The Brain Architects - Center on the Developing Child at Harvard University

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COVID-19 Special Edition: How Do We Rebuild and Re-Envision Early Childhood Services? May 19, 2021

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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. Contents Podcast Speakers Additional Resources Transcript 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 Host Dr. Jack Shonkoff, Center Director Additional Resources Resources from the Center on the Developing Child Re-Envisioning, Not Just Rebuilding: Looking Ahead to a Post-COVID-19 World The Brain Architects: COVID-19 Special Edition: A Different World Working Paper 15: Connecting the Brain to the Rest of the Body: Early Childhood Development and Lifelong Health Are Deeply Intertwined InBrief: Connecting the Brain to the Rest of the Body Health and Learning Are Deeply Interconnected in the Body: An Action Guide for Policymakers What Is Inflammation? And Why Does it Matter for Child Development? How Racism Can Affect Child Development Moving Upstream: Confronting Racism to Open Up Children’s Potential A Guide to COVID-19 and Early Childhood Development 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. 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.

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Connecting Health and Learning Part II: The Implications Jan 20, 2021

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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? Contents Podcast Panelists Additional Resources Transcript 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. Panelists Cindy Mann Dr. Aaliyah Samuel Jane Witowski Additional Resources Resources from the Center on the Developing Child The Brain Architects: Connecting Health & Learning Part I: The Science Working Paper 15: Connecting the Brain to the Rest of the Body: Early Childhood Development and Lifelong Health Are Deeply Intertwined InBrief: Connecting the Brain to the Rest of the Body Health and Learning Are Deeply Interconnected in the Body: An Action Guide for Policymakers What Is Inflammation? And Why Does it Matter for Child Development? How Racism Can Affect Child Development Resources from the Panelists Testing America’s Freedom Podcast Help Me Grow National Center 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. 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…

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Connecting Health and Learning Part I: The Science Dec 08, 2020

Show notes

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! Contents Podcast Panelists Additional Resources Transcript 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. Panelists Dr. Nicki Bush Dr. Damien Fair Dr. Fernando Martinez Additional Resources Resources from the Center on the Developing Child Brain Architects: Connecting Health & Learning Part II: The Implications Working Paper 15: Connecting the Brain to the Rest of the Body: Early Childhood Development and Lifelong Health Are Deeply Intertwined InBrief: Connecting the Brain to the Rest of the Body Health and Learning Are Deeply Interconnected in the Body: An Action Guide for Policymakers What Is Inflammation? And Why Does it Matter for Child Development? How Racism Can Affect Child Development Articles Biel, M.G., Tang, M.H., & Zuckerman, B. (2020). Pediatric mental health care must be family mental health care. JAMA Pediatrics, 174(6):519-520. 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. Bush, N.R., Savitz, J., Coccia, M., et al. (2020). Maternal stress during pregnancy predicts infant infectious and noninfectious illness. The Journal of Pediatrics. Graignic-Philippe, R., Dayan, J., Chokron, S., et al. (2014). Effects of prenatal stress on fetal and child development: A critical literature review. Neuroscience & Biobehavioral Reviews, 43, 137-162. LeWinn, K.Z., Bush, N.R., Batra, A.B., et al. (2020). Identification of modifiable social and behavioral factors associated with child cognitive performance. JAMA Pediatrics, 174(11):1063-1072. O’Connor, T.G., Monk, C., & Fitelson, E.M. (2014). Practitioner review: Maternal mood in pregnancy and child development: Implications for child psychology and psychiatry. J Child Psychol Psychiatry, 55(2): 99-111. Racine, N., Plamondon, A., Madigan, S., et al. (2018). Maternal adverse childhood experiences and infant development. Pediatrics, 141(4). 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 mak…

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COVID-19 Special Edition: Mental Health in a Locked-Down World May 19, 2020

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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 Host Dr. Archana Basu, Research Associate, Harvard T.H. Chan School of Public Health, and clinical psychologist, Massachusetts General Hospital Dr. Karestan Koenen, Professor of Psychiatric Epidemiology, Harvard T.H. Chan School of Public Health Additional Resources International Society for Traumatic Stress Studies: Self-Care for Providers International Society for Traumatic Stress Studies: Vicarious Trauma Toolkit Massachusetts General Hospital: How to Talk to Your Children About the Coronavirus (COVID-19) Massachusetts General Hospital: Parenting At a Challenging Time: Supporting children facing the illness/ loss of a loved one Massachusetts General Hospital: Psychiatry guide to Mental Health Resources for COVID-19 National Child Traumatic Stress Network pandemic resources 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…

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COVID-19 Special Edition: Domestic Violence and Shelter-In-Place May 12, 2020

Show notes

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? In this fourth episode of our COVID-19 series of The Brain Architects, host Sally Pfitzer speaks with Dr. Tien Ung, Program Director for Impact and Learning at FUTURES without Violence. Prior to her work at FUTURES, Tien spent five years as the Director of Leadership and Programs at the Center on the Developing Child. 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 Host Dr. Tien Ung, Program Director, Impact and Learning, FUTURES without Violence Additional Resources Hotlines For a list of state/territory/tribal domestic violence coalitions, please visit:https://ncadv.org/state-coalitions. Anti-Violence Project (LGBTQ) Hotline: 1-212-714-1141 Casa de Esperanza: https://casadeesperanza.org/ — 1-651-772-1611 ChildHelp National Child Abuse Hotline: https://www.childhelp.org/ — 1-800-4A CHILD (422-4453) Crisis Text Line: https://www.crisistextline.org/ — Text home to 741741 Love Is Respect: https://www.loveisrespect.org/ — 1-866-331-9474 National Domestic Violence Hotline: https://www.thehotline.org — 1-800-799-SAFE (7233) National Sexual Assault Hotline: https://www.rainn.org/ — 1-800-656-HOPE (4673) National Suicide Prevention Lifeline: https://suicidepreventionlifeline.org/ — 1-800-273-8255 StrongHearts Native Helpline: https://www.strongheartshelpline.org/ — 1-844-7NATIVE (762-8483) The Northwest Network: https://www.nwnetwork.org/ The Trevor Project: https://www.thetrevorproject.org/ — 1-866-488-7386 Tools and Guides “Caring Relationships, Healthy You” safety card: https://store.futureswithoutviolence.org/index.php/product/caring-relationships-lgbq-safety-card/ Changing Minds – Preventing and healing childhood trauma: https://changingmindsnow.org Coaching Boys Into Men: https://www.coachescorner.org Educate Health Professionals on How to Respond to Domestic Violence: https://ipvhealth.org/health-professionals/educate-providers/ “Hanging Out or Hooking Up” safety card: https://www.futureswithoutviolence.org/hanging-out-or-hooking-up-teen-safety-card/ Promising Futures: Best Practices for Serving Children, Youth and Parents Experiencing Domestic Violence: http://promising.futureswithoutviolence.org Ways to help children and adults living with violence: https://www.futureswithoutviolence.org/wp-content/uploads/Futures_Resources-updated.pdf 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. 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 su…

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COVID-19 Special Edition: Creating Communities of Opportunity May 06, 2020

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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 Host Dr. David Williams, Florence Sprague Norman and Laura Smart Norman Professor of Public Health, Harvard T.H. Chan School of Public Health Additional Resources Harvard Scholar: David R. Williams Social and Behavioral Determinants of Toxic Stress 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 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…

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COVID-19 Special Edition: Self-Care Isn't Selfish Apr 28, 2020

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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 Host Dr. Rahil Briggs, National Director of ZERO TO THREE’s HealthySteps Program Additional Resources Erikson Institute’s Fussy Baby Network: free phone consultations Healthy Steps: Caring for Yourself and Young Children During the Coronavirus (COVID-19) Crisis ZERO to THREE: Tips for Families: Coronavirus 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 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…

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COVID-19 Special Edition: A Different World Apr 21, 2020

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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 Host Dr. 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…

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Serve and Return: Supporting the Foundation Mar 09, 2020

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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! Contents Podcast Panelists Additional Resources Transcript 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. Panelists Dr. Phil Fisher Patricia Marinho Sarah Ryan Additional Resources Resources from the Center on the Developing Child Working Paper 1: Young Children Develop in an Environment of Relationships Serve & Return Interaction Shapes Brain Circuitry 5 Steps for Brain-Building Serve and Return How-to Video: 5 Steps for Brain-Building Serve and Return Play in Early Childhood: The Role of Play in Any Setting Building Babies’ Brains Through Play: Mini Parenting Master Class FIND: Filming Interactions to Nurture Development Articles Beecher, Michael D. & Burt, John M. (2004). The role of social interaction in bird song learning. Current Directions in Psychological Science, 13(6), 224-228. 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. Marler, Peter (1970). Birdsong and speech development: Could there be parallels?. American Scientist, 58(6), 669-673. 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. Sethna, V., Pote, I., Wang, S. et al. (2017). Mother–infant interactions and regional brain volumes in infancy: An MRI study. Brain Structure and Function, 222, 2379–2388. Yu, C. & Smith, L.B. (2013). Joint attention without gaze following: Human infants and their parents coordinate visual attention to objects through eye-hand coordination. PLoS One, 8(11), e79659. Resources from Our Panelists Dr. Phil Fisher The FIND Program Patricia Marinho Tempojunto (in Portuguese) Progama BEM (video in Portuguese with English subtitles) 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 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 ex…

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Toxic Stress: Protecting the Foundation Feb 07, 2020

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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. Contents Podcast Panelists Additional Resources Transcript 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 School Cerella Craig, Community Mental Health Worker, New Haven, CT Megan Gunnar, Professor and Director of the Institute of Child Development, University of Minnesota Jeanette Vega, Training Director, Rise magazine Additional Resources Resources from the Center on the Developing Child A Guide to Toxic Stress Stress and Resilience: How Toxic Stress Affects Us, and What We Can Do About It Infographic: What We Can Do About Toxic Stress Infographic: ACEs and Toxic Stress: Frequently Asked Questions Key Concepts: Resilience Resources Regarding the Separation and Detention of Migrant Children and Families Three Principles to Improve Outcomes for Children and Families Science to Policy and Practice: Applying the Science of Child Development in Child Welfare Systems InBrief: Applying the Science of Child Development in Child Welfare Systems Working Paper: Excessive Stress Disrupts the Architecture of the Developing Brain Working Paper: The Science of Neglect: The Persistent Absence of Responsive Care Disrupts the Developing Brain Resources from Our Panelists Jeanette Vega RISE TIPS: Visits With Children in Foster Care RISE TIPS: Service Planning 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 witha 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. Sal…

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