrics and had agreed to write a clinical report on play in early childhood. It occurred to me that pediatricians often considered play frivolous, parents often considered play frivolous. And there had been an increasing movement about taking the focus on learning standards, and third grade, and literacy, and moving that kind of No Child Left Behind testing standard back into preschool and early child care. And I interviewed a teacher who was weeping because her director said that she should remove the blocks from her child care center. And I said, you know what? That’s nuts!
It started a notion that we could point out to pediatricians that just like any other medicine, they could write a “prescription for play” at all well visits, and that it would convey a message that play was not frivolous, that it was brain-building. We realized the role that play could play in promoting safe, stable, nurturing relationships, which were critical to resilience. And pediatricians could play an important role in incentivizing parents to value play.
I think the pandemic and its ensuing stresses, this child mental health emergency that we’re now seeing, never has it been more important for kids to be able to play. The notion that we’re going to make up for the learning loss through remote learning, by hammering kids with more stressful academic pressure is only compounding the stresses of child mental health. Play has a really important role in buffering the stress that is really preventive.
Sally: Do you have any sense of how many pediatricians are participating in this?
Michael: So it’s an uphill battle. I think just as I think we really were making headway, lo and behold, the pandemic hit. Pediatricians are very supportive of this concept. I think that any changes have been a little bit put on the back burner as they’ve just tried to get kids immunized, move away from virtual visits toward in-person visits. And I think we’ll get back to an emphasis on play. So I think it’s been picked up actually in hospitals in Denmark, and in Salt Lake City, and by the LEGO Foundation. I’ve gotten lots of inquiries on trying to transform pediatric waiting rooms, hospital waiting rooms to really promulgate a lot of these ideas. And part of the purpose is to enable parents to realize the value in observing what their kids are doing during play rather than sitting on their iPhones during the waiting room.
Sally: It’s exciting to hear, and I can only imagine how frustrating that was to feel like you were getting traction and then have this pandemic hit.
Michael: Unbelievable.
Sally: So could you give our listeners three ideas or maybe three tips that represent how pediatricians might guide parents to support healthy child development through play?
Michael: I think that acknowledging when really young infants have that brief period of quiet alertness and they’re cooing, to realize those are meaningful moments, and parents want to be responsive and engaged. Even if it’s brief. It’s important. So that’s number one. When they coo and you coo back at them, they’re really learning about turn-taking. That’s an important skill for the pragmatics of language development, which evolves later on.
Number two, the power of letting kids explore. There’s some wonderful research by Alison Gopnik that if parents were too pushy, you gave them a toy with multiple aspects of it, if parents were too pushy at demonstrating all the things, the kids weren’t interested. If you let the children explore it on their own, they did much more active exploration and were much more joyful about discovering things on their own.
And the third one is just to emphasize the importance of reading, and singing, and letting kids even play. You don’t need to buy expensive toys, playing with wooden spoons and plastic Tupperware that are just around the house. Since parents are using those objects, kids are really excited to pretend that they’re adults and exploring those objects just as the adults are using them.
Sally: It’s funny, they’re all ready to grow up and turn into adults, and here we are as adults sometimes wishing we could be kids again, right?
Michael: Exactly. And I think for parents to, the final advice is as adults, I love George Bernard Shaw’s quote: “We don’t stop playing because we grow old, we grow old because we stop playing.” Probably a good note to end on.
Sally: Perfect. I really have enjoyed talking with you.
Musical interlude
Sally: So that concludes our look at how play builds resilience and what we can do to support it. I’d like to thank all of our guests, those conversations were so much fun, I really learned so much on today’s episode. And thank you for sharing your personal experiences and your stories. I’m your host, Sally Pfitzer, and we hope you’ll join us next time!
The Brain Architects is a product of the Center on the Developing Child at Harvard University. Harold Shawn of Levelsoundz Productions was our audio editor for this episode and Lauren Osgood was our production assistant. Our music is “Brain Power” by Mela from freemusicarchive.org. You can find much more on the science of child development at developingchild.harvard.edu, where we’ll post any resources that were discussed in this episode. We’re also on Twitter (@HarvardCenter), Facebook (@centerdevelopingchild), Instagram (@developingchildharvard), and LinkedIn (Center on the Developing Child at Harvard University).
COVID-19 Special Edition: Mental Health Vital Signs
Jun 16, 2021
The devastating toll of the pandemic has underscored the critical importance of connecting what science is telling us to the lived experiences of people and communities. In March of 2020, we recorded episodes exploring the impact the coronavirus pandemic could have on child development. Now, a year later, we wanted to continue these conversations and discuss what we’ve learned, what needs to change, and where we go from here.
In the final episode in this special series, host Sally Pfitzer speaks with Dr. Nancy Rotter, a pediatric psychologist and the Director of Psychology in Child and Adolescent Psychiatry, Ambulatory Care Division at Massachusetts General Hospital. They discuss how the pandemic changed conversations around mental health, why we need to integrate mental health into the context of overall health, and what caregivers can do to help children prepare for the lessening of restrictions and the return to school.
Subscribe below via your podcast platform of choice to receive all new episodes as soon as they’re released.
Sally: Welcome to The Brain Architects, a podcast from the Center on the Developing Child at Harvard University. I’m your host Sally Pfitzer. In March of 2020, we recorded episodes exploring the impact the coronavirus pandemic could have on child development. You may remember we discussed the importance of self-care for caregivers, and the importance of physical distancing, not social distancing. And now a year later, we wanted to continue those conversations and discuss what we’ve learned, what needs to change, and where we go from here.
Joining us on today’s podcast, we have Dr. Nancy Rotter. She’s a pediatric psychologist and the Director of Psychology in Child and Adolescent Psychiatry, Ambulatory Care Division, at Mass General Hospital. Thanks so much for being with us today, Nancy.
Dr. Rotter: Thanks for having me, Sally.
Sally: So, the pandemic has made conversations about mental health more common and perhaps even less stigmatized. How do we make sure that this perspective and these conversations continue even as vaccines become available and restrictions are lessened?
Dr. Rotter: You know, I agree that there has been some shifting over time in terms of awareness and acknowledgement about mental health and specifically children’s mental health. I think the pandemic has really raised these conversations to a higher level. I think that there’s certainly been comfort in talking about heightened distress that people have experienced due to the pandemic secondary to the many stressors that families have experienced. I think about things like loss of typical childcare support, like daycare, in-person school, or even grandparents caring for children, unemployment or shifts to having to work at home, social isolation. And I think all of these things are widely understood as contributing to how people are coping and to mental health. I think sometimes people find it easier to describe experiences of anxiety and depression in the context of stress and the stress perhaps experienced by the pandemic. You might not hear those words as much. You might hear things that sound less stigmatizing—that people might talk a lot about stress or isolation or fatigue, rather than referring to specific mental health conditions themselves.
I do think that it might be a good direction to go in to think about how we can acknowledge mental health conditions as an aspect of overall health so that we can increasingly talk about things like depression or anxiety or substance use disorders in the same way that we speak about diabetes or heart disease. Shifting towards a more specific and accurate language for mental health conditions can really make a difference. because I think if we do so we can really add clarity for diagnoses, which then result in leading to more effective evidence-based treatments to treat these illnesses. Again, thinking about these like we do other health conditions.
I think the continued progress, to kind of get to the other part of your question, towards the de-stigmatization of mental health conditions will really require increased and ongoing discussions about emotional health, and to have this happen in schools, in the media, within families, and certainly when children go to see their pediatrician. I think that pediatricians more and more are providing mental health screenings at routine exams, asking developmentally based questions to both parents and children or adolescents to screen for things that are concerning—anxiety, depression, suicidality, substance use disorders. And I kind of like the idea of thinking of that type of screening as mental health vital signs. And for me, that fits with the concept that when you go to your pediatrician or you go to your doctor, there’s always vital signs. They take your heart rate and your blood pressure, and it seems to me that using that kind of language really is helpful and is something that’s understandable to everyone and can help to really de-stigmatize the concept of mental health. And I do hope that we continue to work in the direction of integration of mental health into the context of overall health.
Sally: Yeah, absolutely. So many important points, and I especially love that idea of the vital signs. Nancy, from your perspective, has the pandemic exposed any weaknesses in our mental health care systems, particularly for young children? And how should we take those into consideration as we move forward?
Dr. Rotter: I would describe the primary challenges in our mental health care system for young children as twofold. The first relates to access to mental health care and the second is for increased need for prevention and early intervention services. While thinking about the importance of mental health care for children, I think it’s really important to be aware of some of the prevalence rates. For example, 50% of all life-time mental illness begins by age 14 and 75% begins by age 24. So, it’s very clear that making sure that we are keeping an eye on and assessing children and adolescents is key.
I have to say that the pandemic has impacted access to mental health care in somewhat of a complicated way. On the one hand, unfortunately, there’s been an increased need for mental health services for everyone, and specifically for children, and the need has really outstripped the availability of services. This has occurred in the setting of overall improved ability to access care via telehealth. Telehealth, through both the use of video and telephone visits has improved access in many ways. Families who struggle with transportation, that don’t have the time, that have financial limitations—it’s allowed them to access behavioral health care more readily. However, this is further complicated as telehealth access has not been equitable. Black, Latino, and non-English speaking patients, and patients living in communities hardest hit by the pandemic demonstrate consistently lower rates of use and access to video-enabled technology.
And while overall access to care has been a problem during the pandemic and it’s not easily solved, there’s been some hopeful news in Massachusetts. Effective January 1st of this year, the state legislature passed a bill requiring insurers to pay for services conducted by either telephone or by video technology at the same rate of reimbursement that they cover in-person visits. And I do think that’s really going to make a difference. That isn’t going to solve our immediate problem of access during the pandemic, but hopefully that knowing that that’s going to be an option down the road that that will allow for additional ways that we can help people.
In terms of prevention and early intervention, I think addressing the mental health needs of young children when they present with mild symptoms—like sleep or feeding, or toileting, anxiety or behavioral issues—sometimes might not get identified until they reach a level that really requires urgent intervention. However, preventative and early intervention when the initial or the mild symptom becomes apparent can be extremely useful, and my thinking is that it can be improved by having mental health professionals in the clinic, with the pediatricians so that there’s behavioral health care integration. And that way, making services available in the context of the yearly pediatric checkup, which families typically come to, that there would be screening and opportunity for intervention when families are coming every year or even for other visits.
In my work at MGH, in pediatric behavioral medicine, we’ve been very successful at embedding psychologists in specialty medical clinics like gastroenterology and diabetes and food allergy, which is where I work. Sometimes, for example in food allergy, I will meet with a family where a child is very anxious about having a blood test. And so, I can—at a minimum—meet with the child then and if they’re not ready to do a blood test that day with intervention, that now they know me and they can come back a couple of times to see me and I can help prepare them for that. And so, catching families where they’re going to get their medical care and being able to help them in that context is really important and really useful. This is something that has been established in many primary care clinics and hospitals across the country. The idea is to really think about a variety of services that might best meet the needs of the family by offering some in-clinic consultation, some brief treatment, access to parenting groups, and potentially digital health interventions in addition to the more traditional therapy and medication treatments that we all know about.
Sally: I really love this idea of integration. In particular, at the Center, we talk a lot about the need for responsive relationships and I hear a lot of what you’re saying there is that if you’re able to build those responsive relationships early with kids, you have a better chance at allowing them to benefit from your services if they know you better.
Dr. Rotter: Absolutely. And you know, one of the other statistics that I think is so powerful is that when referrals are made by anyone—by physicians or pediatricians—to a mental health professional, approximately 50% of those do not follow through. And so, by having someone actually live in the clinic to meet the family—sometimes even what we call as a warm hand-off—where they just are introduced, they get to see a face and a name, and there’s a connection that can really reduce the gap we have sometimes when they’re referrals that don’t make it to the referral source.
Sally: So, in a Q&A for Mass General Hospital on preparing children for when their parents return to work, you said, and I’ll quote you here, “Parents may experience their own anxiety about having children return to daycare due to the worries about COVID and may inadvertently send signals to children about their own anxiety.” Could you give us some ideas on how we can support caregivers during this adjustment period?
Dr. Rotter: Absolutely, in supporting parents and caregivers, it’s important to be aware that they may have their own mental health needs and perhaps had mental health issues prior to the pandemic. The toll that the pandemic has had on caregivers and parents has been tremendous. Caregivers have been required to step into roles that they were neither trained to do nor prepared for, such as becoming teachers to their children, providing full-time childcare while at the same time working a full-time job or perhaps coping with stress of unemployment or the loss of loved ones.
Self-care strategies can range from taking a few minutes to read an email from a friend, a section of the paper. Additionally, self-care can come in the form of family activities, creating scavenger hunts or obstacle courses for children, or even coming up with healthy cooking projects can combine self-care with family time. And I think that sometimes there are things that we might do that are really self-care that we may not consider self-care. They might be small, or they might be small and done every day and even that sense of routine can provide a break, can provide some comfort, and can provide some predictability. I think we’ve all been dealing with the lack of predictability in quite a profound way during the pandemic. And I’m not sure that’s going to change quickly as things open up in different pieces and in different ways.
Sally: I really appreciate that lens on the caregiver, and I wonder if you could talk a little bit more about how caregivers can ease their children back into normal life, while at the same time remaining cognizant of the stressors of this past year. And if you could speak specifically to infants and toddlers, I think their fears are sometimes a little less obvious to us.
Dr. Rotter: Absolutely, young children may exhibit distress through behavioral changes or shifts in their typical functioning, which can include sleep, eating, toileting, anxiety, tantrums, or increased irritability. And it’s hard to know when that happens what that could be a function of. It’s really important that if there are changes—abrupt changes or unusual changes in a child’s functioning—it’s really important to seek out consultation from your child’s pediatrician in order to rule out any underlying medical issues as a first step. And if at that point in conversation with the pediatrician, the belief is that perhaps what is being experienced by the child are indicators of stress or anxiety, that’s a time where a referral to a mental health professional from your pediatrician can be very helpful.
Many children and families are currently adjusting to the increased amount of time children are spending in-school and/or activities that were not happening during the pandemic restrictions. It’s typical and expected for infants and toddlers to experience discomfort when separating from their parents or caregivers, and this may in fact be exacerbated by the extended period of time they spent at home during the pandemic with parents or caregivers. So, it’s helpful to have a plan in mind. For older children, maybe toddlers, talking with them about familiar school activities that they may remember from when they were in school in the past, such as things that they played with or listening to stories, can help them prepare for their new schedules. But it’s also useful to think about what might be different, like the teacher will be wearing a mask, and there might be new hand-washing rules. They might tell their child, “we’ll wake up in the morning and have breakfast together and then you’ll go off to school, where you’re playing with your friends and you’ll be with your teachers and have lunch with them. And then you’ll return when it’s about time for dinner, we’ll all have dinner together.”
Additionally, for older children, sometimes the process of rehearsing going to school through play with dolls or figures can help reduce the stress. Reading books about returning to school can be useful as well. When possible, even for very young children, doing a short visit to school or daycare to acquaint or reacquaint the child with the classroom and the teacher can ease the transition as well. Even starting back in a more gradual manner can be helpful if that’s an option—going for a couple of hours the first few days and then working up to longer periods of time at the daycare center or preschool. Parents might also find talking with their children in the direct, but simple way about the coronavirus and how their child’s school or daycare has rules to make sure everyone is safe and healthy. For example, they may tell their children that their school is listening to the things that the doctors and the scientists are saying about going to school safely, and those are the things that they’re doing at school.
Sally: I know a lot of kids have been really isolated the last year, some maybe have only one friend or no younger children that they see. So, could you talk a little bit more about that social isolation or maybe potential anxiety that might be resulting from that?
Dr. Rotter: Yeah, I think social anxiety is a concern that many caregivers and parents have and some children have. I think for children who are naturally slightly more shy or anxious, particularly in new situations, that reentering social environments can be quite challenging. I would think a lot with the family about ideas such as previewing what to expect. Sometimes for young children looking at pictures of someone they maybe haven’t seen in a while, thinking about things they did before with that child that might have been fun or interesting when we’re thinking of young children.
Another thing that I talk a lot about with families when children have some anxiety about social situations is the structured play date. I think the idea of having a very specific plan in mind for an activity that’s really time based, so it’s not a long unstructured period of time, but it might be that a child comes over for lawn bowling and cookies and lemonade. And then that’s the end of that particular playdate. Or a specific arts or crafts activity or something along those lines, but that everyone knows what the expectation it, that there’s it’s something else to focus on, and sometimes that really helps to sort of build things. And often, what we’ll find is in those situations, that once children are comfortable with each other or reconnect in the case of they haven’t seen each other in a while that they can sort of take it from there. But some children need more, more structured play dates to help build in that comfort in a social setting.
Sally: There’s so many people, who I think will be comforted by your examples, because you gave really clear ideas on how to move things forward. So really, we’re really delighted.
I’m your host, Sally Pfitzer. The Brain Architects is a product of the Center on the Developing Child at Harvard University. You can find us at developingchild.harvard.edu. We’re also on Twitter @HarvardCenter, Facebook @CenterDevelopingChild, Instagram @DevelopingChildHarvard and LinkedIn, Center on the Developing Child at Harvard University. Brandi Thomas is our producer. Dominic Mathurin is our audio editor. Our music is Brain Power by Mela from freemusicarchive.org. This podcast was recorded at my dining room table.
COVID-19 Special Edition: Building from Strengths: Post-Pandemic Partnerships in Health Care
Jun 10, 2021
The devastating toll of the pandemic has underscored the critical importance of connecting what science is telling us to the lived experiences of people and communities. In March of 2020, we recorded episodes exploring the impact the coronavirus pandemic could have on child development. Now, a year later, we wanted to continue these conversations and discuss what we’ve learned, what needs to change, and where we go from here.
In the third episode in this 4-part special series, host Sally Pfitzer speaks with Dr. Renée Boynton-Jarrett, the founding Director of Vital Village Networks at Boston Medical Center and an Associate Professor of Pediatrics at Boston University School of Medicine. They discuss the cost of failing to address structural inequities with sustainable and comprehensive policy changes, the vital role community leaders played during the pandemic, and why health care systems need to demonstrate trustworthiness.
The next and final episode of this special podcast series will focus on the pandemic’s impact on the mental health system.
Subscribe below via your podcast platform of choice to receive all new episodes as soon as they’re released.
Sally: Welcome to The Brain Architects, a podcast from the Center on the Developing Child at Harvard University. I’m your host Sally Pfitzer. In March of 2020, we recorded episodes exploring the impact the coronavirus pandemic could have on child development. You may remember we discussed the importance of self-care for caregivers, and the importance of physical distancing, not social distancing. And now a year later, we wanted to continue those conversations and discuss what we’ve learned, what needs to change, and where we go from here.
On today’s podcast, we have Dr. Renée Boynton-Jarrett, who is the founding Director of Vital Village Networks at Boston Medical Center and an Associate Professor of Pediatrics at Boston University School of Medicine. So good to have you with us, Renée.
Dr. Boynton-Jarrett: Delighted to be here. Thank you, Sally.
Sally: Renée, in March of 2020, we spoke with Dr. David Williams, who explained that many of the disparities that we saw in the early stages of the pandemic were predictable and the result of longstanding social policies and systemic racism. From your perspective, as an expert in the field, in the past year, what have we learned about these disparities?
Dr. Boynton-Jarrett: I think what Dr. Williams shared is absolutely correct. What we saw happen with the COVID-19 pandemic is it took advantage of the existing inequities and just widened those. So actually, our existing structural racism created a broader opportunity for the pandemic to disparately impact the lives, the well-being, and the health of communities of color and communities that are disproportionately impacted by structural racism. And so, I think one of the things that we have learned or relearned is the tremendous cost of failing to truly address structural inequities with sustainable and comprehensive policy changes.
And as importantly, because we know structural racism is around these interconnected systems and institutions, but there are also these ideologies, mindsets, ways of thinking and being. And if we think about it, those ideologies and mindsets about who’s okay just to remain at risk, to not have the luxury of physical distancing, to not have the luxury of having water to wash hands and do the hygienic practices. We’ve learned that we also have mindsets that truly impact the way in which we view humanity and human dignity and human rights, and that this pandemic has completely taken advantage of the ways in which those mindsets, ideologies, and systems create structures of inequities.
Sally: Could you give us some examples of what changes you think need to happen in the field, particularly how communities and neighborhoods could help?
Dr. Boynton-Jarrett: Yeah. I think your question actually hits on where I see the biggest opportunity for change. So, one of the things we saw happen over and over during the pandemic is in the absence of plans. Strategic plans and responses are being created in real time, and often those decisions—whether they were decisions being made about how vaccines would roll out, whether they were decisions being made about what economic supports and resources will come to families, or what will happen with early care and education, childcare, school—we saw time and time again decisions being made that were not being made with true engagement. Not just engagement of communities, but engagement of community leadership. So really, in partnership with, in conversation with. Those who were closest to the inequities—experiencing them most directly—were not being engaged or brought to the table.
And time and time again, we also saw that the ideas, the wisdom, the strategies that were actually happening within communities were thoughtful, were creative, were real-time responsive. And actually, when we begin to get behind them, we see more protection happening for communities. So, we also saw tremendous community leadership, and in the absence of that leadership, I think that we would have all fared much worse in this pandemic.
Sally: Just anecdotally, I’ve seen that even in some of the work we’ve done at the Center too, and often finding that bringing in members of the community actively from the beginning of projects has been the thing that has made those projects so much more successful. Could you tell us more about your work at Vital Village Networks?
Dr. Boynton-Jarrett: So, Vital Village Networks is based at Boston Medical Center. We promote child well-being and address structural and systemic inequities and systems of care and education in early childhood by doing a couple of things. We really work around establishing sustainable, authentic, and equitable partnerships between caregivers, parents, and community residents and community-based organizations and cross sector institutions—health care, education, advocacy, social service. In this work, we all really focus on expanding leadership trajectories and pathways for community leaders, and that can be through trainings and certifications and expanded opportunities. But we also really think about how do we work to build capacity and enhance existing community-driven solutions? So, how do we build capacity within a community to promote well-being? And often, that involves helping institutions and organizations within the community work with community leaders in a different way and we use a model called co-design. So, how do we create and design things together?
We really work to think about what builds equitable partnerships. What creates a table for truly equitable participation? A lot of approaches to community engagement and community work begin with the deficit lens. They begin with the idea that there’s a problem in the community, and we have a solution, we want to bring the solution. Well, that starting point actually makes it very hard to partner equitably with communities. Because if you think about—even if you were going to pick someone for a team, would you pick someone or something that you had only framed in terms of their weaknesses? Parents don’t do that with their children, right? We all have our strengths and weaknesses. Parents are really good at framing the strengths and uplifting the strengths and building upon the strengths of their children, but we don’t do that with community engagement. We often view a problem and that’s our primary way of understanding a community, and that really creates an imbalance in power from the very beginning. Also, who gets to ask the questions? Who gets to design the evaluation? What type of technology do you need to participate virtually? So, all of these things create barriers for equitable partnerships.
With co-design, we really begin first by understanding that there are solutions that already exist within communities and if we’re not aware of those solutions, it’s because we’re not seeing them, not because they don’t exist. So really beginning by recognizing, appreciating, and valuing the strengths and the wisdom and solutions within communities, which creates a much more level playing field for partnership. The second piece is how do we plan? How do we design together? So, how can we disrupt tools and strategies that bias someone based on their training or education? And how do we create opportunities to design things together that are centered around the diversity of people in the room? And that’s also a particular invitation that no one is at the table only as an expert, but everyone is at the table, both with their expertise and their gifts, as well as as learners. And so, creating that mutuality, that ability for us to be in both roles, all of those factors really lead to the ability to partner with communities and not on behalf of.
Sally: Why do you think there’s a disconnect between health systems and the families they’re supposed to serve? I’m thinking particularly here about the COVID vaccine in relation to this.
Dr. Boynton-Jarrett: What I would share is I think we’ve had a disproportionate focus on distrust about the vaccine. So, when we think about it, when we actually look at the real data that we have, actually the vast majority of people who have been surveyed or interviewed in communities of color are along a continuum of interest in the vaccine, and/or very interested in getting the vaccine or have already received it. So, a very, very small percentage that has said, you know an absolute no. So, that is a strong signal that people are seeking an opportunity to have their questions answered, to have a conversation, and to engage around the vaccine.
Also, what I think we haven’t focused on enough is how do health care institutions demonstrate trustworthiness? So, we want people to trust the vaccine, and that it’s good for their health. And we have like this, I think an overemphasis or an over expectation that what we’re hearing from people is that they don’t trust the vaccine. What we may be hearing from people that we haven’t focused on enough is how do institutions demonstrate that they are trustworthy—that they’re going to share updated information about concerns, or warnings, or emerging complications, or side effects? That they are going to offer the vaccine in settings where you will be able to get your questions answered. That you will have opportunities to hear from other people who have received the vaccine.
And so, what I think that we need to really focus on is also taking a hard look from a lot of current and historical lessons at the ways in which, you know, despite what might be well intentioned efforts, systemic racism truly exists within our institutions, including our health care institution. And how that is experienced for people is sometimes that the institution does not appear to be trustworthy, because time and time again needs are not being heard or listened to or responded to with dignity.
If we are expecting that we can change people’s minds to make them do what it is we’d like them to do, again, that only serves to reinforce, “I’m not wanting to hear your concern. I’m wanting you to follow my guidance, my advice in a system that you have not been invited to help design what this experience would look like.” So, that’s why we’re seeing so much success of vaccines that are being administered at faith-based institutions in partnerships with the faith-based community. That’s why we’re seeing so much success with providers of color that are creating safe and brave spaces for people to learn about, talk about, and discuss the vaccine. And in our work with Vital Village Networks, we’ve had what I would just consider—led by community members—we’ve had love conversations. Conversations that aren’t so much about all of the details, but are just creating a space for people to be honest about any fears they may have, or anxieties that they may have. And time and time again, they connect to what you have learned throughout your life around untrustworthy medical institutions that have demonstrated that time and time again. So, we must do a better job and a different job of demonstrating trustworthiness.
Sally: I really appreciate that response.
I’m your host Sally Pfitzer. The Brain Architects is a product of the Center on the Developing Child at Harvard University. You can find us at developingchild.harvard.edu. We’re also on Twitter @HarvardCenter, Facebook @CenterDevelopingChild, Instagram @developingchildharvard, and LinkedIn: Center on the Developing Child at Harvard University. Brandi Thomas is our producer. Dominic Mathurin is our audio editor. Our music is Brain Power by Mila from freemusicarchive.org. This podcast was recorded at my dining room table.
COVID-19 Special Edition: Superheroes of Pediatric Care: Moving Beyond the Challenges of COVID-19
Jun 02, 2021
The devastating toll of the pandemic has underscored the critical importance of connecting what science is telling us to the lived experiences of people and communities. In March of 2020, we recorded episodes exploring the impact the coronavirus pandemic could have on child development. Now, a year later, we wanted to continue these conversations and discuss what we’ve learned, what needs to change, and where we go from here.
In the second episode in this 4-part special series, host Sally Pfitzer speaks with Dr. Rahil Briggs, National Director of ZERO TO THREE’s HealthySteps program. They discuss the potential impact of the pandemic on infant and toddler development, how an overstressed pediatric health care system responded, and the importance of overcoming equity challenges and public fears to resume well-child visits.
Upcoming episodes of this series will feature expert speakers reflecting on the longstanding social policies and systemic racism that resulted in the pandemic disparately impacting communities of color, and the pandemic’s impact on the mental health system. The experts will discuss how we can take what we learned over the past year and make meaningful changes that will improve outcomes for children and families. Listen to the first episode of this series, where Center Director, Jack P. Shonkoff, M.D. discusses what COVID-19 revealed about the needs of caregivers with young children or during pregnancy.
Subscribe below via your podcast platform of choice to receive all new episodes as soon as they’re released.
Sally: Welcome to The Brain Architects, a podcast from the Center on the Developing Child at Harvard University. I’m your host Sally Pfitzer. In March of 2020, we recorded episodes exploring the impact the coronavirus pandemic could have on child development. You may remember we discussed the importance of self-care for caregivers, and the importance of physical distancing, not social distancing. And now a year later, we wanted to continue those conversations and discuss what we’ve learned, what needs to change, and where we go from here.
Joining us on today’s podcast is Dr. Rahil Briggs, National Director of ZERO TO THREE’s HealthySteps program. Rahil, thanks so much for being here with us today and just for timing, I’m going to jump right into our first question. What can we tell parents and caregivers about the potential effects the pandemic lifestyle changes could have on development, particularly on infants and toddlers?
Dr. Briggs: Thank you Sally, and thanks for having me. I know this question is on a lot of people’s minds. We’re a year into this and what’s been the effect? For some of these kids, it’s half of their life that they’ve lived within the COVID pandemic. But for parents of babies and toddlers, I think we mostly have really good news. Because they are learning through serve and return interactions, it doesn’t need to occur in one particular kind of learning environment or even a specific variety of environments for them to continuously be learning. So, parents can rest assured that babies and toddlers who are having that regular interaction with their primary caregivers in loving, supportive, nurturing ways with all sorts of serve and return moments all day long are still learning a lot. So, reading books, singing, playing music, just observing what’s going on around them. We often talk about—you know nobody expects that you’re going to put your life on hold and read 20 books to your kids every hour, but can you just comment on what you’re doing as you’re cooking dinner? Now I’m putting the water in the pot, and now I’m putting the rice in, and let’s watch it boil—and just really narrating or sportscasting that day.
I’ll say it again and again and again, you know, it’s about really taking care of oneself—avoiding toxic stress, bringing in mindfulness if you can. And I don’t mean that we all become yogis and meditate every day. That is not realistic right now. We’re trying to juggle 12 different things every minute.
It’s about self-care of adults. Self-care is not selfish as we’ve discussed before. Reducing that caregiver stress will reduce baby and toddler stress, and when babies and toddlers are less stressed, they learn better just like us, right? We learn better when we’re less stressed and it’s exactly the same for them. And of course, if there’s one thing we’ve all learned in this last year, it’s that stress can’t be avoided per se, but it’s about regulating. And so, for parents and caregivers it’s about self-regulating or asking for help. And when you do those things, either self-regulate or ask for help, you model really important social-emotional skill that babies will eventually learn through that example.
Sally: Rahil, I really appreciate that connection you just made between the health of caregivers and the health of children. I think it’s something that can easily be overlooked, especially with everything going on. And I’m wondering, are there concrete examples of things that caregivers should look out for? Something that might indicate that their child has been negatively impacted by the uncertainty and chaos surrounding the pandemic?
Dr. Briggs: Sure, so we know that the difference between a one-year-old and a two-year-old say in developmental terms is pretty remarkable. It’s quite different than the difference between a 33-year-old and a 34-year-old, for example. And so, developmental regression is something that you might look at and you might look for. So, is a child who used to be toilet-trained now going back to having accidents or asking for diapers? Or a child who used to be, you know, fully weaned from a bottle, or breastfeeding or a pacifier, suddenly going back in that direction? Those can be signs of them just saying like “Hey, this is all a bit overwhelming for me right now and I want to go back to a place where things are a little bit easier, and I get a lot more soothing and a lot more care.”
From some of the wonderful work of people like Joan Luby and others, we know that preschool age children can be unfortunately depressed. They can be reliably diagnosed with depression, meaning that a number of different professionals would agree: “yes, this looks like depression.” And not too unlike ourselves in the adult phase of life, you know. It could be impacting sleep, diet, interest in everyday things. So, I would say that’s a great time to really reach out to your pediatrician and say, “This is what I’m seeing. Does this feel like the new normal and just what I should expect because of how we’ve all been? Or does this feel like something that needs a little bit more attention?” And so, any prolonged or substantial changes might be something to bring to a pediatrician.
We know that lots of families have been worried about going to the pediatrician. I saw just this week, the American Academy of Pediatrics has put out a new call that parents are superheroes when they bring their children to the pediatrician to get up to date on vaccinations, but it’s also those times to ask those questions and really double-check like is this okay? Is this something to be expected? Or is this something to be worried about?
Sally: So, the pediatric system, like many had to adapt rapidly to the pandemic. What do you think has worked well and what has not worked well?
Dr. Briggs: So, talk about superheroes. When I think about my colleagues in pediatric care at Montefiore and around the country and all through healthcare, the lengths to which people have gone to support families is remarkable. We’ve heard about just pediatric practices, sort of turning themselves inside out and becoming one-stop-shops for families—diapers, formula, and the like. So, just gratitude to everyone in pediatric healthcare. They’ve been stressed, to say the least, and so that pediatric system has had to get retooled to serve adult patients. There have been some children’s hospitals where full floors have become adult-focused out of need, and of course, as people have gotten sick or been less available, we’ve seen that as well.
So, the pediatric system was stressed to say the least. We saw and we continue to see dips in well-child visits. We see dips in vaccinations—not COVID, but all those other diseases that we have these wonderfully evidence-based vaccinations for—and it’s around the country. We’ve also heard about pediatric practices closing, just not being able to stay open for business because the volume was down or because the workforce issues. There’s been a slow rebound on all of these points, but I’d say we’re not quite back yet to pre-pandemic levels and so that means that families are missing out. They’re missing out on that really important care that happens at the pediatric office.
If we don’t reverse this and quickly, that will be concerning. I think about it, especially from an equity lens. When all babies and toddlers have a strong start, and when they can get that start through a partnership through a high performing pediatric practice, the entire country is better, right? Pediatric primary care is like the only setting we have in this country that almost universally reaches all babies, all toddlers, and their families no matter what your income is, no matter, you know where you’re living.
So, I’d say some of the transitions we saw, you know, as folks got to recognize that this new normal was going to be around for a lot longer than they had anticipated. We saw our HealthySteps practices really adhere to the guidance that was put out by the American Academy of Pediatrics and by the CDC. And so, for many practices that meant postponing visits for older kids and only seeing kids birth to age 2 in person. That was some early American Academy of Pediatrics guidance. Some practices experimented with drive through vaccinations, others went fully remote and started seeing families virtually. Telehealth in pediatrics is not quite as seamless as it may be for us in the adult world, right? That was a really big adjustment for people. I think it’ll be here to stay in some form, but lest you think it’s easy, try to imagine a baby or a toddler on the other side of that telehealth visit and telling them, “please sit there for the next three minutes and don’t move and show me the inside of your wrist.” Right? It’s like “uhh no.” So, not always the most compliant.
You know, but for a lot of folks, for families and providers, seeing their patients virtually was better than not seeing them at all. Again, though, I think about equity here. And so many of those inequities that we saw pre-COVID are still relevant. Perhaps more relevant than ever, and they really come to light when we think about telehealth and folks who don’t have multiple computers in the home and the one that they do have is needed for the school-age child to do online schooling. They don’t have unlimited Internet access or cell phone data. And then, when we close the public spaces, previous options like using a computer at the library or the like aren’t really feasible. We’ve heard from our practices in rural areas that broadband access is a huge issue. This was again pre-COVID, and that affects telehealth and of course, remote learning for older children and work.
As we become vaccinated, many of us, you know, practices are mostly back to in-person with the safety precautions that they need, which is really promising. And I would say we’ve all learned a lot. We’ve learned we are more flexible than we knew we could be, and we have been reminded about the inequities that existed pre-COVID because they have been magnified. My real hope is that we renew a focus on changes that really last for families—committed to health, well-being, school readiness of all babies and toddlers. Our work at HealthySteps continues with I’d say even more urgency than we had earlier. And hopefully, the world and the community at large can join us with really that mission to give all babies and all toddlers that incredibly strong start.
Sally: Yeah, you started talking about this a little bit, but I’m curious when families are really stressed and they’re starting to say like, “Well, a well-child visit might be something that I can skip because there’s so much going on and I’m worried about exposure.” What would you say to those families and how would you kind of help them think through what that might mean?
Dr. Briggs: It’s a great question. In terms of skipping well-child visits, we have data that suggests that there are negative outcomes when you skip well-child visits. So, what are some things that can happen? Well, developmental delays can go undiagnosed, and we all know that the earlier we catch those developmental delays and the earlier that we provide evidence-based treatment, the better the outcome for children, sometimes erasing what was a delay in only just a year.
We also know about the incredibly lifesaving importance of vaccinations. We all are pretty well, you know, the number of people who can talk about what an mRNA vaccination does these days is remarkable and hopefully they remember that we’ve got vaccinations for lots of other really life-threatening diseases, and it’s critical—early childhood is the moment when you’re getting vaccinated, right? Almost every visit there’s some combination of vaccinations. They’re just so important.
Growth is an obvious one. Not everybody has a perfect infant scale at home, and so being able to make sure that babies are gaining back that early birth weight and then gaining weight at the rate we would expect really has significant implications for development and well-being overall. So, it’s really one of those visits that feels pretty darn worth it to mask up, to call ahead about safety protocols, and to know that each and every one of those health care providers is going in there every day just as worried about their own health and well-being and that of their families and wouldn’t do anything to put their patients in danger.
Sally: You always make me feel better when I talk to you, Rahil. I love those concrete examples too, I think that’ll be really helpful.
I’m your host, Sally Pfitzer. The Brain Architects is a product of the Center on the Developing child at Harvard University. You can find us at developingchild.harvard.edu. We’re also on Twitter @HarvardCenter, Facebook @CenterDevelopingChild, Instagram @developingchildharvard, and LinkedIn: Center on the Developing Child at Harvard University. Brandi Thomas is our producer. Dominic Mathurin is our audio editor. Our music is Brain Power by Mela from freemusicarchive.org. This podcast was recorded at my dining room table.
COVID-19 Special Edition: How Do We Rebuild and Re-Envision Early Childhood Services?
May 19, 2021
The devastating toll of the pandemic has underscored the critical importance of connecting what science is telling us to the lived experiences of people and communities. In March of 2020, we recorded episodes exploring the impact the coronavirus pandemic could have on child development. Now, a year later, we wanted to continue these conversations and discuss what we’ve learned, what needs to change, and where we go from here.
The first guest in this 4-part special series is Center Director Jack P. Shonkoff, M.D. He and host Sally Pfitzer discuss what COVID-19 revealed about the needs of caregivers with young children or during pregnancy, what we learned about the importance of science over the course of the pandemic, and how we can make changes going forward.
Upcoming episodes of this series will feature expert speakers reflecting on the pandemic’s impact on pediatric and mental health systems, and the longstanding social policies and systemic racism that resulted in the pandemic disparately impacting communities of color. The experts will discuss how we can take what we learned over the past year and make meaningful changes that will improve outcomes for children and families. Subscribe below via your podcast platform of choice to receive all new episodes as soon as they’re released.
Speakers
Sally Pfitzer, Podcast HostDr. Jack Shonkoff, Center Director
Sally: Welcome to The Brain Architects, a podcast from the Center on the Developing Child at Harvard University. I’m your host Sally Pfitzer. In March of 2020, we recorded episodes exploring the impact the coronavirus pandemic could have on child development. You may remember we discussed the importance of self-care for caregivers, and the importance of physical distancing, not social distancing. And now a year later, we wanted to continue those conversations and discuss what we’ve learned, what needs to change, and where we go from here.
Joining us today is Dr. Jack Shonkoff, Director of the Center on the Developing Child. Jack, we really appreciate you being here, and I know we have a lot to cover, so let’s jump right in. Could you tell us what COVID-19 has revealed about the needs of young children, families and people who are pregnant?
Dr. Shonkoff: So immediately, we saw the difference between people who had access to resources that helped them get through and those who before the pandemic were always at the edge and that this put families over the edge in terms of meeting basic needs—food, clothing, housing. But then, there’s the other universal experience of the critical importance of supportive relationships—the critical importance of extended family, neighbors, friends—and the extent to which every parent, regardless of your circumstances, cannot parent a child alone. And the social isolation that so many people felt, from the poorest to the wealthiest.
And so, I think if there’s anything good to take out of this past year, it’s a recognition of the universal needs that all families have to provide a healthy environment for their children, but the tremendous inequalities in resources and buffers and supports that we could all turn to when we are faced with really unusual hardships. So, it’s this balance between kind of universal experience and highly unequal consequences that I think are the lessons from the past year.
Sally: Could you tell us what we’ve learned about science over the course of this pandemic? And especially, how that science relates to what children need.
Dr. Shonkoff: Our work has been deeply grounded in the importance and the value of bringing credible, trusted, scientific knowledge to the table in addressing all of the challenges and opportunities that face families with young children, especially families who are dealing with excessive adversity or burdens. And this past year, has been a real eye-opening experience I think for all of us about both the critical importance of trusted, credible science in the face of threats to our health and well-being and the very significant limitations on how that science can provide direction or guidance about how to move forward.
We certainly learned this past year, not only that science doesn’t always have all of the answers—and especially at the beginning of problem—but that science doesn’t stand still, and that we depend upon science to keep moving forward. And we also have to learn how to make decisions based on incomplete science and based on the best science we have. And in many ways, we’ve always known that. We know that there aren’t answers to every problem. But I think one of the really very complex and and sobering lessons we learned this past year is how science has to be aligned with the lived experiences and the values and beliefs of the population. Because when it isn’t aligned, people can choose to not only not believe in the science, but to adopt alternative perspectives that try to delegitimize science.
So, for me personally, and certainly for the work of our center, this is a real time to just step back and try to figure out how we can maximize the contributions of science and we can leverage cutting-edge science that has solutions—or partial solutions—to our problem, without expecting that science will have all the answers. And certainly, for those of us at the Center on the Developing Child, kind of recognize both the limitations of the science at any time and the power of the science to guide us in more effective approaches to deal with any of the challenges we’re facing.
Sally: Looking forward, what can we do? How can we make changes?
Dr. Shonkoff: We’ve all learned a lot about how much the health of any society depends upon a sense of shared responsibility for each other. To get through this together. Whether it be people caring about their communities, decision leaders caring about the well-being of the country. I think we’ve learned simultaneously that we are all in this together and we all have shared vested interests and we are not all in this with equal resources and equal assets. And this has not just been about the pandemic. We have had the converging crises of an infection out of control, of a massive economic disruption that did not have an equal impact on all parts of the population, and then, of course, we have the dramatically increased consciousness about something that is not a new problem, but the dramatic increase in understanding the unbelievable threat and hardship of systemic racism and structural inequities imposes on families of color and other groups that are disadvantaged in ways that are kind of embedded in our society.
So going forward, I think the health of our society depends upon the extent to which we see all of us as having a shared investment in the well-being of each other. So, this is still politically extraordinarily complicated, but I think one lesson we might take from this is shared interest in everybody doing well. We do know a lot about the kinds of conditions in which young children grow up that increase the likelihood of a healthy, productive outcome: supportive relationships, manageable levels of stress, basic needs met, major opportunities for learning, and buffering and protection from excessive stress activation.
So what do we do going forward? We start with the fact that in a society like ours with our political traditions, there’s a mix of self-reliance and kind of shared responsibility. And no family gets by by itself. So, the question is: Do you pay for it yourself or do we share the responsibility of paying for it for everyone else? Whether it be health care, child care—child care, there’s an interesting tension. Is child care something we need so that parents can go to work or is child care something we need to make sure that children have kind of optimal environments, for their development while their parents are working; because we have learned how the economy cannot move without child care to take care of children while their parents work. So, we could go down the slippery slope of seeing child care as basically something we need to promote parent employment and set very low standards and just say: make sure kids don’t fall our windows or run out in the street and we’re okay. Or we could say we need it for the economy to work, but we also need to build a strong foundation for the next generation. We have to just recognize that at the end of the day, going forward is some combination of making sure that we find some way to support families to meet their children’s needs and promote their children’s health and development. And then thinking about as a country, what kind of resources do we need for population health? But let’s just remember at the end of the day, governments do not raise children. Parents, families, caregivers, raise children. But how they’re able to kind of provide for their children’s needs and their own needs, depends a lot on communities, depends a lot on government, and depends a lot on resources. A lot.
And so, I think going forward for the early childhood system, I would say there are a couple of things that involve more than just how do we rebuild what’s broken down. Because, what we learned from this past year is how fragile the infrastructure is for many essential early childhood services, whether it be child care, early education, early intervention programs, family support programs. It’s a fragile infrastructure. It’s not permanently supported, and its funding is always up in the air. So going forward, I think the big challenges for the early childhood field come in two categories. One is how do we rebuild and re-envision early childhood services so that they are able to have a more stable infrastructure and more predictable funding , so that all of the energies could go into providing supports for families instead of half of the energies going into trying to keep the money flowing. That’s a huge problem. But there’s another part of the early childhood world that hasn’t traditionally been thought of as the early childhood world, but I think is one of the most important messages just coming out of the past year. Which is that for families experiencing structural inequities—the families who are from generation to generation dealing with the way certain structures and policies in our country disadvantage some groups over others , with racism being at the top of the list—the question is how are we going to deal with that and break down those hardships and threats that are critical to the early childhood system.
So, let me be very specific about this. Right now, in the early childhood world, most of our resources, most of our energy is focused on children, their families, and adults who work in programs that provide essential services—and there is a lot that can be done to improve life prospects for children. But, at some point, we’ve got to think about how we go upstream and how do we prevent the things that are causing the problems rather than just figuring out how better and better to kind of treat or help people cope with things that ultimately have to be prevented. So, it’s like this is not just about rebuilding what was lost during the pandemic. It’s not just about trying to reopen child-care centers . It’s taking the best of what we have, but not just trying to kind of rebuild and replenish, but try to re-envision what an early childhood field will look like. And it’s got to be more of a balanced combination. To do what we know how to do to promote responsive relationships and health-promoting environments, but also start to pay more attention to going upstream and at a macro level, at a society level, dealing with what is imposing very unequal hardships and burdens and threats on families raising young children.
Sally: That’s such an important point, Jack. There’s clearly a lot of work that needs to be done. Thanks so much for your time again today.
I’m your host, Sally Pfitzer. The Brain Architects is a product of the Center on the Developing child at Harvard University. You can find us at developingchild.harvard.edu. We’re also on Twitter @HarvardCenter, Facebook @CenterDevelopingChild, Instagram @developingchildharvard, and LinkedIn: Center on the Developing Child at Harvard University. Brandi Thomas is our producer. Our music is Brain Power by Mela from freemusicarchive.org. This podcast was recorded at my dining room table.
Connecting Health and Learning Part II: The Implications
Jan 20, 2021
How do we use the science of early childhood development to implement practical strategies and overcome longstanding barriers in the early childhood field? How can we ensure that families’ voices are heard when we create policies or programs?
To kick off this episode, Center Director Dr. Jack Shonkoff describes what the science means for policymakers, system leaders, care providers, and caregivers.
This is followed by a discussion among a distinguished panel of experts, including Cindy Mann (Manatt Health), Dr. Aaliyah Samuel (Northwest Evaluation Association), and Jane Witowski (Help Me Grow). The panelists discuss how we can break down the silos in the early childhood field, policies affecting prenatal-three, and how policies can change to address the stressors inflicted by poverty, community violence, and racism.
Sally: Welcome to the Brain Architects, a podcast from the Center on the Developing Child at Harvard University. I’m your host, Sally Pfitzer. Our Center believes that advances in science can provide a powerful source of new ideas that can improve outcomes for children and families. We want to help you apply the science of early childhood development to your everyday interactions with children and take what you’re hearing from our experts and panels and apply it to your everyday work.
Today, we’ll discuss how the science we shared in our previous episode, on the early years and lifelong health, can change the way we think about early childhood policy and practice, and what this shift means for policymakers, practitioners, and caregivers. So, I’d like to welcome back Dr. Jack Shonkoff, Professor of Child Health and Development and the Director of the Center on the Developing Child at Harvard University. Hi, Jack. Welcome back.
Jack: Hey, Sally.
Sally: So we talked in the last episode about how the brain is connected to the rest of the body, and especially how the early years really matter when it comes to lifelong health. What does this science mean for policymakers, system leaders, or even caregivers?
Jack: That’s a really important question, Sally. From the beginning of the early childhood field, it’s always been focused on early learning and improving children’s readiness to succeed in school. In the policy world, it’s in education policy, comes out of the education budget. For people who work in early childhood programs, and for parents, it’s about programs that encourage and provide rich learning opportunities for children to develop early literacy competencies.
But the mindset shift here is that it’s not just about early learning in school—it‘s about the foundations of physical and mental health. It’s not just about improving outcomes for greater economic productivity—better educational achievement. It’s also about decreasing the likelihood that you’ll develop heart disease or hypertension, or diabetes, or a wide range of the most common chronic illnesses in society. It’s not just a matter of return on investment—asking “So, how much more economically productive will the population be? How much will we save in incarceration?” It’s also how much will we save in the cost of health care.
Sally: We’ve previously discussed the coronavirus pandemic, as well as the national reckoning regarding systemic racism, and the impact that this current climate has on children and families. Could you talk about how both of those issues are playing out in the context of policy and systems change?
Jack: From a science point of view, disparities in health outcomes is not a new discovery. But from a public understanding point of view, the COVID-19 epidemic and its gross inequalities in exposure and in infection and in complications and in deaths has really put front and center the incredibly important impact of systemic racism and interpersonal discrimination as it affects health. We know that more people of color, particularly African Americans—but also Latino and Indigenous populations—have greater exposure to the infection because of working in jobs that cannot be done at home, more reliance on public transportation, tighter housing circumstances—all of which make it more difficult to be protected from exposure to the infection.
But what’s getting less attention is not just rates of exposure and infection, but also rates of complications. We do know that of those people who are infected, people with underlying medical conditions are more likely to be sicker, and in many cases, more likely to die from the infection. And those underlying conditions are not equally distributed across the population. And they are particularly a higher prevalence in populations of color and in people who have grown up in poverty.
And here, what this new science is telling us is: this is not about adult exposure. These diseases have their roots early in childhood. They have their origins in excessive stress activation—excessive adversity—related to poverty, related to racism, related to exposure to violence, related to unstable housing, and related to food insecurity, all of which present tremendous burdens for families raising young children that increase the risk for excessive stress activation, which early on in life—doesn‘t always affect—but can affect brain development, the development of the immune system, development of metabolic systems.
On the one hand, the impacts of racism belong on the list of a lot of other sources of stress for families. But on the other hand, there are burdens and hardships that are unique to experiencing racism that we have to start to come to grips with in a very different way. If we don’t protect children from that, if we don’t provide the support for families to be able to help protect their children from the stresses in the environments in which they live, then what we see is over time, not only influences on early learning affecting readiness to succeed in school, but greater likelihood to have many of these chronic diseases later in life. And this is a rude awakening and an opportunity for the early childhood field to focus much more not just on early learning and school readiness, but to focus on the early origins of lifelong health problems, both physically and mentally.
Sally: I completely agree with that Jack. And I’d also say that it’s so important that people at the policy and systems level work directly with families who are experiencing these stressors just to make sure they really understand their perspectives and their needs. And up next, Jack’s going to answer a question that’s been submitted by one of our listeners.
Musical interlude
Sally: And we’re back! For this segment, we asked audience members who listened to the podcast to send in any questions they may have for Jack. Today’s question involves the role of significant stress on our abilities to use core life skills—the skills that help us manage information, make decisions, and plan ahead to make healthier long-term choices or avoid impulsive risks, reduce stress, and ultimately improve health. Today’s question comes from a listener named Abbi Wright.
Abbi: My name is Abbi Wright, and I’m a first–year graduate student at Oklahoma State University studying speech language pathology. And my question for Dr. Shonkoff is: how does strengthening core life skills in children affect lifelong health? How can we strengthen those skills in families that are especially vulnerable because of immigration status or racism?
Jack: So that’s a really important question, Abbi. Let me try to answer in the following way. Building core skills is part of a strong foundation of resilience that will help you deal with stresses and engage in more health promoting behavior over your life course and further decrease the risk for disease. For young children, strengthening those skills helps to build coping capacities. That helps bring the stress response down so that when these systems are developing very early on, they’re not being disrupted. One of the things that we are beginning to understand in a much clearer way is that reducing excessive stress activation in the early childhood period helps to protect all these developing biological systems that not only affect learning, but also affect physical and mental health.
Part of the way that we reduce stress activation in young children is by the adults who care for them to provide a sense of safety and security and buffer children from the stresses that are present in the lives of their caregivers. Families are experiencing significant stress. The pressures are greater to be able to provide that sense of safety for children—help them build their own coping skills. We know that some groups are particularly at risk, not for their ability to be good parents, but for the level of threat and hardship and burden that is imposed on families because of structural inequities in our society. Systemic racism is one obvious example. Immigrant families in the United States right now are another good example of families who are dealing with more than the usual amount of stress because even for immigrants whose legal status is not in question, there is an atmosphere of anxiety and threat and concern about the discrimination experienced by many immigrant families. So, the basic biology is the same regardless of your life circumstances. The level of threat—the level of hardship—varies based less on parents’ abilities to help build skills in their children, but more in terms of how much of an external burden of hardship and threat is imposed on families in their everyday lives raising their young children.
Sally: Thanks, Jack. And thank you, Abbi, for that thought provoking question. Up next, our panel will talk more about the implications of this new science for people across the early childhood field.
Musical interlude
Sally: So, on today’s podcast, we have with us Dr. Aaliyah Samuel. She’s the Executive Vice President of Government Affairs and Partnerships at Northwest Evaluation Association, and a Senior Fellow at the Center on the Developing Child. Thanks for being here today, Aaliyah.
Aaliyah: Thanks so much, Sally, for having me. I’m really looking forward to the conversation today.
Sally: Also joining us on today’s podcast, we have Cindy Mann, partner at Manatt Health and former Deputy Administrator at the Centers for Medicare and Medicaid Services, and former Director of the Center for Medicaid and CHIP services. Hi, Cindy, great to have you with us.
Cindy: It’s a pleasure. Thanks so much for including me.
Sally: And also, on today’s podcast, we have Jane Witowski. State Director of Help Me Grow South Carolina. Thanks for joining us, Jane.
Jane: Thanks so much. I’m happy to join the group today for this very important conversation.
Sally: My first question is for you, Aaliyah. Could you discuss the policy silos in state and federal government? What mindsets have shaped the current policy landscape?
Aaliyah: I will say one of the fundamental challenges is really the cross and inter-agency communication. It’s just really important both at the federal level and as well as the state and local level, that we get individuals that represent multiple systems to come to the table and have conversations. That is how we can start to really think about how to blend and braid funding to ensure that we get the maximum number of families—children—getting access to these programs.
We have seen the evolution over really the last I would say five to 10 years, where it has moved from early childhood being a woman’s issue to a workforce issue and a non-partisan issue. When I was Director at the National Governors Association of the Education Division, we watched the 2018 gubernatorial campaigns very closely. And of the 36 governors that were running at the time, there was not one that did not make a reference to early childhood and its importance to some degree. So, I can say that early childhood and this issue around childcare, families, our youngest citizens, is truly a non-partisan issue, which I think is important to underscore because it creates a recognition that it doesn’t matter what side of the aisle you’re on, this is an important issue.
I think too as we talk about some of the mindsets or even the current policy landscape, I will say, one of the things COVID has really done is exposed the inequities that were hidden in plain sight. We can’t ignore the data, we can’t ignore the disparities, we can’t ignore the communities and individuals and families that have been hit the hardest, and who have historically been hit the hardest, and will also have the most challenges recovering from the pandemic and all that’s come with it. I think, ultimately, what is really lacking is the voice of those who are impacted the most. I heard a quote once, that I really do believe, which says, don’t do anything for us without us. I think as we start to really think about reshaping the policy landscape to address some of these inequities, we need to make sure that there is diversity at the table of decision makers, but also those who will be impacted the most, and making sure that we’re underscoring their voices.
Sally: Yeah, that’s such a great point, and leads into my next question for you, Cindy. Can you speak about the policies affecting prenatal to three?
Cindy: Let me just start by underscoring a point, which is that the country is moving in this direction. I’m seeing all across the country, movements in pediatric practice, in health care, in Medicaid programs, in state government, in local communities along these paths. So, I really do think these are all achievable.
Everybody has to have access to health care coverage. Start there. That is not the case now. And while children are more likely to be covered than other groups, the rate of insurance for children has been dropping in the last couple of years. And mostly, they’ve been dropped off in Medicaid and not picked up elsewhere, and there’s a lot of different reasons for that. There’s also groups of children who because of their immigration status are just not eligible for coverage. Also, one of the I think really important tenets of good pediatric practice is to make sure that parents’ needs are met as well. We also have a number of states that have not extended Medicaid to low-income parents, and that really disenfranchises the family in terms of being able to access the kind of care that families need to make kids strong and healthy.
Some of the other policy issues that need to happen are, is to really begin to integrate behavioral health and physical health. Those two worlds have lived often in very separate silos. That’s not how kids live, that’s not how families live. We need attention to the social and economic needs of families as a very integrated way of addressing those issues in the practice of the provision of health care coverage. A real focus on equity throughout all of the policies that we’re moving forward. As Aaliyah said, there’s no secret to the fact that we have significant structural racism and disparities based on race, and COVID has laid bare and put that, again, in our face, and we need to do something about it. And it really does take a very intentional focus on trying to address disparities to deal with it.
We also have a financing issue. So much of the recent investments around social determinants—help with homelessness, help with hunger—have been driven by this perception of a return on investment to the healthcare sector. Well, that mostly leaves kids out, because while there is a market return on investment if you invest in young children’s health care, that return doesn’t always happen in a very short period of time, and that return also sometimes happens to other parts of our system. To our education system, to our juvenile justice system, to our child welfare system. So, we need a way of really having cross-sector collaboration in the design and in the financing of the full range of services for kids.
Sally: And Jane, I’m wondering if you could speak to us from the healthcare and community service perspective, how do the families you work with feel about the policies in early childhood? Is there a sense that change is needed?
Jane: Sure. I would characterize the mindset as hopeful and encouraged. And what I’ve experienced is a real desire to work together across sector, and was pleased to hear Cindy bring that up as one of her last points in that cross-sector collaboration how necessary it is. And I’ve seen that at the local level and at the state level. However, it’s accompanied by a real frustration about how to go about it. There’s still a lot of confusion, and also barriers. When providers are faced with funding restrictions, staff capacity, regulatory mandates, and still this mindset of needing to stay in your lane. One of the reasons that I’m hopeful is the Help Me Grow system, which 20 years ago was seen as an innovation and an opportunity to bring together those service providers with the common goal of meeting family’s needs. And so, I’ve seen how it can allow service providers to break down those barriers, and to help make connections that are really meaningful for families.
Aaliyah: Sally, can I just chime in here? Jane, when you said the flexibility, particularly in the regulations and staff capacity that is so spot on. I do a lot of advocacy work both at the federal and state level. One of the things we are advocating hard on is allowing for flexibility in the regulation so that at the community level, the funds can be used in the way that best fits the community needs. We fundamentally have to take a step back and stop being so prescriptive on what we think communities need, and create the funding structure to then package it to a community to make the changes and provide the supports that they need.
And also, it’s ironic when you mentioned the innovation piece or staff capacity. It’s so hard to be innovative when you’re pumping out reports, when you’re seeing families one after another. And so, we have to think about how do we create the place and space for innovation to happen. And that takes time, that takes time to plan, it takes time to collaborate across systems. We can’t keep expecting do what you’re doing with no additional funds or support, and then be innovative on top of that. It just doesn’t happen that way. And you can have the most well-intended people who have the passion and the ideas to innovate, but if they don’t have the capacity it’s not going to happen.
Cindy: I’d love to jump in on this part of the conversation as well. Another important point is to build the infrastructure in the community to be able to help connect people—health care sector—to community-based organizations and other resources. You can’t expect that a pediatrician is going to figure out where to send their families if they’re homeless or if they’re hungry. Or maybe you can send them, but you can’t necessarily do the follow up that’s needed to make sure that those needs get met. So, increasingly different communities are coming up with and states coming up with integrator organizations. They can be Accountable Communities of Health, is what Washington state calls them. North Carolina is planning to set up lead entities to help coordinate community–based organizations in certain regions and connect them to the healthcare sector.
So, we absolutely can’t do this just on the fly. We’ve got to create systems—systems of financing and systems of working together—that are adequately funded so that this can work. And let me just also underscore a point made before that I neglected to raise, which I so firmly believe in the importance of families being not only at the table, but really in leadership to really figure out what those priorities are, and whether the system is working well, and whether the system is not working well. So, both at the policy table, and then as real time monitors of how well the system is working for kids.
Sally: How can policies change to address the stressors inflicted by poverty, community violence, and racism?
Aaliyah: First, we have to acknowledge that they exist. That has to be step one. The stressors, the impacts of racism, bias, violence. What is real to someone who exists and has to exist in those communities, versus those who only have a perception based off of what their realities are, what their community is. It creates that disconnect. And the realities of families at all levels are different, and we have to acknowledge that. We can’t turn a blind eye, we can’t say, well, I’ve never seen it, so, I don’t think that that’s true. I will say—I‘ll give a personal example. I have two sons, but my youngest son has some really significant health care needs. I didn’t understand the challenges of being a mom with a child with special healthcare needs until I had one. I was an educator, I have a master’s degree in special education. But it’s very different when it’s your child and you’re trying to navigate the education system, the health care system, and advocate for your child who is struggling.
There’s two parts. One, policymakers have to be more intentional in bringing in the voices of the people most proximate to these issues. And really include their voices, not just into the considerations, but into the actual decision making. I also think from the community aspect, we really have to hone in and recognize that policymakers work for us. They work for us. And it is okay as a community to stand up and require our policymakers to not only adhere to their campaign promises or challenges within the community, but recognizing that in their role, it is their fundamental obligation to hear from the constituents. And so, whether that is writing a letter, whether it’s writing an email, whether it’s having a phone call, all of those small actions at a community and individual level do matter. The more active we are at the local level and really elevating our voices and the needs, it makes policymakers pay attention. We have to recognize that not addressing racism, stress, poverty, has a multi-generational effect. It doesn’t only affect the adults right now, but it affects the children and even the children’s children. And so, if we really want to start breaking these cycles of poverty and racism, we have to start addressing them now.
And so, I think holistically, it’s just time to take a step back and think about how do we really ensure access to these support programs, to health care, and what that means so that we can really start to address and see the changes around improving wealth outcomes for families, health outcomes for families, and really educational outcomes as well.
Sally: To follow up on that, I have a pretty big question for this panel, which is, what does an ideal future look like from your perspective in this cross-policy system space?
Cindy: That is a big question. So, let’s imagine a world where first of all, everybody has a source of payment for their healthcare needs. That seems to be basic, it’s true in most westernized countries, it is not true in the United States. So, let’s start with that. And then, let’s go to the narrow world of healthcare, and let’s break down those lanes—those silos. I think it was Jane that mentioned everybody’s in their lane and it’s hard to break out. Well, children and families, they don’t live in lanes. They live in the community, they live in their homes, they live in their real life, and we need to meet them where they are. So, let’s start with having an integrated healthcare delivery system where we treat the whole family and the whole child. And then, let’s go beyond the healthcare system. Let’s look at all of the agencies and departments and entities that are really in very close regular contact with kids, and think about how they can work together with the healthcare sector. That’s schools, that’s child care, that’s the juvenile justice system, that’s parks and recreation. What do we need to keep kids and families healthy? So, beginning to work together.
And then working—as I mentioned before—with community-based organizations, who really do have a lot of expertise on how to address homelessness and hunger. They may not have all the resources they need for sure, but they need to be working together in concert both to deliver the services and to have everybody advocate for more resources to the extent that more resources are needed.
We need to have a very intentional equity lens as we go about these collaborations in the delivery of services and the thinking about where the financing should be prioritized. And we need to have all of this with the construct of families in the lead. And particularly, communities of color, given the health disparities. I’ve had the occasion of working with community-based organizations that are led by the community, and I’m taken by Aaliyah’s reference. I never learned more about the system as when I’m talking to parents of kids with special health care needs. They are so expert not just on what their kid needs, but on what works and what doesn’t in the health care system.
So, if you’re really wondering how to get smart on all of this, sit down with some families that have really been trying to navigate the struggle, whether it’s because they’re homeless and they’re trying to get care for their kids, or whether their kid has special health care needs. They are the experts and they really need to guide us as we go forward.
Sally: I really love this thread and I feel like it’s been followed through our entire conversation today. Really just making sure you have the right voices at the table—not for them to just for react to something that’s already been created, but to be there to actually create these things, and I think that’s extremely important. And Jane, I’m wondering if you could talk a bit more from your perspective about how these silos that everyone’s been referring to throughout the conversation truly impact families and communities.
Jane: I would like to tell you the story about a family we worked with, a lower income family who identified themselves as Latino. Dad worked in construction, mom was home with four children. The older children were in school. And she had reached out to Help Me Grow because she had some real concerns about her youngest child—lack of language skills primarily, but also some behavior issues, which may have been associated with those communication challenges.
The family lives in a rural part of our state, which while services are available in a nearby city, transportation is not available. And the mom and the child were connected with our early intervention to have an evaluation. But when we did some follow up with them, we understood they missed the appointment. Why? Because the car that they were using broke down, and the family had no money to get the car fixed. So, the story could have ended right there with the child in need, a frustrated parent, and a frustrated service provider not truly understanding what was going on. But it didn’t thank goodness, and I think that shows the resiliency that this mom had in understanding that she really had a child who had some needs and she wanted to get help for her child. And a care coordinator at Help Me Grow, who really understood the social and environmental challenges that that family was facing, and who came up with some innovative solutions to make sure that the child and the mom could get to the appointment. So, we ended up with a child who was evaluated and qualified and is still receiving early intervention services. And I just feel like that’s an example of how we can work together in a coordinated fashion to have a positive impact on outcomes for children.
Imagine a community where children and families could access services without any restrictions. A community where every individual member shared a common goal of improving outcomes for all children, and where programs and resources and services that families might need, such as the health care, early learning experiences, healthy nutrition, would work together as a coordinated system. I do see one challenge, and I’d love to hear some thoughts that Cindy might have around this, is that historically, child health care providers haven’t been viewed as full participants in this community network. And yet, ironically, they are the very first service providers for children, and really continue to see the majority of children on a regular basis throughout their earliest years.
And so, I think one of our goals should also be to intentionally embed child healthcare practitioners seamlessly into this network of community providers. Think about this provider network as an electrical power grid. So, when the grid is really functioning well, there’s this reliable flow of resources, and families can access them and plug in whenever it is that they need to. Help to keep children healthy and really provide opportunities for them to be successful, and for their families to be well. There’s work to be done on building and maintaining such a strong grid because it’s complex and it often requires some work to untangle pieces of the grid so that there is a guarantee that we won’t experiences any outages.
But I think that that is an opportunity for us, if you think about how we can provide access to multiple resources and have a reliable flow of resources for families so that we can have some influence on that lifelong healthy trajectory that we want children to begin with.
Aaliyah: Sally, if I could just build on that. Jane, I so see the same future and community that you just outlined. That is the world that I not only want to exist in, but I want for my sons as well. For those who would say, well, you know what, I don’t have kids, why should this matter? And for people who respond in that way or have that question, my response is, we are all connected in some way, shape, or form. None of us exists in isolation. We all have a mother, a brother, a sister, an aunt, a cousin, a coworker, somebody that we care about. And our communities are all interconnected. We have to think about not only the health and well–being and safety for those in our immediate concentric circles, but thinking about how those concentric circles are nestled within others. And if we don’t really think about the support of all, that as a whole, as a community, as a state, as a nation, we are not going to be able to succeed.
Cindy: I want to jump in too at Jane’s invitation to talk a little bit about the issue she raised, which is our children’s health care providers not really given the resources and the voice that is commensurate with the importance of the work that they do. We really do need to build the mechanisms to hear from those pediatric providers, to support those pediatric providers, and to bring the families, again, into the discussion and into the dialogue. We’ve got the future of the nation and children in our hands, and we’re being very short-sighted by not devoting the kind of resources that’s needed.
Now, there are a lot of advances in this area. We’re really seeing some additional investments put into those practices. Extra dollars to help with care coordination. Extra dollars to make sure there’s family navigators, child navigators, to really help families make their way through the health care system, but also beyond the health care system. If they need to apply for SNAP, if they need to have assistance in terms of housing subsidies. So, the design is not a mystery. Help Me Grow has that design, other pediatric practice innovations have that design. We need to value it and to put our resources in it.
Aaliyah: When you mentioned the care coordination, that was the game changer for us with our youngest son. Between the age of nine months and three, he had over eight specialists in two different states. And I was a working mom, I had a four-year-old, and I was trying to consistently figure out which specialist, track medications, give the referral. I mean, it was a true nightmare. And finally, at the age of three, we finally got a care coordinator who managed all five of the primary specialists that my son was seeing at the time. That was when I could finally take a step back and breathe because I had someone helping me navigate this complex health system.
Cindy: Thank you for sharing that. We need to really have a much more family-centered system of care management, where the alliance of that care manager is to the child and the family, not to a particular institution, not to a hospital or a rehab center or a specialty practice. But I am here for the child, I am here for the family. We also need to not just put all the burden on the families, we also need people in power positions to align with those families’ voices, and to say, yes, it is time to put a different balance in our investments in this country. And that’s healthcare sector leaders, that’s business leaders as well really stepping up to the plate and saying we’ve got to do things differently.
Many, many years ago, I was working with a pediatric clinic in Boston Medical Center. And they were seeing a system—a lot of no shows as they call them, in terms of people not coming for their appointments. And they did a survey. They reached out and asked their patients, what’s going on in your lives? Why aren’t you able to make appointments? In a non-judgmental way, really trying to find out what was happening. And of course, not surprisingly, the two issues were, I didn’t have childcare and I didn’t have transportation. I was desperately trying to come into the appointment. It was really high priority, it’s not that it wasn’t a priority for families, but they had very concrete barriers of lack of transportation and lack of childcare. And then the institution said, fine, we’ll develop some shuttle buses. And they developed their own system of transportation. It couldn’t solve everybody’s problem, it wasn’t perfect, but it was a really important step forward in the community. And they also set up childcare in the clinic so that a mom could come and bring her other children and not worry that they weren’t going to be attended to or that they would be bored or otherwise get into trouble. And so, it really became a family center.
So, it really goes to the point of listening on a one-on–one basis to the family, and also soliciting their advice and respecting that they very much want to be full partners in the system, and mostly care so much about the well–being of their children. Instead, entities have imposed copayments, saying, well, people don’t appreciate care unless they pay money. Well, that will be a barrier to care. So, listen to what people want and construct your policies accordingly.
Jane: As a service provider, we have to be not just engaging parents, but really listening to parents. And include them in the work we do, the plans that we make. Too many times, I think parent engagement is looked at sort of as a have to, check the box, we do it. But, that’s not enough. So, I would definitely put that out there as an opportunity and sort of a mandate, a challenge to all of us who are not truly in a meaningful way, including that voice at the table.
Aaliyah: I think the only thing I would say is as we continue to move towards equitable outcomes, we have to really understand that moving towards equitable outcomes is not going to confirm equity. There are two different things. By trying to make sure everyone has access, that doesn’t mean we’ll get the outcomes that we need. There are some that are resting back and kind of sitting back and saying, well, they could access that program if they wanted to. But if we don’t really unpack it, like the perfect example that Cindy just gave, then we’re not going to get to the outcomes that we’re really trying to drive towards.
Sally: Thank you all so much for joining us. I really enjoyed this conversation, and especially, the different perspectives that you each brought to the table. When we come back, Dr. Shonkoff and I will be discussing another common misconception about early childhood development and lifelong health.
Musical Interlude
Sally: I’m joined again by Dr. Jack Shonkoff, who’s going to help clear up another myth that exists in the early child development field. So Jack, we’ve talked a lot about how interactions between genes and environment shape human development and lifelong health. And yet, when some people talk about adult diseases, the conversation can turn to being about whether the disease that person has or this person has is a result of genetics or if it’s a result of their lifestyle choices.
Jack: The reason why that’s a myth is that it’s basically telling us that if you develop a chronic disease as an adult, particularly the most common chronic diseases like heart disease and hypertension, diabetes, addictions, depression, that it’s either genetic or it’s because you are not living a healthy lifestyle. And that kind of setup is a really important myth to burst. Because what we do know is that all health outcomes are a mix of differences in genetic predispositions, and whether we’re living health promoting or health disrupting lifestyles. Not to say that it doesn’t matter how well you exercise or how well you eat. It’s also not true to say that there’s no genetic contribution to the greater risk to have a particular health impairment.
Very, very few, and none of these common chronic conditions are primarily genetically determined. And many of these conditions that are found to be associated with not very healthy lifestyles, you don’t exercise, you eat poorly, you’re overweight, your blood pressure’s up and you have a heart attack, people can look at that and say, well, yeah, that’s your own fault because of the way you live. What we’re missing is that the relatively higher risk or protection against these diseases starts very early in life. It starts prenatally and the first few years after birth. And that’s why it is so important that we try to protect children from excessive adversity, and why we want to help bring down excessive stress activation because it affects these developing systems very early in life, when they are relatively immature, that can have an effect on the greater likelihood of good health or the greater likelihood of being at risk for many common diseases.
Musical Interlude
Sally: And we’re back with Dr. Jack Shonkoff to wrap up today’s episode. Jack, we’ve talked a lot about changes that need to happen at the policy level, the systems level, and even the program level. What would you say to parents or caregivers who are hearing this information and thinking, well, I can’t wait for these changes to happen, I need to help my child now. Why should this new science make our listeners more hopeful that these changes can occur, and what can we be doing in the meantime?
Jack: Let me answer first by saying that not being hopeful is never an alternative. Ever. If we’re talking about the health and wellbeing of young children, both our own children, if we’re looking at it from a family perspective, or all of our own children, if we’re looking at it from a community or societal perspective, there’s no room for hopelessness.
I think the most important message for parents about this new mindset is that all of the things that you have been doing right to provide an environment for your young child that promotes early learning, healthy social and emotional development, and prepares your child to come to school ready to succeed, you don’t have to do anything differently to build a strong foundation for your child’s physical and mental health. A lot of attention has been directed in the early childhood field to the importance of responsive relationships, the need for serve and return interaction between young children and the adults who care for them. The importance of buffering children from stresses in the lives of families who work really hard to help build their children’s ability to be able to adapt to the stresses of everyday life. The importance of building skills to help to deal with stresses and hardships. The importance of building resilience that then transforms into being able to cope with adversity and to learn effectively and do well in school. That same resilience, those same kinds of coping skills, not only protect the developing brain, they protect the developing immune system. They protect developing metabolic systems. All of the wonderful things that parents do for their children. It used to be done in the service of early learning without even thinking about you doing the same thing to protect your child’s health now and in the future.
The reason to be more hopeful about this is that we have a very strong science-based explanation for why what happens early in life influences all of the things that make for a healthy, productive, successful, engaged population for society. It’s very hopeful to think that if that science message gets out with the credibility that it deserves, that a broader part of the population will understand what a terrible missed opportunity is to not invest very early in the lives of children whose families are facing significant adversity and to understand that we will all benefit at the end of the day. Doesn’t mean that there isn’t a lot of hard work to be done at the policy level, a lot of hard work to be done at the service delivery level. A lot of hard work to be done to help families with young children across the population to be empowered, to advocate for what families need to kind of raise healthy and competent children. All of that to me presents a lot of hope. It doesn’t underestimate the struggle to change policies, but we have more information and knowledge to work with.
Sally: Absolutely. There’s clearly a lot of work that needs to be done. But hearing your perspective as well as the voices of our panelists earlier in the call definitely makes me feel optimistic that change is possible. I’d like to once again thank our guests, Cindy Mann, Dr. Aaliyah Samuel, Jane Witowski, and Dr. Jack Shonkoff. And thanks to Abbi Wright for your question. I’m your host, Sally Pfitzer, and we’ll see you next time.
The Brain Architects is a product of the Center on the Developing Child at Harvard University. You can find us at developingchild.harvard.edu, where we’ll post any resources that were discussed in this episode. We’re also on Twitter @Harvardcenter, Facebook at Center Developing Child, Instagram @developingchildharvard, and LinkedIn Center on the Developing Child at Harvard University. Brandi Thomas and Charley Gibney are our producers. Bridgette Cyr is our audio editor. Our music is Brain Power by Mela from freemusicarchive.org.
Connecting Health and Learning Part I: The Science
Dec 08, 2020
How do our biological systems work together to respond to chronic stress? What do these responses mean for early learning and lifelong health? And when we say that early experiences matter, what do we mean by early? This episode of The Brain Architects podcast addresses all these questions and more!
To kick off this episode, Center Director Dr. Jack Shonkoff describes the body’s stress response system, how our biological systems act as a team when responding to chronic stress, and the effects chronic stress can have on lifelong health.
This is followed by a discussion among a panel of scientists including Dr. Nicki Bush (University of California-San Francisco), Dr. Damien Fair (University of Minnesota), and Dr. Fernando Martinez (University of Arizona). The panelists discuss how our bodies respond to adversity, inflammation’s role in the stress response system, the effects of stress during the prenatal period and first few years after birth, and how we can use this science to prevent long-term impacts on our health.
Boyce, W.T., Levitt, P., Martinez, F.D., McEwen, B.S., & Shonkoff, J.P. Genes, environments, and time: The biology of adversity and resilience. Pediatrics. In press.
Shonkoff, J.P., Boyce, W.T., Levitt, P., P., Martinez, F.D., & McEwen, B.S. Leveraging the biology of adversity and resilience to transform pediatric practice. Pediatrics. In press.
Shonkoff, J.P., Slopen, N., & Williams, D. Early childhood adversity, toxic stress, and the impacts of racism on the foundations of health. Annual Review of Public Health. In press.
Transcript
Sally: Welcome to The Brain Architects, a podcast from the Center on the Developing Child at Harvard University. I’m your host Sally Pfitzer. Our center believes that advances in science can provide a powerful source of new ideas that can improve outcomes for children and families. We want to help you apply the science of early childhood development to your everyday interactions with children and take what you’re hearing from our experts and panels and apply it to your everyday work.
In today’s episode, we’ll discuss how early experiences, especially during the prenatal period and first few years after a baby is born, get inside the body and can have long–term impacts on lifelong health. Here to help us dig into that science around the early years and lifelong health is Dr. Jack Shonkoff who is the Professor of Child Health and Development, and the Director of the Center on the Developing Child at Harvard University. Hi Jack. It’s really great to have you back.
Jack: Hi Sally. Great to be with you. Thanks very much.
Sally: Let’s dive right in. In previous podcasts, we’ve discussed the impacts of stress and specifically you referred to this term of toxic stress, but we never really went too much into the detail about the body’s stress response system. I’m wondering if you could explain how the body responds to stressors or adverse experiences and environments.
Jack: Yeah. That’s a really good question. For starters, the fact that we have a stress response system is really good. It’s protective for us. It actually can be lifesaving. It’s built into our body because this is how we deal with threat or challenges or hardships. This is the basis of the fight or flight response. So, what’s going on inside our body? Well, when we are stressed, a number of systems in the body get activated. Stress hormone levels are elevated and distributed all through the body. Our heart rate goes up, our blood pressure goes up. This is controlled by signals from the brain to the heart and the cardiovascular system. Our immune system is activated and there’s an inflammatory response. Our metabolic systems are activated to produce more energy for our body—more energy for our muscles, if we have to run or if we have to fight or more energy to think more clearly.
The important message here is that the stress response is not just in our brain, it’s in all of the biological systems in our body that are constantly communicating with each other. They’re all reading the environment, they’re getting feedback, they’re communicating with each other. And this is what allows us to deal with challenges, to deal with an acute threat. The best way to think about this is to think about your brain and your immune system and your metabolic system and your cardiovascular system as all different members of a team. Success as a team depends upon each member of the team having a specific contribution to make. And a successful team depends upon interaction and alignment with each other. If any one part is not pulling its own weight, that affects the whole team.
The immune system is another one of those team players. It is our body’s defense against infection. It’s our body’s ability to respond to injuries that require wound repair, and also helps us to be protected against other kinds of toxic exposures that might come in. Inflammation is the first response of the immune system to the threat of let’s say infection, or let’s say a wound like a cut. Think of it as the mobilization of the kind of first responders of our biological system. Now, everybody knows what inflammation looks like outside the body. When you have a cut or some kind of an injury that’s bleeding, and as it starts to heal, you notice that the area around the cut is red, it can be warm in the beginning, it may be particularly sensitive or painful. That’s the inflammatory response that is actually fighting against germs coming in. It’s kind of cleaning out body tissue that may have been injured by bacteria or viruses or trauma, physical trauma and it is beginning to initiate the healing process. And then over time the redness goes away and it’s less painful and the wound is healed.
Well, that inflammation also can happen internally in the body. Now, in the beginning in a stressful situation, inflammation is very helpful internally. It mobilizes your body’s defenses against infection, and it’s meant to then deal with that acute injury or threat and suppress it. But what happens if the stress continues? This is what we refer to as toxic stress. So, in the beginning, it’s protective, but over time, that inflammation can then start to have a wear and tear effect on the body. It can actually start to disrupt organ systems. Here’s one or two examples. We know that inflammation accelerates atherosclerosis, kind of forming plaques that can clog up your arteries around your heart. Inflammation can also affect metabolic systems leading to insulin resistance internally and increasing the risk for diabetes. Individuals who have severe depression have elevated inflammatory markers in their body, evidence of elevated inflammation.
We know that chronic inflammation internally doesn’t automatically mean you’ll get any of the diseases that I just mentioned, but it means that it increases your risk, which is now beginning to help us understand what is it about chronic severe stress that makes people more likely to develop chronic diseases, not just mental health problems, but physical health problems.
Sally: That’s really interesting. And hearing you talk about how early experiences of chronic stress can have more of a long–term impact, I’m imagining that these impacts are not likely evenly distributed. Right? And I’m wondering if you can talk a little bit more about that.
Jack: We have a very serious problem certainly in this country of unequal access to healthcare and unequal treatment in the health care system. And those are very important and clearly need a lot of work. But that’s not the whole story about disparities in health outcomes. Before we get to issues about healthcare, how does it happen that we have inequalities in the prevalence of many stress-related diseases like heart disease and hypertension and stroke? The new science is helping us get inside the body and say what is it about chronic stress and chronic hardship that leads to health problems? How does that happen? Some of this we’ve talked about already, which is the chronic activation of multiple parts of the stress response system that can have a wear and tear effect on different organs and biological systems leading to the most common and the most expensive chronic diseases in adult life.
So, when we think about that problem of chronic adversity, and we know there are some very consistent and predictable differences in terms of racial and ethnic disparities in health outcomes, starting with prematurity and low birth weight, and then extending all the way up to obesity and heart disease and type 2 diabetes and a variety of other chronic disorders. So how do we understand this? Well, here is some of the things that are very important for all of us to focus on. Number one, the differences by race and ethnicity are not genetic. There may be for some individuals, a greater risk for some diseases related to genetics, but from a population basis, certainly for race, race is a social construct, there’s no biological basis for race and certainly not when we’re talking about illnesses.
This gets us back to the discussion that we’ve been having about how chronic stress and chronic stress activation lays the foundation for greater risk for health problems later in life. Often, we make a list of sources of chronic adversity. We talk about poverty, we talk about racism, we talk about exposure to violence, we talk about a serious mental illness in a family, a young child living alone with a mother with severe depression who loves her child as much as any mother does but can’t be consistently responsive because of depression which is an illness. The body’s stress system and its response is the same regardless of the source of the stress.
There’s something about systemic racism and the kind of interpersonal discrimination that’s part of the daily lives of people who are subjected to structural inequities, things that are built into society, that really requires us to take a careful look and say on the one hand, racism is a source of stress like many other sources of stress, but on the other hand, systemic racism and being constantly subjected to the indignities of discrimination raises a different question, which is: what do we do about that? How do we protect young children from the racism that their families and other caregivers have to deal with?
The real solution to this is to go upstream and to deal at the source with the hardships and the threats of systemic racism that are bearing down on families, rather than focusing on helping families to cope with that racism. This is prevention in its true sense, which is not just to kind of put a band–aid on things, but to go to the source. I think the increased consciousness that we have in our society right now about systemic racism in a way that has always been known to families of color, but has sometimes been invisible—many times been invisible to families who do not know what it’s like to be victimized by chronic racism presents a really important opportunity for us to be much smarter and much more effective about how we think about this issue.
Sally: You brought up some really important points. And we’re actually going to be getting more into the policy and system solutions in the next episode, so stay tuned. But can you tell us a little bit more about why early in childhood development is so important? So, I know we say early a lot, but what does that actually mean?
Jack: Yeah. This is a really important question about what we mean by early and this is one of the real game changers about connecting the brain to the rest of the body. There’s an increasing public understanding that chronic stress activation can affect the development of the brain and ultimately affect your readiness to come to school prepared to succeed. But what this new science is telling us as we connect the brain to the rest of the body, is it’s not just about early learning, it’s also about the foundations of lifelong health.
And if you think about the way we approach early childhood policies and early childhood programs, we have over the years realized that kindergarten is a nice time to start school, but actually it’d be better to start school earlier especially for children who are living under difficult circumstances. We have been increasing our investment in preschool for three and four-year-olds. Makes a lot of sense, good decision in terms of public policy. But for the children who are experiencing the most severe stress, that’s not early because the effects of this serious adversity begin very early.
In fact, they begin even before you’re born. A pregnant woman who is in an environment where there’s very little support, where there’s constant stress activation, and also may be problems with inadequate nutrition, exposure to pollutants in the environment, these kinds of stressors and adversities can actually affect the development of the fetus before a baby is born. And certainly, in early infancy in an environment that is constantly stressed, this can really affect the environment of relationships in which very young children grow up.
When we start to talk about health and not just learning, and we think about how all of these biological systems are responding to the environment, the science is sending us a very clear message. In the face of significant chronic adversity, we need to begin way before age three and four, in terms of providing an environment that’s more supportive of healthy development to reduce those sources of external stress. Metabolic systems and the immune system begin to show effects that may be more difficult to change later as early as the prenatal period and certainly in the first two years after birth.
And so, that’s the important message of this new science for the early childhood period. It’s about health as well as about learning. And early in the face of severe adversity means prenatal and the first two or three years after birth. The bottom line for all of this is we are now learning that what happens early on prenatally and in the first couple of years sets you on a pathway to be either more at risk for some problems or more protected for some problems. But it’s not an absolute prediction. It’s never too late to make things better, but in the long run, you’re always better off by having the best health-promoting experiences as early as possible.
Sally: Yeah. I’ve often heard you use that phrase that early is better, but it’s never too late. And I’m really glad to hear that continue to come up in our podcast because it’s such an important message for listeners to take home. When we come back, we’re going to have Jack answer a question that was submitted by a listener, and we’re going to dive into that question together.
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Sally: And we’re back, and now we’re going to answer a question from one of our listeners. I know how much I enjoy getting a chance to ask you questions, Jack. And this time we thought we’d ask the audience. Here’s one from Sid Gardner.
Sid: Hello. I’m Sid Gardner, President of Children and Family Futures. And my question for Dr. Shonkoff is the impact of prenatal substance exposure is mentioned briefly as one item in the list of toxic effects. How does this affect physical and mental health and what can we do about it?
Jack: Sid, that’s a really important question and I really appreciate it. There’s a very well-described phenomenon of fetal alcohol effects or fetal alcohol syndrome that exposure to alcohol at different times during pregnancy can have significant effects on brain development and also physical features that are very noticeable after a baby is born.
We have lots of examples of how certain exposures to substances that are particularly disruptive to different organ systems based on where they are in their development before birth can have significant consequences after birth. This is about sensitive periods in development, which by definition are periods when that particular organ or that particular function is optimally responsive to environmental influences, even the environment in the uterus. And so, positive experiences promote healthy development and adverse experiences or exposures can disrupt development. That question about prenatal substance exposures, substance abuse is a critical question because it’s the poster child for how we need to pay attention to making sure that we promote a healthy environment in which pregnancy takes place.
All of the systems, the biological systems that we’ve been talking about, the brain, the immune system, the metabolic system develop over time. And when we’re very young, including before we’re born, these systems are relatively immature and they are developing their capacities and they’re developing their structures in part on a timetable that’s genetically determined. When things develop is pretty much genetically determined, but how they develop is literally shaped by the environment in which that development is taking place.
So, if we think about alcohol, whether this is threatening or not to health depends not simply on exposure, but on the timing. And so that’s why from a prevention point of view, the more we know about when are the sensitive periods and how can we prevent exposure to substances or infections that can influence later development, that’s how we promote and preserve good health and promote healthy development. It’s about timing and it’s about the differential sensitivity, the different levels of sensitivity of different parts of the developing brain and developing body as the normal processes of growth and development take place.
Sally: Thanks Jack. And thanks Sid for that great question. Remember if you have a question for Dr. Shonkoff, you can always send us a message on one of our social media channels. We’re on Twitter, Facebook, Instagram, and LinkedIn. Up next, our panel will dig even deeper into the science of early childhood development.
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Sally: Joining us on this podcast today is Dr. Damien Fair. Dr. Fair is the Redleaf Endowed Director of the Masonic Institute for the Developing Brain, Professor in the Institute of Child Development, College of Education and Human Development, Professor in the Department of Pediatrics at the University of Minnesota Medical School and a 2020 MacArthur Fellow. Thanks for being on the podcast today, Dr. Fair.
Dr. Fair: Thanks, Sally. Glad to be here.
Sally: Also joining us is Dr. Nicole Bush, Associate Professor in the University of California, San Francisco Department of Psychiatry and Pediatrics, the Director of the Division of Developmental Medicine and the Lisa and John Pritzker Distinguished Professor of Developmental and Behavioral Health. Welcome to the podcast, Dr. Bush.
Dr. Bush: Thank you. It’s a pleasure to be here.
Sally: We also have Dr. Fernando Martinez, University of Arizona Regents Professor of Pediatrics and the Director of the Asthma and Airway Disease Research Center. Nice to speak to you, Dr. Martinez.
Dr. Martinez: Nice to be here.
Sally: I’m going to start by asking this question to you Dr. Fair. Science is now telling us more about how the brain works with other systems in the body to respond to adversity, and could you say more about what’s actually happening in a child’s body developmentally among these systems?
Dr. Fair: That’s a great question. Now, some would argue that the two most complex systems of the body are the brain and the immune system. Of course, I’m a neuroscientist so I always put the brain at number one. But unlike other organs in the body, like the heart or the lungs or the gut, which are located in very specific parts of our body, the immune system is simply everywhere. Immune cells and the chemical messengers flow freely through our bloodstream. They wiggle their way into different parts of our body everywhere.
For many years, it was very difficult to identify or even think about how the brain might interact with the immune system in response to stress or adversity, anxiety, things like that. And it’s now quite clear that they interact in lots of ways and very specifically in development. For example, immune cells, and again, the chemical messengers that are generated in these immune organs like bone marrow, the spleen, lymphatic system, which kind of cleans out a lot of stuff related to the immune system, all have very intricate ties to the brain.
And we know that stress in particular has a very large effect on the immune system in development. The highest vulnerabilities are likely in younger ages. The immune system is critical for normative development. It may actually come to some surprise to most, but all the neurons that we’re ever going to have for our lives typically are at their final resting place right about the time that we’re born.
And then by the time we’re two, you have this proliferation of connections that go throughout the entire brain related to all those neurons. And then over time, over development, we slowly start to prune away these neurons and these different connections. That’s what it means to mature. Now it’s almost like a sculpture where you’re slowly chipping away to get the final product. Well, it turns out that the immune system is really important for that pruning and that cleaning things up. It probably doesn’t come to too much surprise that the changes in the activity of the immune system have very big impacts on brain development over our lifetime.
Dr. Martinez: I think it’s important to stress what Damien was saying. There’s no one system that reigns. We are one thing. And therefore, while we’re developing, if there are extreme sources of stress, it is the whole system that responds wrongly. That’s why none of these effects are on just one organ. Of course, they may be more important for one organ, for example exposures to pollution may affect more the lungs, but now we know that it affects all other organs, including the heart, the brain, of course, the immune system and so forth. That’s an important concept, that we respond like a whole body, not like a single organ.
Sally: That’s actually a really good segue into the next question which I have for you Dr. Martinez. Could you for our listeners go into more detail about inflammation’s role in the stress response system and how it can help or actually hurt us, especially young children whose systems are still developing.
Dr. Martinez: Well in the face of exposures, the body has a system of recognition of these exposures. This process of recognizing what is out there that is not dangerous and what is out there that is dangerous. The response is that of activating the cells that are there, that are part of the immune system that are kind of the first stage of response. That first stage of response is perhaps the most primitive that we have, but it’s very effective sometimes and it’s enough for this danger to go away.
When we are unable to completely clear that first stage, then the second stage occurs. And during that second stage, other cells come from other organs, and a full-blown response develops. Inflammation then is the result of these two phases of the response. Its main objective is to get rid of an acute insult, whatever that insult may be. But when these insults become chronic, in other words, when they develop for a long period of time, or when we have learned not to recognize what is acute and what is dangerous, we start developing what is called a chronic inflammatory response. It’s almost as if we are overdoing it as thinking that we have to be defending ourselves constantly. And that is what is called the chronic inflammatory response.
It’s important to understand that there are these two dimensions of inflammation. One is inflammation as a good thing. Inflammation is a way in which the body responds to an insult to get rid of the insult, to control the insult, to destroy bacteria, viruses, whatever it is that is attacking. But there is a second aspect to it which is this chronic aspect. When you have all these chemical signals and all these cells hanging around the organs that are affected by chronic inflammation, what starts happening is that the organ starts something that we call remodeling. In other words, it starts reorganizing itself. And this is very important during development when the organs are growing. Because now, together with the normal signals of growth and development, you’re seeing these other signals that are interfering with the normal signals that tell the organs how is it that they have to grow. And they start growing “the wrong way.” Asthma, for example, becomes a disease that has transformed the organ. And now we don’t only have to reverse the inflammation that caused this in the first place, but we have to reverse the remodeling of the organ, the remaking of the organ. That’s why it’s important to understand that avoiding the factors that determine chronic inflammation is very important because it has long-term consequences for the individual.
Sally: Dr. Bush, what does the science say about the effects of adversity and stress during the prenatal period and the first few years after a baby is born?
Dr. Bush: It’s a great question. Young children’s brains are remarkably malleable and they constantly are seeking and absorbing information from their environments that their brains need and use to adapt. And this helps ensure their survival and optimize capacity to learn and thrive. But childhood adversities have the potential to affect these systems in a way that leads to impacts on things such as cardio-metabolic health, depression, diabetes, and multiple other health domains across the life course.
People have been getting kind of earlier and earlier in the chain of development to understand where can we make the biggest impact? Where can we understand both the influence and opportunity for intervention? And so, some folks are leaning closer towards thinking their priorities should be focused on the first 1000 days of life. Adversity during this period has strong prediction of a variety of health outcomes. That’s why early safety–net programs, paid parental leave, and high-quality childcare and preschool are so critical to our nation’s health.
Something that hasn’t received as much public attention is that an increasing number of studies are demonstrating that children’s biological systems begin to be shaped in the womb during pregnancy, and at this developmental stage, they’re substantially influenced by their mother’s biology. Most people recognize that a mother’s pregnancy nutrition or her exposure to cigarette smoke is something we really need to be careful about because they’re so important for the baby’s development, but also things like her sleep health and experiences of stress actually affect her physiology in a way that programs the fetus’s development, and then influence that fetus’s risk for a range of developmental, emotional and physical health problems throughout their life course.
One of our team’s studies of low-income families just recently showed that mom’s reports of feeling overwhelmed by stressors during pregnancy predicted major increases in number of infants’ infections and non-infectious illnesses. So basically, babies of stressed pregnant mothers were sicker and they required more care from their pediatrician in the emergency room. And findings like this point to how critical it is for us to take care of pregnant women, not just for their own health and wellbeing, but for that of their children.
Recent evidence that it isn’t just maternal stress during pregnancies that’s transmitted, but a mother’s own adverse childhood events, her ACEs, or her traumatic experiences during her own childhood appear to affect her biology through her adulthood in a manner that affects her baby’s development in utero. So, to put that in another way, a mom’s own childhood stress can 20, 30 years later have a programming influence on her offspring’s early and later life mental and physical health. This shows a truly trans-generational inheritance of the experiences of major environmental stressors, and it also shows us that intervening to help children either by preventing trauma or supporting them in coping with it after the fact can impact future generations’ health too.
Sally: Our listeners may be hearing this and they may be thinking something along the lines of, if my children experienced a lot of adversity or stress early on that they might be in trouble in terms of their development. Or even if I experienced a lot of stress and adversity early on that I might be in trouble. What could you do to prevent chronic health conditions from developing or to help build resilience?
Dr. Bush: Well, since I just ended with some stressful news about pregnancy stress, I’m really happy to point out that we are finding out a lot about how pregnancy is also an incredible window of opportunity to improve maternal and child health. We have findings showing that a stress reduction intervention in pregnancy leads to improved stress physiology, function, and more adaptive, emotional, and behavioral responses in infants. And we’re also finding that high–quality parenting in the first year of life buffers infants from prenatal stress effects. And another study showing that parental understanding of infant development and having appropriate expectations for infant or toddler behavior completely buffer one-year-olds from the risk of prenatal stress associations. Although more importantly, data suggests that if we were to reduce or eliminate major stressors like racism, poverty, food insecurity, and abuse, we would prevent the need to focus on building up those protective factors, and it would certainly have major cost benefits for society.
Dr. Fair: I will add to that great discussion and just highlight that the early brain, the child brain, just as it’s vulnerable to certain types of changes with regard to stress and factors that we’ve been discussing here, the time is also when it’s most malleable, plastic, and resilient. Meaning the interventions are going to be more effective at this early age as well. And it provides an opportunity for us to really try to change thetrajectory by correcting things that may have gone wrong in the past.
Dr. Martinez: It’s also important to understand that for anything that we’re exposed to, there is a very high diversity of responses in the population. There are many sources for this diversity, which is also called heterogeneity of response. Among these sources, there are exposures and behavioral changes and so forth that Dr. Bush was saying counteract other exposures and other effects. It’s not written than the person who is exposed to a very significant amount of distress during the first years of life is condemned to have chronic inflammation and to have remodeling, reorganization of the organs, and there’s nothing to do about it. Quite surely, there are people who live in that situation but come along and don’t develop those responses. That may be in the future a way in which we counterbalance those negative effects by this resilience that is also so marked as a characteristic of human beings.
Dr. Bush: I love that Dr. Martinez highlighted the kind of individual differences in who has adverse outcomes after experiencing a lot of chronic adversity. At the same time, a lot of people are remarkably resilient for a variety of reasons, some internal, some external. And what we want to do is promote that resilience, but also not frighten everyone into thinking they’re doomed to cardiovascular disease because they had a difficult childhood. The flip side, also very glad that Dr. Fair highlighted how malleable we are for positive changes in early childhood. We have some really exciting evidence across a range of studies that show you can reverse the harmful effects of traumatic events on child biology, through evidence-based therapy interventions. In some cases, the children receiving therapy actually show biological repair and healthier outcomes than some control group kids. And so, there’s lots of reasons to be hopeful that our bodies have the capacity to not only survive and cope with adversity, but rise above sometimes doing better in the end.
Dr. Fair: And the good news is there are a whole host of things that our policy makers can assist to make sure the trends are good. Individual and family support structures, strong access to good education, economic security, all those social factors have a large, large impact on long-term outcomes in our kids, depending on some of the things that we’re talking about today.
Dr. Bush: In addition to caring for children and their parents, it’s also really important for listeners to recognize that adversity and trauma do harm children and families across the entire socioeconomic spectrum. We need to address those directly for all people, all communities by screening in early childhood, screening in pregnancy and screening in adulthood for histories of trauma, so that we can address these social needs of individuals. I’m really hoping that we can make efforts to help insurance providers see the benefit of evolving their understanding, how to care for children, and that that includes caring for their caregivers, both family caregivers, and preschool and early childcare, reimbursement for screening and follow-up for treatment. The data are really compelling that in addition to those solutions being both just and right, that investments in prevention and early treatment could save incredible amounts of money in our societies.
Sally: Thank you all for being here. We really appreciate hearing your individual expertise and also how your knowledge can really build off of each other to give us a full picture of what’s going on. When we come back, Dr. Shonkoff will be discussing a common misconception about early childhood development and lifelong health.
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Sally: I’m joined again by Dr. Jack Shonkoff, who’s going to help clear up some myths and misconceptions in early childhood development. So, Jack, we’ve talked a lot about how early experiences can affect health many years later, but many people wonder how it can be possible that experiences we have before we can even remember them could affect lifelong health.
Jack: It’s really one of the most important myths that we need to bust. And the simple answer to that is that we may not have conscious memories of things that happened very early in our lives, in our infancy, especially traumatic experiences or significant adversity, but what the science is telling us is, the body doesn’t forget what’s happening in these very early months and years. We’re not talking about inevitable poor outcomes,but significant stress activation well before a young child tends to have any sense of what’s going on, creates physical changes, physiological changes, inside the body that affect brain development, can affect the development of the immune system, the cardio-metabolic systems.
So, people who may be a little bit skeptical that something that happened when you were an infant can affect your mental health later, but at least you could begin to see the connection. There’s no logic for people to think that that would have something to do with whether you get heart disease 50 years later. But what the science is telling us is that those biological changes early on can increase your risk for these physical health problems later on. That’s one of the most important messages coming from this new science that is compelling us to connect the brain to the rest of the body. Because what happens early on is not only important for learning and social and emotional development and school achievement, but it’s an important influence on your physical and mental health for the rest of your life.
Sally: That’s such an important point Jack. And I think today’s myth was a particularly dangerous one. I’m really glad we had an opportunity to discuss it at greater length and that you were able to bust it.
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Sally: We discussed a lot of important issues today to explain why the early years are so important and especially why intervening early is so important. And I’m sure we gave our listeners a lot to consider or at least I hope we did. I’d like to end by asking you, Jack, to give our listeners one key takeaway that they should leave this podcast with today.
Jack: I think what’s really important about the big picture for what the science is telling us is a couple of things. Number one is, there are no perfect brains, there are no perfect immune systems. How we grow up, how we learn, what our health is like is related to the interaction between how we are individually wired to begin with and what our life experiences are about. And the important part of our life experiences, the most important, is the environment of relationships that we grow up in. And then also of importance is the physical environment in which we grow up. How safe is it? How protected or exposed are we to toxic substances in the environment, lead, mercury? How much space do we have to move around? So all of these things together, interacting with how everybody is unique from a genetic point of view results in a wide, wide range of normal development.
Our role as parents, as other caregivers, as a community and as a society is to do whatever we can to provide a health-promoting and growth-promoting environment for children, recognizing that everything we do that’s supportive will increase the likelihood of a very successful and fulfilling life.
The bottom line for all of this is it’s a matter of balance. The more the pile up of risk factors and threats, the greater the risks. The more we build up protection and support for the environment in which children grow up, the smaller the likelihood of problems. The important thing to remember is that the way biology works, it’s always trying to make things right. When things happen in the environment that threaten health, all of the systems in our body are reading the environment and they are responding to try to keep us healthy, they’re responding to get us back on track. These new scientific insights should really be a source of reassurance for us and at the same time, a wake-up call about the kinds of life experiences that are threatening so that we can protect children as early in their lives as possible.
Sally: Thanks so much for your time again today, Jack.
So how can we protect children and promote healthy development and lifelong health as early as possible? In our next episode, we’ll discuss what this science means for listeners, including caregivers, policymakers, practitioners, and system providers.
I’d like to once again thank our guests, Dr. Damien Fair, Dr. Nicole Bush, Dr. Fernando Martinez, and Dr. Jack Shonkoff. And thanks to Sid Gardner for your question. I’m your host, Sally Pfitzer, and we hope you’ll join us next time!
The Brain Architects is a product of The Center on the Developing Child at Harvard University. You can find us at developingchild.harvard.edu, where we’ll post any resources that were discussed in this episode. We’re also on Twitter, @HarvardCenter, Facebook, @centerdevelopingchild, Instagram, @developingchildharvard, and LinkedIn- Center on the Developing Child at Harvard University. Brandi Thomas and Charley Gibney are our producers. Bridgette Cyr is our audio editor. Our music is Brain Power by Mela from freemusicarchive.org.
COVID-19 Special Edition: Mental Health in a Locked-Down World
May 19, 2020
While some countries and U.S. states are beginning to reopen businesses and other gathering places, the pandemic is still very much with us. Physical distancing will likely be a way of life until a vaccine for COVID-19 is widely available. So much change, including the threat of illness, and grief of those who have lost loved ones, means that mental health is a great concern.
Fortunately, there are things we can do to support our mental health at this time, especially when caring for young children or other family members. In this episode of The Brain Architects, host Sally Pfitzer speaks with Dr. Karestan Koenen, Professor of Psychiatric Epidemiology at the Harvard T.H. Chan School of Public Health, and Dr. Archana Basu, Research Associate at the Harvard T.H. Chan School of Public Health, and a clinical psychologist at Massachusetts General Hospital. They discuss what supporting your own mental health can look like, as well as ways to support children you care for at this time. They also talk about what mental health professionals all over the world are doing to help take care of our societies in the midst of the pandemic, and how they’re preparing for the challenges that come next.
Speakers
Sally Pfitzer, Podcast HostDr. Archana Basu, Research Associate, Harvard T.H. Chan School of Public Health, and clinical psychologist, Massachusetts General HospitalDr. Karestan Koenen, Professor of Psychiatric Epidemiology, Harvard T.H. Chan School of Public Health
SAMHSA Disaster Distress 24/7 Helpline: 1-800-985-5990 or text ‘TalkWithUs’ to 66746
Transcript
Sally: Welcome to The Brain Architects, a podcast from the Center on the Developing Child at Harvard University. I’m your host, Sally Pfitzer. Since our last podcast series was released, things have changed drastically as a result of the Coronavirus pandemic. During this unprecedented time, we’d like to share resources and provide guidance that you may find helpful. So, we are creating a series of podcast episodes that address COVID-19 and child development. This episode is the fifth in our series, and todays guests are Dr. Karestan Koenen, Professor of Psychiatric Epidemiology at the Harvard T.H. Chan School of Public Health, and Dr. Archana Basu, Research Associate at the Harvard T.H. Chan School of Public Health and the Clinical Psychologist and Massachusetts General Hospital. Thank you both for being here I’m really looking forward to the conversation.
Dr. Koenen: Thank you Sally. It’s great to be here.
Dr. Basu: Thank you so much.
Sally: So Karestan, what makes this pandemic different from other traumatic events that many people have experienced in terms of mental health?
Dr. Koenen: There are a number of characteristics that make the COVID-19 pandemic different than other traumatic events, even than other disasters. I actually lived in New York City during the 9/11 terrorist attacks, and I’ve seen some similarities in terms of this in that things were shut down, there was a pervasive feeling of threat, there was loss of life, and it was very disruptive and it was something that people really – in New York, anyway – talked about for a long time. It persisted and affected everyone in the city. What’s different about this is the length of time people are being affected, how pervasive it is in terms of our community but the state, nationally, and globally it’s the first time that I’ve had experienced a traumatic event that my colleagues in Africa are experiencing some version of it, my colleagues in Mexico, and then I think because it affects so many different aspects of our lives. We talk about trauma, and we think of things that are unpredictable and uncontrollable and overwhelm our ability to cope. This has certainly been unpredictable; a lot of things feel out of our control and on top of that we have other things that can in themselves be traumatic like unexpected bereavement, job loss, a stigma people are experiencing. I think the sheer pervasiveness of it – how it’s affected every aspect of our life. Finally, I think one of the things we know about disasters is that social support is so important for resilience, for people’s recovery, and to buffer them from the effects of disaster. In the middle of this, we’re being told to physically distance to prevent the spread of COVID, and that really cuts into our ability to get social support or to socially support each other, so that is something certainly different than I’ve experienced before or anything I’ve studied actually.
Sally: So Archana, I know you work with children and families on all of these issues around grief, which I know we were just kind of referencing. I’m wondering if you can talk a little bit more about the different kinds of grief that families might be experiencing at this time.
Dr. Basu: I guess I’d like to start by acknowledging that loss is a very common part of human experience, even outside of the pandemic. As an example, in the U.S. each year more than 600,000 people die of heart disease alone. This is not to minimize the losses that we’re experiencing now, but only to say that we as humans are used to experiencing losses and adapt to it on a pretty ongoing basis, and there’s a large body of evidence to suggest that we are adaptive and resilient. This is especially true for children because child development inherently offers many opportunities for change and positive adaptation with appropriate support. That being said, as Karestan highlighted, there are many unique elements to the pandemic in terms of the pervasiveness and the unpredictability as well as the limited or lack of access to typical support systems or resources, for instance due to physical distancing requirements. That certainly makes it unique and challenging. As of today, more than 80,000 fatalities have been reported in the U.S. alone. Families are certainly worried about their own health, their loved one’s health and well-being, or are coping with a death of a loved one. Right now, with travel restrictions, not being able to come together as families or with friends, that’s definitely a pretty big challenge. Many families have been unable to engage in typical funeral rituals, and parents are wondering how to support kids, and some are even wondering whether to say something. Generally, the research supports the idea that open age-appropriate communication can be very valuable in helping children. There are some specific helpful resources; really practical tips in terms of what language or words parents can use to explore how their kids are understanding these experiences, what worries they might have, and we can certainly provide links to that in perhaps the website to our podcast. Briefly, I will just say that open communication really helps to understand what children are observing and experiencing and can help them not be alone in their worries. I would say that would be the number one goal is to help children recognize what they’re feeling, validate those emotions, and for them to feel that they are not alone in this experience. The other element is what you referred to in your question is outside of bereavement, all of us are experiencing losses in our everyday lives. I think one way in which we support each other through tough times is by reaching out and connecting with our friends and family, by holding hands, by giving each other a hug, and we can’t do that right now. Also, I’ve been hearing from younger adults graduating; seniors in college, that they’re experiencing a pretty tremendous sense of loss around routine rituals that form a sense of community like graduation ceremonies. They don’t have that sort of eager anticipation as they’re launching into adulthood. Overall, I guess I would say children can be resilient, but the way forward may not always look and feel that easy. They’ll be moments of frustration and confusion. We would expect that – there is nothing normal about what we are experiencing, so to acknowledge and validate even these everyday experiences of loss would be quite valuable in supporting kids and families.
Sally: I’ve been thinking so much about how so many different people that I know have been experiencing this grief in different ways. You think, “Those high school students – that’s so hard”, or you think, “Oh, those college students – that’s so hard.” There’s so many different traditions and cultural pieces that we are missing right now, and that just changes how we are in our society. Karestan, I’m wondering if you could provide some specific examples; our listeners have often found it helpful to have some concrete ideas about how mental health experts are supporting families now, and then also how they’re preparing for those long-term health impacts.
Dr. Koenen: So, what’s been remarkable to me in terms of the pandemic is how the mental health community, and I mean that in academics, but frontline practitioners and students and people just interested in mental health, or companies that are interested in mental health have really stepped forward to offer resources from something like Headspace is offering free services to health care workers, and we’ve been offering these mental health forums at Harvard Chan School of Public Health. ADAA and CDC are offering all kinds of mental health resources. People have really stepped up to put those resources online, and I think that’s been unparalleled. I’ve never seen, again I worked in New York after the 9/11 terrorist attacks, and there was a cooperation around the mental health community, but I didn’t even see it at this scale then. I guess the other piece is the global collaboration I’ve never seen before. I’ve been on email chains with colleagues from Italy, China, South Korea; some of whom I knew before, some of them I didn’t. Figuring out what they are seeing and what has helped in terms of mental health locally. One center that I am affiliated with at Harvard decided to have a panel of people from China and South Korea talk about going back to work. Using the fact that it is global, and that countries are in different stages to problem-solve some of the things that would come up. Not that necessarily whatever they do would work here, but it would at least perhaps give us some ideas. Another thing has been a sort of rapid move to telehealth, which is something that actually insurance providers have been quite challenging to get reimbursed prior to the pandemic. It seemed like within weeks people had moved their practices to some form of telehealth, which could mean video, or it could mean telephone. That is something that I think has made services to people, especially to people who already had them, more accessible. Those are some things the community has done, and I think is a really positive thing going forward.
Sally: Absolutely. I’m wondering if you could help us think about what parents and other caregivers could do, specifically what they could do right now to support children’s emotional and mental wellbeing.
Dr. Basu: Foremost, readjusting expectation. Whatever little the parents can do to support themselves really matters because they are right now in fact the primary support system for kids. Obviously, parents are the most influential in terms of child development, but right now when kids don’t have access to other support systems, I would say it is even more important. As parents, we are not that great with prioritizing our own needs. It’s sort of kids, and work, and what everybody else needs in the household. Maybe, their own parents, and then if you get 5 hours of sleep, you’re lucky. I get that this is not an easy thing to focus on, but it’s sometimes just helpful to remind ourselves that every little bit counts even if it’s just twenty extra minutes of sleep, if it’s seven minute cup of coffee in the morning, maybe that sets the tone for the start of the day – simple, deep breathing. Another element could be focusing on what kids and families can control. So, thinking about your own routine – what’s helpful for yourself. Doing what works but keeping it simple – basic stuff. Managing sleep routines, eating, exercise, maintaining virtual social connections through technology. All of those things help. So, readjusting expectations and taking the time to sort of figure out routines that can be helpful, help us think about what we can control, and talking about it and checking in to see what’s working. These are some of the basic things I would highlight, and of course one of the biggest advantages right now to telemedicine is that it is more accessible if you have a phone, a computer, or a tablet. Get in touch with a primary care provider to seek guidance and support if this remains challenging, which would be quite understandable.
Dr. Koenen: Outside of COVID, providers are being underutilized. My colleagues who study health care services report that I think that it is down to somewhere 30% of capacity for non-COVID related medical calls, so thus, people should not hesitate as providers are actually available. One of the things that Archana and I have talked about, because we both have sons but they are very different ages, is that kids tend to be most concerned about what directly affects them, while adults we can get concerned about all of these things that might be abstract. One of the examples we have given is that when my son’s school was cancelled, the first thing he worried about was whether the homework due on Monday was going to be due, and whether it is going to be graded, and if they’re going to have to go to school longer. These very specific things, not to say he doesn’t worry about other things, but they are specific things. The younger kids – the playground that they usually run up to there’s yellow tape around it, so there’s these very immediate things. I think as a parent myself, I sometimes can trivialize these things. I find myself being like, “You’re worried about that, we’re in a pandemic, why are you worried about that?” But kids do worry about what is most direct and sometimes most concrete, and so by acknowledging and responding to those concerns which may seem kind of silly in our adult heads, that can provide a lot of comfort to them too.
Sally: Absolutely. You’ve both touched quite a bit on this, but I think I’ll throw this question to both of you to answer. We’ve been talking a little bit about how you’re saying that kids are responding to things that are most direct in their environment, and we know that the toll in this pandemic hasn’t been evenly distributed and will likely continue to not be evenly distributed. Some people are at much greater risk for both medical and economical consequences, and are you seeing that to be true for emotional and mental health consequences as well? If so, what could be done about that?
Dr. Koenen: Great question. When some of the groups we are seeing as most at risk for mental health consequences are 1 in 5 people in the U.S. – adults in the U.S. – live with a mental health disorder, so people who already had a prior mental health disorder or mental health condition, the conditions of the physical distancing for people with a mental disorder removed social supports and things that also may be accessed to other care groups – day programs, etc. Those people have been particularly affected had they already been socially isolated. The Kaiser Family Foundation came out with some statistics, and some of it’s not surprising. It’s families, actually parents, parents are reporting more mental health issues and people who experience economic downturn or job loss. We know from the 2008 recession that job loss and foreclosure are associated with increased risk of mental health issues. Thirdly, low income in communities of color have been disproportionately affected. I saw some data from a colleague published in New York which showed that higher mortality from COVID was related to income. We know that there’s been disproportionate mortality for communities of color. Also, in such communities, there is a greater digital divide, so we talk about a lot of these resources have been put online and there’s a lot of virtual support. But, we also know that 15% of Massachusetts households kids don’t have computers or didn’t have computers before this. And those again tend to be disproportionately in low income and communities of color. Those are some of the people I think disproportionately affected with risk of mental health problems who are disproportionately experiencing the COVID as well as the financial consequences.
Dr. Basu: I think the family focused care piece is really critical, and this is again very consistent with the Center’s philosophy around multi-generational models to support kids and families. I can’t really say this enough – I think supporting kids also needs to involve a model that supports parents. I would say that type of family focused care as one possible model moving forward is very key. The second one that Karestan and I and others have talked about, and maybe Karestan can chime in on this, is the aspect that there are many other communities or system within which kids and families live, work, and develop. That includes schools and community-level organizations, and faith-based organizations. I think part of supporting mental health care would involve partnering with these community-based organizations. This might include formal leaders and key stakeholders, but also potentially developing collaborations with more informal key stakeholders. There’s a lot of evidence that we can provide effective mental health care by not just working with specialists like psychologists and psychiatrists which is absolutely necessary, but also with more community-based healthcare workers, for example, and Karestan can speak of what we can learn in terms of the global context.
Dr. Koenen: Sure. Something that I hope that can come out of this pandemic is the better recognition that mental health is critical as the foundation of all health and the foundation of a healthy society. Rather than treating mental health like a side issue that we deal with when it’s an apparent big problem, we think of it more proactively. The burden isn’t left on individuals or even on families to seek help when things get to the crisis point. I think one of the things we can learn from our global partners and countries, where there may be 60 psychiatrists in the entire country treating a population and very few other trained medical professionals, is people having to introduce other models where community health workers or just leaders in the community, people who the community would acknowledge they look up to, training them in mental health practices that can then be disseminated into the community.
Dr. Basu: I think what Karestan highlighted in her previous comments is that there is also a lot of research to suggest that longstanding systemic issues can manifest in mistrust of health systems and beliefs about mental health that can impact engagement with care. So, engaging in the ways that Karestan highlighted, where people trust. Those are really valuable ways to engage people in just thinking about social and emotional health – engaging and starting that conversation.
Sally: Interesting. A lot of times at the Center when we’re talking about stress effects or stress response, we also like to talk about resilience. I’m wondering what you would say in terms of resilience around this pandemic.
Dr. Koenen: One of the things that has come up for me in terms of resilience is flexibility. We’re being called on to be very flexible, and we don’t always think of that in terms of resilience, but I think in this it is particularly true. I give my own example, one of my main coping strategies that works tremendously well 95% of the time is that I am a planner and I can see my plan backwards. I really had to be like “I plan, God laughs right now”, because so many things change all the time and as a parent now, we don’t know what this all brings. Having to be flexible myself, and model flexibility for my son who’s doing online school, he doesn’t know what the week is going to hold. The schedule is different everyday for his school, etc. Learning to roll with it and change your expectations. The other thing is I’ve been trying to figure out is, “What are the things that are most important to me? What are the priorities for my family, for myself”, and keeping them simple and only having a few of them. The normal expectations of everything we’re going to get done is not going to happen, and I also think that as a parent you have to choose your battles. An example is, well if your kids doing all their work and been on their Zoom calls for school and did all of their homework without complaint, does it matter if they got dressed? Maybe it does, maybe it doesn’t, but do you want to fight over what they’re wearing? Maybe you do, maybe you don’t. There are probably other things about having to choose what you’re going to focus on, and are you going to let go of some of the things or some of the time to make it more manageable.
Dr. Basu: To follow up on one of the things that Karestan started with was this idea of flexibility and it’s really something in our work with kids and families we talk up front about. One of those ideas is developing a toolbox of things that work for you as a family, and really think about what works for your child. I will often ask parents and older kids, “what has worked for you in the past?” So, we may not have been in the pandemic before, but we certainly experienced transitions and stressors and challenges in other ways. Asking them what has worked for you in the past and then thinking about how we can adapt those for right now. Also, recognizing that especially with kids, what works this morning, may not work at night or the next day, so thinking of it as a toolbox of skills or ideas they can use to cope is very helpful and certainly along the lines of having a flexible approach and definitely underscoring readjusting the expectations. I would definitely agree with both of those. I think the other thing that I would say is that individual resilience partially depends on systemic resilience. Really thinking about what are ways in which we can support families and schools and some of the other community-based organizations because those are the contexts in which children and families and all of us live our lives. There’s a recent study that found that among adolescence who received any mental health services between 2012-2015, that for 35% of the kids the only point of contact for getting mental health services was from their schools. So, forming partnerships with schools is actually really important because kids may not even access care through hospitals or specialists, but for a large portion of kid’s, schools might be the only point of service for them.
Sally: Excellent. I think that there are so many listeners who are especially going to relate to that readjusting expectations piece. That one really resonated with me as well. Well, thank you both so, so much.
Dr. Basu: Thank you so much.
Dr. Koenen: Thanks, Sally.
Musical interlude
Sally: I’m your host, Sally Pfitzer. The Brain Architects is a product of the Center on the Developing Child at Harvard University. You can find us at developingchild.harvard.edu. We’re also on Twitter @HarvardCenter, Facebook @CenterDevelopingChild, and Instagram @DevelopingChildHarvard. Brandi Thomas is our producer, and Charley Gibney is our producer and audio editor. Our music is Brain Power, by Mela from FreeMusicArchive.org. This podcast was recorded at my dining room table.
COVID-19 Special Edition: Domestic Violence and Shelter-In-Place
May 12, 2020
Shelter-in-place orders are meant to help protect our communities from the current coronavirus pandemic. But for some people, home isn’t always a safe place. For those who are experiencing domestic violence, or believe they know someone one who is, what options are available to stay both physically healthy and safe from violence?
Tien discusses important, practical steps those at home can take to keep themselves and their children safe, as well as strategies others can use if they think someone they know may be experiencing domestic violence. She also addresses the resilience of survivors, and what our communities can do both during and after COVID to listen to and engage in real responsive relationships with adults and children alike.
The next episode of this special podcast series will focus on the mental health implications of a global pandemic. Subscribe below via your podcast platform of choice to receive it as soon as it’s released.
A note on this episode: If you or someone you know is experiencing domestic violence, you can contact the National Domestic Violence Hotline: 1-800-799-SAFE (7233) or the National Sexual Assault Hotline: 1-800-656-HOPE (4673).
Speakers
Sally Pfitzer, Podcast HostDr. Tien Ung, Program Director, Impact and Learning, FUTURES without Violence
Sally: Welcome to The Brain Architects, a podcast from the Center on the Developing Child at Harvard University. I’m your host, Sally Pfitzer. Since our last podcast series was released, things have changed drastically as a result of the Coronavirus pandemic. During this unprecedented time, we’d like to share resources and provide guidance that you may find helpful. So, we are creating a series of podcast episodes that address COVID-19 and child development. A quick word about today’s episode: as you’ve probably guessed from the title, we’ll be discussing the subject of domestic violence, including mentions of sexual violence and abuse. We just want to give a heads up to those who may be sensitive to this subject matter so you can make an informed decision about whether this topic is right for you at this time. If you or someone you know may be experiencing domestic violence, you can contact the National Domestic Violence Hotline at 1-800-799-SAFE, that’s 1-800-799-7233, or the National Sexual Assault Hotline at 1-800-656-HOPE, that’s 1-800-656-4673. This podcast is the fourth in our series, and our guest today is Dr. Tien Ung, Program Director of Impact and Learning at FUTURES Without Violence. Prior to her work at FUTURES, Tien spent 5 years as the Director of Leadership and Programs here at the Center on the Developing Child. Thank you so much for being here with us today Tien, we’re really glad to have you.
Dr. Ung: Thank you, Sally. I’m glad to be back here to talk with you all about this.
Sally: Just so our listeners know, we’re recording this podcast today on a video call, so the sound quality may be different from what you’re used to hearing when we typically record this podcast in the studio. I’m going to start us with this first question. Tien, what are you seeing and hearing from your local partners, law enforcement, and families about indicators of domestic violence since stay at home orders started?
Dr. Ung: Sheltering in place does present very unique circumstances and challenges for people who are not safe at home. We know for example, that 1 in 4 women experience violence by an intimate partner in their lifetime. We know that 2 out of 3 children are exposed to trauma and violence. We know recently from the Rape, Assault & Incest National Network that for the first time in 25 years, their national hotline is receiving calls from minors, such that more than half of their calls coming in over the last couple of months have been from minors. We also know that at this time, reports of abuse and neglects against children are dropping. We know at least in Massachusetts, and I suspect in other states across the U.S. as well, that 80% of reports that come in from mandated reporters about child abuse and neglect are coming in from health professionals, educators, first responders, people who do not have eyes and ears on what’s happening behind closed doors at home right now. We also know very recently that phone calls to police stations across the nation are rising in response to domestic disputes. I think in fact, just today, we learned that a mass shooting in Canada had roots in domestic violence, which highlights, actually, what we’ve known for quite some time, that there is a strong correlation between domestic violence and mass shootings. Current stay in place orders present very specific challenges to people who are not safe at home. There’s also good news. While it is true that communities of care serve as an organic system of surveillance and monitoring bringing attention to harm that’s being done behind closed doors, we also know that those same communities serve as protective factors for children and victims of family violence and domestic violence. Faith communities, social communities, health and medical communities, as well as human service and educational communities, and legal and judicial communities—they all come together under normal circumstances to create a system and an ecology of care and protection. Those are things that I think will be important for us to unpack a little bit on the call today.
Sally: This is obviously a really challenging time, and if someone is experiencing domestic violence and they are a parent, what might they be able to do to escape that given we are in the shelter in place?
Dr. Ung: Because parents don’t have access to their normal pathways for connections, it really is very hard for them to reach out and get the help and support they need. It goes back to basic safety planning; things like making sure survivors know to put their hair in a bun rather than in a ponytail, because when your hair is in a ponytail there is more to grab onto which can cause injury. Making sure they are scanning their environments and looking for places to shelter in place in their homes where there’s not easy access to knives, for example, so don’t run into the kitchen. Doing a quick scan to see what they can use as shields or whatnot to protect themselves and reduce the likelihood of serious injury if a fight does breakout. We’re really back to basics, Sally, which is hard to believe. Some of the things we marvel about are the ways in which, and this is something that I think the Center knows well and talked about a lot when I was there, that survivors in children are incredibly resilient, and they know how to keep themselves safe, and they know what to do to manage the episodes of violence and aggression in their homes. It’s just really about giving them the support and letting them know that if things are really, really bad and they need to get out and get out quick, finding ways for them to have that. Every state, for example Sally, has a state collation for domestic violence. They are the people who know what services are in place for each state, what shelters are up and running, and what, importantly, batterer intervention programs are also up and running. They also have wonderful relationships with local law enforcement and the courts and are really good partners.
Sally: Those resources that you were saying that each state provides, how would someone get connected to that if they weren’t aware? Is that a website, or how would someone find that information?
Dr. Ung: That’s a great question. It is a website. I can make sure you all have information to that as part of this podcast so that you can put it on your website for people. It is split out by national level resources, as well as youth specific level resources, as well as resources specifically for the LGBTQ community. (Editor’s Note: That website is available here: https://ncadv.org/state-coalitions)
Sally: That’s really helpful, thanks. I’d like us to think a little bit more about what listeners or friends and family and neighbors could do to help prevent increases in domestic violence from affecting more kids.
Dr. Ung: I think that’s a good place to move into. We developed, actually on our website you can find a tip sheet of 10 simple steps that friends and family can take during this time if you’re worried about a loved one sheltering at home, or specifically about the safety; the physical, psychological, sexual, and emotional safety of someone sheltering in place. Some of them involve continuing to reach out and check in. We are sort of punctuating the notion that social distancing really isn’t the goal, physical distancing is the goal, but social connection should not go away in the face of requirements around physical distancing. We’ve been trying to practice ourselves by using the concept of physical distancing to promote the idea that finding ways to connect socially and support socially is really important. Checking in and reaching out to your family member and your friends are really important. Asking them what they need on a day to day basis, asking them if they’re okay, asking them directly if they are feeling safe. We like to encourage family members, and also community based social groups, like faith-based groups, to come together and think about how you might support families that you know are more vulnerable by preparing meals, by pulling dollars and helping families with real concrete, basic material needs. We’ve been encouraging family members and friends to reach out and offer parents relief from 24/7 parenting by offering to read a young child a book on the phone, or get on Zoom and do some crafts with someone, or even just getting on Zoom and watching a movie, or finding ways to engage in just fun. You can take your iPhone, for example, we’ve talked to people about playing hide and seek with young people with the iPhone around the house. Finding ways to offer some respite, relief, and support and connection. We’ve invited family and friends who know there might be family violence at home to find safe ways to have private conversations and establish a code word. Some of the words that some of our shelters are using have to do with “masks needed please,” so the survivor at home who’s not safe might text a service provider a code word: “masks needed please,” and that would indicate that that provider needs to initiate a police response to the house. Finding code words like that, so people can have strategies where they can get help and support in the height of the state of emergency is something we’ve talked about as well.
Sally: I love the concrete examples that you gave how you can interact with people who aren’t actually in that space. Although, I do imagine some families don’t even have access to technology, which might compound that even more.
Dr. Ung: Yes, I think that’s absolutely true. I think in those cases, families have their networks. The friends and neighbors of families who don’t have access to technology—they find ways to communicate and stay in touch, so what we’ve been inviting people to do is to find ways to maintain those connections to check in on people, and first and foremost to offer support. Anything that we can do to reduce stress and reduce burden is really important right now.
Sally: So, back to the resilience piece, obviously you spent a lot of time when you were at the Center helping us craft this curriculum around the 3 Science Principles. We were curious if you could talk a little bit more about what the science of child development tells us about what we need to do to prevent or alleviate the problems you were just describing.
Dr. Ung: You know, we know that the experience of trauma like exposure to domestic violence for children has three broad-level impact levels on children. They have biological impacts, which I think at the Center we talk about as the ways in which adversity gets under the skin and impacts children’s health system—raising risk across the life course for negative impacts in learning health, and behavior. We also know that it has psychological impacts, relative to influencing how young people think, feel, act, and interact with others. Lastly, we know that the exposure to prolonged trauma like witnessing domestic violence or experiencing family violence in the home can lead to negative social impacts, interfering with how children and young people relate and make decisions in the context of interpersonal health and engagement. In that context, we’ve been trying to draw a lot on the science that the Center organizes and produces to help people design strategies and programs and policies that buffer impacts in those three areas. When this is all said and done, which seems to be a very relative framing, there will be – we all anticipate—a long period of recovery. A lot of the conversation right now, Sally, is focused around the stress and the trauma of sheltering in place when home is not a safe place, but we’ve been paying a lot of close attention to near-term and long-term stressors that families that were already vulnerable before COVID are going to be facing sort of burdens and levels of stress. There have been 58,000+ deaths in the U.S. right now, and that number is going to continue to sore while we live through all of this. It’s not just family members of young people and children and youth who are dying, but teachers and coaches and people who represent really important relationships in the lives of young people. That’s a wave that we’re really trying to get ahead of and prepare for now. We think the best systems of care pre-COVID, during-COVID, and post-COVID ought to be organized around creating experiences and conditions that help young people and their families thrive, survive, reduce burden and stress in their lives, and create and sustain meaningful, interactive, positive relationships. A lot of that is promoting people’s capacities and skill in terms of being able to have very authentic and genuine conversations with their service providers, with their neighbors, with their faith communities, with their family, about what it means to be in a safe and healthy relationship, and to really promote that as doorways to service deliveries and service provision, rather than business as usual, which is the only access to serve this provision a vulnerable children in a family can have is through a surveillance and a monitoring system, which only produces stigma and also decreases, I think, the likeliness that if you need help and want help you can actually get it. Nobody wants to get help when help comes with the conditions of needing to be labeled a victim or a batterer, frankly.
Sally: It’s so challenging to take such a huge topic and cut it down into 15 minutes, so thank you for allowing us.
Dr. Ung: Thank you for inviting me.
Musical interlude
Sally: I’m your host, Sally Pfitzer. The Brain Architects is a product of the Center on the Developing Child at Harvard University. You can find us at developingchild.harvard.edu. We’re also on Twitter @HarvardCenter, Facebook @CenterDevelopingChild, and Instagram @DevelopingChildHarvard. Brandi Thomas is our producer, and Charley Gibney is our producer and audio editor. Our music is Brain Power, by Mela from FreeMusicArchive.org. This podcast was recorded at my dining room table.
COVID-19 Special Edition: Creating Communities of Opportunity
May 06, 2020
While the current coronavirus pandemic is affecting all of us, it isn’t affecting all of us equally. Some communities—especially communities of color—are feeling the brunt of the virus more than others, in terms of higher rates of infection as well as economic fallout, among many other ways.
In this third special COVID-19 episode of The Brain Architects podcast, host Sally Pfitzer is joined by Dr. David Williams, the Florence Sprague Norman and Laura Smart Norman Professor of Public Health, Harvard T.H. Chan School of Public Health, and Professor of African and African American Studies, Harvard Faculty of Arts and Sciences. Dr. Williams discusses ways in which the coronavirus pandemic is particularly affecting people of color in the U.S., and what that can mean for early childhood development. He also pinpoints the importance of creating “communities of opportunity” that will allow all families to thrive—both during and after this pandemic.
Upcoming episodes of this special podcast series will focus on domestic violence, and the mental health implications of a global pandemic. Subscribe below via your podcast platform of choice to receive all new episodes as soon as they’re released.
Speakers
Sally Pfitzer, Podcast HostDr. David Williams, Florence Sprague Norman and Laura Smart Norman Professor of Public Health, Harvard T.H. Chan School of Public Health
Sally: Welcome to The Brain Architects, a podcast from the Center on the Developing Child at Harvard University. I’m your host, Sally Pfitzer. Since our last podcast series was released, things have changed drastically as a result of the Coronavirus pandemic. During this unprecedented time, we’d like to share resources and provide guidance that you may find helpful. So, we are creating a series of podcast episodes that address COVID-19 and child development. This episode is the third in our series, and our guest today is Dr. David Williams, the Florence Sprague Norman and Laura Smart Norman Professor of Public Health – Harvard T.H. Chan School of Public Health, and Professor of African and African American Studies -Harvard Faculty Arts & Sciences. Thanks for being with us today, Dr. Williams.
Dr. Williams: Thank you, it’s good for me to be here with you.
Sally: Just so our listeners know, we’re recording this podcast today on a video call, so the sound quality may be different from what you’re used to hearing when we typically record this podcast in the studio. So, the data that’s coming out now that we’ve been seeing continue to reinforce the research that you have been doing for many years around racial disparities, and we’re seeing that this virus is disproportionately effecting people of color. What are you seeing now in terms of the data?
Dr. Williams: We are seeing in multiple states more than half of all deaths from the Coronavirus are African American, and in virtually every state the percent of deaths of African Americans who die from the Coronavirus exceeds—it’s larger than the percent of African Americans in the population in that state. So, there is a disproportionate negative impact on African Americans in New York City, and we see a similar pattern for Hispanics. I think the important point I would like to make at the onset is that first, this is not a surprise. Two, this reflects a longstanding pattern, not just for Coronavirus but for virtually all of the leading causes of death. And that this pattern does not reflect failures on the part of the individuals, the families, and the communities that experience such disproportionate losses.
Sally: I think a lot of times when we’re hearing about this data coming out, there is a missing component where people are hearing this is disproportionately affecting communities of color, but there is not a lot of talking happening right now around the ‘Why?’. Could you share a little bit more about what the underlying causes of this disproportionate impact actually are?
Dr. Williams: Sure. Before we talk about underlying causes, I think it’s also important to emphasize that when we see one group in our society disproportionately affected, it affects all of us. It is about all of us. We are all connected. Higher rates of death for one population effects the entire profile and the entire risk for all of the population. In terms of what are the causes of these patterns? We’ve known for a long time many of the culprits. Number one I would mention is lower income, lower education, lower occupational status. In virtually every country of the world, persons of lower levels of education and income have higher rates of disease and death than those who are better off than they are. And when we say race and ethnicity in the United States, we are talking about groups that really vary dramatically in economic resources. I’ll give you two numbers that makes this very concrete. If you look at the latest income data for the United States, published in 2019 by the U.S Census Bureau1, we find that for every dollar of household income White households receive, African American households receive .59 cents. That .59 cents to the dollar figure is identical to the racial gap in income in 1978. Most of my students think we have made a lot more progress than that. As bad as the income gap is, it dramatically understates racial differences in access to economic resources. Because income captures a flow of resources into the household, it tells us nothing about the economic reserves that households have to cushion short falls of income. We get that from data on wealth. The latest report from the Federal Reserve Board indicates that for every dollar of wealth White households have, African American households have .10 cents, and Latino households have .12 cents.2
So, we are looking at groups that are disproportionately, economically disadvantaged; number one. And in multiple ways that raises the health problems and challenges that they will face. COVID-19 really illustrates this phenomenon very powerfully. What we know is that minorities have early onset of disease, early onset of chronic conditions, hypertension, diabetes, heart disease, all occur at younger ages. Part of this is driven by the lower economic status and higher levels of stress. Also, persons of color disproportionately in jobs where they have to go to work in order to get paid. We are working in jobs that don’t provide benefits, often don’t provide healthcare benefits, which lowers access to medical care. In New York City, for example, the hardest hit area of the pandemic, 60% of the essential workers in New York City are persons of color.3 Research also documents that in disadvantage communities, even if you get access to primary medical care, many of those primary care providers do not have admitting privileges at the best academically based or private health care systems where the best specialists are, so that those populations are also limited in the access to quality care. More generally, there is at least one study since the COVID-19 epidemic has begun that looked at a data from multiple states and that reported for testing for COVID-19 that African Americans, with the same symptoms as whites, showing up requesting a test were less likely to get the test.4 We also have evidence of the persistence of discrimination in terms of access to tests in addition to the fact that most of the testing sites are in suburban communities and there are fewer testing sites in central city communities that have a larger unrepresentative minority population.
COVID-19 is a perfect storm in terms of having a disproportionate negative impact on disadvantaged populations in the United States.
Sally: A lot of what you’re describing reminds me of that saying, “a person’s zip code has more to do with their health outcomes than their genetic code does.” What does that mean and how does that relate to this current situation?
Dr. Williams: I think it’s important to recognize that challenges these communities face are long standing and it didn’t happen by chance – they are not random events. They actually reflect the successful implementations of social policies. We had social policies implemented in the United States, but residential racial segregation being one of the most profound of them in terms of its far reached negative effects that still persist today that restricted a way a person lives based on race or ethnicity. That has had a dramatic effect in reducing access to opportunities – opportunities in early childcare and good early childcare environments. Access to good early education, access to employment opportunities. Opportunity in terms of the quality of neighborhood and housing environments and whether it’s easy or difficult to get exercise safely in your neighborhood. Whether it’s easy or difficult to have access to good primary care in your neighborhood. Across a broad range of factors that drive opportunity and success and society, we have large segments of our population restricted by these historic inequities.
Just to illustrate how powerful some of these effects are; a national study led by Harvard economists showed that if we could eliminate residential segregation in the United States overnight, we would completely eliminate or erase black and white differences in income, in education, and in unemployment, and reduce the black white differences in single motherhood by two-thirds.5 All of those differences driven by opportunities linked in place. What we need to think is how can we create communities of opportunity? Communities with high-quality early childhood programs, where every child is given a fighting chance to be successful—not only prepared for school, but also prepared for good health – a good foundation for health for the rest of their life. What can we do to reduce childhood poverty? What can we do to enhance employment opportunities for parents? One of the ways we can improve outcomes for children is by enhancing opportunities for their parents. How can we improve housing and neighborhood conditions?
The good news is there are examples of programs in the United States that are doing these things right now, and many of the studies show that these programs not only work but they will save society money. There is a range of opportunities of things we could do now to make a difference. When we take care of all of us and all of us have the opportunity, we not only build a more educated, a more productive workforce, we not only enhance the economic productivity of our society and the global economic competitiveness of our nation, but we also do something more that is profound, and that is we take care of all of us. We are all in this together, and what hurts one of us hurts all of us. It is in our best interest to work together to create a society that provides opportunity for everyone.
Sally: You mentioned stress as a factor contributing to the racial disparities and outcomes. Would you mind talking a bit more about how stress can affect communities and long-term health?
Dr. Williams: Sure. I want to talk a little bit more about the fact that minorities; African Americans, Latinos, Native Americans, have higher rates of underlying chronic conditions. The question is why? Is it their fault? Is it all linked to the bad choices that they are making? What the research points to is that you are looking at populations that are experiencing higher levels of stress. In some of my own work, I have found that the most of common stressors—stressors like loss of a loved one, unemployment, financial difficulties, violence in a neighborhood—all of these occur at higher levels among African Americans and among U.S. born Latinos.6 Not only do they have higher levels of the individual stressors, but they have greater clustering of stressors, so if you have one you are more likely to have multiple. What research is pointing out is that living out of the conditions of high levels of chronic stress leads to a physiological dysregulation across multiple biological systems. There is a body of research suggesting that at the same chronological age, racial ethnic minorities may be biologically older than Whites in the United States.7 It reflects the high levels of exposure to psychosocial as well as physical chemical stressors.
Let me give a practical example of the physical chemical stressors. There is one recent study done by researchers at Harvard University documenting that persons who live in areas with higher levels of air pollution, which are disproportionate minority, those persons if they get COVID-19, it is more severe and they’re more likely to die.8 The air pollution, this chemical stressor, has a negative effect in terms of adversely impacting health. In addition to higher levels of the chronic stressors, one of my areas of research has also been looking at stress of racial discrimination. I have developed measures to capture discrimination. One of them that is very widely used around the world is called The Everyday Discrimination Scale.9 It captures minor indignities – being treated with less curtesy and respect than others, receiving poorer service than others at restaurants or stores. The research documents that these little indignities accumulate and adversely impact physical health, mental health, the quality of sleep. It predicts early onset of multiple chronic diseases and even adversely impacts how individuals access and utilize medical care. If you’ve been treated badly in multiple domains of society, then you become less trusted in even the healthcare context. What emerges is a picture of the cumulation of negative experiences of chronic stress that have long term negative impacts on health.
The challenge, though, is that most Americans are unaware that racial ethnic disparities even exist. Raising awareness levels is really important, because if we don’t even know a problem exists, we are not mobilized to address it. Maybe COVID-19 provides us an opportunity to become more informed and hopefully to become more committed to working together to create a better future for all.
Sally: So, we’ve talked a lot about racial disparities in physical health related to COVID-19, but could you talk a little bit more about other ways in which people of color may be disproportionately impacted by this pandemic?
Dr. Williams: COVID-19 is an unprecedented challenge that we are all facing together as a society. This unprecedented challenge is a physical health problem, but it is going to produce a large scale of economic devastation, which we have touched on to some degree. It also will have large scale, negative emotional consequences. One of the things that we really need to think of is how do we provide support for all communities, but especially those who are already suffering disproportionately from the economic effects—those who are suffering disproportionately from the loss of loved ones. When we say that African Americans and Latinos are experiencing higher rates of death, that’s people losing mothers and fathers, grandparents, brothers and sisters. This is a community that will also be experiencing higher levels of grief and loss in addition to all of the negative effects of the pandemic. So, we really need to think of how can we enhance the access to emotional resources that helps people cope, and how all of us as individuals, even as we socially distance, we do not emotionally distance. That we do reach out to others and be supportive and be helpful, so that people can still have that sense of caring from others and that sense of emotional support from others.
Sally: I’m imagining that many listeners might be wondering what they can do, and how we might be able to help change this for the future?
Dr. Williams: Sure. I think when it comes to stress and environment, there are things that individuals who are suffering now can do that can protect them from some of the negative effects of stress. So for example, even the research on stress in general, but also research on discrimination in particular, points out that individuals who are embedded in close-knit, emotionally supportive relationships, the quality of social ties can reduce at least some of the negative effects of stress on health. There are some research suggesting that higher levels of religious involvement can also protect individuals from some of the negative effects of stress on health. There are things that can be done at the individual level. At the same time, what can we do to create environment where stress levels are lower? How can we create high quality neighborhoods so we will reduce the levels of neighborhood stress? How can we promote greater civility and respect of others as a value, so that we reduce the occurrence of discrimination in the first place? How do we make workplaces more friendly and more stress free than they currently are today? So, I think we do need to think of the high-level policy solutions that create environments that are low in stress, even as we empower individuals to more effectively cope with and deal with the stresses they face.
Sally: I really appreciate you taking the time, I know it’s incredibly busy and I know there are a lot of people asking for your time, so thank you so much for the opportunity to interview you.
Dr. Williams: You’re very welcome.
Musical interlude
Sally: I’m your host, Sally Pfitzer. The Brain Architects is a product of the Center on the Developing Child at Harvard University. You can find us at developingchild.harvard.edu. We’re also on Twitter @HarvardCenter, Facebook @CenterDevelopingChild, and Instagram @DevelopingChildHarvard. Brandi Thomas is our producer, and Charley Gibney is our producer and audio editor. Our music is Brain Power, by Mela from FreeMusicArchive.org. This podcast was recorded at my dining room table.
COVID-19 Special Edition: Self-Care Isn't Selfish
Apr 28, 2020
In the midst of a global pandemic, pediatricians are serving a unique role. While the coronavirus is generally showing milder effects on babies and children than on adults, there are still health concerns and considerations for infants in need of scheduled vaccinations, and kids who are home all day with parents who may be facing stressful situations.
In the second episode of our special COVID-19 series of The Brain Architects, host Sally Pfitzer speaks with Dr. Rahil Briggs, National Director of ZERO TO THREE’s HealthySteps program, to discuss how pediatricians are serving their patients during the pandemic, including using telehealth; why caregiver health is child health; and what she hopes the healthcare system can learn as a result of the pandemic.
Upcoming episodes will focus on racial disparities in the effects of the virus, and domestic violence. Subscribe below via your podcast platform of choice to receive all new episodes as soon as they’re released.
Speakers
Sally Pfitzer, Podcast HostDr. Rahil Briggs, National Director of ZERO TO THREE’s HealthySteps Program
Sally: Welcome to The Brain Architects, a podcast from the Center on the Developing Child at Harvard University. I’m your host, Sally Pfitzer. Since our last podcast series was released, things have changed drastically as a result of the Coronavirus pandemic. During this unprecedented time, we’d like to share resources and provide guidance that you may find helpful. So, we are creating a series of podcast episodes that address COVID-19 and child development. This episode is the second in our series, and our guest today is Dr. Rahil Briggs, the National Director of ZERO TO THREE’s HealthySteps Program. Good morning, Rahil.
Dr. Briggs: Good morning, Sally.
Sally: And just so our listeners know, we’re recording this podcast today on a video call, so the sound quality may be different from what you’re used to hearing when we typically record this podcast in the studio. Rahil, what are you starting to see out in the field with pediatric practices effected by this virus, particularly in the HealthySteps locations, and how are the pediatricians starting to respond to the Coronavirus situation?
Dr. Briggs: Sure, thanks Sally. It’s an excellent question and honestly, depending on when listeners are catching this it may have already changed by now. The American Academy of Pediatrics is really our guide star for figuring out what’s going on and what they’re recommending, but a couple of facts on the ground really remain the same. That pediatric primary care is the main system we have for reaching young children. In a normal time, whatever that was and may be in the future, pediatric primary care reaches nearly all young children in our country. Right now, the American Academy of Pediatrics in recognition of the importance of vaccinations, and in recognition of the importance of really high quality newborn pediatric care continues to recommend actually, that families bring newborns, and bring infants and toddlers who need vaccinations into the primary care practice. So, that is pretty extraordinary and speaks to the importance of those services even with the Coronavirus swirling around. As you know, there are about 12-13 well child visits in those first three years. 7 of them occur in the first year of life, and a big chunk occur in that newborn period where they are checking everything from the bilirubin levels to maybe redoing the newborn blood stick to the weight gain and all these really critical pieces. So to your question – what are we hearing now and what are we hearing from our HealthySteps specialists who work side by side alongside the pediatricians in these practices? We’re hearing that babies still need vaccinations, and parents are more stressed than ever. That really needs attention. All of this discussion about how children are saved by the worst impacts of the medical parts of the Coronavirus, they are at home often with parents who are incredibly stressed and really looking for new approaches and ways to just frankly get through the day. So that is where our HealthySteps specialists are really coming in handy. I’ll leave you with one particular point that has really stuck with me. We had one of our HealthySteps practices in Colorado say that they were going to move to drive through vaccination services, which sort of boggles the mind, but I suppose that’s the world we are living in right now. And as they grappled with that and went back and forth with whether or not that was the right thing to do, they decided they weren’t going to do drive through vaccination services. One of their driving pieces was knowing how important it would be for the family to still touch base with the HealthySteps specialist. They’re hearing that families are running out of diapers, families are struggling to get formula, families are struggling to get needed medications for children with special healthcare needs. The HealthySteps specialists are doing so much of that care coordination and that systems navigation because as we know this is disproportionately affecting those who are impacted by poverty.
Sally: Would you mind giving us a really quick summary of what HealthySteps is for the listeners who may not know about the program?
Dr. Briggs: Sure. HealthySteps is a team-based, evidence-based primary care program where we add a new team member to the primary care network, which is a HealthySteps specialist who is an expert in child development, focusing a lot on parent-child relationships, focused on infants and toddlers; babies, toddlers, birth to three. We are an evidence-based program and have a three-tiered system of intervention with a universal level of services that include needed screenings for family concerns and child concerns and follow up on those screenings. And then a tiered level of intervention based on need for families with young children.
Sally: That’s really interesting, and you’re actually teeing us up for our next question. How are pediatricians helping families manage stress with all that’s happening right now, and what advice would you be thinking about giving to those families that are dealing with the highest adversity and stress?
Dr. Briggs: It’s a great question, Sally. I think a couple of things remain true, even though we are living through pretty extraordinary times. We know that there are two main ingredients for happy families with healthy children, and those continue to be safe, stable and nurturing relationships and a sense of routine and predictability to some extent. So obviously right now people are very stressed, and families are worried about lost income or even about not having enough groceries on the table. We also know from some of the great work that’s been done that babies pick up on that stress. They’re like recording devices that are always on. We don’t get to choose whether they record just the good or some of the bad, it is always on. So, what do you do and what can pediatricians do to help families during this time? I’d say three important things. One, and again this remains true no matter what time we are in – take care of yourself so that you can take care of your children. It’s about going easy on ourselves. Recognizing that nobody can overnight, turn into a perfect stay at home employee, pre-school teacher, care coordinator, systems navigator and parent when you’re not sleeping because you’re worried about trying to get food on the table. It’s about asking for help and organizations are scrambling to try to figure out the best ways to help families – moving to telehealth and moving to much more nimble service delivery options. Two, some semblance of a daily schedule. I think again this is a moment to go easy on yourself. It doesn’t have to be color coded and beautiful and every 5 minutes mapped out, but some daily schedule where there is some play time, time without screens and hopefully safe outdoor time. We’re advising families to expect that behavior will change and you may see in young children sleep disruptions or feeding difficulties. One thing we know for sure is that they’re going to be sensing the worry in the house and the stress in the house and needing a few extra hugs. And three, connecting with children when parents are in a good place. When they feel that they can be that safe, stable and nurturing environment for the children, and if not then to take a break and to ask for help. Maybe one of the best parts of being a toddler is that favorite books are just that and can be read every single day and multiple times a day. There’s not that exhaustion. Being able to just spend that 5 minutes. Depending on the age of the kid and how good their receptive language and understanding is, we can also explain to them a little bit about what is happening here in a developmentally appropriate way, but they rely on parents to interpret the world around them. If parents are sort of saying ‘no, no it’s fine, it’s all good you have nothing to worry about’, that’s going to feel discordant to a young child. So I would say really helping parents develop the language to explain that there is a virus and it’s making some people sick, children are not getting very sick from it, we’re staying home to help keep other people from getting sick and what can we do to really make sure we stay well? We have to wash our hands and not give hugs to prevent the spread of the virus. And we have to focus on our youngest patients to ensure that there are healthy and resilient families in the future.
Sally: Yeah, I hear a lot of what you are talking about also kind of swirling around mental health needs. I was wondering if you could speak a little more to what families and friends and neighbors and communities could do to help support the entire family’s mental health needs in the current situation.
Dr. Briggs: I was reflecting back I think earlier this week when a friend of mine who is a social worker himself, and someone that I’ve always thought of as very mentally healthy. He hasn’t seen struggle with depression or anxiety, and he is one of those folks who can be the calm within the storm. We were chatting and he told me he had a panic attack. He’s 45 years old, never had a panic attack before in his life. These are pretty extraordinary times and so they are taking a toll on folks. I think with all of this worry that we are hearing it’s incredibly important for parents to be that home base, for parents to be able to provide some of that calmness routine. They don’t need the latest game, they don’t need the latest app, it’s not about the latest and greatest sort of interventions. It’s about just some level of safety and stability in this highly stressful situation. Self-care is not selfish. It’s the best way that we can take care of ourselves and our children. There are plenty of resources out there that used to be fee-based and now are free, like Headspace and Calm. Physical activity to the extent we can get it; walking, jogging, jogging in place if need be, dancing, whatever it is that feels good and can be done safely. Cooking, journaling, taking a bath, having a cup of tea, chatting with friends, getting on a video chat. If you’re not a member of a HealthySteps practice and don’t have access to that mental health support right there in pediatrics, there are also other support organizations that have moved completely to an online service delivery model and are free. The Erikson Institute’s Fussy Baby Network is one of them. They’re starting to, I think starting last week, providing online support, video home visits, parent web support groups, they’re launching Facebook live sessions for infant massage and baby yoga and play and connection ideas. So, all sorts of options. And again, just asking for help. One thing that I’ve learned through this last month already is that we’re all just doing the best we can and we’re all struggling in one way or another. We have a section on our website on healthysteps.org on caring for yourself during Coronavirus, and there is also a zerotothree.org for tips for families Coronavirus if that could be helpful.
Sally: What are the pros and cons of health services that are delivered by technology instead of in person?
Dr. Briggs: Telehealth is emerging as this wonderful solution to so many of our problems, and it is absolutely a vehicle that can really help us reach families right now. There are some challenges to telehealth, not the least of which is that the guidelines around telehealth vary state by state. So you have 50 sets of guidelines about how to use telehealth, who can be reimbursed, what qualifies as a telehealth visit and then when we think about infants and toddlers, if you’ve ever tried to get an 18 month old to just stand in front of the camera for a 20 minute telehealth visit – good luck, right? I think as much as it’s an extraordinary platform and we can really extend the reach of services through telehealth, we’re going to see limitations both because we don’t have a national infrastructure around this and because infants and toddlers are not great at sitting still for the camera. We’re losing some of that key interaction piece of the parent and the child together perhaps and creating even more stress for a family because Dad is worried making sure that the baby stays in front of the camera for this visit. So, we are thinking a lot about yes, the promise of telehealth and the unique challenges particularly related to infants and toddlers.
Sally: You’re definitely speaking to the fact that our healthcare providers are being seen as real heroes right now, and we are wondering what should our healthcare system learn from this experience in order to adapt and improve the system for the future?
Dr. Briggs: Maybe, we finally recognize that we absolutely need a healthcare infrastructure for everybody in our country, and maybe we finally recognize that that healthcare infrastructure includes mental health. That there is no health without mental health. That there is no child health without caregiver health, and that goes for mental health as well, and that developmental wellbeing is a key construct in there. I am thinking so much about our increased understanding of all of these drivers of health. We’ve known for a long time that you can’t solve all problems within those four walls of the medical practice. That if someone goes back to unstable housing, if someone goes back to community violence, that those things are going to undo the important health interventions efforts we’ve made. My first decade of work was at Montefiore Health System in the Bronx, a borough where people are dying from COVID at twice the rate of their neighbors and the rest of New York, due largely to pre-existing health conditions and other risk factors associated with poverty. There is a higher incidence of asthma in the Bronx, largely based on a higher incidence of air pollution in the Bronx. And so, my greatest hope for all of us is that we recognize what heroes healthcare workers are and we recognize that we need a massive rethinking of the healthcare system to focus on those drivers of health that have to do with safe housing and environmental justice and safe and stable and nurturing relationships that are going to really create the foundation for health for folks, whether they’re facing this virus or another one down the road. We’ve got an extraordinary moment to get this right coming out of it, and it’s about whether or not we’ll have the courage to do so, the will to do so, and the resources to do so.
Sally: Thank you so much, Rahil for taking the time to be with us today. You’ve articulated so clearly the importance in making sure healthcare, including mental healthcare, is available for all. And that as you said, caregiver health is child health. We’re really grateful that you took the time to speak with us today.
Dr. Briggs: Thanks, Sally.
Musical interlude
Sally: I’m your host, Sally Pfitzer. The Brain Architects is a product of the Center on the Developing Child at Harvard University. You can find us at developingchild.harvard.edu. We’re also on Twitter @HarvardCenter, Facebook @CenterDevelopingChild, and Instagram @DevelopingChildHarvard. Brandi Thomas is our producer, and Charley Gibney is our producer and audio editor. Our music is Brain Power, by Mela from FreeMusicArchive.org. This podcast was recorded at my dining room table.
COVID-19 Special Edition: A Different World
Apr 21, 2020
While the coronavirus pandemic has changed many things around the world, it has not stopped child development. In this series of special episodes of The Brain Architects podcast, we aim to share helpful resources and ideas in support of all those who are caring for children while dealing with the impacts of COVID-19.
The first guest of this special series is Center Director Dr. Jack Shonkoff. He and host Sally Pfitzer discuss how to support healthy child development during a pandemic, including the importance of caring for caregivers. They also talk about what we’ve already learned as a result of the coronavirus, and what we hope to continue learning.
Upcoming episodes of this special series will focus on how pediatricians are responding, racial disparities in the impact of the virus, and more. Subscribe below via your podcast platform of choice to receive all new episodes as soon as they’re released.
Speakers
Sally Pfitzer, Podcast HostDr. Jack Shonkoff, Center Director
Transcript
Sally: Welcome to The Brain Architects, a podcast from the Center on the Developing Child at Harvard University. I’m your host, Sally Pfitzer. Since our last podcast episode was released, things have changed quite drastically as a result of the Coronavirus pandemic. We hope you and your loved ones are safe and well. During this unprecedented time, we would like to share resources and provide guidance that you may find helpful, so we’re creating a series of podcasts episodes that address COVID-19 and how it relates to child development. Our guest today is Center Director, Dr. Jack Shonkoff. Jack, thanks so much for joining us.
Dr. Shonkoff: Thank you, Sally. It’s always a pleasure.
Sally: So just so our listeners know, we’re recording this on a video call, so the sound quality will be a little different from when we are in the studio. We hope these conversations will be useful anyway. Especially to those parents, childcare providers, social workers, teachers, healthcare providers and any others who are with children every day during this crisis. So, I’ll start with the first one. Jack, how do you think the pandemic may be affecting very young children, so the infants and toddlers? There has been a lot of attention to the need for distance learning for older kids. But, what do you think about what these younger children might need?
Dr. Shonkoff: That’s a really important question, Sally, because this pandemic is different from anything that any of us have experienced around the world. Basic principles of child development, basic concepts of the science that we know don’t change, then I would say from my perspective try it on both the best science we have and the best common sense that once again this is all about relationships. This is all about the environment of relationships in which young children are developing and which they are growing up. So, the risk of the conversation is how do we feel that in this context, but it’s not a difference science, it’s not a different understanding of what children need, it’s just a different world right now.
Sally: Yeah. So, I am sure many of our listeners have heard this term “social distancing,” but I know that it is also lately being referred to as the need for physical distancing. Can you talk a little bit more about the science behind that, and what it means for children?
Dr. Shonkoff: Yeah, this is the question that I’m most concerned about. There are two different bodies of science that we are talking about right now. Normally, we talk about the science of early childhood development—science of brain development—and now we are also dealing with the science of infectious disease. It’s really physical distancing that we are talking about. Actually, social distancing is exactly what we don’t want if social distancing means that we get further apart in terms of our interactions socially as opposed to physically. Let me just talk a little bit about each. So, why is physical distancing so important? Because this is the way we stop the spread of this virus. This virus is incredibly contagious. It can jump from one person to another over a six-foot span. Everybody has heard about keeping 6-feet away. And, because it is so contagious and spreading all over the world, and without a treatment and without a vaccine, the only real strategy we have to stop the spread of this virus is to not have people be close enough to each other so they can pass the virus from one person to another—it’s a population issue, it’s a community issue. So yeah, we have to do that. We have to minimize the physical contact to stop the spread of the virus. They’re saying time—social connection, hugging, being together— is one of the most critical dimensions of healthy development. It is the heart of serve and return interaction between young children and the adults that care for them. So, that’s a core concept for healthy development. Physical distancing is a core concept for stopping the spread of a virus. The challenge is: how do we reconcile those two? If we just come together physically, the virus doesn’t stop. If we separate physically and don’t find a way to stay connected, then we are creating an environment that is undermining the healthy development in young children. I have to say, I want to express tremendous solidarity with the parents, the caregivers, service providers, who are struggling with this tension between the need to get connected and the mandate to stay physically apart.
Sally: Would you have any recommendations for any family members of caregivers who are experiencing that tension that you were just describing?
Dr. Shonkoff: Absolutely. So, I think the first thing—and this is again, a good example of where basic principle in development under normal circumstances doesn’t change—in a crisis, development goes on, even though the crisis is here. So, one really important thing to remember is that interaction between young children and the adults who care for them and serve and return responsiveness is not something that has to happen every minute of every waking hour. The issue is not all or nothing. And the extent to which it may be more difficult—not because people don’t have opportunities—because adults are really struggling with the pressures and the tensions that they’re feeling. I think many parents out there, many of the caregivers, all of us know that when we’re feeling significant stress, anxiety, unease and maybe even depression about what’s going on, that you don’t have as much energy to be on your best game all of the time. In this particular crisis, it is very important for people to understand that it is okay, and it is important for adults to have a little bit of downtime and pay attention to their own needs. It’s all a matter of balance, right? So, the first thing to think about is what your child needs is a reasonable amount of attentive interaction with you during the day, but that you also need time for yourself. You need time to have your needs met, and that’s also very true in non-crisis situations. In fact, one of the cardinal principles of the science of early childhood development is that if we want to create the best kind of environment for learning and healthy development for young children, we have to make sure that the adults who care for them are having their needs met as well. You know, people often use the example of the airplane: ‘parents put your own mask on before you put your child’s mask on.’ That’s not: ‘you’re more important than your child.’ It’s a way of saying, ‘you can’t take care of your child if your basic needs aren’t met.’ So this is where social relationships—networks—this is where parents supporting each other by smartphone, by FaceTime, or whatever. Interactions that parents have with other members of extended family, their community, their faith-based organizations, service providers you have a relationship with. All of these are necessary, not just to help you meet your child’s need, but to help you meet your own needs. In this particular crisis we are in right now, meeting the needs for the adults who care for children is the only way to meet the needs of children. You can not bypass the needs of the adults.
Sally: So, I think one of the things that’s really obvious about this pandemic is that it is affecting everyone, and every person has some connection or story or something that they are grappling with. I have been thinking about a lot of families that are dealing with economic distress, and wondering if the children who are living in those families are more at risk for toxic stress, and if we can think more about how we might instead try to build resilience.
Dr. Shonkoff: Let’s talk a little bit about toxic stress first, before talking about if you’re more or less at risk for it. It’s very important to start with that toxic stress does not refer to the cause of the stress. It refers to the body’s physiological response to the stress: your heart rate goes up, your blood pressure goes up, your stress hormones are activated. The difference between toxic stress and what we call tolerable stress is the extent to which people can manage the stress and feel some sense of safety and control, which brings your stress system back down to baseline. So, for young children—babies, toddlers, preschoolers—obviously their capacity to manage their own stress is not entirely up to them, it’s up to the adults who care for them, who do two very important things that make toxic stress tolerable. One is to provide a sense of safety in the children—a sense that you are being taken care of in spite of what is going on around you by the adults who are caring for you. So, once again, we come back to the fact that the adults who provide that sense of safety have to feel that sense of safety themselves. And, none of us—none of us—are capable of feeling safe and secure all by ourselves, all of the time. It doesn’t matter how much money you have, how much education you have—we all need relationships to help us deal with stress. Now, the other part that turns toxic stress into tolerable stress is helping a child develop a sense of being able to cope. So, it’s not just protecting the child from the stress, but helping to build the skills that really make for resilience. It’s basically having some sense of regulating your activity and being engaged in things, but maybe you feel some sense of mastery. That’s why play is so important. Play is probably the most important thing. For those parents out there—anybody who is involved in childhood programs already knows this—let me tell you from a science point of view that if you’re concerned about how a young child can manage and learn to cope with the stresses going on around a family, create opportunities to play with your child, create opportunities for your child to play alone and not necessarily having always to play with an adult. Focus on: ‘how do I provide an environment in which my child can play?’ Because that kind of play is the way the brain builds strong circuits for resilience—for mastery. Give your child and yourself a break. Be comfortable with playing with your child and following your child’s lead and engaging with serve and return interactions will be tremendously protective for your child’s brain and the rest of the body. Your question, Sally, was is this even tougher for families who are more economically insecure, and certainly for families whose economic insecurity under normal times is not very stable, in these times right now, the pressures are immensely greater, So, what we have to do as a society—as human beings— is to recognize that some people are going to need more help from others to create that sense of safety and security in their homes while everyone is being isolated, and to be sure that we are protecting the developing brain, the physical and mental health for young children. Why is that important? It’s important because it’s the right thing to do. What kind of human beings would we be if we didn’t do that? It’s important also, because that’s how we are protecting society by making sure we are promoting healthy development in everyone so that we all benefit later because we have a healthier population and a more productive population. So, yes, some people need more support than others, particularly families who are dealing with housing instability, families who are dealing with food insecurity—those very basic bare essentials. There are a lot of families dealing with those kind economic insecurities now who have not dealt with this before. We absolutely have to pay attention to the needs of families who need extra support, who don’t have the reserves or the resources themselves—it’s an absolute imperative certainly for the well-being of the children. Give families security and stability, and they will provide a protective and safe environment for their children.
Sally: I’ve certainly heard you say—and I know others have often said— that small things can make a big difference for kids and families. As I’m listening to you talk, I keep thinking it would be helpful to get again some concrete examples of what families, friends, neighbors, communities could do at this time to support each other, just to get us through with the least, long-term harm to children’s development.
Dr. Shonkoff: I’m going to start mostly with what adults can do for each other. I really think that the answers for what—in this crisis—what adults can do for children is very basic and simple: provide a sense of safety and security, provide opportunities to play, engage in an interactive way—serve and return interaction—and your child will get through this just fine. So, the concrete things that can be done to protect the development of children come down to a pretty standard list of things that basically adults need to feel safe and secure. I can mention a few of them, but I think the most important thing for starters is to say just like when we think about experiences and finding experiences for young children, there is no one size fits all, right? So, what do adults need to feel a sense of safety and security in the face of this tremendous anxiety? Before we go to services, let’s start with what people informally provide for themselves. You have friends. You have neighbors. You have extended family. They may be close by, they may be far away—ironically, in the world we are living in right now, it doesn’t matter how far they are away. You can’t be that close to them physically, so you have a telephone and a smartphone, you can look at people with whatever that media would be. People need to be able to share with each other what they need—generally emotionally, and socially—and be ready to give to each other what we’re each asking of each other. And that includes informal arrangements with communities that could include the house of worship and the community around that you may be affiliated with. It could be a mother’s group or play group, it could be whatever. So, that’s for starters. Some people really have a rich network of relationships to draw on—independent of income or education. But then there are people who either don’t have a rich network to start with, or have it and it’s not meeting the needs, and that’s where we could provide more assistance through services. This is a great investment, especially now, by us as a society to provide a safety and support and reassurance for families who don’t have the informal supports that are needed. There is no shame in asking for that and there should be no hesitance in providing that. Stress reduction, right? You need ways to reduce your stress, but different things work for different people. The list of the usual things that work for most people in some way in combination, start as simple as taking deep breaths. Especially if you’re feeling like you’re getting very stressed out. It’s not just a mindset thing, it’s actually physiologically—it’s helping to bring your blood pressure down, it’s helping to bring your heart rate down, so a deep breath and a slow exhale. Some people have learned how to do meditation. That’s important, that’s good. If you need a few minutes to do that, do it, and don’t worry about the fact ‘oh my goodness I am not interacting with my child’. Let your child play while you just go off on the side and relax. Music—dancing—could be a great way to reduce stress. And for some people, stress reduction is just getting on the phone with a good friend and pouring your heart out, and in the end saying, ‘thank you for this conversation, I feel so much better.’ So, stress reduction, finding what works for you—there’s no one size fits all. You’re giving yourself a little bit of space from your child during the day. Because at the end of the day, it’s all about us helping each other. So, the concrete things are not hard to remember and they’re not complicated. There is a lot of heavy-duty science behind it, but it can just point out to a few things: take care of yourself, figure out how to reduce the stress you’re feeling—the stress you’re feeling is normal, if it’s feeling out of control, then get some help. Don’t be afraid to ask for help, we all need help. The bottom line being is that it varies from person to person. This is the time to really be in touch with what works for you.
Sally: So Jack, even though we are still in the really early days of this crisis, and I think it’s really important to emphasize that right now we’re completely, as you said, just try to get through day to day and understand the science behind this. It can also be tempting to start thinking about if there might be any long-term lessons that we could have in mind as a society that might eventually emerge. Again, recognizing fully that we are just at the beginning.
Dr. Shonkoff: I think that is a really important question, and for me, the first answer to that lessons learned is not so much a new lesson to be learned, but an old lesson that maybe we will learn this time in a way we haven’t before. We are all in this together. Everybody is affected by what is going on right now. The extent to which we share responsibility and help each other get through is really important for all of us, right? I mean, in some ways COVID-19 is an amazing example of how we each need everybody to behave responsibly and protect everybody else. This is not just about what is good for you. Let’s just take the physical distancing, right? If people don’t do it, other people are hurt by that. And if other people don’t do it, you are hurt by that. So, if we all share the responsibility, we all benefit. And if some part of the population is indifferent, doesn’t care, doesn’t pay attention, is just focused on its own needs, then we all pay a price for that. I mean, what great messages and lessons to take out of this crisis for how we should be under “normal circumstances.” Fast forward, at some point we’ll go back, and we will know that everybody with young kids is doing the best they can to raise healthy kids, and we all depend on that as a society. And some people are struggling more because they have less money, they have less education, they have less economic opportunity. We all benefit if we all take care of each other and do our job, and we all suffer, and we all pay a price if we don’t take care of each other and share the responsibility. I’d love that lesson to come out of this pandemic.
Sally: Thank you so much, Jack for taking the time to be with us today. I really appreciated your concrete advice, and I also especially appreciated the remarks you made about how this might be affecting different families in a variety of ways. I know at the Center, we’re trying to think of ways in which we can support our community, and some of that, of course means that we’re asking. But it also means that we’re trying to be responsive and put out resources that we hope will be beneficial. In that way, we hope whatever was said here will be helpful. We recognize that it might not be beneficial for every person listening, but we hope that today we could have hit on something that might help someone through this time. We’re really looking forward to continuing to hear from some of your friends and colleagues, Jack, in upcoming episodes of this short podcast series we’re doing on COVID-19. And we’re really grateful for your time, so thanks again.
Dr. Shonkoff: Thank you, Sally. I’s always a pleasure to have these conversations with you. Thank you very much.
Musical interlude
Sally: I’m your host, Sally Pfitzer. The Brain Architects is a product of the Center on the Developing Child at Harvard University. You can find us at developingchild.harvard.edu. We’re also on Twitter @HarvardCenter, Facebook @CenterDevelopingChild, and Instagram @DevelopingChildHarvard. Brandi Thomas is our producer, and Charley Gibney is our producer and audio editor. Our music is “Brain Power,” by Mela from FreeMusicArchive.org. This podcast was recorded at my dining room table.
Serve and Return: Supporting the Foundation
Mar 09, 2020
What is “serve and return”? What does it mean to have a “responsive relationship” with a child? How do responsive relationships support healthy brain development? And what can parents and caregivers do in their day-to-day lives to build these sorts of relationships? This episode of The Brain Architects podcast addresses all these questions and more!
Fortunately, there are many quick, easy, and free ways to create responsive relationships with children of any age. To kick off this episode, Center Director Dr. Jack Shonkoff describes the science behind how these interactions—known as “serve and return”—work.
This is followed by a discussion among a panel of scientists and practitioners including Dr. Phil Fisher, the Philip H. Knight Chair and Professor of Psychology at the University of Oregon, and director of the Center for Translational Neuroscience; Patricia Marinho, founder and CEO of Tempojunto and co-founder of Programa BEM; and Sarah Ryan, director of Life Skills at Julie’s Family Learning Program. The panelists discuss what it looks like to serve and return with children on a daily basis, and how to encourage these interactions.
Kok, R., Thijssen, S., Bakermans-Kranenburg, M. et al. (2015). Normal variation in early parental sensitivity predicts child structural brain development. Journal of the American Academy of Child and Adolescent Psychiatry, 54(10), 824–831.
Kuhl, P.K., Ramírez, R.R., Bosseler, A., Lin, J.L. & Imada, T. (2014). Infants’ brain responses to speech suggest analysis by synthesis. Proceedings of the National Academy of Sciences. 111(31), 11238-11245.
Levy, J., Goldstein, A. & Feldman, R. (2019). The neural development of empathy is sensitive to caregiving and early trauma. Nature Communications, 10, 1905.
Ramírez-Esparza, N., García-Sierra, A. & Kuhl, P.K. (2014). Look who’s talking: Speech style and social context in language input to infants is linked to concurrent and future speech development. In press: Developmental Science, 17(6), 880-91.
Rifkin-Graboi, A., Kong, L., Sim, L.W. et al. (2015). Maternal sensitivity, infant limbic structure volume and functional connectivity: A preliminary study. Translational Psychiatry, 5, e668.
Romeo, R.R., Leonard, J.A., Robinson, S.T., et al. (2018). Beyond the 30-million-word gap: Children’s conversational exposure is associated with language-related brain function. Psychological Science, 29(5), 700-710.
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Sally: Welcome to The Brain Architects, a new podcast from The Center on the Developing Child at Harvard University. I’m your host, Sally Pfitzer. Our Center believes that advances in science can provide a powerful source of new ideas that can improve outcomes for children and families. We want to help you apply the science of early childhood development to your everyday interactions with children, and take what you’re hearing from our experts and panels and apply it to your everyday work. In today’s episode, we’re going to dive into the science behind serve and return interactions and we’ll learn how important responsive relationships are to healthy development. Later in the podcast, we’ll incorporate these positive interactions into ordinary moments throughout your day. Here to discuss serve and return is Dr. Jack Shonkoff, who is the professor of Child Health and Development and the director of the Center on the Developing Child at Harvard University. Hey, Jack, we’re so glad to have you back.
Jack: Great to be here.
Sally: Today we’re going to dig into this concept of serve and return, so I’m wondering if you could start just telling us a little bit about what serve and return is.
Jack: Serve and return is a very simple phrase that tells us about how important the back and forth interaction is between very young children, actually beginning immediately after birth, and the adults who care for them. Serve and return, as we’re using it now, refers to how parents, or other adults who care for young children, exchange vocalizations. They make sounds, they look at each other. There’s back and forth interaction that occurs naturally between babies, very young children and the adults who care for them. These are things that parents and other caregivers do pretty naturally. Even if you haven’t had a course in child development, we are biologically wired to be engaged in that kind of serve and return interaction because it is necessary for healthy development. If we didn’t do it, if it required a course in child development, millions of years ago we would have become extinct as a species because babies’ brains and young children’s brains wouldn’t have developed in the way they do. It’s the essence of what promotes healthy brain development very early.
Sally: Why is that important for healthy development of a child?
Jack: It’s not simply important, it’s critical, because the brain is wired to expect this kind of back and forth serve and return interaction. It’s really the way the brain builds its circuits, the way the brain develops the capacity for different skills. Here’s a really good example. How do birds learn a song? Very similar to how do humans learn their language, which is speaking. A really elegant experiment was done once. Newly hatched baby songbirds who, at that point, didn’t know their songs. They removed them from the adult songbirds and raised them in cages with very high-fidelity recordings of the song for that songbird. You can guess what the punchline is here. Those birds never learned to sing, ever. Even though they heard the song beautifully, there was no opportunity to practice it and interact and get feedback from the adults.
Sally: That’s so fascinating. I’m imagining, as a listener, my first question might be, am I supposed to engage in this serve and return interaction at all times with children? If I’m busy doing something else, am I missing a really critical moment to build the child’s brain?
Jack: The best general answer is extreme on anything is usually not good. As much as it would be really bad for a baby or a young child to be ignored, most of the time, it is not helpful to be interacted with all of the time. That’s not the real world and children of all ages need some time to process what’s going on by themselves. It’s a balance issue. Is there anybody out there listening to this who don’t want a break at some point from all the nice chatter and interaction? We all need a little bit of a break.
Sally: We all need a break.
Jack: Absolutely.
Sally: Absolutely.
Jack: The important thing is when children are young and they don’t really understand a lot about what’s going on, that is not a time to say, “Well, it doesn’t really matter.”
Sally: Can you give us some examples? Not necessarily of how to serve and return, but how specifically does that serve and return interaction build a strong foundation?
Jack: It actually works in two ways. One is how it helps to shape and model brain connections. The other is the extent to which, if a baby doesn’t get that kind of responsive interaction, it triggers a stress response. The serve and return interaction is both important for its positive, it’s what scientists call experience expectant development, the brain is expecting it, but the other part of it is that because the brain is expecting it, when it doesn’t get it, the stress system gets activated because it’s biologically dangerous for a baby.
Sally: So when it comes to serve and return interactions, how do you know what might be too much, what might be too little?
Jack: Like everything else in development, there’s no one size fits all model for this, but at the end of the day it’s about knowing your baby and knowing your own style and finding a comfortable way of interacting. That fits in a very, very wide range of normal. And I think we also ought to talk about the stresses on parents. Some parents are working full time and have less hours in the day to spend with their child. I think one of the worst phrases we’ve ever imposed on parents is this issue of the importance of quality time in the evening, to make sure you get that quality time and if you’re working all day, well, guess what? There’s probably no time in the 24-hour daily cycle that’s more challenging for everybody than kind of early evening at the end of a long day. Some parents are struggling with a lot of stresses in their lives and there are many parents who are dealing with depression. Postpartum depression is a very real thing. People are overwhelmed by lots of problems. They can have a hard time summoning up the energy. And what, really, people need to understand is you don’t have to spend hours and hours a day with rich interaction. It’s the time you spend together. If there’s very little interaction, then you can’t summon that energy, then it’s really important to get help. But if the time you spend together includes a reasonable amount of positive interaction, you’re there. You don’t have to worry about whether there needs to be more.
Sally: Thanks Jack, I really loved hearing about serve and return and how it can be important to build responsive relationships in the children in our everyday lives. And when we come back, we’ll have a few experts on serve and return who are joining us for a panel discussion.
Musical interlude
Sally: Here to help us talk through the implications of serve and return, we have Dr. Phil Fisher, who is the Philip H. Knight Chair and Professor of Psychology at the University of Oregon and the Director of the Center for Translational Neuroscience. Hi, Phil.
Phil: Hey, Sally. Great to be here and connect with you.
Sally: Also joining us is Ms. Patricia Marinho, who’s the founder and CEO of Tempojunto, and cofounder of Programa BEM, who’s from Sao Paulo, Brazil. Hey, Patricia.
Patricia: Hi, Sally. What a pleasure to be here with you.
Sally: Also joining us is Ms. Sarah Ryan, who’s the director of Life Skills at Julie’s Family Learning Program here in Boston. Welcome to the podcast, Sarah.
Sarah: Hi, Sally. Thank you so much for having me.
Sally: Okay, let’s go ahead and get started. Sarah, this first question is for you. How have you used the concept of serve and return in your work?
Sarah: I work with young mothers and we have their children actually on site in our childcare center. I have them for one hour every day and we do a parenting or life skills curriculum, so I actually get to teach serve and return and touch on it every single day with them and talk about specific examples: what their child offered, what they offered back, and talk about enhancing or pointing and naming or adding one thing, adding a color, adding a shape.
Sally: How have you seen that impact your families? Does it help them get a better understanding of serve and return interactions or just how their child is developing?
Sarah: Well, I would say all of the above. Then they feel this sense of competence and mastery. My young moms don’t have their high school diplomas. They’re working on those. And they often haven’t thought of themselves as valuable teachers, as competent, as capable, and many of them didn’t receive high quality, consistent serve and return in a nurturing way. So when they realize they can do it and they have every tool they need already to grow their children’s brains and to develop them, it’s really empowering. It’s really exciting to watch parents and the young moms really come alive and then get excited about doing more of it and reporting back what their children do and feeling so much pride in that.
Sally: Right. It’s that positive reinforcement cycle, right? They understand that they actually already have all the skills that they need to do this. And, Phil, that actually reminds me a lot of your work and I’m wondering if you could share a bit about results that maybe you’ve seen–how people, when they start to better understand what serve and return is, how they are better able to interact with their children.
Phil: Sure. I’d be happy to talk about that. First of all, I think the whole concept of serve and return has really had a huge impact in how we communicate about the science of early childhood in the sense that it’s just a really straightforward and vivid way to convey this idea of back and forth interactions being so central. In our own work, one of the things that’s been really essential has been to clarify that the serve and return process is most impactful when it begins with the child. So that is the extent to which the child is exploring the world, is using language or vocalizations and the adult notices the child serve and then returns it. But what’s really transformative, I think it’s pretty clear that we’re pretty hardwired to notice what children are doing and respond, but it can still go beneath the radar for people to have awareness of what they’re doing and that’s why a lot of us, I think, are now gravitating toward techniques like video coaching that can really make it apparent to people how they are participating in the serve and return process and therefore should just do more of it.
Patricia: I’d like to add on something. I think that the word transformative is very powerful in terms of thinking of serve and return. And I’d like to give my testimony as a mom because I think the first encounter that I have with this knowledge of serve and return was thinking about the way I personally act with my kids. It was amazing to see, to really understand the metaphor that the child was ready to explore and I would be the one helping them. I discovered the knowledge of serve and return and decided to apply in my personal life and I found this transformation both in myself and in my relationship with my kids and with my children. So I think this transformation aspect is really very, very powerful.
Sally: Yeah. And it picks up on what both Sarah and Phil were saying that once parents have the opportunity to see how serve and return can actually be building their child’s brains and be building that positive relationship, it’s self-perpetuating. You want to do more and more of it. Right? Sarah, I’m wondering if you could speak a little bit to if there’s an adult that might be in your program who says, “I actually never really experienced this serve and return interaction with my own parent and now I’m expected to engage with it with my child and it feels overwhelming and maybe it’s a science concept that I don’t really want to dig into too much.” What would you say to that parent to increase that interaction between them and their child?
Sarah: You know, I have had women who say, “That wasn’t my experience at all. I was not to be heard,” or, “My parents were busy working to provide and we didn’t have that.” They want something different. And I really just start with their strengths. I very often have seen them with their children and so I will bring up an example and point that out and then they sort of take it from there. They very consistently expand upon that and how great that moment was or what happened next or what preceded that before I happened upon them. And then we go from there. They feel the success, they feel the relationship and they want more of that. So, really, it’s not difficult to get folks to lean into that as powerful and as meaningful.
Sally: Absolutely. Patricia, have you seen similar interactions with the mom’s that you work with?
Patricia: As Jack said, we are biologically wired to serve and return. So when we just start to pay attention to what we’re doing and see the lights in the eye of the kid when we are interacting with them and the pleasure that you feel when you are responding to them, so whenever the family has the opportunity to lead that, they want more. We can help people find back the pleasure of being a parent. We spent so much time talking about the struggles and how hard it is. And it is something hard. It’s an art to raise a kid. But when we help parents go through the route of finding the pleasure of being a parent, and for instance, in my field of work, we work a lot with play and we put play as a center place in terms of making parents really have back and forth interactions with the kids and everything we do in terms of play, everybody ends up smiling. So whenever we can close the gap between the concept and something that makes people’s lives better, it’s almost always easily understood and applied.
Sally: So I’m imagining as a listener something that might come up might be someone saying, “Well, I’d love to be doing the serve and return interaction all the time. I want to build the strongest brain and the best foundation for my child, but I’m also extremely busy and I’m juggling so many different things throughout the course of my day.” Could any of you respond to what if you’re a busy parent, how can you make sure that you’re increasing the serve and return opportunities or finding ways to look for this in your everyday lives?
Phil: I’m happy to talk a little bit about that. First and foremost, serve and return is a process that can happen in seconds. It’s not an idea that you need to set aside an hour or two per day, so any opportunity to notice what the child’s doing. Think about it in terms of how are they serving and how you can return the serve is going to benefit the child in the long run. I think that’s probably one of the most important things to think of. The other is that serve and return happens in the context of everyday things that are going on in people’s lives. So whether it’s mealtime or whether it’s time where you’re getting into the car or driving somewhere, if the child is with you at the grocery store. So it’s not about like, “Do this for a certain amount of time every day.” It’s just when you have the opportunity to do it, these are moments that are really building healthy brain architecture.
Patricia: I love to use the expression, “Playful parenting,” to describe an attitude that we can have in our daily lives so that we can really enjoy all this moments that Phil just described that happens all the time. So you spend some time with your kid, maybe it’s not so much, it’s not enough or it’s not all the time that you’d like to have, but instead of complaining about the lack of time, because we would all be doing that and we have the playful parenting as a concept, you’ll see that you can really find joyfulness and you can enjoy every minute you have with your kid, if you are in the right frame of mind.
Sarah: I would just like to add something that Patricia mentioned: playful parenting. My parents always identified that they want a good relationship with their children, so this is a simple way to teach them. The serve and return interaction teaches them a way, a concrete way to start developing a relationship that is back and forth, that will develop and evolve into the children’s teenage years and adolescence and it’s going to be this continuous back and forth. The relationship starts now, and I tell my parents, “Your children are babies, but you want them to talk to you when they’re teenagers about what’s going on in their lives and that back and forth starts right here. You’re already starting that relationships with them.” They want to be able to have their children come to them and talk to them.
Sally: I noticed we’ve been using the term parent a lot in these conversations and, Phil, I’m wondering does this have to be a parent that’s doing the serve and return interaction?
Phil: The idea of what serve and return can really involve is that it’s an adult in the process of returning a child’s serves and those can be exploration, but they can also be that the child’s upset or crying. It’s really any adult with whom the child has a meaningful relationship where the serve and return process is so critical. So you can think about this in terms of other adults in the family, whether it’s a cousin of the parent or whether it’s a grandparent. It can be foster or adoptive parents, for sure. And it can also be, and this is extremely important, it can also be in childcare and preschool settings. That adults who are the child’s educator or teacher can be ones that are instrumentally involved in returning children’s serves. So it’s really any adult with whom the child has a meaningful relationship where that serve and return process is going to be especially beneficial.
Sally: Great. Up next our panelists are going to answer some of your social media questions.
Musical interlude
Sally: Now we’re going to open it up to some of our social media followers who submitted questions to the Center. I will start with this question to you, Patricia. This is a social media question from light.annika from Instagram and they ask, “Is serve and return better for infants and toddlers or can it also work with older kids?”
Patricia: It can definitely work with older kids because the basics of it is understanding there is a person and establishing communication. So when you start from your kid, your infant, paying attention to what they’re looking at, their serve and return is based on that. Later on, you will be a better listener to your older kid, your teen kid, and you’ll be a person that will make sure that you listen first and speak later because you understand there is a communication process.
Sally: Here’s another one from light.annika and, Phil, I’d like to address this one to you. “Should I explain to a baby everything we do and see?”
Phil: It’s absolutely not necessary to explain to a baby everything we do and see. In fact, a very young baby isn’t going to have the capacity to understand everything that is seen and done. It’s really a question of noticing what the child is doing and then responding. And you can respond either by using words to respond, to name what the child is expressing or looking at. Or you can also use other kinds of acknowledgement. Some of them can be just nodding your head or saying, “Um-hmm,” things that help them to understand that you see them and you hear them and you understand what they’re focused on.
Sally: It’s all the stuff I’m doing right now that you guys can’t see. I’m nodding and acknowledging and I’m returning your serves, I promise.
Phil: We can tell that you’re listening by your response.
Sally: Excellent.
Phil: And the other thing I want to put in as a really important note here is that parents often are interested in understanding this idea of if a child is focused on one thing and then they shift their attention to another, if the serve and return process involves following the child’s lead and kind of going from the end of one thing to another, is that what you should always be doing? Or are there times when it’s helpful to kind of encourage the child to stay at what they’re focused on? The concept of serve and return is really built around the idea of following what it is that the child is doing and I think especially for children under age three, this idea that there’s a point at which they’ve had enough of focusing on a particular task and that their attention shifts to something else is really critical. And that one of the things that parents can do that’s most helpful is to just wait and see what the child is doing and follow their attention from one thing to another. As children get older it may be possible to direct their attention back to something that’s a task at hand, that is important to focus on. Whether it’s eating or something else that might be important to have sustained attention. This idea of noticing what the child’s doing, mapping onto their serve and then returning their serve doesn’t mean that all day, every day parents should just be following what the child’s doing. There are plenty of times when you’re needing to leave the house, the child has to be put in their car seat, you’re walking across the street where it’s not up to the child to do what they want to do. The adult really has to be the one who’s determining what’s happening and that’s just fine. There’s in no way an effort to say, “Only do what your child wants to do.” It’s more about, as we’ve all been saying, noticing the situations where you have the opportunity to let the child lead, to notice what they’re doing and then to return their serve that are particularly helpful for brain development.
Sally: Here’s another one. This is from ellemeez from Instagram. Sarah, I’ll address this one to you. She asks, “I have two little boys who are almost four years apart. What’s the best way I can engage them both?”
Sarah: Sure. There’s some things that are just so universal. What is important to you? What do you have fun doing? What do your children have fun doing? And following them. So if you have a dance party in your house, this is good for everybody. If you are enthusiastic when somebody starts to dance and then everybody’s dancing. If you take what the older child is capable of doing and let them start the serve and return with the younger child, the younger child is always so much more interested in whatever the older child is doing than with the parent is doing, most of the time. Anytime you can have that magical moment where the older child is engaged with the younger child and they’re both leading the way and back and forth and then the parents just hop in occasionally in that. There’s so many natural moments to let the older child engage the younger child.
Patricia: I want to say something else about this question. When she says that the best way I can engage with them both, there’s for me something behind that is investing some time to understand your kids, who they really are and what they like. Sometimes we forget to do that, to not come up with our own ideas of how to engage them. But just to work with the things that they like to do and if you know that it’s not that hard to engage them.
Sally: That was a really great conversation and I just really want to thank all of you for your time being here and for giving us your expertise on these topics. And up next, Dr. Jack Shonkoff will be here to debunk another early childhood development myth.
Musical interlude
Sally: We’re back with Dr. Jack Shonkoff. We’ve been talking a lot today about the need for active engagement between child and a caregiver in that serve and return interaction that you were sharing and it sort of reminded me of that expression that we often hear people use in our line of work, where people will say things like “babies are sponges” or that “their brains are always absorbing,” but from what we heard today, that doesn’t seem to be a correct analogy.
Jack: I’m really glad you use that analogy, Sally, because we do talk about babies as sponges a lot. From a scientific point of view, sponges is probably not the best way to describe babies because a sponge kind of sits there and passively absorbs what’s coming. What’s different about serve and return is that the baby is, or any young child, is an active agent of that interaction. It’s not just passively absorbing, it’s also serving. It’s feeding into that interaction and that’s the key difference. So we are not passive sponges, even though we soak up everything around us. We are active agents in our own development.
Sally: We are not passive sponges. That’s the sound clip I’ll take away from this.
Jack: Parents who buy educational videos for babies like classical music or show you beautiful art, that that’s been studied and it’s been found that it has no effect on children. Why? It’s only one-way. There’s no serve and return. You’re just passively listening. That’s not how kids learn to talk. A lot of research on language development shows us that at birth the brain is capable of learning and speaking any language in the world fluently. And in the beginning it’s listening. It’s kind of listening to all that chatter going on around. It’s beginning to differentiate sounds. By 9 to 12 months of age, research is very clear that children are already losing the ability to differentiate sounds in languages they’ve never heard. The brain is pruning away that ability and focusing on just the language it’s heard. So whether it’s language development, whether it’s learning about cause and effect, whether it’s learning just about everything in the world, it’s the back and forth interaction, studied in animals, studied in humans, that comes out to the simple term of serve and return. You can’t just feed information into a baby’s brain. You have to engage in an active back and forth serve and return interaction where the baby is playing a role and the adult is playing a role and you influence each other. That’s how healthy brain development happens. That’s serve and return.
Sally: Thanks, Jack. Another myth busted. Up next, how do we add serve and return interactions to our already busy lives?
Musical interlude
Sally: We’ll leave you with some really simple ways to get started with incorporating serve and return into your everyday lives. And it can be as easy as playing peek-a-boo or where’s baby, a game where there’s back and forth between you and a child.” Or you can just take a few seconds to notice what a baby or toddler is looking at and then talk to them about it. So, for example, if you’re looking at a toy, you can say something like “That’s a ball” Or a doll, or a block—whatever you’re looking at, it’s just important that you’re sharing the attention. And then you would describe it in words. You might say something like “it’s round and green.” You’d wait for their reaction and then you’ll share that interaction back and forth. So if you’re not used to talking through everything with a baby, don’t worry. It does get easier with practice. And even these really simple steps are making amazing connections in a child’s brain. I’d like to, once again, thank our guests, Dr. Phil Fisher, Ms. Patricia Marinho, and Ms. Sarah Ryan and Dr. Jack Shonkoff. I’m your host Sally Pfitzer and we’ll see you next time. The Brain Architects is a product of the Center on the Developing Child at Harvard University. You can find us at developingchild.harvard.edu, where we’ll post any resources that were discussed in this episode. We’re also on Twitter at Harvard Center, Facebook at Center Developing Child, and Instagram at Developing Child Harvard. Brandi Thomas, Charley Gibney, and Kristen Holmstrand are our producers. Bridgette Cyr is our audio editor. Our music is Brain Power by Mela from freemusicarchive.org. The podcast is recorded at PRX Podcast Garage in Allston, Massachusetts.
Toxic Stress: Protecting the Foundation
Feb 07, 2020
What is toxic stress? What effects can it have on a child’s body and development, and how can those effects be prevented? What does it mean to build resilience? This episode of The Brain Architects explores what “toxic stress” means, and what we can do about it.
Host Sally Pfitzer is once again joined by Center Director Dr. Jack Shonkoff as they dive into the different types of stress, including what makes certain stress “toxic,” while other stress can be tolerable or even positive for children. They discuss the effects that toxic stress can have on developing brains, as well as what it means to be resilient to sources of stress, and how parents and caregivers can help encourage that resilience in children. Dr. Shonkoff also emphasizes the point that, even for those who may have experienced toxic stress, “it’s never too late to make things better.”
Then, listen to a panel discussion featuring Pediatrician Dr. Kathleen Conroy, Community Mental Health Worker Cerella Craig, Professor and Researcher Dr. Megan Gunnar, and Training Director for Rise Magazine Jeanette Vega, as they discuss the various ways in which they encounter toxic stress and its effects in their work. The panelists speak openly about how toxic stress can affect families and children—including ways in which the systems set up to help can be the cause of further stress—and how to talk about toxic stress in a way that doesn’t make things feel hopeless to those who have experienced it. They also dig into strategies they employ in their various fields to help children and families deal with stress, and move what might be toxic stress back to tolerable levels. Download the episode and subscribe to the podcast today.
Panelists
Dr. Kathleen Conroy, Associate Clinical Director, Boston Children’s Primary Care, and Assistant Professor, Harvard Medical SchoolCerella Craig, Community Mental Health Worker, New Haven, CTMegan Gunnar, Professor and Director of the Institute of Child Development, University of MinnesotaJeanette Vega, Training Director, Rise magazine
Risemagazine.org features lots of stories by parents involved in the child welfare system for other parents.
Transcript
Sally: Welcome to The Brain Architects, a new podcast from the Center on the Developing Child at Harvard University. I’m your host, Sally Pfitzer. Our center believes that advances in science can provide a powerful source of new ideas that can improve outcomes for children and families. We want to help you apply the science of early childhood development to your everyday interactions with children, and take what you’re hearing from our experts and panels and apply it to your everyday work. In today’s episode, we’re going to explore this concept called toxic stress, which is a buzzword you may have heard and potentially used incorrectly. So we’re going to discuss what toxic stress is and what it can do to a child’s body and development, and we’ll learn a little bit more about what we can do to counteract its effects. Here to discuss this topic of toxic stress with us is professor of child health and development and the director of the Center on the Developing Child, Dr. Jack Shonkoff. Hey Jack.
Jack: Hey Sally.
Sally: So glad to have you back with us today.
Jack: Great to be here.
Sally: Today, we’re digging into a topic that has quite a bit of research around it and a lot of different ideas out there in terms of what it actually is and how it affects children’s brains. And this is the topic of toxic stress. So from your perspective, could you just give us a little bit of background on what is toxic stress and how did the term come to be?
Jack: This is a really important one to talk about. The story starts with a group of scientists working together to figure out how to make biological aspects of stress understandable for the public. When we talk about stress, we’re talking about not the thing that causes stress, but the body’s response to stress, what’s going on inside of our bodies biologically. And in the culture in the United States, there’s no sympathy for stress. To think about the impacts of stress on children is something we should worry about. It’s a roadblock of people saying, “Let them just suck it up and get over it.” But you can’t ask babies to pull themselves up by their bootstraps. So, the stress response can save our lives, but its only meant to be up long enough to deal with the threat and then go back. So, the first thing we did was come up with a very simple three category way of thinking about stress. The first level we called positive stress. What’s positive stress for a very young child? It’s the stress of the first day in a childcare center where people are all strangers. It triggers the stress response, but it doesn’t last very long when there are adults who help you deal with the stress and deal with the strangeness of the childcare center and the stress system comes back down and you’re back to baseline. The next level we call tolerable stress. Tolerable stress is there’s a serious illness in a family or you’ve just survived a natural disaster. Again, it’s the same stress system getting activated. The question is, how do you get it back down? And when it’s a really serious threat, that’s where serve and return interactions and supportive relationships are critical. It first creates a sense of safety for the child, “You’ll be okay, I’m here, I’m taking care of you.” It also is modeling and helping children build their own coping skills to deal with stress, which is critical for a healthy life. The third level is what we call toxic stress, and by that it’s the same elevation of all of these biological responses. The system doesn’t go back to baseline quickly and it stays elevated for days or weeks or months. What causes toxic stress? It’s not so much what causes the stress, it’s whether there are people there who will help you deal with it and feel more comfortable. So, toxic stress is when there is no reliable adult to help you through. It’s the stress from severe chronic neglect. It’s the stress from being in deep poverty or in a violent environment where you don’t feel like anybody is helping you feel safe. Toxic stress is about the absence of adult support to get through. And we’ve learned to talk about that always connected to the idea of resilience because kids can do well in horrible circumstances if there’s an adult to help them through. It’s usually a parent, but it doesn’t have to be a parent, it could be another family member, it could be a neighbor, it could be a preschool teacher, it could be a childcare provider. We don’t talk about toxic stress anymore without talking about how you build resilience to make sure that any potential toxic stress gets converted into tolerable stress.
Sally: Could you talk a little bit more about what you mean by resilience and is there a way that we know how to actively build that in brains?
Jack: Resilience is learning coping skills, it’s learning adaptive skills, it’s being able to feel a sense of control over what’s going on. But when children are very young and they feel less control and the resilience is built by adults creating a sense of safety and protection and then modeling for children. There isn’t a day that goes by for any child at any age where there aren’t challenges and what parents are doing in terms of building resilience without calling it resilience is they’re helping the child develop a sense of what scientists call agency, a sense that you have some control over your own life. It’s things like what you eat and whether you only eat candy or will eat some reasonably healthy foods, whether you learn to share your toys. The critical issue for children is are the adults who care for them able to provide a sense of safety? Sometimes the adults are so traumatized themselves that they can’t without help. This is why when you’re on an airplane and they say if the oxygen masks come down, put your own mask on first before you assist your child. That’s based on good scientific understanding. Adults have to be capable of providing that. If you have at least one secure relationship that is, gives you a sense of safety and security, you are on your way to building resilience. ‘Cause, it’s those relationships that provide safety and help model coping behavior that are the active ingredients in building resilience.
Sally: As challenging as it can be to talk about and as uncomfortable as it can be to really think through, could you tell us a little bit about what does actually happen to a brain of a child who’s experiencing toxic stress? I think it’s really important for listeners to understand the biological implications of what this trauma can really be doing for children.
Jack: Yeah, I’m really glad you asked that question because different parts of the body that are dimensions of the stress response system have different effects in different ways. So for example, very high levels of stress hormones, particularly one that’s called cortisol, which in the acute situation is very protective, it helps make you more alert and it helps you deal with stress. If that stress hormone stays up for a long period of time, it actually starts to have a negative wear and tear effect on parts of the brain. So, the parts that are most vulnerable to chronically elevated stress hormones are a parts of the brain that affect your memory, that affect your ability to regulate your emotions and behaviors. There are other parts of the stress system, for example, elevated inflammation. If that stays very high, that can affect parts of the brain that make you more at risk for serious cognitive thinking problems and actually later in your life increase your risk for dementia, but at the same time it’s affecting other parts of the body. Inflammation creates heart disease. It increases the risk for a lot of chronic illnesses like arthritis. It’s the wear and tear effect on the body of this stress activation, which actually accelerates aging. But remember, every time we talk about this, this is not a doomsday scenario because stress is normal. Stress is part of our everyday life. It’s not about whether you’re experiencing stress, it’s about whether there are adults to help you learn how to deal with it and help you feel safe.
Sally: Yeah. If a child experiences toxic stress or if a listener is thinking about the toxic stress they experienced in their childhood, what would you sort of say to them about these outcomes that you’ve described?
Jack: Anytime I give a lecture anywhere or a presentation, there are always people in the audience who are sitting there saying, “Oh my goodness, this is me.” I know that because they come up to you after you’ve given a presentation and people will say, “I’m really understanding what’s been going on in my life in a different way.” For some people it’s very frightening. For some people it’s a relief to say, “This isn’t my fault. I’m not a weak character. Now I understand.” But what’s most important is that none of us is perfect, none of us has a life without challenges, but the brain and the rest of the body is always trying to get back on track. That’s the other thing about biology. If you’re weighted down with risk factors and problems in your life and you find supports and you find ways to build better skills to cope, the brain can’t wait to get back on track, it is always trying to do that. We know this is something that we don’t have to passively sit by and accept. We can always do something. We can always make things better, always. Better to get it right early, the first time. Better to prevent problems than try to figure out how to treat them later. But it’s never too late to make things better. It’s never too late to improve outcomes.
Sally: Jack, as we wrap up here, I wanted to think a little bit more with you about how parents or caregivers or anyone who’s really interacting with these children who might be experiencing stress can make sure that these stress responses are more tolerable as opposed to more toxic.
Jack: Yeah. This is a really important question because there’s so many times when we oversimplify the story. I think the key difference between tolerable and toxic stress at any age is not the cause of the stress, but how your body is dealing with the stress. And the younger you are, the more you depend upon adults to kind of provide that protection. Although there’s no age at which we do it by ourselves. So we’re always looking for support. Um, I think what’s really important for, particularly for parents to understand and, and providers of, of early care and education who spend lots of time with kids is that very often the challenges facing the children may be more than a parent or a childcare provider alone can deal with. And there’s no shame in saying I need help. I need help to protect my child. I need help to make sure that my child is protected in the face of these circumstances we’re dealing with, or I need help to be able to help my child develop better skills, to cope, and to be more resilient. I think one of the most dangerous things and one of the most harmful things that we do is to basically send a message to parents and childcare providers and others who are facing serious challenges and tough circumstances to kind of say to them, you know, “This is all on you and, and, um, if you don’t do a good job, you know, X things are gonna happen.” I think one of the healthiest and most promising ways for any of us to deal with, with threat and challenge is to be able to say when we need help. And so it’s not just the help that children need from adults, um, can only best be given when adults who need help themselves to do that are comfortable enough and we make it easy enough to provide that help for the adults. The relationship is between the young child and the adult is critical. Adults thrive in their own environment of relationships. None of us can do everything by ourselves. And if we understand that importance, then we will minimize, if not eliminate toxic stress in the lives of everybody.
Sally: Thank you, Jack, for being here and for talking with us about this really important concept. I think it’s especially important to note that while toxic is extremely serious, it’s also not the end of the road for anyone and that there’s lots of things we can do to mitigate against the effects. When we come back, we’ll chat with a few special guests to discuss the work that they do to actually prevent toxic stress and support those who’ve experienced it.
Musical interlude
Sally: Joining us today to talk about toxic stress is Professor Megan Gunnar. She’s the professor and director of the Institute of Child Development University of Minnesota. Hey Megan.
Megan: Hi, it’s wonderful to be on this conversation.
Sally: Also on the call we have Jeanette Vega, who’s the training director at Rise magazine. Hi, Jeanette.
Jeanette: Hi. Thank you so much for inviting me on this podcast today.
Sally: Also here is Dr. Kathleen Conroy, associate clinical director, Boston Children’s Primary Care and assistant professor at the Harvard Medical School. Hi Kathleen, glad to have you.
Kathleen: Thanks so much for having me.
Sally: And also joining us is Cerella Craig who’s a community mental health worker, New Haven, Connecticut. Welcome to the podcast, Cerella.
Cerella: Hi, happy to be here. I’m looking forward to speaking with you all today.
Sally: Cerella, I’m wondering actually if you could provide some insight for us on if you see the effects of toxic stress in the work that you do directly with families.
Cerella: Yes, so one of my primary responsibilities as a research assistant and community health worker is recruiting people who are at high risk for toxic stress into mental health services. What for me that sometimes looks like is a mom who’s very untrusting or who is very skeptical and almost as a result of losing trust of systems that have constantly failed her. We’re not talking about the type of neglect that may have come from a parent. It’s a different neglect. So we’re talking about a neglect from systems that have failed to serve these moms. Now, what I see is really a lack of trust, a lack of belief that there’s the ability to help.
Sally: Jeanette, I’m wondering what you have been seeing from your perspective.
Jeanette: I’ve been working with parents for the past 15 years that were affected by the child welfare system, the school system, hospital systems. They were telling us that they were facing toxic stress themselves. I lost my son, I ended up losing my job, I had to quit going to school. I ended up losing family members and it just felt like my anger would jump from a hundred to a thousand on a daily basis because these things were constantly happening to me and they were repeatedly happening for a long period of time. That’s what families face when they face child welfare and when we’ve been studying this at Rise, how the child welfare system is giving parents toxic stress, they’re giving parents five different services to do in a week and they have to visit their children weekly and do therapy and parenting and anger management classes.
Sally: Kathleen, are you seeing a similar situation? I know you work a lot with young parents, and I’d be curious to hear if you have seen similar distrust as Cerella described, but also what the effects of toxic stress have been on some of the children that you’ve been working with.
Kathleen: We see a lot of families who have been failed time and time again or challenged time and time again by trying to access systems that should be set up to help them, systems like public benefits, school systems, childcare systems, the healthcare system, which often put a lot of barriers in people’s way. We know there’s a ton of implicit bias in these systems. We know there’s a ton of negativity in these systems and often people who are particularly low-income people are trying to access resources in these systems and spending a lot of their time doing that, I think this can become a form of trauma and in of itself for folks. Indeed, I think we spend a lot of time attempting to build trust and repair in some cases. I think one of the advantages we have in pediatrics is that we get to have longitudinal relationships with patients, which is one of the things that’s really joyful about it. But sometimes we see things develop over time with families where we’ll see an infant who appears to be thriving with a family because they’re meeting their gross motor milestones and they’re going along through their first year of life. And it’s only later that we start to see some developmental outcomes that might not be as ideal and recognize that often these kids were experiencing a lot of stress and that we’ve maybe missed the opportunity to help parents work on that with their child. That’s one of the things that we’ve started to pay a lot of attention to in pediatrics is how do we talk to families about the stress their children are experiencing? How do we acknowledge that children experience stress? How do we distinguish tolerable from non-tolerable stress? And how do we help parents best work with their kids and promote their development? Since we know that parents are working so hard on that, how do we help them in the best way that we can?
Sally: Yeah. Jeanette, I’m wondering if you have any guidance from your work that you do in communicating directly with parents and thinking about how they talk about this toxic stress and how they are able to kind of work through it with their children.
Jeanette: At Rise, we’ve been working into getting knowledgeable about toxic stress. I ran that statement science tells us that healthy brain architecture depends on genes and environment by my parents’ staff this week, and a parent says it just sounds like scientists are saying that if you are a person of color—referring to the genes—and if you live in low-income communities—referring to the environments—that your family members are just screwed and you will get toxic stress.
Kathleen: I think that Jeanette, you’re pointing out such a wonderful and really important point that if we start talking about certain circumstances as determinative, right? Like, oh, if you’re experiencing this or that, then there’s this irreparable harm done and it’s a simple equation. And in fact, if we’re portraying it that way, we’re selling both the idea and people short, right? Because what we know is that many, many parents are parenting really well despite facing significant adversity–they’re modeling building relationships, they’re modeling emotional self-regulation under difficult circumstances. And I think we need to remind parents that when they are showing those amazing skills to their children and when they’re portraying as much love and consistency as they can under difficult circumstances, that’s actually building their children’s life skills, right? They’re actually giving their child something. I think it’s a really good point that if we’re talking about things being determinative, we are going to lose our audience for this message and we’re going to be very incorrect.
Sally: Yeah, Megan, I’m wondering what you have been seeing from your perspective as a scientist directly working on this research, responding to both of those questions that were posed.
Megan: Oh boy, these are very big challenges and precisely some of the ones that we were worried about as we worked on the language. It is really to try to translate the science so we can change what we know children need and what we do for kids, really on the structural level of societal change. The original reason to talk about it as involving both genes and experience was to get away from the idea that if you weren’t doing well it was because you were born that way. Now we have this massive problem for as a society we need to remove the barriers or reduce the barriers for families and children who are growing up in situations or living in situations that are not supportive of brain health. Right? It’s not that nobody in those environments will experience brain health because families are amazing at what they are doing to try to compensate for everything that’s coming down on them. But as a society we should start removing some of those barriers. So it depends on your experiences, but parents are great. And even in these difficult circumstances, most parents are doing well. The problem is the complexity of this and trying to get the message weighted appropriately so that we acknowledge the fact that there are inequities in our society and those inequities are increasing the risk of harm to our kids and to our future society, while not, at the same time, going deterministic. So I think that means that when you’re working with individuals, you say, “Look, we understand. None of this is going away until we make the structural changes that makes our society more just and equitable for everyone. But in the meantime, what can we do to help you protect, buffer and support your child?” Right?
Cerella: Megan, what I’ve seen a lot of that comes around teaching people skills that they can use in real time. I think in a perfect world, this change would happen a lot quicker than in reality. It’s going to happen, so in the meantime, what we need to do and what I’ve seen to be effective is to send parents home with skills, with tools that can teach them how to do either meditation practices or breathing exercises or steps to learn problem solving techniques. Some of these structures at home where they can promote their own wellbeing and that of their children. I think that’s really the best shot we have at ensuring some of the wellbeing of mothers and children around toxic stress because it’s not going to go away, so we really have to teach some concrete skills that can be used in the moment, that are easy, that are cheap, that are accessible. I think that’s one way parents can be encouraged to promote health within their home.
Megan: Oh, I agree completely. Yes. And it’s just combined with the message that we know this is not your fault, is the piece that sometimes, I know you all are giving, but I’m not sure that we are making it really clear when we talk about toxic stress that we don’t think it’s the fault of the families. What we believe is it’s the fault of the way we’ve constructed society, but what do we do to help families mitigate those negative influences?
Sally: Yeah. Cerella, I really appreciated your specific examples of resources that parents or caregivers can use. I think a lot of people listening to this podcast may have experienced toxic stress themselves. They may know children that are experiencing toxic stress and what we want to make sure we do is leave people with the impression that there’s hope, there’s opportunity to build resilience. I’d be curious to hear from others what kinds of skills and resources you’ve given to parents or caregivers or worked with them to develop that might be beneficial for others listening.
Jeanette: What we found helpful at Rise and what parents have said has been helpful, even for myself, is definitely having at least one person who’s very supportive. Having that peer-to-peer support with someone who understands what you’re going through has been amazing and just parents overcome little situations.
Cerella: I can definitely support what you said around social support being a tool that you’ve seen parents use. You’ll hear people say the best part about this intervention was hearing that there were other women going through the same things that I’m going through. Outside of just that anecdotal evidence, can any of the scientists speak to some of the implications of social support and has that from a toxic stress perspective been shown to be helpful?
Megan: So one of the most powerful buffers of stress is supportive relationships. We call it social buffering. It works across the mammalian species, whether you’re a rat with another rat, a parent with a child or two adults. So having another person with you who is emotionally supportive is a very powerful stress buffer. It’s the best we got, which is why the kind of history that you might have that makes it hard to trust others is something to be of concern and where we might want to help families or parents repair so that they can find people that they can trust. The work you’re doing and the way that you’re going about doing it, it is relationships, right? Relationships are the key thing across all of human development, child into adulthood.
Cerella: Can we talk a little bit about how a lack of basic needs served as a barrier and how those things need to be addressed first. Very specifically, if you have a family who’s hungry, we can’t start a conversation about resilience until I can focus enough to hear what you’re saying if you’re my pediatrician.
Jeanette: I’ve been doing surveys here from parents. What are their basic needs and what is it that drives their families to stress or crisis mode? I was shocked to find out that the first thing most parents say is food, lack of enough food to last me the whole month, they say public assistance doesn’t provide enough food stamps to last the whole month. They get like, “I’m hungry. I’m not thinking straight. I’m not planning for my future. I’m just thinking about when am I getting that meal for my children and myself for tonight?” I don’t think parents can even focus on bigger issues unless we start acknowledging, like you said, and being aware that when parents are facing basic needs issues, they’re not going to focus on the bigger issues that are causing them any stress in their life. Another strategy that we use is breaking down what’s going on in your life. Like I said, I work with parents affected by the child welfare system. What I tell them is, “If you’re feeling toxic stress, let’s break down what’s going on in your life and prioritize what you need to do. So let’s say you don’t have food and you’re also about to get evicted from your apartment, let’s concentrate on getting food on that table for today and tomorrow and then next week let’s get working on the eviction.”
Kathleen: The other thing we have to do is just making careful that we ask parents what it is they want to focus on, right? Because I think sometimes you guys are talking about this concept of hierarchy of needs, right? And I think the hierarchy of needs on some level is deeply biological, right? None of us function well when we haven’t eaten or slept, when we don’t feel safe, right? And so of course it makes sense that we need to meet our most basic needs first. I think sometimes in places where we’re prepared to meet more than one need, we also just want to make sure that we’re not assuming where somebody is coming in and we want to ask them what the needs are that they want to work on. That’s something I think healthcare needs to do a lot better on is to say, “Can I let you guide?” Which is the part that’s most important here and something that I think many of us are trying to get better at in our practice.
Sally: Up next, our panelists are going to answer some of your social media questions.
Musical interlude
Sally: So now that you’ve answered a lot of my questions, we’re gonna have an opportunity to answer some questions from our social media followers. This first one I’m going to address to you Megan. This comes from Fishlovesphoenix from Instagram, who asks, “What about babies who were born with medical issues? My baby had to sleep away from me for two months after he was born premature and I’m stressing over the lifelong effects. What can I do to minimize them? Or is it too late? He’s three now.”
Megan: Well, it’s never too late. Ever. Even, it’s not even too late for me and I’m in my 60s. The issue of premature birth and needing to be in an NICU for a period of time is a significant issue. This is not the environment that we evolved to develop in and there’s been a lot of work in neonatal intensive care units on how to make that environment more supportive of the infant’s development. And some of that has had to do with as soon as the baby is stable, being able to support the development of that infant with the parent. Now the part that’s important for the baby, it probably doesn’t have to be the actual parent, it’s the touch and the stroking and the holding and so on, once the baby’s stable. But for the parent it’s that it’s critically important. It is important to help the parent feel that they’re able to take care of that child and do well by that child and that when the child comes home they are going to be able to provide for what the child needs. There is a great deal of plasticity left in development and many, many, many babies who were born prematurely go on to do just incredibly well.
Sally: Yeah, that’s great. Kathleen, do you want to address the same question from your perspective as a pediatrician?
Kathleen: Well, I just really agree with everything that Megan said. This notion that she introduced of plasticity just means things are changing and have the capacity to change and improve over time. I think that parents do a tremendous amount of good when their children are in the NICU and they are able with a stable baby to hold and do the skin to skin with that baby. And I know parents often really enjoy that and the kids enjoy it too. Then I also think about for these folks who you have so many nights after you take that baby home and you are instilling all the good, caring, and attachment during that time period. For folks who’ve had to have that experience or at an older age with a medically complex child providing that wonderful consistency when the child is able to have it goes a long way.
Sally: Great. We have another question from Fieryboots2, who asks, “What can I do right now to help protect my child against the harmful effects of stress?” And I’m wondering, Cerella, if you could give us some ideas that you’ve seen with your work.
Cerella: I think the best that we can do to really model some of those healthy practices coming to mind when we’re talking about parents and children. I think breathing exercises, and I keep going back to that because it’s simple, it’s easy and I think some of the scientists will attest to the fact that it’s almost like a physiological reset within your body when you are feeling these really intense feelings. It’s a quick method that you can use to bring yourself down and there are a ton of ways that you can do this with your child as well and get them into the practice of bringing themselves off that ledge when they’re really hyped up in terms of big feelings. I think the more that we can just try to model some of those healthy coping mechanisms for our children, that could really go a long way.
Jeanette: As a parent myself, I think nothing is more powerful than just love and compassion to the children and just understanding what the child is feeling and actually talking to them about it, depending on their age level, has been very helpful for some families also.
Megan: I agree with everything that was just said. One of our challenges though I believe is making sure that we’re protecting them from the potential impact of toxic stress versus protecting them from stress. Stress is actually an important part of growing up and experiencing and learning to handle it and not having people take care of it for you completely is critical to be enabled to develop resilience and we talk about that as positive stress. Positive stress doesn’t look like you’re happy, it often looks like you’re very unhappy, frustrated, angry. And as parents and teachers and so on, we sometimes have great desire to take that pain away, whereas it’s normative pain. So, we’ve been talking about toxic stress to really identify the serious stress issues that many children face.
Kathleen: I’ll just say I think whenever we’re thinking about whether we need to shield our kids from stress, I think we should be asking is there a life skill my child is trying to build here that I want to give them the opportunity to build? Whether that’s learning to go to sleep on their own or learning to walk into school by themselves, things that we really want the child to be able to do and thrive in versus protecting the child from something that’s in fact traumatic. And I think when we can test it a bit with that question, we may be able to sort out the difference between tolerable stress and life skills promotion versus toxic stress.
Sally: That was a really great conversation and I just really want to thank all of you for your time being here and for giving us your expertise on these topics. And up next, Dr. Shonkoff is back to discuss a common misconception people have about toxic stress.
Musical interlude
Sally: And we’re back with Dr. Jack Shonkoff, we’re talking about toxic stress. And Jack, this is a particularly favorite part of the podcast for me, we’re thinking about myths and I think there are many of them when it comes to toxic stress. So for you, what is the most important myth that you would like to dispel related to this issue?
Jack: I would say the biggest misconception of toxic stress is when people talk about it to describe the cause of the stress, rather than understand it’s the biology of the stress response. It refers to what’s going on inside your body when your stress system is activated. Toxic stress is not referring to what’s toxic about the cause of the stress activation, it’s how does the body deal with serious threats. Toxic stress is how your body is responding and nobody is helping you feel safe. Think about some of these school shootings. Everyone has experienced the same trauma, but there’s tremendous variability in how people respond to it. That’s the way we need to think about toxic stress. It’s not the trauma, it’s the response and the response is wide. And most people do not experience toxic stress because most people have somebody to turn to. It’s not in any way minimizing the horror of the event, but that’s not what toxic stress is about. And toxic stress is when you’re all by yourself for more than a day or two, or more than a couple of days, it’s when you’re all by yourself for weeks and months.
Sally: When you’re talking, I’m thinking about the situation at the border, which is so heartbreaking thinking about that sometimes children are being separated from their caregiver for such a long stretch of time. You can just imagine that system being activated for–
Jack: Right. But here’s where a misunderstanding can work on either side. So let’s stick with the border separation, or we could take survivors of a school shooting because it’s the same. From a toxic stress point of view, it’s the same. So if someone wants to pull out from that, some child who has done remarkably well and survived, and puts up as an example of, “You see that kid over there? Look at what that child went through and that child is really okay. So the rest of you should also be that strong.” That’s just so wrong, not to mention unfair. But scientifically it’s wrong because, yeah, there are people who get through.
Jack: In the same way that if a child is completely incapacitated and devastated with life-long, serious mental health and physical problems, it would be equally wrong to say, “See that child? That’s what we have done to every child who’s been separated from parents. That’s what we’ve done to every child who’s been a survivor of a school shooting.” It’s just not true. So, if there’s one thing the science is just screaming at us, it’s about human variation, it’s about you can’t over-generalize. But the concept of toxic stress is real. It’s real. It’s physical. It’s biological. The threat of toxic stress and what it could lead to is real. No scientists disagree with that.
Sally: I really appreciate you being here Jack and for sharing that really important information. Up next, we’re going to talk a little bit more about how to apply this information and have conversations about toxic stress with people in your lives.
Musical interlude
Sally: So, if this conversation left you wanting to discuss toxic stress further, we thought that it might be helpful to leave you with some meaningful ways to talk about it. If you bring up the subject, make sure to always talk about toxic stress alongside the idea of resilience. The two always go hand in hand because recovery from the effects of toxic stress is possible, though it is hard work. You can say something like, “Toxic stress can be harmful to healthy development, but there are always ways to heal from it and no one who’s experienced toxic stress is damaged beyond repair.” The Brain Architects is a product of the Center on the Developing Child at Harvard University. You can find us at developingchild.harvard.edu, where we’ll post any resources that were discussed in this episode. We’re also on Twitter @Harvardcenter, Facebook @Centerdevelopingchild, and Instagram at @Developingchildharvard. Brandi Thomas, Charley Gibney and Kristen Holmstrand are our producers. Bridgette Cyr is our audio editor. Our music is Brain Power by Mela from freemusicarchive.org. The podcast is recorded at PRX Podcast Garage in Allston, Massachusetts.
Brain Architecture: Laying the Foundation
Jan 10, 2020
Why are the early years of a child’s life so important for brain development? How are connections built in the brain, and how can early brain development affect a child’s future health? This episode of The Brain Architects dives into all these questions and more.
First, Dr. Jack Shonkoff, director of the Center on the Developing Child, explains more about the science behind how brains are built—their architecture—and what it means to build a strong brain.
This is followed by a panel discussion with Dr. Judy Cameron, professor of psychiatry at the University of Pittsburgh; Debbie LeeKeenan, an early childhood consultant and former director of the Eliot-Pearson Children’s School at Tufts University; and Dr. Pia Rebello Britto, the global chief and senior advisor for the Early Childhood Development Program Division at UNICEF. These panelists discuss the practical side of building brain architecture, and what any parent or caregiver can do to help give children’s brains a strong foundation. Download the episode and subscribe now!
Sally: Welcome to The Brain Architects, the new podcast from the Center on the Developing Child at Harvard University. I’m your host, Sally Pfitzer. Our center believes that advances in science can provide a powerful source of new ideas that can improve outcomes for children and families. We want to help you apply the science of early childhood development to your everyday interactions with children, and take what you’re hearing from our experts and panels and apply it to your everyday work. In today’s episode, we’re going to dive into the concept of brain architecture and learn a little bit more about the science behind it. We’ll learn why the early years are really important for brain development, and think about how connections are built in the brain, and what a strong or weak foundation in the brain can mean for a child’s future health and development. Here to help us explain brain architecture is Dr. Jack Shonkoff, professor of child health and development, and director of the Center on the Developing Child at Harvard University. Welcome, Jack.
Jack: Hey, Sally. Good to be here.
Sally: We have a lot of questions to dive into today, but first, can you explain where the idea of brain architecture came from? I’ve heard you use the metaphor of a house before, which I’ve found to be really helpful in really thinking about that foundation that’s set in the early years.
Jack: Almost 20 years ago, the National Scientific Council on the Developing Child realized that we needed metaphors to take very complicated science and present it with a phrase that would capture what it was about, and would be remembered. What came from our early conversations was this very simple fact that brains are built over time. We latched onto this concept of brain architecture, and any building begins with a strong foundation. If the foundation is strong, the building will last a long time, and if the foundation has a crack in it, or it’s weak, the building may not fall apart, but you won’t be able to build on it very much over time without having to deal with some of the weaknesses. Think of the building communities where multiple houses are built, that they’re all exactly the same. But then people move in, and they bring their own decoration, and they’re own style to it, and every house that’s built with the same basic design ends up looking very different. The more we got into the architecture metaphor, the more we realized how powerful it is in terms of understanding this process of brains being built over time.
Sally: As I’m listening to you, it’s making me think about the nature/nurture argument. I know that the current science has a lot to say around that. Is brain architecture determined solely by our genes?
Jack: I love this question. This whole idea of how much is genetic and how much is the result of experience used to be a very fierce argument among scientists. We now know that there’s a very strong genetic and a very strong experience influence. To stick with the architecture metaphor, think of the genetic contribution as the architect’s blueprint, before you begin to build a building. That’s the way genetics contributes. It’s why most children, they sit up at a certain age, walk at a certain age. But how those skills develop, how they’re built, how strong they are, what the design looks like, very little of that is influenced by genetics. It’s influenced by, it’s the world in which kids live, the experiences they have, the environment of relationships they live in, that shape the development of the blueprint for that individual. Genes determine when circuits get built. Experience, individual differences in people’s life experiences determine how those circuits get built. Together, they both explain the development of brain architecture.
Sally: That’s so fascinating. I know a lot of our listeners are folks who are working directly with kids. I’m wondering if you can give them some examples what that building responsive relationships looks like, and also how that actually goes into building brain architecture.
Jack: Another great question. The key feature of what we mean by “environment,” and what we mean by “experiences” that shape brain development really come down to the nature of the interaction between very young children and the adults who care for them. The brain is wired to expect interaction with other people. It’s not looking for interaction with tablets, or mobile phones, mainly because those stimulus sources are not interactive. This need for interaction is built into our biology, into our genes. It comes from eons and eons of evolution. If there wasn’t a reason for it, it wouldn’t appear over and over again over eons. From a developmental point-of-view, somebody has to be there engaging and interacting, and providing experiences from which you can learn, in order for your brain to build strong circuits. If the brain is getting bad input, the brain struggles to learn how to deal with it. If the brain is getting no input, it’s an all-signal alert that the world is crashing down on you, not because it’s harming you, but because it’s ignoring you. Positive experiences strengthen brain circuits. Threatening negative experiences weaken brain circuits, at the time that they’re being made.
Sally: One last question. I can’t help but ask, given what you’ve just described about how detrimental some of these things can be to a developing brain, and I’m thinking about listeners who have either experienced this themselves, or have had children that have experienced this, and that sense that they might have of “This is a doomed situation. My foundation is crumbling and completely weak, and from there on, I’m not able to continue to build my house.” I just wondered if you could address that.
Jack: I’m really so glad you asked that question, Sally, because there are no perfect brains. The best parents in the world do a dozen things wrong every day. There’s a lot of science about brain development, but raising healthy, competent children is much more a bumbling art than it is a precise science, right? There’s a core concept in biology about adaptation and resilience over time, so that it is never too late to strengthen the brain’s capacity to do things. Anybody who says, “Past a certain age, there’s nothing you can do,” is ignorant of what science has to say. On the other hand, it’s not true that early doesn’t matter. It’s a balance. Having problems early on, perhaps having a weaker foundation, is not a doomsday scenario at all. It just means that some things are going to have to be worked on a little bit harder. They would have been easier if we had gotten it right the first time, but it’s not too late. The take-home messages here are earlier is always better than later, prevention of difficulties is better than trying to remediate difficulties later. But it is never, ever too late to strengthen capacities. The brain is always trying to get things right. If it goes off-track, it’s always trying to get back on-track. That’s the beauty of the science. It’s also the beauty of the magic of human development.
Sally: Thank you so much. I’ll leave you with that. “Earlier is better, but it’s never too late.” Thank you so much.
Jack: Thank you, Sally. I appreciate it.
Sally: When we come back, we’ll welcome a few special guests.
Musical interlude
Sally: Here to discuss the implications of the science of brain architecture, we have Judy Cameron, Ph.D. Judy is a professor psychiatry, University of Pittsburgh, and the CEO of Working for Kids: Building Skills, LLC. Welcome to the podcast, Judy.
Judy: Thank you. I’m really happy to be here.
Sally: We also have Debbie LeeKeenan joining us. Debbie’s an early childhood consultant and former director of the Eliot-Pearson Children’s School at Tufts University. Hi, Debbie.
Debbie: Hi. It’s an honor to be here. I’m looking forward to the conversation.
Sally: Also joining us on the podcast, we have Pia Rebello Britto, Ph.D. She’s the global chief and senior advisor, Early Childhood Development Program Division, at UNICEF. Welcome, Pia.
Pia: It’s a pleasure to be on. Thank you for inviting me.
Sally: I’d like to start by asking why is it critical for parents, teachers, and even policy makers to understand the importance of brain architecture?
Judy: It’s important that people, all people who interact with children, understand brain architecture, and how brain architecture is made. Because experiences play a really strong role. The brain is genetically programmed to make connections, but whether those connections stay, become strong, and are permanent and there for the child to use their whole lifetime, depends on having experiences that strengthen them. You want parents to strengthen children’s brain circuits. You want teachers to do that. At the policy level, you want policy makers to vote for things that will give all children that opportunity.
Pia: To complement Judy, I want to focus a bit on the policy makers, in terms of their understanding of brain architecture. Ultimately, as we know, for these positive experiences to occur between children and their caregivers or parents, these adults in the child’s life need time. They need resources. They need services. All of that enables them, then, to be able to engage with their children in a meaningful manner. Policy makers, employers in the business sector, all of them create the right policies and enabling environment to then give the parents that time, that space, the resources they need. Their understanding of brain architecture, and the value it holds and how it occurs, is very important, then, to enable parents to engage in what they love the most, to engage and interact with their children.
Sally: Great. Debbie, I know you’ve been in the field for quite some time, in a variety of roles. I think our listeners would like to know what are some specific things that teachers, parents, and caregivers can do to actually help build a healthy brain?
Debbie: We know that young children learn through everyday play and exploration in safe and stimulating environments, and with relationships with their families, teachers, and caregivers. Young children learn when they’re using their whole body and senses. Giving opportunity for young children to explore open-ended materials that can be manipulated and combined in different ways, these provide unlimited play and learning opportunities. We’re talking about blocks, little figures, animals, toy cars, balls, spoons, buckets, pans, baskets, or recycled materials. Through all of that, the early childhood brains are opened to new experiences, and children are testing new theories, and changing old theories when they learn something new. This kind of constructive play allows experimentation, problem solving, higher-order thinking, and as well as language development and social skills. They develop new ideas and schema. It helps them with language development, cognitive skills, problem solving, and taking on other perspectives and self-regulation. All of these things are a way that teachers, parents, and caregivers can help the brain develop from very young ages.
Judy: I think that what Debbie has said is exactly right, and one thing parents are always asking is “How can we fit this into our everyday life?” Giving them examples of what they can do while they’re cooking dinner, what they can do while they’re driving in the car, what they can do when they’re just hanging out with their kids, so that they can begin to be creative. They have ideas that anytime can be a learning time for a child.
Sally: Great. Judy, you were part of a team that created a whole game around the concept of brain architecture. Could you tell us a little bit more about that game? Who plays it? What do you think people actually learn from it?
Judy: The Brain Architecture Game, people work in small groups. They have a task of building a brain. They roll the dice to get their genetic background. That gives you the structure of the base of the brain. And then, they draw Life Experience cards, and the Life Experience cards might be a good experience, a really bad stress, which we would call a toxic stress, or a tolerable stress, a stress that can be good for the growth of the brain or not, that it could be toxic, and it really depends on how much social support. A key issue in the game was to get people to understand that social supports are really important. They build their brain out of pipe cleaners with the supports being straws, and they debate with each other, “Okay. Where am I going to use this support? How tall can we get it? Do we need a little bit more of a sturdy base?”
Sally: Yeah, Judy, I’ve facilitated that game a few times, and I’m always struck by how many times I hear the term ” that’s not fair” when people are watching their brains collapse.
Judy: That’s true. I’ve played it with over 12,000 people. I remember playing it at a legislature at one point where the whole legislature decided to take an hour out of their day. One legislator came in the room, and he said, “I’m going to build a fantastic brain. I really care about children, and I’m a good architect.” And I said, “Excellent.” And then, his brain collapsed. And when I asked him what happened, he said, “Oh. It wasn’t my fault,” and I didn’t say anything. I just looked right at him, and he said, “Oh, my gosh. That’s what you’re trying to teach us. It’s not children’s fault.”
Sally: I always think that’s such an interesting concept that, of course, that’s part of what you’re trying to teach throughout these experiences. Pia, I’m wondering from your perspective, if you can share why the concept of brain architecture is so important for us to consider internationally, and do you have some examples of how this concept is being used all around the world?
Pia: Yeah. This is actually a very seminal concept for us to build on internationally and build on globally because the situation of children really calls us to take serious actions. So, I’m not sure if you’re familiar with but a few numbers to help you contextualize how important this is. The first is that over 250 million children around the world, especially in low- and middle-income countries, are at risk of not achieving that developmental potential. And when we look further into that number and understand what’s going on, we know that in 2018, 29 million babies were born into conflict affected areas where they’re born into these areas where they are exposed to high degrees of toxic stress. We know that over 300 million children live in areas with toxic air that we know can damage the developing brain. So, we know there’s a lot of risk factors in the environment. Okay so, that’s the broad environment. So, what’s going on in the daily lives of children? We find out across sort of our work that only about 60% of children receive that sort of early stimulation and responsive care from their parents and caregivers on a consistent basis. So really, it’s just about over half are receiving that type of care that we know is so integral for brain architecture. So, the case for why we need to bring this, this concept, globally is really important. The whole world community aims to achieve certain goals and targets, and in 2014, to have a very powerful seminar at UNICEF. Judy was there. Jack was there. The world’s leading neuroscientists were there, and they very clearly laid out a case for what happens when you build this brain architecture and what happens when it gets derailed. Now, for the first time in history, there was a goal that looked at child development. There was an indicator and a target that all countries now are accountable for, that they are supporting children to make this happen, and that’s super powerful. We never had that at a population level before. Another example I can throw out really quickly is most parents around the world do not have access to this information of why their engagement with their child matters, why responding to their baby’s cues matter so much. They don’t have access to this information. So at UNICEF, we launched Early Moments Matter. It’s now the largest global campaign. The essence of Early Moments Matter is that babies’ brains are built and they need the active ingredients. They need eat, play love. They need care. They need protection. And we were actually through the Early Moments Matter, we’re able to reach over 2 billion people with these messages.
Debbie: I loved hearing those examples, Pia, with the UNICEF program and those Early Moments. I could give an example locally here in Seattle. I’m involved with a program called PEPS, Programs for Early Parent Support, and the concept here is that the first thousand days of a baby’s life are the most important, and yet many families, many parents feel isolated or have all these other negative experiences. So, this program tries to connect families with other families, creates kind of a small community learning group for parents where they get together maybe a group of 10 to 12 families in different settings, partnering with different agencies to really provide access to all kinds of families. Another point that I thought was important: one of these toxic stress factors is also about the racism and community violence that families and children experience. And one of the things in my work that we’ve found is that as adults in children’s lives, we have an opportunity to choose materials for children, whether they’re books, whether they’re toys, that provide both mirrors and windows for children. This really helps them build their positive social identity development, which happens to begin at birth. And I like this metaphor of mirrors and windows meaning we want to expose children with materials with experiences that reflect who they are, that help them feel good about their identity. And at the same time, you want opportunities to provide materials, books, that may provide windows for children and families to see people that are different than them.
Judy: I also had something that might be worth thinking about. We have been collecting data from communities that we work with, and most of these are very impoverished communities, about child development. We’re checking development of children over a one-year period, so measurements of the stress exposure of the parents and the children, poverty level, education level, as well as videotaping them with their parents and scoring parent-child interactions. And a really interesting finding is that parent-child interactions can be very strong no matter how much family stress is experienced. So, you have parents living in really stressed environments, but if they have very good serve and return interactions, if those are strong from the parents, the child will be doing better even in the face of stress.
Pia: And just building on Judy’s point, one such context we haven’t discussed too much is families who are on the move, migration, refugee status, families who are living through protracted crisis, conflict, and those who are suffering sort of links of humanitarian or climate change-related emergencies. And what we’re finding when we are working with families with young children in these areas is that caring for the caregiver is as important as giving messages to the caregiver about their young child. And in order for parents to feel sort of on top of the game, in order for them to be able to care for children in the manner that’s most suitable for their kids, they need caring as well for their own emotional wellbeing.
Sally: Judy, I’m wondering if you could also weigh in on that question on how to build social-emotional skills, in particular in how it relates to regulation.
Judy: Happy to. So, in the communities we’re working in, there often is a lot of disruption in the family setting, and so we’ve put a lot of emphasis on getting adults in a community to think more broadly about who can provide kids with the skills that they need and with learning environments. And we think of this as charging stations. We talk about the fact that you need to plug the phone in in order to function. Each of us needs to have a support in order to function, and we start by talking to adults about, “What is your charging station? What do you do when you really need to feel better?” This connects very closely to what Pia said earlier about taking care of the parents and making sure that the adults that are interacting with children are taken care of also. But then, we expand it to, “What are the charging stations in your communities that can work to help children?” And that gets people to think much more broadly about the fact that it’s not just parents. It’s not just childcare providers. It’s not just teachers that have an impact on children in children’s development. Everybody in the community can play a role. The matter is getting everybody in the community to realize that they can play an important role in helping children learn skills.
Sally: Excellent. Up next, our panelists are going to answer some of your social media questions.
Musical interlude
Sally: Since our panelists have answered all of my questions, let’s move on to some of yours. So, haleyraepearce from Instagram asks, “How do we make sure young children are successful in their transition to school?”
Debbie: Preparation is always important, but I also like to say not too early because typically in the early childhood years, children don’t have a good concept of time. So when we talk about preparing children, we’re not talking about months in advance but maybe a week in advance what’s going to happen, and you want to do it in a very concrete way, maybe visiting the school, reading stories about going to school. I also think always bringing something from home to school is also a good strategy that helps with transitions. I think that a key idea is preparation but doing it in a concrete way and kind of figuring out the when to start that preparation, not too early and not too late.
Pia: Just adding to that. The model we use at UNICEF is children ready for school, parents ready for school, but school’s ready for children. So, I want to build on what Debbie presented. Preparation is key, and preparation is key on the part of the school as well to be able to receive children in. And in many of the contexts in which we work, we have a lot of different issues linked to school readiness, for example, multiculturalism, multilingualism. So many of our children are for the first time coming into schools where maybe the language spoken at home is not the language that is being spoken in the classroom or part of the curriculum. So, a lot of the focus and emphasis is also on preparing these teachers and the school administration to be able to receive children to sort of smooth and ease their transition.
Judy: I can also comment on this from a much broader perspective. So, Debbie and Pia have talked about the literal transition from living at home in your family to starting to go to school. But what’s really important to remember is how well children do in that transition, and in school is going to be very dependent on brain development earlier in life. So throughout their time growing up. And so it really behooves parents and those who are interacting with children to try to help them build strong social-emotional skills, strong problem-solving skills, a strong image of themselves so that they are ready to make that transition.
Sally: I love the variety of perspectives there. We had sort of some really concrete specific examples, and then zoomed out to more global and then thinking about how that all relates to brain architecture will be really helpful for our listeners. So attipay61 from Instagram asks, “I’m a teacher of one -to two- year-olds, and in your opinion, what is a good timeframe to expect children of that age to grasp, understand and remember a concept? Simple examples, hands are not for hitting, or food goes in your mouth. Some days things are a little challenging because it feels like this is what we say all day.” I bet some listeners will relate to that.
Debbie: And I’m chuckling here too, as I take care of my grandchildren this age. I’m thinking about that. First of all, there’s these first two years of life, is what we call the sensory motor stage. And often infants are busy discovering relationships between their bodies and the environment, and this is actually how they’re learning. When we say don’t put things in your mouth, yet, that’s how they learn through sensory experiences. Through their seeing, hearing, smelling, tasting, touching, et cetera. I think we can also through simple words, repetition, signs, gestures, a 12-month-old can understand the concept, what we put in our mouth, food goes in our mouth, toys we put in the bucket or in the basket. But instead of saying, “No toys in the mouth”, we’ll often say, “Put the toys here, we’ll eat our snack in our mouth.” Things like that. So being concrete and yet understanding that this is where they are developmentally, what their brain understands, so it’s not like it’s a misbehavior I always say, but a typical behavior.
Judy: I would have a different perspective, that is that what we really have to remember is the way brain development happens is that the genetic program tells neurons, brain cells to make connections. And what causes those connections to be strengthened and become a stable brain circuit is experiences that use the connections. I get asked many times, “How many times do you have to use a connection to increase the probability of it being permanent, and really strong?” And the answer is thousands and thousands of times. And so you have a teacher or a parent who’s working with one- and two-year-olds who says, “I’ve told them over and over again about this. Why do they still not get it?” They really have to have used that part of their brain thousands of times. And we need to understand that it really takes a lot of work on the part of the growing brain to form a strong, stable pathway.
Sally: Thanks to our panel for offering that expertise and thank you to our social media followers for submitting some great questions. Up next, Dr. Shonkoff is back to debunk an early childhood myth that may have actually heard.
Musical interlude
Sally: And we’re back with Dr. Jack Shonkoff, and we’re going to talk about a myth that exists in the early childhood field. This is a segment I’m particularly excited about, because I think there are a lot of myths out there. I know you are particularly passionate about, and it is that 90% of a child’s brain is formed by the age of three. So could you tell us a little bit about that myth and why it is not a correct fact?
Jack: Should I start with why this drives neuroscientists insane? Let me just start with something simple, which is why that’s wrong. To say that 90% of the brain is completed by age three, or age four or age five is to completely misunderstand the very basic concept of a developing brain. Is there anybody out there who could make some sense of the idea that a three-year-old now has 90% of all of the competence and skills and knowledge that you’ll have for the rest of your life? From a common-sense point of view, that’s just ridiculous. If we’re talking about brain development, we’re not talking about how big your brain is, or how much it weighs. We’re talking about its circuitry. You don’t have to be a neuroscientist. Ask anybody who knows anything about kids, how much of a difference is there between what a two-month-old can do and what a five-year-old can do? But here’s why it’s damaging. If 90% of your brain development is completed by age three or four, what does that tell us? What it tells us is not only to get hysterical about the first three or four years of life and drive yourself crazy, it also tells you, okay, you’re four, you’re five years old now, you’re there, it’s done. It implies it’s too late to do anything. It implies there’s not a whole lot you need to do to promote healthy brain development afterwards, because most of it is over.
Sally: It also implies that at some point you get to 100%, which contradicts exactly what you just said earlier, that we’re still developing.
Jack: Exactly. It creates a lot of misperceptions and misunderstandings that could affect the way we think about how much of an impact can adults have on children? But let me tell you why it’s continued. I was speaking at a conference once, and I was on a panel with some people, one of whom who got up there who made this comment about how 90% of the brain, and I said, you know that’s wrong, right? You know what he or she said to me? That person said, “I know, you’ve told me that, but do you see the look on the audience’s face when I say that? Do you see how jazzed they get? Do you see how much they understand the importance of the early years? I know it’s wrong, but it’s effective.” And perpetuating that myth is terrible. Not only because it’s wrong, it creates ideas in people’s heads that end up being damaging to how we can help children all through their lives to be who they can be. Sally, to your point about it never reaches 100%, this is the other side of the coin. People ask this question about how flexible and adaptive is the brain? We know that resilience also is something that’s built over time. If you have a weak foundation early on because you hadn’t had time to develop resilience, you can develop resilience later, and you can get better and things can be better. So then the question becomes, is it ever too late? It gets harder the older you get. But if there’s anyone out there listening to this podcast who’s 103 years old, who learned one thing from this podcast, goes to sleep and tomorrow wakes up and remembers it, a new connection was made in the brain.
Sally: Thanks Jack. Up next, how can we take the science of brain architecture and apply it to everyday situations?
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Sally: We’ve learned about the science of brain architecture, and its implications, and we’ve learned that your brain is never fully developed. We’re always learning. Now we’ll leave you with something that you can do today, tomorrow, or even next week to promote healthy brain architecture. Do you have to go pick up groceries this week, for example, while your little ones tag along? Well, when you’re searching for ripe apples, ask your child if they can point out all of the green ones. While you’re picking out cereal, maybe ask them if they can find all the cereals that start with C. Simple games like these require children to understand rules, hold those rules in mind and then follow them. So while you’re shopping for groceries, they’re actually building their brain. I’d like to, once again thank our guests, Dr. Judy Cameron, Professor Debbie LeeKeenan, Dr. Pia Britto, and Dr. Jack Shonkoff. I’m your host Sally Pfitzer, and we’ll see you next time. The Brain Architects is a product of the Center on the Developing Child at Harvard University. You can find us at developingchild.harvard.edu, where we’ll post any resources that were discussed in this episode. We’re also on Twitter @HarvardCenter, Facebook @CenterDevelopingChild, and Instagram @DevelopingChildHarvard. Brandi Thomas, Charley Gibney, and Kristen Holmstrand are our producers. Bridgette Cyr is our audio editor. Our music is Brain Power, by Mela from FreeMusicArchive.org. The podcast is recorded at PRX Podcast Garage in Allston, Massachusetts.
Coming Soon: The Brain Architects Podcast
Dec 17, 2019
Center staffers Sally Pfitzer, Charley Gibney, and Brandi Thomas record an episode of The Brain Architects podcast
Healthy development in the early years provides the building blocks for educational achievement, economic productivity, responsible citizenship, strong communities, and successful parenting of the next generation. By improving children’s environments, relationships, and experiences early in life, society can address many costly problems, including incarceration, homelessness, and the failure to complete high school. But if you’re a parent, caregiver, teacher, or someone who works with children every day, you may be wondering, “Where do I start?!”
From brain architecture to toxic stress to serve and return, The Brain Architects, a new podcast from the Center on the Developing Child at Harvard University, will explore what we can do during this incredibly important period to ensure that all children have a strong foundation for future development. Listen to the trailer, and subscribe now!
Transcript
Sally: Welcome to the brain architects. A new podcast from the center on the Developing Child at Harvard University. I’m your host, Sally Fetzer. We want to help you apply the science of early childhood development to your everyday interactions with children and everyday work.
Speaker 1: Those building blocks, those really connections in the brain that prepare us for all of the learning that follows start in the new-born period.
Speaker 2: These adults in the child’s life need time, they need resources, they need services, and all of that enables them to engage with their children in a meaningful manner.
Speaker 3: We see a lot of families who have then failed time and time again by trying to access system that should be set up to help them.
Speaker 4: Parents are facing basic need issues they’re not going to focus on the bigger issues that are causing them any stress in their lives.
Speaker 5: Each of us needs to have a support in order to function. What do you need to feel better?
Speaker 6: The brain is always trying to get things right, if it goes off track, it’s always trying to get back on track. That’s the beauty of the science. It’s also the beauty of the magic of human development.
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