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Resilience

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COVID-19 Special Edition: Mental Health Vital Signs

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  In the third episode in this 4-part special series, host Sally Pfitzer speaks with Dr. Renée Boynton-Jarrett, the founding Director of Vital Village Networks at Boston Medical Center and an Associate Professor of Pediatrics at Boston University School of Medicine. They discuss the cost of failing to address structural inequities with sustainable and comprehensive policy changes, the vital role community leaders played during the pandemic, and why health care systems need to demonstrate trustworthiness. The next and final episode of this special podcast series will focus on the pandemic’s impact on the mental health system. Subscribe below via your podcast platform of choice to receive all new episodes as soon as they’re released. Speakers Sally Pfitzer, Podcast HostDr. Renée Boynton-Jarrett, Founding Director of Vital Village Networks at Boston Medical Center and Associate Professor of Pediatrics at Boston University School of Medicine Additional Resources    Vital Village Networks  The Brain Architects Podcast: COVID-19 Special Edition: Creating Communities of Opportunity Thinking About Racial Disparities in COVID-19 Impacts Through a Science-Informed, Early Childhood Lens Early Childhood Adversity, Toxic Stress, and the Impacts of Racism on the Foundations of Health Brief: Moving Upstream: Confronting Racism to Open Up Children’s Potential Infographic: How Racism Can Affect Child Development Re-Envisioning, Not Just Rebuilding: Looking Ahead to a Post-COVID-19 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 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. On today’s podcast, we have Dr. Renée Boynton-Jarrett, who is the founding Director of Vital Village Networks at Boston Medical Center and an Associate Professor of Pediatrics at Boston University School of Medicine. So good to have you with us, Renée. Dr. Boynton-Jarrett: Delighted to be here. Thank you, Sally. Sally: Renée, in March of 2020, we spoke with Dr. David Williams, who explained that many of the disparities that we saw in the early stages of the pandemic were predictable and the result of longstanding social policies and systemic racism. From your perspective, as an expert in the field, in the past year, what have we learned about these disparities? Dr. Boynton-Jarrett: I think what Dr. Williams shared is absolutely correct. What we saw happen with the COVID-19 pandemic is it took advantage of the existing inequities and just widened those. So actually, our existing structural racism created a broader opportunity for the pandemic to disparately impact the lives, the well-being, and the health of communities of color and communities that are disproportionately impacted by structural racism. And so, I think one of the things that we have learned or relearned is the tremendous cost of failing to truly address structural inequities with sustainable and comprehensive policy changes. And as importantly, because we know structural racism is around these interconnected systems and institutions, but there are also these ideologies, mindsets, ways of thinking and being. And if we think about it, those ideologies and mindsets about who’s okay just to remain at risk, to not have the luxury of physical distancing, to not have the luxury of having water to wash hands and do the hygienic practices. We’ve learned that we also have mindsets that truly impact the way in which we view humanity and human dignity and human rights, and that this pandemic has completely taken advantage of the ways in which those mindsets, ideologies, and systems create structures of inequities. Sally: Could you give us some examples of what changes you think need to happen in the field, particularly how communities and neighborhoods could help? Dr. Boynton-Jarrett: Yeah. I think your question actually hits on where I see the biggest opportunity for change. So, one of the things we saw happen over and over during the pandemic is in the absence of plans. Strategic plans and responses are being created in real time, and often those decisions—whether they were decisions being made about how vaccines would roll out, whether they were decisions being made about what economic supports and resources will come to families, or what will happen with early care and education, childcare, school—we saw time and time again decisions being made that were not being made with true engagement. Not just engagement of communities, but engagement of community leadership. So really, in partnership with, in conversation with. Those who were closest to the inequities—experiencing them most directly—were not being engaged or brought to the table. And time and time again, we also saw that the ideas, the wisdom, the strategies that were actually happening within communities were thoughtful, were creative, were real-time responsive. And actually, when we begin to get behind them, we see more protection happening for communities. So, we also saw tremendous community leadership, and in the absence of that leadership, I think that we would have all fared much worse in this pandemic. Sally: Just anecdotally, I’ve seen that even in some of the work we’ve done at the Center too, and often finding that bringing in members of the community actively from the beginning of projects has been the thing that has made those projects so much more successful. Could you tell us more about your work at Vital Village Networks? Dr. Boynton-Jarrett: So, Vital Village Networks is based at Boston Medical Center. We promote child well-being and address structural and systemic inequities and systems of care and education in early childhood by doing a couple of things. We really work around establishing sustainable, authentic, and equitable partnerships between caregivers, parents, and community residents and community-based organizations and cross sector institutions—health care, education, advocacy, social service. In this work, we all really focus on expanding leadership trajectories and pathways for community leaders, and that can be through trainings and certifications and expanded opportunities. But we also really think about how do we work to build capacity and enhance existing community-driven solutions? So, how do we build capacity within a community to promote well-being? And often, that involves helping institutions and organizations within the community work with community leaders in a different way and we use a model called co-design. So, how do we create and design things together? We really work to think about what builds equitable partnerships. What creates a table for truly equitable participation? A lot of approaches to community engagement and community work begin with the deficit lens. They begin with the idea that there’s a problem in the community, and we have a solution, we want to bring the solution. Well, that starting point actually makes it very hard to partner equitably with communities. Because if you think about—even if you were going to pick someone for a team, would you pick someone or something that you had only framed in terms of their weaknesses? Parents don’t do that with their children, right? We all have our strengths and weaknesses. Parents are really good at framing the strengths and uplifting the strengths and building upon the strengths of their children, but we don’t do that with community engagement. We often view a problem and that’s our primary way of understanding a community, and that really creates an imbalance in power from the very beginning. Also, who gets to ask the questions? Who gets to design the evaluation? What type of technology do you need to participate virtually? So, all of these things create barriers for equitable partnerships. With co-design, we really begin first by understanding that there are solutions that already exist within communities and if we’re not aware of those solutions, it’s because we’re not seeing them, not because they don’t exist. So really beginning by recognizing, appreciating, and valuing the strengths and the wisdom and solutions within communities, which creates a much more level playing field for partnership. The second piece is how do we plan? How do we design together? So, how can we disrupt tools and strategies that bias someone based on their training or education? And how do we create opportunities to design things together that are centered around the diversity of people in the room? And that’s also a particular invitation that no one is at the table only as an expert, but everyone is at the table, both with their expertise and their gifts, as well as as learners. And so, creating that mutuality, that ability for us to be in both roles, all of those factors really lead to the ability to partner with communities and not on behalf of. Sally: Why do you think there’s a disconnect between health systems and the families they’re supposed to serve? I’m thinking particularly here about the COVID vaccine in relation to this. Dr. Boynton-Jarrett: What I would share is I think we’ve had a disproportionate focus on distrust about the vaccine. So, when we think about it, when we actually look at the real data that we have, actually the vast majority of people who have been surveyed or interviewed in communities of color are along a continuum of interest in the vaccine, and/or very interested in getting the vaccine or have already received it. So, a very, very small percentage that has said, you know an absolute no. So, that is a strong signal that people are seeking an opportunity to have their questions answered, to have a conversation, and to engage around the vaccine. Also, what I think we haven’t focused on enough is how do health care institutions demonstrate trustworthiness? So, we want people to trust the vaccine, and that it’s good for their health. And we have like this, I think an overemphasis or an over expectation that what we’re hearing from people is that they don’t trust the vaccine. What we may be hearing from people that we haven’t focused on enough is how do institutions demonstrate that they are trustworthy—that they’re going to share updated information about concerns, or warnings, or emerging complications, or side effects? That they are going to offer the vaccine in settings where you will be able to get your questions answered. That you will have opportunities to hear from other people who have received the vaccine. And so, what I think that we need to really focus on is also taking a hard look from a lot of current and historical lessons at the ways in which, you know, despite what might be well intentioned efforts, systemic racism truly exists within our institutions, including our health care institution. And how that is experienced for people is sometimes that the institution does not appear to be trustworthy, because time and time again needs are not being heard or listened to or responded to with dignity. If we are expecting that we can change people’s minds to make them do what it is we’d like them to do, again, that only serves to reinforce, “I’m not wanting to hear your concern. I’m wanting you to follow my guidance, my advice in a system that you have not been invited to help design what this experience would look like.” So, that’s why we’re seeing so much success of vaccines that are being administered at faith-based institutions in partnerships with the faith-based community. That’s why we’re seeing so much success with providers of color that are creating safe and brave spaces for people to learn about, talk about, and discuss the vaccine. And in our work with Vital Village Networks, we’ve had what I would just consider—led by community members—we’ve had love conversations. Conversations that aren’t so much about all of the details, but are just creating a space for people to be honest about any fears they may have, or anxieties that they may have. And time and time again, they connect to what you have learned throughout your life around untrustworthy medical institutions that have demonstrated that time and time again. So, we must do a better job and a different job of demonstrating trustworthiness. Sally: I really appreciate that response. I’m your host Sally Pfitzer. The Brain Architects is a product of the Center on the Developing Child at Harvard University. You can find us at developingchild.harvard.edu. We’re also on Twitter @HarvardCenter, Facebook @CenterDevelopingChild, Instagram @developingchildharvard, and LinkedIn: Center on the Developing Child at Harvard University. Brandi Thomas is our producer. Dominic Mathurin is our audio editor. Our music is Brain Power by Mila from freemusicarchive.org. This podcast was recorded at my dining room table. Header photo by Christina Morillo from Pexels

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. <blockquote> <h2>Contents</h2> <h4><a href="#podcast" rel="nofollow" target="_blank">Podcast</a></h4> <h4><a href="#speakers" rel="nofollow" target="_blank">Speakers</a></h4> <h4><a href="#additional-resources" rel="nofollow" target="_blank">Additional Resources</a></h4> <h4><a href="#transcript" rel="nofollow" target="_blank">Transcript</a></h4> </blockquote> In the third episode in this 4-part special series, host Sally Pfitzer speaks with Dr. Renée Boynton-Jarrett, the founding Director of <a href="https://www.vitalvillage.org/" rel="nofollow" target="_blank">Vital Village Networks</a> at Boston Medical Center and an Associate Professor of Pediatrics at Boston University School of Medicine. They discuss the cost of failing to address structural inequities with sustainable and comprehensive policy changes, the vital role community leaders played during the pandemic, and why health care systems need to demonstrate trustworthiness. The next and final episode of this special podcast series will focus on the pandemic’s impact on the mental health system. Subscribe below via your podcast platform of choice to receive all new episodes as soon as they’re released. <h2>Speakers</h2> <a href="https://developingchild.harvard.edu/people/sally-pfitzer/" rel="nofollow" target="_blank"></a>Sally Pfitzer, Podcast Host <a href="https://developingchild.harvard.edu/people/jack-shonkoff/" rel="nofollow" target="_blank"></a><a href="https://www.bumc.bu.edu/busm/profile/renee-boynton-jarrett/" rel="nofollow" target="_blank">Dr. Renée Boynton-Jarrett, Founding Director of Vital Village Networks at Boston Medical Center and Associate Professor of Pediatrics at Boston University School of Medicine</a> <h2>Additional Resources</h2> <ul> <li> <ul> <li><a href="https://www.vitalvillage.org/projects" rel="nofollow" target="_blank">Vital Village Networks </a></li> <li><a href="https://developingchild.harvard.edu/resources/the-brain-architects-podcast-covid-19-special-edition-creating-communities-of-opportunity/" rel="nofollow" target="_blank">The Brain Architects Podcast: COVID-19 Special Edition: Creating Communities of Opportunity</a></li> <li><a href="https://developingchild.harvard.edu/thinking-about-racial-disparities-in-covid-19-impacts-through-a-science-informed-early-childhood-lens/" rel="nofollow" target="_blank">Thinking About Racial Disparities in COVID-19 Impacts Through a Science-Informed, Early Childhood Lens</a></li> <li><a href="https://www.annualreviews.org/doi/abs/10.1146/annurev-publhealth-090419-101940" rel="nofollow" target="_blank">Early Childhood Adversity, Toxic Stress, and the Impacts of Racism on the Foundations of Health</a></li> <li><a href="https://developingchild.harvard.edu/resources/moving-upstream-confronting-racism-to-open-up-childrens-potential/" rel="nofollow" target="_blank">Brief: Moving Upstream: Confronting Racism to Open Up Children’s Potential</a></li> <li><a href="https://developingchild.harvard.edu/resources/racism-and-ecd/" rel="nofollow" target="_blank">Infographic: How Racism Can Affect Child Development</a></li> <li><a href="https://developingchild.harvard.edu/re-envisioning-not-just-rebuilding-looking-ahead-to-a-post-covid-19-world/" rel="nofollow" target="_blank">Re-Envisioning, Not Just Rebuilding: Looking Ahead to a Post-COVID-19 World</a></li> <li><a href="https://developingchild.harvard.edu/resources/connecting-the-brain-to-the-rest-of-the-body-early-childhood-development-and-lifelong-health-are-deeply-intertwined/" rel="nofollow" target="_blank">Working Paper 15: Connecting the Brain to the Rest of the Body: Early Childhood Development and Lifelong Health Are Deeply Intertwined</a></li> <li><a href="https://developingchild.harvard.edu/resources/inbrief-connecting-the-brain-to-the-rest-of-the-body/" rel="nofollow" target="_blank">InBrief: Connecting the Brain to the Rest of the Body</a></li> <li><a href="https://developingchild.harvard.edu/guide/a-guide-to-covid-19-and-early-childhood-development/" rel="nofollow" target="_blank">A Guide to COVID-19 and Early Childhood Development</a></li> </ul> </li> </ul> <ul> <li></li> </ul> <h2>Transcript</h2> Sally: Welcome to The Brain Architects, a podcast from the Center on the Developing Child at Harvard University. I’m your host Sally Pfitzer. In March of 2020, we recorded episodes exploring the impact the coronavirus pandemic could have on child development. You may remember we discussed the importance of self-care for caregivers, and the importance of physical distancing, not social distancing.  And now a year later, we wanted to continue those conversations and discuss what we’ve learned, what needs to change, and where we go from here. On today’s podcast, we have Dr. Renée Boynton-Jarrett, who is the founding Director of Vital Village Networks at Boston Medical Center and an Associate Professor of Pediatrics at Boston University School of Medicine. So good to have you with us, Renée. Dr. Boynton-Jarrett: Delighted to be here. Thank you, Sally. Sally: Renée, in March of 2020, <a href="https://developingchild.harvard.edu/resources/the-brain-architects-podcast-covid-19-special-edition-creating-communities-of-opportunity/" rel="nofollow" target="_blank">we spoke with Dr. David Williams</a>, who explained that many of the disparities that we saw in the early stages of the pandemic were predictable and the result of longstanding social policies and systemic racism. From your perspective, as an expert in the field, in the past year, what have we learned about these disparities? Dr. Boynton-Jarrett: I think what Dr. Williams shared is absolutely correct. What we saw happen with the COVID-19 pandemic is it took advantage of the existing inequities and just widened those. So actually, our existing structural racism created a broader opportunity for the pandemic to disparately impact the lives, the well-being, and the health of communities of color and communities that are disproportionately impacted by structural racism. And so, I think one of the things that we have learned or relearned is the tremendous cost of failing to truly address structural inequities with sustainable and comprehensive policy changes. And as importantly, because we know structural racism is around these interconnected systems and institutions, but there are also these ideologies, mindsets, ways of thinking and being. And if we think about it, those ideologies and mindsets about who’s okay just to remain at risk, to not have the luxury of physical distancing, to not have the luxury of having water to wash hands and do the hygienic practices. We’ve learned that we also have mindsets that truly impact the way in which we view humanity and human dignity and human rights, and that this pandemic has completely taken advantage of the ways in which those mindsets, ideologies, and systems create structures of inequities. Sally: Could you give us some examples of what changes you think need to happen in the field, particularly how communities and neighborhoods could help? Dr. Boynton-Jarrett: Yeah. I think your question actually hits on where I see the biggest opportunity for change. So, one of the things we saw happen over and over during the pandemic is in the absence of plans. Strategic plans and responses are being created in real time, and often those decisions—whether they were decisions being made about how vaccines would roll out, whether they were decisions being made about what economic supports and resources will come to families, or what will happen with early care and education, childcare, school—we saw time and time again decisions being made that were not being made with true engagement. Not just engagement of communities, but engagement of community leadership. So really, in partnership with, in conversation with. Those who were closest to the inequities—experiencing them most directly—were not being engaged or brought to the table. And time and time again, we also saw that the ideas, the wisdom, the strategies that were actually happening within communities were thoughtful, were creative, were real-time responsive. And actually, when we begin to get behind them, we see more protection happening for communities. So, we also saw tremendous community leadership, and in the absence of that leadership, I think that we would have all fared much worse in this pandemic. Sally: Just anecdotally, I’ve seen that even in some of the work we’ve done at the Center too, and often finding that bringing in members of the community actively from the beginning of projects has been the thing that has made those projects so much more successful. Could you tell us more about your work at Vital Village Networks? Dr. Boynton-Jarrett: So, Vital Village Networks is based at Boston Medical Center. We promote child well-being and address structural and systemic inequities and systems of care and education in early childhood by doing a couple of things. We really work around establishing sustainable, authentic, and equitable partnerships between caregivers, parents, and community residents and community-based organizations and cross sector institutions—health care, education, advocacy, social service. In this work, we all really focus on expanding leadership trajectories and pathways for community leaders, and that can be through trainings and certifications and expanded opportunities. But we also really think about how do we work to build capacity and enhance existing community-driven solutions? So, how do we build capacity within a community to promote well-being? And often, that involves helping institutions and organizations within the community work with community leaders in a different way and we use a model called co-design. So, how do we create and design things together? We really work to think about what builds equitable partnerships. What creates a table for truly equitable participation? A lot of approaches to community engagement and community work begin with the deficit lens. They begin with the idea that there’s a problem in the community, and we have a solution, we want to bring the solution. Well, that starting point actually makes it very hard to partner equitably with communities. Because if you think about—even if you were going to pick someone for a team, would you pick someone or something that you had only framed in terms of their weaknesses? Parents don’t do that with their children, right? We all have our strengths and weaknesses. Parents are really good at framing the strengths and uplifting the strengths and building upon the strengths of their children, but we don’t do that with community engagement. We often view a problem and that’s our primary way of understanding a community, and that really creates an imbalance in power from the very beginning. Also, who gets to ask the questions? Who gets to design the evaluation? What type of technology do you need to participate virtually? So, all of these things create barriers for equitable partnerships. With co-design, we really begin first by understanding that there are solutions that already exist within communities and if we’re not aware of those solutions, it’s because we’re not seeing them, not because they don’t exist. So really beginning by recognizing, appreciating, and valuing the strengths and the wisdom and solutions within communities, which creates a much more level playing field for partnership. The second piece is how do we plan? How do we design together? So, how can we disrupt tools and strategies that bias someone based on their training or education? And how do we create opportunities to design things together that are centered around the diversity of people in the room? And that’s also a particular invitation that no one is at the table only as an expert, but everyone is at the table, both with their expertise and their gifts, as well as as learners. And so, creating that mutuality, that ability for us to be in both roles, all of those factors really lead to the ability to partner with communities and not on behalf of. Sally: Why do you think there’s a disconnect between health systems and the families they’re supposed to serve? I’m thinking particularly here about the COVID vaccine in relation to this. Dr. Boynton-Jarrett: What I would share is I think we’ve had a disproportionate focus on distrust about the vaccine. So, when we think about it, when we actually look at the real data that we have, actually the vast majority of people who have been surveyed or interviewed in communities of color are along a continuum of interest in the vaccine, and/or very interested in getting the vaccine or have already received it. So, a very, very small percentage that has said, you know an absolute no. So, that is a strong signal that people are seeking an opportunity to have their questions answered, to have a conversation, and to engage around the vaccine. Also, what I think we haven’t focused on enough is how do health care institutions demonstrate trustworthiness? So, we want people to trust the vaccine, and that it’s good for their health. And we have like this, I think an overemphasis or an over expectation that what we’re hearing from people is that they don’t trust the vaccine. What we may be hearing from people that we haven’t focused on enough is how do institutions demonstrate that they are trustworthy—that they’re going to share updated information about concerns, or warnings, or emerging complications, or side effects? That they are going to offer the vaccine in settings where you will be able to get your questions answered. That you will have opportunities to hear from other people who have received the vaccine. And so, what I think that we need to really focus on is also taking a hard look from a lot of current and historical lessons at the ways in which, you know, despite what might be well intentioned efforts, systemic racism truly exists within our institutions, including our health care institution. And how that is experienced for people is sometimes that the institution does not appear to be trustworthy, because time and time again needs are not being heard or listened to or responded to with dignity. If we are expecting that we can change people’s minds to make them do what it is we’d like them to do, again, that only serves to reinforce, “I’m not wanting to hear your concern. I’m wanting you to follow my guidance, my advice in a system that you have not been invited to help design what this experience would look like.” So, that’s why we’re seeing so much success of vaccines that are being administered at faith-based institutions in partnerships with the faith-based community. That’s why we’re seeing so much success with providers of color that are creating safe and brave spaces for people to learn about, talk about, and discuss the vaccine. And in our work with Vital Village Networks, we’ve had what I would just consider—led by community members—we’ve had love conversations. Conversations that aren’t so much about all of the details, but are just creating a space for people to be honest about any fears they may have, or anxieties that they may have. And time and time again, they connect to what you have learned throughout your life around untrustworthy medical institutions that have demonstrated that time and time again. So, we must do a better job and a different job of demonstrating trustworthiness. Sally: I really appreciate that response. I’m your host Sally Pfitzer. The Brain Architects is a product of the Center on the Developing Child at Harvard University. You can find us at <a href="http://developingchild.harvard.edu" rel="nofollow" target="_blank">developingchild.harvard.edu</a>. We’re also on Twitter @HarvardCenter, Facebook @CenterDevelopingChild, Instagram @developingchildharvard, and LinkedIn: Center on the Developing Child at Harvard University. Brandi Thomas is our producer. Dominic Mathurin is our audio editor. Our music is Brain Power by Mila from <a href="http://freemusicarchive.org" rel="nofollow" target="_blank">freemusicarchive.org</a>. This podcast was recorded at my dining room table. <h5>Header photo by <a href="https://www.pexels.com/@divinetechygirl?utm_content=attributionCopyText&amp;utm_medium=referral&amp;utm_source=pexels" rel="nofollow" target="_blank">Christina Morillo</a> from <a href="https://www.pexels.com/photo/group-of-people-sitting-in-conference-table-laughing-1181400/?utm_content=attributionCopyText&amp;utm_medium=referral&amp;utm_source=pexels" rel="nofollow" target="_blank">Pexels</a></h5>

COVID-19 Special Edition: Building from Strengths: Post-Pandemic Partnerships in Health Care

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  In the second episode in this 4-part special series, host Sally Pfitzer speaks with Dr. Rahil Briggs, National Director of ZERO TO THREE’s HealthySteps program. They discuss the potential impact of the pandemic on infant and toddler development, how an overstressed pediatric health care system responded, and the importance of overcoming equity challenges and public fears to resume well-child visits. Upcoming episodes of this series will feature expert speakers reflecting on the longstanding social policies and systemic racism that resulted in the pandemic disparately impacting communities of color, and the pandemic’s impact on the mental health system. The experts will discuss how we can take what we learned over the past year and make meaningful changes that will improve outcomes for children and families. Listen to the first episode of this series, where Center Director, Jack P. Shonkoff, M.D. discusses what COVID-19 revealed about the needs of caregivers with young children or during pregnancy. Subscribe below via your podcast platform of choice to receive all new episodes as soon as they’re released. Speakers Sally Pfitzer, Podcast HostDr. Rahil Briggs,  National Director of ZERO TO THREE’s HealthySteps Program 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: Self-Care Isn’t Selfish 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 A Guide to COVID-19 and Early Childhood Development    Resources recommended by Dr. Rahil Briggs    Psychology Today: What Parents of Babies and Toddlers Need Right Now American Academy of Pediatrics: A superhero moment HealthySteps: Caring for Yourself and Young Children During the Coronavirus (COVID-19) Crisis ZERO to THREE: Tips for Families: Coronavirus Rapid Assessment of Pandemic Impact on Development (RAPID) – Early Childhood USA Today: Opening ‘so many doors for families’: COVID-19 underscores the importance of wraparound care for new moms and children Early Childhood Depression May Impact Brain Development in Later Years Brazelton Touchpoints Center ZERO TO THREE: Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood and official DC:0-5 Training for advanced infant and early childhood mental health professionals    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 on today’s podcast is Dr. Rahil Briggs, National Director of ZERO TO THREE’s HealthySteps program. Rahil, thanks so much for being here with us today and just for timing, I’m going to jump right into our first question. What can we tell parents and caregivers about the potential effects the pandemic lifestyle changes could have on development, particularly on infants and toddlers? Dr. Briggs: Thank you Sally, and thanks for having me. I know this question is on a lot of people’s minds. We’re a year into this and what’s been the effect? For some of these kids, it’s half of their life that they’ve lived within the COVID pandemic. But for parents of babies and toddlers, I think we mostly have really good news. Because they are learning through serve and return interactions, it doesn’t need to occur in one particular kind of learning environment or even a specific variety of environments for them to continuously be learning. So, parents can rest assured that babies and toddlers who are having that regular interaction with their primary caregivers in loving, supportive, nurturing ways with all sorts of serve and return moments all day long are still learning a lot. So, reading books, singing, playing music, just observing what’s going on around them. We often talk about—you know nobody expects that you’re going to put your life on hold and read 20 books to your kids every hour, but can you just comment on what you’re doing as you’re cooking dinner? Now I’m putting the water in the pot, and now I’m putting the rice in, and let’s watch it boil—and just really narrating or sportscasting that day. I’ll say it again and again and again, you know, it’s about really taking care of oneself—avoiding toxic stress, bringing in mindfulness if you can. And I don’t mean that we all become yogis and meditate every day. That is not realistic right now. We’re trying to juggle 12 different things every minute. It’s about self-care of adults. Self-care is not selfish as we’ve discussed before. Reducing that caregiver stress will reduce baby and toddler stress, and when babies and toddlers are less stressed, they learn better just like us, right? We learn better when we’re less stressed and it’s exactly the same for them. And of course, if there’s one thing we’ve all learned in this last year, it’s that stress can’t be avoided per se, but it’s about regulating. And so, for parents and caregivers it’s about self-regulating or asking for help. And when you do those things, either self-regulate or ask for help, you model really important social-emotional skill that babies will eventually learn through that example. Sally: Rahil, I really appreciate that connection you just made between the health of caregivers and the health of children. I think it’s something that can easily be overlooked, especially with everything going on. And I’m wondering, are there concrete examples of things that caregivers should look out for? Something that might indicate that their child has been negatively impacted by the uncertainty and chaos surrounding the pandemic? Dr. Briggs: Sure, so we know that the difference between a one-year-old and a two-year-old say in developmental terms is pretty remarkable. It’s quite different than the difference between a 33-year-old and a 34-year-old, for example. And so, developmental regression is something that you might look at and you might look for. So, is a child who used to be toilet-trained now going back to having accidents or asking for diapers? Or a child who used to be, you know, fully weaned from a bottle, or breastfeeding or a pacifier, suddenly going back in that direction? Those can be signs of them just saying like “Hey, this is all a bit overwhelming for me right now and I want to go back to a place where things are a little bit easier, and I get a lot more soothing and a lot more care.” From some of the wonderful work of people like Joan Luby and others, we know that preschool age children can be unfortunately depressed. They can be reliably diagnosed with depression, meaning that a number of different professionals would agree: “yes, this looks like depression.” And not too unlike ourselves in the adult phase of life, you know. It could be impacting sleep, diet, interest in everyday things. So, I would say that’s a great time to really reach out to your pediatrician and say, “This is what I’m seeing. Does this feel like the new normal and just what I should expect because of how we’ve all been? Or does this feel like something that needs a little bit more attention?” And so, any prolonged or substantial changes might be something to bring to a pediatrician. We know that lots of families have been worried about going to the pediatrician. I saw just this week, the American Academy of Pediatrics has put out a new call that parents are superheroes when they bring their children to the pediatrician to get up to date on vaccinations, but it’s also those times to ask those questions and really double-check like is this okay? Is this something to be expected? Or is this something to be worried about? Sally: So, the pediatric system, like many had to adapt rapidly to the pandemic. What do you think has worked well and what has not worked well? Dr. Briggs: So, talk about superheroes. When I think about my colleagues in pediatric care at Montefiore and around the country and all through healthcare, the lengths to which people have gone to support families is remarkable. We’ve heard about just pediatric practices, sort of turning themselves inside out and becoming one-stop-shops for families—diapers, formula, and the like. So, just gratitude to everyone in pediatric healthcare. They’ve been stressed, to say the least, and so that pediatric system has had to get retooled to serve adult patients. There have been some children’s hospitals where full floors have become adult-focused out of need, and of course, as people have gotten sick or been less available, we’ve seen that as well. So, the pediatric system was stressed to say the least. We saw and we continue to see dips in well-child visits. We see dips in vaccinations—not COVID, but all those other diseases that we have these wonderfully evidence-based vaccinations for—and it’s around the country. We’ve also heard about pediatric practices closing, just not being able to stay open for business because the volume was down or because the workforce issues. There’s been a slow rebound on all of these points, but I’d say we’re not quite back yet to pre-pandemic levels and so that means that families are missing out. They’re missing out on that really important care that happens at the pediatric office. If we don’t reverse this and quickly, that will be concerning. I think about it, especially from an equity lens. When all babies and toddlers have a strong start, and when they can get that start through a partnership through a high performing pediatric practice, the entire country is better, right? Pediatric primary care is like the only setting we have in this country that almost universally reaches all babies, all toddlers, and their families no matter what your income is, no matter, you know where you’re living. So, I’d say some of the transitions we saw, you know, as folks got to recognize that this new normal was going to be around for a lot longer than they had anticipated. We saw our HealthySteps practices really adhere to the guidance that was put out by the American Academy of Pediatrics and by the CDC. And so, for many practices that meant postponing visits for older kids and only seeing kids birth to age 2 in person. That was some early American Academy of Pediatrics guidance. Some practices experimented with drive through vaccinations, others went fully remote and started seeing families virtually. Telehealth in pediatrics is not quite as seamless as it may be for us in the adult world, right? That was a really big adjustment for people. I think it’ll be here to stay in some form, but lest you think it’s easy, try to imagine a baby or a toddler on the other side of that telehealth visit and telling them, “please sit there for the next three minutes and don’t move and show me the inside of your wrist.” Right? It’s like “uhh no.” So, not always the most compliant. You know, but for a lot of folks, for families and providers, seeing their patients virtually was better than not seeing them at all. Again, though, I think about equity here. And so many of those inequities that we saw pre-COVID are still relevant. Perhaps more relevant than ever, and they really come to light when we think about telehealth and folks who don’t have multiple computers in the home and the one that they do have is needed for the school-age child to do online schooling. They don’t have unlimited Internet access or cell phone data. And then, when we close the public spaces, previous options like using a computer at the library or the like aren’t really feasible. We’ve heard from our practices in rural areas that broadband access is a huge issue. This was again pre-COVID, and that affects telehealth and of course, remote learning for older children and work. As we become vaccinated, many of us, you know, practices are mostly back to in-person with the safety precautions that they need, which is really promising. And I would say we’ve all learned a lot. We’ve learned we are more flexible than we knew we could be, and we have been reminded about the inequities that existed pre-COVID because they have been magnified. My real hope is that we renew a focus on changes that really last for families—committed to health, well-being, school readiness of all babies and toddlers. Our work at HealthySteps continues with I’d say even more urgency than we had earlier. And hopefully, the world and the community at large can join us with really that mission to give all babies and all toddlers that incredibly strong start. Sally: Yeah, you started talking about this a little bit, but I’m curious when families are really stressed and they’re starting to say like, “Well, a well-child visit might be something that I can skip because there’s so much going on and I’m worried about exposure.” What would you say to those families and how would you kind of help them think through what that might mean? Dr. Briggs: It’s a great question. In terms of skipping well-child visits, we have data that suggests that there are negative outcomes when you skip well-child visits. So, what are some things that can happen? Well, developmental delays can go undiagnosed, and we all know that the earlier we catch those developmental delays and the earlier that we provide evidence-based treatment, the better the outcome for children, sometimes erasing what was a delay in only just a year. We also know about the incredibly lifesaving importance of vaccinations. We all are pretty well, you know, the number of people who can talk about what an mRNA vaccination does these days is remarkable and hopefully they remember that we’ve got vaccinations for lots of other really life-threatening diseases, and it’s critical—early childhood is the moment when you’re getting vaccinated, right?  Almost every visit there’s some combination of vaccinations. They’re just so important. Growth is an obvious one. Not everybody has a perfect infant scale at home, and so being able to make sure that babies are gaining back that early birth weight and then gaining weight at the rate we would expect really has significant implications for development and well-being overall. So, it’s really one of those visits that feels pretty darn worth it to mask up, to call ahead about safety protocols, and to know that each and every one of those health care providers is going in there every day just as worried about their own health and well-being and that of their families and wouldn’t do anything to put their patients in danger. Sally: You always make me feel better when I talk to you, Rahil. I love those concrete examples too, I think that’ll be really helpful. I’m your host, Sally Pfitzer. The Brain Architects is a product of the Center on the Developing child at Harvard University. You can find us at developingchild.harvard.edu. We’re also on Twitter @HarvardCenter, Facebook @CenterDevelopingChild, Instagram @developingchildharvard, and LinkedIn: Center on the Developing Child at Harvard University. Brandi Thomas is our producer. Dominic Mathurin is our audio editor. Our music is Brain Power by Mela from freemusicarchive.org. This podcast was recorded at my dining room table.

COVID-19 Special Edition: Superheroes of Pediatric Care: Moving Beyond the Challenges of COVID-19

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 HostDr. Jack Shonkoff, Center DirectorAdditional 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.

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. <blockquote> <h2>Contents</h2> <h4><a href="#podcast" rel="nofollow" target="_blank">Podcast</a></h4> <h4><a href="#speakers" rel="nofollow" target="_blank">Speakers</a></h4> <h4><a href="#additional-resources" rel="nofollow" target="_blank">Additional Resources</a></h4> <h4><a href="#transcript" rel="nofollow" target="_blank">Transcript</a></h4> </blockquote> 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. <h2>Speakers</h2> <a href="https://developingchild.harvard.edu/people/sally-pfitzer/" rel="nofollow" target="_blank"></a>Sally Pfitzer, Podcast Host <a href="https://developingchild.harvard.edu/people/jack-shonkoff/" rel="nofollow" target="_blank"></a>Dr. Jack Shonkoff, Center Director <h2>Additional Resources</h2> <h3>Resources from the Center on the Developing Child</h3> <ul> <li> <ul> <li><a href="https://developingchild.harvard.edu/re-envisioning-not-just-rebuilding-looking-ahead-to-a-post-covid-19-world/" rel="nofollow" target="_blank">Re-Envisioning, Not Just Rebuilding: Looking Ahead to a Post-COVID-19 World</a></li> <li><a href="https://developingchild.harvard.edu/resources/the-brain-architects-podcast-covid-19-special-edition-a-different-world/" rel="nofollow" target="_blank">The Brain Architects: COVID-19 Special Edition: A Different World</a></li> <li><a href="https://developingchild.harvard.edu/resources/connecting-the-brain-to-the-rest-of-the-body-early-childhood-development-and-lifelong-health-are-deeply-intertwined/" rel="nofollow" target="_blank">Working Paper 15: Connecting the Brain to the Rest of the Body: Early Childhood Development and Lifelong Health Are Deeply Intertwined</a></li> <li><a href="https://developingchild.harvard.edu/resources/inbrief-connecting-the-brain-to-the-rest-of-the-body/" rel="nofollow" target="_blank">InBrief: Connecting the Brain to the Rest of the Body</a></li> <li><a href="https://developingchild.harvard.edu/resources/health-and-learning-are-deeply-interconnected-in-the-body-an-action-guide-for-policymakers/" rel="nofollow" target="_blank">Health and Learning Are Deeply Interconnected in the Body: An Action Guide for Policymakers</a></li> <li><a href="https://developingchild.harvard.edu/resources/what-is-inflammation-and-why-does-it-matter-for-child-development/" rel="nofollow" target="_blank">What Is Inflammation? And Why Does it Matter for Child Development?</a></li> <li><a href="https://developingchild.harvard.edu/resources/racism-and-ecd/" rel="nofollow" target="_blank">How Racism Can Affect Child Development</a></li> <li><a href="https://developingchild.harvard.edu/resources/moving-upstream-confronting-racism-to-open-up-childrens-potential/" rel="nofollow" target="_blank">Moving Upstream: Confronting Racism to Open Up Children’s Potential</a></li> <li><a href="https://developingchild.harvard.edu/guide/a-guide-to-covid-19-and-early-childhood-development/" rel="nofollow" target="_blank">A Guide to COVID-19 and Early Childhood Development</a></li> </ul> </li> </ul> <ul> <li></li> </ul> <h2>Transcript</h2> 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 <a href="http://developingchild.harvard.edu" rel="nofollow" target="_blank">developingchild.harvard.edu</a>. 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 <a href="http://freemusicarchive.org" rel="nofollow" target="_blank">freemusicarchive.org</a>. This podcast was recorded at my dining room table.

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

Connecting Health and Learning Part II: The Implications

Connecting Health and Learning Part I: The Science

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

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 &amp; Incest National Network that for the first time in 25 years, their national hotline is receiving calls from minors, such that more than half of their calls coming in over the last couple of months have been from minors. We also know that at this time, reports of abuse and neglects against children are dropping. We know at least in Massachusetts, and I suspect in other states across the U.S. as well, that 80% of reports that come in from mandated reporters about child abuse and neglect are coming in from health professionals, educators, first responders, people who do not have eyes and ears on what’s happening behind closed doors at home right now. We also know very recently that phone calls to police stations across the nation are rising in response to domestic disputes. I think in fact, just today, we learned that a mass shooting in Canada had roots in domestic violence, which highlights, actually, what we’ve known for quite some time, that there is a strong correlation between domestic violence and mass shootings. Current stay in place orders present very specific challenges to people who are not safe at home. There’s also good news. While it is true that communities of care serve as an organic system of surveillance and monitoring bringing attention to harm that’s being done behind closed doors, we also know that those same communities serve as protective factors for children and victims of family violence and domestic violence. Faith communities, social communities, health and medical communities, as well as human service and educational communities, and legal and judicial communities—they all come together under normal circumstances to create a system and an ecology of care and protection. Those are things that I think will be important for us to unpack a little bit on the call today. Sally: This is obviously a really challenging time, and if someone is experiencing domestic violence and they are a parent, what might they be able to do to escape that given we are in the shelter in place? Dr. Ung: Because parents don’t have access to their normal pathways for connections, it really is very hard for them to reach out and get the help and support they need. It goes back to basic safety planning; things like making sure survivors know to put their hair in a bun rather than in a ponytail, because when your hair is in a ponytail there is more to grab onto which can cause injury. Making sure they are scanning their environments and looking for places to shelter in place in their homes where there’s not easy access to knives, for example, so don’t run into the kitchen. Doing a quick scan to see what they can use as shields or whatnot to protect themselves and reduce the likelihood of serious injury if a fight does breakout. We’re really back to basics, Sally, which is hard to believe. Some of the things we marvel about are the ways in which, and this is something that I think the Center knows well and talked about a lot when I was there, that survivors in children are incredibly resilient, and they know how to keep themselves safe, and they know what to do to manage the episodes of violence and aggression in their homes. It’s just really about giving them the support and letting them know that if things are really, really bad and they need to get out and get out quick, finding ways for them to have that. Every state, for example Sally, has a state collation for domestic violence. They are the people who know what services are in place for each state, what shelters are up and running, and what, importantly, batterer intervention programs are also up and running. They also have wonderful relationships with local law enforcement and the courts and are really good partners. Sally: Those resources that you were saying that each state provides, how would someone get connected to that if they weren’t aware? Is that a website, or how would someone find that information? Dr. Ung: That’s a great question. It is a website. I can make sure you all have information to that as part of this podcast so that you can put it on your website for people. It is split out by national level resources, as well as youth specific level resources, as well as resources specifically for the LGBTQ community. (Editor’s Note: That website is available here: https://ncadv.org/state-coalitions) Sally: That’s really helpful, thanks. I’d like us to think a little bit more about what listeners or friends and family and neighbors could do to help prevent increases in domestic violence from affecting more kids. Dr. Ung: I think that’s a good place to move into. We developed, actually on our website you can find a tip sheet of 10 simple steps that friends and family can take during this time if you’re worried about a loved one sheltering at home, or specifically about the safety; the physical, psychological, sexual, and emotional safety of someone sheltering in place. Some of them involve continuing to reach out and check in. We are sort of punctuating the notion that social distancing really isn’t the goal, physical distancing is the goal, but social connection should not go away in the face of requirements around physical distancing. We’ve been trying to practice ourselves by using the concept of physical distancing to promote the idea that finding ways to connect socially and support socially is really important. Checking in and reaching out to your family member and your friends are really important. Asking them what they need on a day to day basis, asking them if they’re okay, asking them directly if they are feeling safe. We like to encourage family members, and also community based social groups, like faith-based groups, to come together and think about how you might support families that you know are more vulnerable by preparing meals, by pulling dollars and helping families with real concrete, basic material needs. We’ve been encouraging family members and friends to reach out and offer parents relief from 24/7 parenting by offering to read a young child a book on the phone, or get on Zoom and do some crafts with someone, or even just getting on Zoom and watching a movie, or finding ways to engage in just fun. You can take your iPhone, for example, we’ve talked to people about playing hide and seek with young people with the iPhone around the house. Finding ways to offer some respite, relief, and support and connection. We’ve invited family and friends who know there might be family violence at home to find safe ways to have private conversations and establish a code word. Some of the words that some of our shelters are using have to do with “masks needed please,” so the survivor at home who’s not safe might text a service provider a code word: “masks needed please,” and that would indicate that that provider needs to initiate a police response to the house. Finding code words like that, so people can have strategies where they can get help and support in the height of the state of emergency is something we’ve talked about as well. Sally: I love the concrete examples that you gave how you can interact with people who aren’t actually in that space. Although, I do imagine some families don’t even have access to technology, which might compound that even more. Dr. Ung: Yes, I think that’s absolutely true. I think in those cases, families have their networks. The friends and neighbors of families who don’t have access to technology—they find ways to communicate and stay in touch, so what we’ve been inviting people to do is to find ways to maintain those connections to check in on people, and first and foremost to offer support. Anything that we can do to reduce stress and reduce burden is really important right now. Sally: So, back to the resilience piece, obviously you spent a lot of time when you were at the Center helping us craft this curriculum around the 3 Science Principles. We were curious if you could talk a little bit more about what the science of child development tells us about what we need to do to prevent or alleviate the problems you were just describing. Dr. Ung: You know, we know that the experience of trauma like exposure to domestic violence for children has three broad-level impact levels on children. They have biological impacts, which I think at the Center we talk about as the ways in which adversity gets under the skin and impacts children’s health system—raising risk across the life course for negative impacts in learning health, and behavior. We also know that it has psychological impacts, relative to influencing how young people think, feel, act, and interact with others. Lastly, we know that the exposure to prolonged trauma like witnessing domestic violence or experiencing family violence in the home can lead to negative social impacts, interfering with how children and young people relate and make decisions in the context of interpersonal health and engagement. In that context, we’ve been trying to draw a lot on the science that the Center organizes and produces to help people design strategies and programs and policies that buffer impacts in those three areas. When this is all said and done, which seems to be a very relative framing, there will be – we all anticipate—a long period of recovery. A lot of the conversation right now, Sally, is focused around the stress and the trauma of sheltering in place when home is not a safe place, but we’ve been paying a lot of close attention to near-term and long-term stressors that families that were already vulnerable before COVID are going to be facing sort of burdens and levels of stress. There have been 58,000+ deaths in the U.S. right now, and that number is going to continue to sore while we live through all of this. It’s not just family members of young people and children and youth who are dying, but teachers and coaches and people who represent really important relationships in the lives of young people. That’s a wave that we’re really trying to get ahead of and prepare for now. We think the best systems of care pre-COVID, during-COVID, and post-COVID ought to be organized around creating experiences and conditions that help young people and their families thrive, survive, reduce burden and stress in their lives, and create and sustain meaningful, interactive, positive relationships. A lot of that is promoting people’s capacities and skill in terms of being able to have very authentic and genuine conversations with their service providers, with their neighbors, with their faith communities, with their family, about what it means to be in a safe and healthy relationship, and to really promote that as doorways to service deliveries and service provision, rather than business as usual, which is the only access to serve this provision a vulnerable children in a family can have is through a surveillance and a monitoring system, which only produces stigma and also decreases, I think, the likeliness that if you need help and want help you can actually get it. Nobody wants to get help when help comes with the conditions of needing to be labeled a victim or a batterer, frankly. Sally: It’s so challenging to take such a huge topic and cut it down into 15 minutes, so thank you for allowing us. Dr. Ung: Thank you for inviting me. Musical interlude Sally: I’m your host, Sally Pfitzer. The Brain Architects is a product of the Center on the Developing Child at Harvard University. You can find us at developingchild.harvard.edu. We’re also on Twitter @HarvardCenter, Facebook @CenterDevelopingChild, and Instagram @DevelopingChildHarvard. Brandi Thomas is our producer, and Charley Gibney is our producer and audio editor. Our music is Brain Power, by Mela from FreeMusicArchive.org. This podcast was recorded at my dining room table.

COVID-19 Special Edition: Domestic Violence and Shelter-In-Place

Healthy development in the early years provides the building blocks for educational achievement, economic productivity, responsible citizenship, strong communities, and successful parenting of the next generation. By improving children’s environments, relationships, and experiences early in life, society can address many costly problems, including incarceration, homelessness, and the failure to complete high school. But if you’re a parent, caregiver, teacher, or someone who works with children every day, you may be wondering, “Where do I start?!” From brain architecture to toxic stress to serve and return, The Brain Architects, a new podcast from the Center on the Developing Child at Harvard University will explore what we can do during this incredibly important period to ensure that all children have a strong foundation for future development.

While the current coronavirus pandemic is affecting all of us, it isn’t affecting all of us equally. Some communities—especially communities of color—are feeling the brunt of the virus more than others, in terms of higher rates of infection as well as economic fallout, among many other ways. In this third special COVID-19 episode of The Brain Architects podcast, host Sally Pfitzer is joined by Dr. David Williams, the Florence Sprague Norman and Laura Smart Norman Professor of Public Health, Harvard T.H. Chan School of Public Health, and Professor of African and African American Studies, Harvard Faculty of Arts and Sciences. Dr. Williams discusses ways in which the coronavirus pandemic is particularly affecting people of color in the U.S., and what that can mean for early childhood development. He also pinpoints the importance of creating “communities of opportunity” that will allow all families to thrive—both during and after this pandemic. Upcoming episodes of this special podcast series will focus on domestic violence, and the mental health implications of a global pandemic. Subscribe below via your podcast platform of choice to receive all new episodes as soon as they’re released. Speakers Sally Pfitzer, Podcast HostDr. David Williams, Florence Sprague Norman and Laura Smart Norman Professor of Public Health, Harvard T.H. Chan School of Public HealthAdditional 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 &amp; Sciences. Thanks for being with us today, Dr. Williams. Dr. Williams: Thank you, it’s good for me to be here with you. Sally: Just so our listeners know, we’re recording this podcast today on a video call, so the sound quality may be different from what you’re used to hearing when we typically record this podcast in the studio. So, the data that’s coming out now that we’ve been seeing continue to reinforce the research that you have been doing for many years around racial disparities, and we’re seeing that this virus is disproportionately effecting people of color. What are you seeing now in terms of the data? Dr. Williams: We are seeing in multiple states more than half of all deaths from the Coronavirus are African American, and in virtually every state the percent of deaths of African Americans who die from the Coronavirus exceeds—it’s larger than the percent of African Americans in the population in that state. So, there is a disproportionate negative impact on African Americans in New York City, and we see a similar pattern for Hispanics. I think the important point I would like to make at the onset is that first, this is not a surprise. Two, this reflects a longstanding pattern, not just for Coronavirus but for virtually all of the leading causes of death. And that this pattern does not reflect failures on the part of the individuals, the families, and the communities that experience such disproportionate losses.  Sally: I think a lot of times when we’re hearing about this data coming out, there is a missing component where people are hearing this is disproportionately affecting communities of color, but there is not a lot of talking happening right now around the ‘Why?’. Could you share a little bit more about what the underlying causes of this disproportionate impact actually are? Dr. Williams: Sure. Before we talk about underlying causes, I think it’s also important to emphasize that when we see one group in our society disproportionately affected, it affects all of us. It is about all of us. We are all connected. Higher rates of death for one population effects the entire profile and the entire risk for all of the population. In terms of what are the causes of these patterns? We’ve known for a long time many of the culprits. Number one I would mention is lower income, lower education, lower occupational status. In virtually every country of the world, persons of lower levels of education and income have higher rates of disease and death than those who are better off than they are. And when we say race and ethnicity in the United States, we are talking about groups that really vary dramatically in economic resources. I’ll give you two numbers that makes this very concrete. If you look at the latest income data for the United States, published in 2019 by the U.S Census Bureau1, we find that for every dollar of household income White households receive, African American households receive .59 cents. That .59 cents to the dollar figure is identical to the racial gap in income in 1978. Most of my students think we have made a lot more progress than that. As bad as the income gap is, it dramatically understates racial differences in access to economic resources. Because income captures a flow of resources into the household, it tells us nothing about the economic reserves that households have to cushion short falls of income. We get that from data on wealth. The latest report from the Federal Reserve Board indicates that for every dollar of wealth White households have, African American households have .10 cents, and Latino households have .12 cents.2  So, we are looking at groups that are disproportionately, economically disadvantaged; number one. And in multiple ways that raises the health problems and challenges that they will face. COVID-19 really illustrates this phenomenon very powerfully. What we know is that minorities have early onset of disease, early onset of chronic conditions, hypertension, diabetes, heart disease, all occur at younger ages. Part of this is driven by the lower economic status and higher levels of stress. Also, persons of color disproportionately in jobs where they have to go to work in order to get paid. We are working in jobs that don’t provide benefits, often don’t provide healthcare benefits, which lowers access to medical care. In New York City, for example, the hardest hit area of the pandemic, 60% of the essential workers in New York City are persons of color.3 Research also documents that in disadvantage communities, even if you get access to primary medical care, many of those primary care providers do not have admitting privileges at the best academically based or private health care systems where the best specialists are, so that those populations are also limited in the access to quality care. More generally, there is at least one study since the COVID-19 epidemic has begun that looked at a data from multiple states and that reported for testing for COVID-19 that African Americans, with the same symptoms as whites, showing up requesting a test were less likely to get the test.4 We also have evidence of the persistence of discrimination in terms of access to tests in addition to the fact that most of the testing sites are in suburban communities and there are fewer testing sites in central city communities that have a larger unrepresentative minority population.  COVID-19 is a perfect storm in terms of having a disproportionate negative impact on disadvantaged populations in the United States.  Sally: A lot of what you’re describing reminds me of that saying, “a person’s zip code has more to do with their health outcomes than their genetic code does.” What does that mean and how does that relate to this current situation? Dr. Williams: I think it’s important to recognize that challenges these communities face are long standing and it didn’t happen by chance – they are not random events. They actually reflect the successful implementations of social policies. We had social policies implemented in the United States, but residential racial segregation being one of the most profound of them in terms of its far reached negative effects that still persist today that restricted a way a person lives based on race or ethnicity. That has had a dramatic effect in reducing access to opportunities – opportunities in early childcare and good early childcare environments. Access to good early education, access to employment opportunities. Opportunity in terms of the quality of neighborhood and housing environments and whether it’s easy or difficult to get exercise safely in your neighborhood. Whether it’s easy or difficult to have access to good primary care in your neighborhood. Across a broad range of factors that drive opportunity and success and society, we have large segments of our population restricted by these historic inequities.  Just to illustrate how powerful some of these effects are; a national study led by Harvard economists showed that if we could eliminate residential segregation in the United States overnight, we would completely eliminate or erase black and white differences in income, in education, and in unemployment, and reduce the black white differences in single motherhood by two-thirds.5 All of those differences driven by opportunities linked in place. What we need to think is how can we create communities of opportunity? Communities with high-quality early childhood programs, where every child is given a fighting chance to be successful—not only prepared for school, but also prepared for good health – a good foundation for health for the rest of their life. What can we do to reduce childhood poverty? What can we do to enhance employment opportunities for parents? One of the ways we can improve outcomes for children is by enhancing opportunities for their parents. How can we improve housing and neighborhood conditions?  The good news is there are examples of programs in the United States that are doing these things right now, and many of the studies show that these programs not only work but they will save society money. There is a range of opportunities of things we could do now to make a difference. When we take care of all of us and all of us have the opportunity, we not only build a more educated, a more productive workforce, we not only enhance the economic productivity of our society and the global economic competitiveness of our nation, but we also do something more that is profound, and that is we take care of all of us. We are all in this together, and what hurts one of us hurts all of us. It is in our best interest to work together to create a society that provides opportunity for everyone.  Sally: You mentioned stress as a factor contributing to the racial disparities and outcomes. Would you mind talking a bit more about how stress can affect communities and long-term health? Dr. Williams: Sure. I want to talk a little bit more about the fact that minorities; African Americans, Latinos, Native Americans, have higher rates of underlying chronic conditions. The question is why? Is it their fault? Is it all linked to the bad choices that they are making? What the research points to is that you are looking at populations that are experiencing higher levels of stress. In some of my own work, I have found that the most of common stressors—stressors like loss of a loved one, unemployment, financial difficulties, violence in a neighborhood—all of these occur at higher levels among African Americans and among U.S. born Latinos.6 Not only do they have higher levels of the individual stressors, but they have greater clustering of stressors, so if you have one you are more likely to have multiple. What research is pointing out is that living out of the conditions of high levels of chronic stress leads to a physiological dysregulation across multiple biological systems. There is a body of research suggesting that at the same chronological age, racial ethnic minorities may be biologically older than Whites in the United States.7 It reflects the high levels of exposure to psychosocial as well as physical chemical stressors.  Let me give a practical example of the physical chemical stressors. There is one recent study done by researchers at Harvard University documenting that persons who live in areas with higher levels of air pollution, which are disproportionate minority, those persons if they get COVID-19, it is more severe and they’re more likely to die.8 The air pollution, this chemical stressor, has a negative effect in terms of adversely impacting health. In addition to higher levels of the chronic stressors, one of my areas of research has also been looking at stress of racial discrimination. I have developed measures to capture discrimination. One of them that is very widely used around the world is called The Everyday Discrimination Scale.9 It captures minor indignities – being treated with less curtesy and respect than others, receiving poorer service than others at restaurants or stores. The research documents that these little indignities accumulate and adversely impact physical health, mental health, the quality of sleep. It predicts early onset of multiple chronic diseases and even adversely impacts how individuals access and utilize medical care. If you’ve been treated badly in multiple domains of society, then you become less trusted in even the healthcare context. What emerges is a picture of the cumulation of negative experiences of chronic stress that have long term negative impacts on health.  The challenge, though, is that most Americans are unaware that racial ethnic disparities even exist. Raising awareness levels is really important, because if we don’t even know a problem exists, we are not mobilized to address it. Maybe COVID-19 provides us an opportunity to become more informed and hopefully to become more committed to working together to create a better future for all.  Sally: So, we’ve talked a lot about racial disparities in physical health related to COVID-19, but could you talk a little bit more about other ways in which people of color may be disproportionately impacted by this pandemic? Dr. Williams: COVID-19 is an unprecedented challenge that we are all facing together as a society. This unprecedented challenge is a physical health problem, but it is going to produce a large scale of economic devastation, which we have touched on to some degree. It also will have large scale, negative emotional consequences. One of the things that we really need to think of is how do we provide support for all communities, but especially those who are already suffering disproportionately from the economic effects—those who are suffering disproportionately from the loss of loved ones. When we say that African Americans and Latinos are experiencing higher rates of death, that’s people losing mothers and fathers, grandparents, brothers and sisters. This is a community that will also be experiencing higher levels of grief and loss in addition to all of the negative effects of the pandemic. So, we really need to think of how can we enhance the access to emotional resources that helps people cope, and how all of us as individuals, even as we socially distance, we do not emotionally distance. That we do reach out to others and be supportive and be helpful, so that people can still have that sense of caring from others and that sense of emotional support from others.  Sally: I’m imagining that many listeners might be wondering what they can do, and how we might be able to help change this for the future? Dr. Williams: Sure. I think when it comes to stress and environment, there are things that individuals who are suffering now can do that can protect them from some of the negative effects of stress. So for example, even the research on stress in general, but also research on discrimination in particular, points out that individuals who are embedded in close-knit, emotionally supportive relationships, the quality of social ties can reduce at least some of the negative effects of stress on health. There are some research suggesting that higher levels of religious involvement can also protect individuals from some of the negative effects of stress on health. There are things that can be done at the individual level. At the same time, what can we do to create environment where stress levels are lower? How can we create high quality neighborhoods so we will reduce the levels of neighborhood stress? How can we promote greater civility and respect of others as a value, so that we reduce the occurrence of discrimination in the first place? How do we make workplaces more friendly and more stress free than they currently are today? So, I think we do need to think of the high-level policy solutions that create environments that are low in stress, even as we empower individuals to more effectively cope with and deal with the stresses they face.  Sally: I really appreciate you taking the time, I know it’s incredibly busy and I know there are a lot of people asking for your time, so thank you so much for the opportunity to interview you. Dr. Williams: You’re very welcome.  Musical interlude Sally: I’m your host, Sally Pfitzer. The Brain Architects is a product of the Center on the Developing Child at Harvard University. You can find us at developingchild.harvard.edu. We’re also on Twitter @HarvardCenter, Facebook @CenterDevelopingChild, and Instagram @DevelopingChildHarvard. Brandi Thomas is our producer, and Charley Gibney is our producer and audio editor. Our music is Brain Power, by Mela from FreeMusicArchive.org. This podcast was recorded at my dining room table. References 1U.S. Census Bureau 2019 Income Data 2https://www.federalreserve.gov/econres/scfindex.htm?mod=article_inline 3https://comptroller.nyc.gov/reports/new-york-citys-frontline-workers/ 4https://rubixls.com/2020/04/01/health-data-in-the-covid-19-crisis-how-racial-equity-is-widening-for-patients-to-gain-access-to-treatment/ 5Cutler, David M., and Edward L. Glaeser. 1997. “Are Ghettos Good or Bad?” The Quarterly Journal of Economics 112(3): 827–72. 6https://scholar.harvard.edu/files/davidrwilliams/files/williams_dr_pearlin_paper_stress_mental_hlth_jhsb_2018.pdf 7https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4197001/ 8https://projects.iq.harvard.edu/covid-pm 9Everyday Discrimination Scale

COVID-19 Special Edition: Creating Communities of Opportunity

In the midst of a global pandemic, pediatricians are serving a unique role. While the coronavirus is generally showing milder effects on babies and children than on adults, there are still health concerns and considerations for infants in need of scheduled vaccinations, and kids who are home all day with parents who may be facing stressful situations. In the second episode of our special COVID-19 series of The Brain Architects, host Sally Pfitzer speaks with Dr. Rahil Briggs, National Director of ZERO TO THREE’s HealthySteps program, to discuss how pediatricians are serving their patients during the pandemic, including using telehealth; why caregiver health is child health; and what she hopes the healthcare system can learn as a result of the pandemic. Upcoming episodes will focus on racial disparities in the effects of the virus, and domestic violence. Subscribe below via your podcast platform of choice to receive all new episodes as soon as they’re released. Speakers Sally Pfitzer, Podcast HostDr. Rahil Briggs, National Director of ZERO TO THREE’s HealthySteps ProgramAdditional 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 mental healthcare, is available for all. And that as you said, caregiver health is child health. We’re really grateful that you took the time to speak with us today. Dr. Briggs: Thanks, Sally. Musical interlude Sally: I’m your host, Sally Pfitzer. The Brain Architects is a product of the Center on the Developing Child at Harvard University. You can find us at developingchild.harvard.edu. We’re also on Twitter @HarvardCenter, Facebook @CenterDevelopingChild, and Instagram @DevelopingChildHarvard. Brandi Thomas is our producer, and Charley Gibney is our producer and audio editor. Our music is Brain Power, by Mela from FreeMusicArchive.org. This podcast was recorded at my dining room table.

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 <a href="https://www.healthysteps.org/" rel="noopener noreferrer nofollow" target="_blank">ZERO TO THREE’s HealthySteps program</a>, 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. <h2>Speakers</h2> <a href="https://developingchild.harvard.edu/people/sally-pfitzer/" rel="nofollow" target="_blank"></a>Sally Pfitzer, Podcast Host Dr. Rahil Briggs, National Director of ZERO TO THREE’s HealthySteps Program <h2>Additional Resources</h2> <ul> <li><a href="https://www.erikson.edu/fussy-baby-network/" rel="noopener noreferrer nofollow" target="_blank">Erikson Institute’s Fussy Baby Network: free phone consultations</a></li> <li><a href="https://www.healthysteps.org/article/caring-for-yourself-and-young-children-during-the-coronavirus-covid-19-crisis-147" rel="noopener noreferrer nofollow" target="_blank">Healthy Steps: Caring for Yourself and Young Children During the Coronavirus (COVID-19) Crisis</a></li> <li><a href="https://www.zerotothree.org/resources/3210-tips-for-families-coronavirus" rel="noopener noreferrer nofollow" target="_blank">ZERO to THREE: Tips for Families: Coronavirus</a></li> </ul> <h2>Transcript</h2> 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 <a href="http://healthysteps.org" rel="nofollow" target="_blank">healthysteps.org</a> on caring for yourself during Coronavirus, and there is also a <a href="http://zerotothree.org" rel="nofollow" target="_blank">zerotothree.org</a> for tips for families Coronavirus if that could be helpful. Sally: What are the pros and cons of health services that are delivered by technology instead of in person? Dr. Briggs: Telehealth is emerging as this wonderful solution to so many of our problems, and it is absolutely a vehicle that can really help us reach families right now. There are some challenges to telehealth, not the least of which is that the guidelines around telehealth vary state by state. So you have 50 sets of guidelines about how to use telehealth, who can be reimbursed, what qualifies as a telehealth visit and then when we think about infants and toddlers, if you’ve ever tried to get an 18 month old to just stand in front of the camera for a 20 minute telehealth visit – good luck, right? I think as much as it’s an extraordinary platform and we can really extend the reach of services through telehealth, we’re going to see limitations both because we don’t have a national infrastructure around this and because infants and toddlers are not great at sitting still for the camera. We’re losing some of that key interaction piece of the parent and the child together perhaps and creating even more stress for a family because Dad is worried making sure that the baby stays in front of the camera for this visit. So, we are thinking a lot about yes, the promise of telehealth and the unique challenges particularly related to infants and toddlers. Sally: You’re definitely speaking to the fact that our healthcare providers are being seen as real heroes right now, and we are wondering what should our healthcare system learn from this experience in order to adapt and improve the system for the future? Dr. Briggs: Maybe, we finally recognize that we absolutely need a healthcare infrastructure for everybody in our country, and maybe we finally recognize that that healthcare infrastructure includes mental health. That there is no health without mental health. That there is no child health without caregiver health, and that goes for mental health as well, and that developmental wellbeing is a key construct in there. I am thinking so much about our increased understanding of all of these drivers of health. We’ve known for a long time that you can’t solve all problems within those four walls of the medical practice. That if someone goes back to unstable housing, if someone goes back to community violence, that those things are going to undo the important health interventions efforts we’ve made. My first decade of work was at Montefiore Health System in the Bronx, a borough where people are dying from COVID at twice the rate of their neighbors and the rest of New York, due largely to pre-existing health conditions and other risk factors associated with poverty. There is a higher incidence of asthma in the Bronx, largely based on a higher incidence of air pollution in the Bronx. And so, my greatest hope for all of us is that we recognize what heroes healthcare workers are and we recognize that we need a massive rethinking of the healthcare system to focus on those drivers of health that have to do with safe housing and environmental justice and safe and stable and nurturing relationships that are going to really create the foundation for health for folks, whether they’re facing this virus or another one down the road. We’ve got an extraordinary moment to get this right coming out of it, and it’s about whether or not we’ll have the courage to do so, the will to do so, and the resources to do so. Sally: Thank you so much, Rahil for taking the time to be with us today. You’ve articulated so clearly the importance in making sure healthcare, including mental healthcare, is available for all. And that as you said, caregiver health is child health. We’re really grateful that you took the time to speak with us today. Dr. Briggs: Thanks, Sally. Musical interlude Sally: I’m your host, Sally Pfitzer. The Brain Architects is a product of the Center on the Developing Child at Harvard University. You can find us at <a href="http://developingchild.harvard.edu" rel="nofollow" target="_blank">developingchild.harvard.edu</a>. We’re also on Twitter <a href="https://twitter.com/harvardcenter" rel="noopener noreferrer nofollow" target="_blank">@HarvardCenter</a>, Facebook <a href="https://www.facebook.com/CenterDevelopingChild/" rel="noopener noreferrer nofollow" target="_blank">@CenterDevelopingChild</a>, and Instagram <a href="https://www.instagram.com/developingchildharvard/" rel="noopener noreferrer nofollow" target="_blank">@DevelopingChildHarvard</a>. Brandi Thomas is our producer, and Charley Gibney is our producer and audio editor. Our music is Brain Power, by Mela from <a href="https://freemusicarchive.org/" rel="noopener noreferrer nofollow" target="_blank">FreeMusicArchive.org</a>. This podcast was recorded at my dining room table.

COVID-19 Special Edition: Self-Care Isn't Selfish

COVID-19 Special Edition: A Different World

Serve and Return: Supporting the Foundation

Toxic Stress: Protecting the Foundation

Brain Architecture: Laying the Foundation

Center staffers Sally Pfitzer, Charley Gibney, and Brandi Thomas record an episode of The Brain Architects podcastHealthy development in the early years provides the building blocks for educational achievement, economic productivity, responsible citizenship, strong communities, and successful parenting of the next generation. By improving children’s environments, relationships, and experiences early in life, society can address many costly problems, including incarceration, homelessness, and the failure to complete high school. But if you’re a parent, caregiver, teacher, or someone who works with children every day, you may be wondering, “Where do I start?!” From brain architecture to toxic stress to serve and return, The Brain Architects, a new podcast from the Center on the Developing Child at Harvard University, will explore what we can do during this incredibly important period to ensure that all children have a strong foundation for future development. Listen to the trailer, and subscribe now! Transcript Sally: Welcome to the brain architects. A new podcast from the center on the Developing Child at Harvard University. I’m your host, Sally Fetzer. We want to help you apply the science of early childhood development to your everyday interactions with children and everyday work.  Speaker 1: Those building blocks, those really connections in the brain that prepare us for all of the learning that follows start in the new-born period.  Speaker 2: These adults in the child’s life need time, they need resources, they need services, and all of that enables them to engage with their children in a meaningful manner.  Speaker 3: We see a lot of families who have then failed time and time again by trying to access system that should be set up to help them.  Speaker 4: Parents are facing basic need issues they’re not going to focus on the bigger issues that are causing them any stress in their lives.  Speaker 5: Each of us needs to have a support in order to function. What do you need to feel better?  Speaker 6: The brain is always trying to get things right, if it goes off track, it’s always trying to get back on track. That’s the beauty of the science. It’s also the beauty of the magic of human development. 

Center staffers Sally Pfitzer, Charley Gibney, and Brandi Thomas record an episode of The Brain Architects podcast Healthy development in the early years provides the building blocks for educational achievement, economic productivity, responsible citizenship, strong communities, and successful parenting of the next generation. By improving children’s environments, relationships, and experiences early in life, society can address many costly problems, including incarceration, homelessness, and the failure to complete high school. But if you’re a parent, caregiver, teacher, or someone who works with children every day, you may be wondering, “Where do I start?!” From brain architecture to toxic stress to serve and return, The Brain Architects, a new podcast from the Center on the Developing Child at Harvard University, will explore what we can do during this incredibly important period to ensure that all children have a strong foundation for future development. Listen to the trailer, and subscribe now! <h2>Transcript</h2> Sally: Welcome to the brain architects. A new podcast from the center on the Developing Child at Harvard University. I’m your host, Sally Fetzer. We want to help you apply the science of early childhood development to your everyday interactions with children and everyday work. Speaker 1: Those building blocks, those really connections in the brain that prepare us for all of the learning that follows start in the new-born period. Speaker 2: These adults in the child’s life need time, they need resources, they need services, and all of that enables them to engage with their children in a meaningful manner. Speaker 3: We see a lot of families who have then failed time and time again by trying to access system that should be set up to help them. Speaker 4: Parents are facing basic need issues they’re not going to focus on the bigger issues that are causing them any stress in their lives. Speaker 5: Each of us needs to have a support in order to function. What do you need to feel better? Speaker 6: The brain is always trying to get things right, if it goes off track, it’s always trying to get back on track. That’s the beauty of the science. It’s also the beauty of the magic of human development.

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