 My name is Molly McMunn. I'm the community relations and public affairs specialist here at Bay State Franklin Medical Center and As part of my role I get to sit on various boards and committees here in the community and have made some fantastic partnerships with some of our community partners, the communities that care coalition being one of them and of that relationship was born the idea for this event here today. I'm also a parent of a daughter who's 13 years or 14 years old and The conversation amongst my group of friends has been this very topic here the importance of Discussing it with each other discussing it with professionals and discussing it with our children. So, thank you all for coming I do want to share quickly Bay State's mission is to improve the health of the people in our communities every day with quality and compassion and When I read that the key word in that statement to me as communities I didn't say improve the health of our patients that of course first and foremost We want to improve the health of our patients But we're also committed to improving the overall health and well-being of everyone in our community That includes quality of life preventative care mental health and educational opportunities such as this So, thank you all very much for coming. We hope to do more of these in the future And I also want to I have a couple housekeeping notes here And we have presenters this evening our cat Alan she's a coalition coordinator at the communities that care coalition Lots of C's And she'll be giving you more information about the communities that care coalition and the hard work that they do and Cheryl Pascucci who's a nurse practitioner here at Bay State Franklin Medical Center. Thank you And I also want to let everyone know if you need to use the restrooms to go out into the main lobby Take a right take it right after the gift shop and you're on your left So that's another one of our common questions and please feel free to help yourself to more food if you'd like to And I also want to introduce our co-sponsors this evening if you wanted to come up and say a couple words So good evening everyone, okay, no, I'm not blinded My name is a lot of girl joy and I am the coalition coordinator for a greenfield based coalition I work with Siobhan Kara. We're going to talk to you in just a sec and we are A health and wellness coalition that focuses on youth substance use coalition Use substance use and other issues that are related So youth well-being youth development very similar to the communities that care coalition But we're focused on the greenfield footprint and cat will be telling you a little bit more about how we do this kind of work In a minute. I just wanted to say hello to all of you and thank you for coming We're really pleased to be able to co-sponsor this event and also to say that we just received Federal funding for an additional five years of work. We're really thrilled to be here We're very happy to have base state as a local hospital supporting our work Through this event in many other ways and if you're interested in being involved in our coalition You will get a follow-up email if you said you wanted to hear about other events And you can then contact us and come to our coalition meetings or other events that we're going to be holding in the local area So thanks again for being here I'm now just going to really briefly introduce Cara and Siobhan who are going to talk to you about youth and parent engagement Hi, I'm Cara younger. I'm the Engagement facilitator that's what it is So I run a youth-led Prevention team through the greenfield like in the greenfield footprint So if you have any kids that are interested in getting involved in prevention Helping support local events things like that and just being a good face in the community center to me And I'm Shawn Fitzgerald I am doing the parent enrichment and that's a new role for me with foresee and I'm really excited about that So again, if you did check off that you want any more information and anything like that you'll be hearing Thank you for coming One last thing I forgot to mention is that you can avoid to send your aisle here because the camera set up in the back That would be fantastic and I'd like to pass it over to Kat Allen. Thank you Thanks everyone for being here on this very snowy. Well, not yet, but potentially Evening I'm impressed and so many people made it out And it's it's awesome that you are taking your time to be here and learn with us and thank you again to the hospital This idea came up and Molly just jumped on it and she had the full support of the hospital And I'm so glad because she was able to get the word out in all kinds of ways I also wanted to introduce some of the people that I work with at the communities of care coalition so my name is Kat Allen, I'm with the communities of care coalition and Rachel back there and I are co-coordinators of the communities of care coalition. We are regional coalition We serve the 30 towns of Franklin County in the north bobbin And we've worked on substance use prevention and nutrition and physical activity promotion for youth primarily And Jeanette is our evaluation coordinator. She runs the survey So if you have any kids in the schools that have ever taken the youth health survey Jeanette runs that and Jeanette also is the person who put together this presentation. She is the brains of this operation I'm just the mouth If there are questions that I can answer we'd be like But in any case and I also wanted you to introduce Stacy Langnecht who is The volunteer chair of our parent education work group for the communities at care coalition so if you're interested in getting more involved with Substance use prevention or youth health promotion Please talk to Stacy or me and we'd love to have you so get me started Oh, I put this because I knew I was going to forget Disclaimers my disclaimers. I already told you that she's the brains of the operation I am not a doctor and I'm not a scientist or a medical researcher and So I am presenting the information that we have gleaned for many other sources and So I just don't want to claim to be More than I am but I know that people are really interested in this information It seemed like people wanted to hear us so Also, I cannot claim to be unbiased I don't think there's anyone that could speak on any topic in an unbiased way I've been working in substance use prevention youth substance youth youth prevention for 16 years I still can't say it But in any case, I mean I Have various opinions and we're going to do our best to just be objective and let you come up with your own Opinions for your parenting practices, but so the communities that care coalition is a coalition of schools Human service agencies local government law enforcement businesses faith-based organizations parents and youth and we work together to improve the health and Well-being of young people in Franklin County and the North Coven all the 30 towns surrounding The outline of my part of the presentation I'm going to speak for a little bit and then Cheryl's going to speak and then we're going to have question and answer The outline from my piece of the presentation here four questions. I'm going to try to answer one How is the developing brain more susceptible to harm than the adult brain? To how does marijuana affect the developing brain? three how common is youth marijuana use in this area at this time and For what can we do to help prevent youth use? Okay, so Let's get started question number one. How is the developing brain more susceptible to harm? So Looks like my kids sometimes Compared to childhood and adulthood adolescence is a time of heightened sensation and reward-seeking risk-taking and impulsivity pure influence mood swings capacity to learn and Exuberance right great things bad things hard things easy things but different in many ways Okay, so this is a video That shows oh gosh This is a video that shows the maturation of the human brain Look at this From age 4 to 21. So this is a completion. I was too slow and it disappeared on me No, but I did it come back. There we go. So So this is the maturation of the human brain from age 4 to 21, so let's see it again What you'll notice here is That the brain is maturing from the back to the front you're looking at it like this so that's the back to the front and That's going to become relevant because of what happens in sort of the back of the brain versus the front of the brain and this Maturation is actually a reduction in the gray matter in the brain So what's happening during this process is not building new neurons But a pruning of the existing neurons were born with so many and there's this pruning process like if you imagine pruning a tree Where the neurons that are not used go away and the neurons that are used get Get coated they turn into neural superhighways so to speak So the neurons that get used a lot become faster and more efficient through this process called myelination Which is basically your brain puts this fatty substance around that neuron so that it's insulated It's like insulating an electrical wire the impulse can go more directly from one place to another so again, there's this this Process of pruning the neurons that you're not using and myelinating making more efficient the ones that you are using during during adolescence One doctor J.D. I'm not sure he say it Describe it as the use it or lose it principle So if a team is doing music or sports or academics Then those are the cells and connections that will be hardwired If they're lying on the couch or playing video games Then those are the cells and connections that are going to survive So, you know, you are building what are your what are your go-to coping mechanisms when you have big feelings You're building, you know all these different pathways in your brain during adolescence By the way Please feel free if there's something that doesn't make sense I am happy to have people sort of jump in and ask questions if we get to too much of that I'll stop you, but please feel free to stop me for for now So this Cartoon this is the teenage mouse. I can totally get away with this. So during adolescence Because the back of the brain starts developing right so from Childhood you suddenly have this very well-developed amygdala and the amygdala is the part that is in charge of the reward system So it's as developed as it will be in adulthood But what you don't have is the well-developed prefrontal cortex to go along with it So there's there's a spin of an imbalance where the rewards become really great but the control To balance out those rewards isn't necessarily as great and that's why there's heightened risk taking and sensation seeking Among adolescents now that's not necessarily a bad thing like we need risk takers We need so there are plenty of advantages to that, but it is a difference here. This is the simplification of the brain's reward system and so here we have two neurons and dopamine is The chemical that gets released from one neuron into the other for pleasure for rewards like yes I got that food. I got that Sex when I got that chocolate whatever it is the dopamine system is what sends that pleasurable signal and From the neurons point of view so here's like a normal Reaction to a really yummy meal you get that sense of pleasure drugs on the other hand You're getting a huge amount of dopamine there So just a flooding of dopamine in that synaptic space there So when the brain's reward system is repeatedly overstimulated It adjusts to reduce the dopamine levels So just like if you're exposed to loud sounds a lot over and over again You lose those little hairs that sense the loud sounds You're exposed to a lot of dopamine those dopamine receptors Get pruned away. So your own ability to feel pleasure gets reduced over time so this is Bring images Compilations of a person with a substance use disorder and a healthy subject when exposed to something pleasurable so here we have high dopamine levels This is somebody who's not currently You know high on a drug not currently using a drug but but has been you know repeatedly exposed So the dopamine response is dulled So this is a review point so the three I the question we were just answering here is like Why are adolescent brains more susceptible to addiction so there were sort of three main points I was trying to make what what were some of them I got any of them What's up Repeat the question. What were the three main reasons why the adolescent brain is different from the adult brain or three That's right. The the prefrontal cortex is not yet developed exactly so the control systems aren't fully on board or as By the time Pruning in my nation they're making super highways and that has it that is happening then during adolescence So those repeated behaviors can become Hard-wired much more than they can during adult during adulthood. Yep, and there was one more That's right exactly that it make Dilla and they're Wow, you I was sure that we were not gonna get all three of these on the first try and I was like I know what's gonna happen people are gonna give me totally right answers that aren't the answers I thought So anyway, yes, we did that exactly right So those are the three the three main points. So dependence on substances drugs and alcohol and other and I would add Video games and you know cell phone the ping that goes off when you get a light get all of that stuff But dependence on substances is highly correlated with early use which is not surprising given what we just saw right so 40% of those who begin drinking at age 15 will develop an alcohol use disorder and Only set as compared to only 7% who begin drinking at age 21. So here's age at first use and This is prevalence of alcohol use disorders So you can see for each year that a young person waits to begin using Alcohol their risk of dependency goes down now. We can't we can't claim causation And that's going to be a theme Throughout this presentation. We can't say that it's because they waited, but we can theorize that That because of all the things that we just talked about about the developing brain and because of the coping strategies that you're learning During adolescence and the habits and the friendships that you that you create during that time We can theorize that there is at least in part some, you know a chicken and egg, but a cause a some piece of causal relationship I believe so Yes, when you say a child who begins drinking. Are you saying a child that tries drinking or a child that is drinking? Excellent question. I don't know if which what this study is referring to I do know that Like first sip for non-religious purposes is relevant to use like there are a number of studies that You know that will use any drink not regular use but first first Drink that's not for religious purposes as the marker of the age of first years Jeanette do you anything to add to that? So so it can vary study to study but But there is sort of there is a difference between you know, even some use has some impact And we're going to see a lot of that because it's going to get less and less definitive as we go along There's a lot we don't know so especially here, right? So how does marijuana affect the developing brain? first a little bit about marijuana the marijuana plant cannabis has about 480 natural chemical compounds the two that we hear about the most are THC and CBD CBD stands for cannabidiol and THC stands for tetrahydro cannabidiol and those are the two substances we hear the most about with THC having the sort of more hallucinogenic effects and CBD often being attributed many of the more common effects, but there's all these different chemicals and they work in Together in ways that we don't necessarily understand at all so Like most drugs both THC and CBD mimic natural brain messengers That's a lot of times what a drug is is like something that mimics the natural messengers in your brain and Causes a pleasurable pleasurable response, but maybe in higher amounts. So you can see this is Anandamide anandamide. I don't know how you say that but that is the Brain's chemical that is associated with pleasure and here's THC and they have very similar similar chemical structures, so Cannabinoid receptors are found all over the body. So the body has many many places that THC and CBD can Attach to those receptors throughout the brain throughout the body So and other cannabinoids also from marijuana can bind with these natural Receptors and alter natural signals. So some of the oh before I get there I Think everyone has probably heard this but so THC is a psychoactive Ingredient CBD the non-psychoactive ingredient Since the 1960s we've seen a dramatic Increase in the amount of THC in Marijuana that is you know out in the rap and of course it depends on the particular batch of marijuana The CBD levels have remained more or less Pretty pretty constant But this has gone up tremendously. So whereas in 1960 the THC level Concentration was point two percent now This is 2011. So this is not recent data. It's eleven point four percent. So you know what What we were smoking in college not to you know But like what what people were smoking in college is not the same as what is available today And what your parents were exposed to in college was not the same either And there is now this proliferation of THC concentrates This is the pictures of them some common street names for them But oils and butters and shatters and hash oil and It can also come in many different forms, right? You can smoke marijuana There's lots and lots of proliferation edibles, which is the biggest sort of market share growing beverages now with marijuana vaporizing and other forms So that's a big change from what we have known Acute effects of using marijuana during intoxication. So here we have the brain and Altered judgment is possibility slowed reaction time euphoria increased appetite Panic paranoia psychosis Impaired memory the now it's not to say that everybody's experiencing all these every time these are these are effects that can happen obviously impaired coordination Altered pain sensitivity and anti nausea effects now you can see that a number of these are very positive, right? There's positive effects. There's negative effects. There's all different things Like, you know, you can imagine obviously anti nausea effects can be very helpful for people increase appetite that these are There is so much that we Still don't know in ways that marijuana may be very useful that have not been studied There are also many different kinds of effects that can happen. So here's a little bit about marijuana and driving Lab and simulator studies show that marijuana impairs driving skills and the more THC in the marijuana the greater the impairment What's interesting is though that when people Use marijuana and then drive they think they are at least as good a driver if not a better driver They don't recognize the impairment that they're feeling now. It is true that alcohol Impairs you more than marijuana for driving But that doesn't mean that there's not impairment for marijuana and it also doesn't mean that Introducing marijuana will mean that drunk driving will go down in Colorado what they saw with driving I think it was Colorado in that Washington. I don't remember. I will say it in a minute, but marijuana only Drivers who had you know were driving impaired only 33% of them Were just under the influence of marijuana The rest had marijuana and alcohol or other drugs and alcohol or just other drugs So and those effects can be sort of compounding So marijuana used with alcohol causes greater impairment that either one alone and it is Colorado in 2014 Drivers testing positive for THC two-thirds had alcohol and or other drugs in their system as well as marijuana So And we have questions My going all right in terms of pace Yeah, can you speak to? Heavy metals in or are you going to I can't I can't answer that question It's a really good one because that's not regulated at all or yeah, I can't answer that one. I don't know I know Like with vaping which vaping devices can be used to smoke marijuana And I know there is a concern that heavy metals show up in the Vapor the vapor the aerosolized chemicals that come through a vaping device But I I don't know much more than that. Does anyone else know more than that that? Share briefly. Okay. Sorry about that. Good question. Yeah Why are the levels so much higher? Why are the levels so much of THC going up because of breathing? Yeah, because you know people have been reading the plan for a greater and greater Effect so and I suspect that will happen You know continue to happen more and more as the industry now is involved and incentivized to To bring them So other questions Yeah, you said that um, there are natural receptors in the human body that THC and CBD attached And I've heard that as an argument for the pro marijuana industry that hits it's pretty natural And we're already hardwired to receive these chemicals. Yes. And so yes I mean and that's a big theme in like Michael Collins book He writes about how marijuana was involved, you know, and and what's my argument against that? My argument against that is so is heroin when heroin mimics natural receptors opioids mimic natural receptors heroin comes from the poppy seed Nobody would say oh, therefore heroin is natural and therefore it should be fine morphine or whatever so That's not an argument saying it's bad marijuana is bad But it's an argument saying just because it mimics a natural receptor does not make it good just because that's that's what all drugs do Right That's right, especially given how much it's been altered because it's not the same drug that it's not the same plant What we're using now what you're getting it at in a in a beverage with marijuana is not the same as What came out of plants a hundred years ago? Good questions. Thank you. Yeah Yes, yes It's Yes But I think they're all waiting to see exactly how it happens like at this point you hear stories my colleague a lot I had a story or somebody had a story of like being on a plane going home from California and the person next to them had a marijuana infused beverage and drank it and Had a psychotic episode did not realize that the serving size of that beverage was one cat full One cat full is the serving size So I Mean we're fortunate like you know the ODing on marijuana is not a common thing That's not but having that a psychotic episode is not a happy feeling for somebody Who thinks they're Any reference to the ODing thing, but also the drug interactions Like with friend is on And marijuana it's not a good combination a lot of my clients. I've seen I've seen patients go psychotic when respiratory infection and the doctor first scribes friend is on They're still using that's a good point Dr. Yeah, that's a really good Yeah, what is the legal age for someone to be able to Cruise down to Northampton 21 21 I think right now very strict it's not to say that a 20-year-old couldn't still get marijuana from You know the old sources, right? I mean access was never much of a barrier for marijuana kids could get marijuana before it was legal That's definitely true and You know legal marijuana will certainly increase access it through some channels But I think the concern might be more like advertising and so on and I think Massachusetts I Think has been you know doing a pretty good job of prepping regulations to make it Pretty pretty friendly to prevention for preventing youth use. So I'm gonna keep moving But don't let that stop you if there's burning questions. So How does marijuana affect the developing brain? Oh, so this is the second half of that second question, which is what are the longer term effects? Okay, so we just talked about what happened. You're high This one we have if there's so many more questions than answers about this, right? Because marijuana has been a schedule one drug. We have not been able to do studies on this There's been no federal funding for studies. We know very little about the positive and negative effects in terms of like scientific knowledge But one thing researchers agree on is that frequent marijuana use during adolescence Has more serious consequences than used by adults That's that if there's one main message that I've got today for you. That's it. Okay So here's some of the potential longer term effects of regular marijuana use of youth development Issues with attention memory and learning Poor educational and life outcomes. No again, I just want to remind you this is potential longer term effects More questions than answers here, but we have reason to believe these could be issues, right? Poor education and life outcomes loss of IQ for persistent heavy users again a potential Longer term effect and I'll tell you a little bit about each of these and potential for addiction to marijuana and increased risk of Addiction to other drugs. So let's oh and increased risk Whoops risk of risk of psychosis, but increase risk of psychosis. So here we go Deficits in cognitive functioning among active users many studies show that adolescents who use marijuana heavily Tend to score worse than non-users on tests of attention verbal learning memory and processing speed that could be Causation or correlation. We don't know we know there. Well, we know there's a correlation But and also even when they're not high. So here's the correlation for verbal learning Non-users are scoring much better than or significantly better than marijuana users in terms of verbal learning and then memory here delayed recall non-users versus users Deficits are larger for those who use more and those who begin use And this piece of evidence sort of lends some credibility to the fact that there may likely be some Causality there because with sustained abstinence functioning is largely restored. So that kid who then stops using for a couple of weeks and retests their Their responses. So this is two weeks of abstinence here Here's the gap between users and non-users and then with two weeks of abstinence three weeks of abstinence We're seeing a closing of that gap okay Adult life outcomes affected by marijuana use in adolescence. So these are adults Who were using? Significantly when they were or who are using at different levels when they were adolescents So this is using zero times and the percent that were college grad by age 25 All the way down to using four hundred or more times and the percent where they were college grads So you can see there's a correlation between regular marijuana use and college graduation and Also a correlation between regular marijuana use and unemployment. So the more times people were using marijuana The more likely they were to be unemployed again Could be correlation could be causation probably some combination of the two, right? So increasing use of marijuana from age 15 to 21 was also associated with lower Relationship quality and lower life satisfaction at age 25 to me. This is you know when I think about my kids like college grad by age 25 like it would be nice, but like Life satisfaction and relationship quality. That's it. That's a big deal Not that whatever So lots of adult IQ associated with marijuana dependence in adolescence. So here I'm talking about Dependence not casual one-time use. This is the study is regular use. So the most comprehensive study of marijuana and cognitive function that has been done to date was the Dunedin study I think it's Dunedin which followed a thousand individuals from birth to age 38 They assess their IQ at age 13 and at age 38 and they assess their marijuana use and dependence at five different points in time From 18 to 38 so fair amount of information collected over a long period of time on about a thousand people And they control for use of alcohol and other substances and for socio-economic status and for years of education What they found was that those who developed marijuana dependence before age 18 Showed an IQ decline in adulthood. So this is sort of Sciences attempt to look at causality Through longitudinal studies. So the longer their dependence persisted the greater the decline in IQ With the decline of eight IQ points for the most persistent users those who began using in adulthood did not show IQ decline and Quitting in adulthood did not restore functioning in those who began in adolescence Does it somewhere it says? somewhere it said 8 IQ points if you started out as average like 50th percentile IQ and you lost eight IQ points I think that puts you at the 26th percentile in IQ So that's a significant drop especially if we're talking across populations, right? If we have lots of kids becoming dependent on marijuana You know or and even if you're not talking cross population you've been talking to your own kid, right? That's a big deal So there were other studies However other good quality studies that showed no association between marijuana use and IQ loss these two studies had Good sample sizes and found no association between marijuana use and IQ after adjusting for various co-founders and so on the difference was These studies were Less heavy use less frequent use So they're not necessarily a contradiction of the Dunedin study But it may be that the picture is a little more complicated that light use of marijuana during adolescence Doesn't necessarily have these strong effects and heavy use so One of the other things that we worry about with marijuana use during adolescence is psychosis and schizophrenia The centers in the brain that are activated during marijuana use are some of the same centers that are activated during a psychotic episode, you know, that's it's sort of the you know, creativity centers and so on but on Marijuana use at age 18 and later risk of schizophrenia. So the number of times the marijuana was used is Correlated with the number of cases of schizophrenia Here's a different study here or a different graph Regular marijuana use seems to increase schizophrenia risk in those with the gene for schizophrenia So you don't necessarily know if you have the gene or not, but then those who were genetically susceptible And who were daily users? That's them. So there they were seven times more likely to Develop schizophrenia than any of the rest of the cohorts, especially, you know 14 times more likely than the ones who were susceptible and didn't use Does that make sense? So here we go. How common is youth marijuana use? So this is the percentage of US 12th grade students who report past month use of cigarettes marijuana and alcohol And this is national data So we have these really nice trends in alcohol use going down cigarette use going down Marijuana has been peeking up a little bit. Okay, so that's national data local data This is our Franklin County and North quabbin teens 8th 10th and 12th graders that we survey every year about 2,000 kids And this is the data on alcohol use marijuana use and cigarettes if there's two things you remember from this presentation I hope you remember this most kids are making healthy decisions and more and more they are yeah, what tools do you pull? Um greenfield Gilmonic you mohawk pioneer frontier Mahar Athol four rivers and Franklin County technical school Um, I don't have a great answer for that question But because we have public funding for the We we we're definitely open to conversations with the private schools. Yeah. Yeah E-cigarettes, we only started measuring and they just went like this Yeah, so that's a big issue and I really believe that kids have been Given the kids have been given really misinformation from the companies. I mean there are plenty of E-cigarette Packages that say zero milligrams of nicotine And kids think that they're using and then you look on the back And it says this product contains nicotine and then they've done testing and there's like seven twenty four There's nicotine in there. So That is a big issue that we are trying to get on absolutely But I realized I only have a fewer minutes left of my car, so I'm gonna keep moving percentage of local youth reporting past month use of marijuana by grade so here we are this is the 8th graders locally in 2003 19% had used in the past month and here we are in 2018 6% So it's a really nice decline. There's still room for improvement and who knows what's gonna happen with that now That we have legal marijuana. That's why we need to keep our eye on the prize. That's eight graders That's why we don't have kids, right? Why not a seventh grader? And then 10th grade also a nice decline 12th grade not as much of a decline, right? We're not seeing such great patterns, but um, I know that's the breakdown and here we have the breakdown by gender Here we have some gender equity happening at the expense at the expense of girl's health, right? So and Here's by demographic group just so we are aware of what's happening. It is definitely an issue of all Racial and ethnic groups sexual orientation of family income, but there are some that are at greater risk And that's just important for us to be aware of here's White kids and this is pulled over multiple years so that so that it's a high enough sample size to be relevant, but you can see that Students that identify as lesbian gay bisexual Not sure have higher rates of youth lower income youth have higher rates of youth youth and for the most part non white students have higher rates of youth and You know, I really believe that the companies also know how to Target most vulnerable youth in terms of lower income and so on so that's something we need to be aware of This is just important information for us to have the overlap between current alcohol cigarette and marijuana use So these are marijuana users, right? This is the ones that only use marijuana This is the ones that use marijuana alcohol cigarettes marijuana and alcohol just alcohol Anyway, so you just get an idea that there's a fair amount of overlap and a lot of times kids feel like oh there's the pot smokers and there's the drinkers, but actually that Venn diagram is kind of Been bored a lot of fair amount But important to remember that seven in ten students do not use any alcohol cigarettes or marijuana And that's this whole white part and that's the message that we need to get out to students So that they actually feel like it's safe to be in the majority. Yeah This is still local yes all these grass What No, thank you this is our survey of 8th 10th and 12th grade students in those nine public school districts I mentioned Yeah, okay, is that problematic? So in my remaining two minutes actually it's remaining 30 seconds What can we do to help prevent youth use this is important Disclaimer yes see this is my always forget the disclaimer So I've added these exclamation points the disclaimers are you can do everything We can do everything perfectly and some kids will still use and as a parent like you can do everything By the book and your kid will still use so I just want to be sure that this does not sound like blaming To anyone whose kid is experimenting or anything like that But there are things that we can do to help reduce the risk as a community as individual parents and so on So I just wanted to make that disclaimer One community what our kids What are they seeing on the streets, what do you know, what are what are the the scenes that they are? Exposed to when they walk around what does it look like adults do in the community? Including advertising and marketing. This is an app from Colorado a free dab a classic drug dealer Free dab your first time or whatever Advertising What are we seeing on the sides of our buildings? This was a medical marijuana? Clinic in Colorado with like Cookie Monster and everything that kids were walking past to get to school Right, but meanwhile, this is a Northampton dispensary, right? So we're doing something right to begin with and I'm not saying everything but But you know, we have choices that we have to make as a community here's products and packaging like this and We have other alternatives, right? Prevention in schools we are fortunate that all of our local schools have this wonderful life skills program in The middle schools that teaches kids social skills and emotional skills that have been proven to be effective and reducing youth substance use and violence and making for healthier happier young people so Make sure that your school is doing this wholeheartedly and Young people that you work with are getting the information It's a little bit about life skills that I'm just gonna skip but here's also oops, this is Another program that all the schools are now doing this typically the school nurses But in some cases guidance counselors We're having a conversation with every student in ninth and maybe tenth grade ninth grade and one other grade about Their substance use and asking them like do you ever use and they're opening up a conversation and getting a referral if the kid is using heavily So that's another great Prevention in the community strategy and then prevention in the family How long do your parents think it is for you to use marijuana kids who say very wrong? 64% don't use Kids who say wrong 16% don't use do I have this right? And then it not wrong at all In any case the point is that parental attitudes about substance use are highly highly correlated with youth youth Kids do care what their parents think whether they say it or not. We have a big So of the 64% who say it's my parents say it's very wrong only 7% of them use of The 8% who say my parents say it's not wrong at all 75% of them use so The hospital was super generous to print these beautiful marijuana top kids for everyone who came tonight and this is such a lovely tool so please check it out and Another tool that we want to make sure you know about is there's an app that you can download for free onto your phone called talk They hear you and you can Practice it's a 10 to 15 minute experience where you talk to a little computerized kid about It's very cool. I recommend giving it a try if you want to 10 to 15 minutes There was one other resource that I was talking with somebody about mentioning So right also another resource that I don't have listed up here is that the North quabban community coalition is offering a free text messaging program for any parents the text they'll text like once a week with tips and Notices and inspirational whatever quotes and stuff. So if anyone wants to get involved with that We're gonna have or get on that list. We have some evaluations at the end We're gonna ask for your feedback and you can write that in So thank you. I'm sorry And we have time for more question and answer And by the way the power place for my presentation and Sheryl's are already on the communities that here Coalition website Okay, so Thank You Kat. That was awesome. I learned a lot about you guys Really super helpful. So my part of the presentation is about How to actually have a conversation with kids about something that's pretty challenging. So my name is Cheryl. Pascucci I'm a family nurse practitioner here at Bay State Franklin. So I'm not a teacher and I'm not a therapist I'm nearly coming at this as a health care provider and Here at the hospital what you may probably haven't heard but what we're doing here is training every hospital employee with which is like 14 16,000 employees and something called compassionate connections and The whole point of it is how do you have really difficult? conversations with folks about things that are you know Tend to trigger us and we react to so we're all employees here It's a four-hour training if you're a contractor and you come in this building you're going to go through this training and I thought like that's really good fodder for this conversation because We we want to know how to make a connection. So in this conversation So we don't free each other out and we're not reacting. We're not reacting. They're not reacting And I thought if we could just sort of share some of the ways that this has been really successful for us I've been a facilitator for compassionate connections for the last couple years. I've also been trained In stress management at the events of Henry Institute of my body medicine at Mass General So I I have this this real interest in how to just have a conversation with With folks about things that are that are super difficult so we'll We'll talk a little bit about how we do this in practice and a lot of it has to do with the risk versus Benefit of all of the decisions that we're making so in medicine We it doesn't matter what it is if it's a pill if it's a procedure if it's surgery We go through this process of saying what is the risk versus the benefit of doing this this thing? Taking this pill or taking this drug or or whatnot and what we we know to be true is that these the ways that we we are teaching kids all the work that the The communities that care coalition are doing and whatnot about building resiliency that there's zero risk and Just so much benefit So all of these things that we can do to help build our kids resiliency is prevention for Ultimately having any issues with with addiction and whatnot. So we really want to talk about healthy behaviors When when kids even come to us and say like what do you think about this? I would say well We want you to be as healthy as possible and really that what Molly said about the mission here at the hospital You know in the olden days what happened in the hospital was kind of what happened in the hospital But it is a new day, right? So our our objective is really the health and well-being of the entire community this whole Franklin County area and the North Quarbon area is Is what we're interested in so this is a huge part of what our our goals are So Can you read that? Have you seen this before so Jeremy? Oh Well, no, but I am now Anything important over the last few years So one of the things that we learn in compassionate connections is this idea of be aware and prepare So just noticing like what's going on with your with this kid like how subtle changes happen They used to sing in the shower and they don't do it anymore But just being aware to the subtleties is a gift, right? It's just your your ability to sort of sit notice and assess what's what's going on and then to prepare yourself so when When something is challenging is about to happen like Something you know the conversation needs to happen So how do you get yourself in a good place where you can have a reasonable conversation without that trigger without that reactivity? so When Molly was talking about a child's brain developing from the amygdala to the prefrontal cortex, this is going to blow your doors off, but 95% of the time even as adults we are only using that back part of our brains We almost never five percent of the time does a thought that we're having an experience We're having actually make it to the prefrontal cortex in our brain where reality testing happens Where we critically think about anything some of you have heard me say this before but this is the reason why We actually need to take a moment like to get ourselves in a good place to have this conversation It can't just be reacting in the moment because it just burns bridges So when you think about All right, 95% of the time I'm I'm my fear response is triggered just this conversation about marijuana Can be really triggering for us even with us like in this room never mind with with a child So we know that this this called it we call it the stress response the stress response It's the reason for 60 to 90 percent of all visits to primary care So the reasons why we're feeling the way we're feeling a lot of this has to do with the how much stress That we are feeling around lots of issues, but but in particularly now with With with drug use and marijuana So if you think how do I How do I prepare myself for this conversation? We want this this This experience we want to be able to access all of our prefrontal cortex all of the critical thinking and and all of our Synapses working together So just about stress a little bit. These are just the the conditions this is brand new research 2018 about our our Having our sleep impacted so not getting enough sleep has a ton of of It's called allostatic load, but it what it means is the stress that happens to your body When we don't get good breastful sleep So just think that's one thing right think of all the things that could cause stress on our body so real physical conditions to Just stress and the reason why this is also important is because of genetics so when Mal when Cat was talking about the the the The risk of schizophrenia if you have a gene that some that that you're predisposed to schizophrenia So right so you have your DNA. It's lined up in a particular way. It's what we believe That's what we're how we're hard-wired, right? So these are the kinds of things that we believed if those are that's my gene pool Like that's what's that's what's going to happen to me But what we know now and maybe you've heard about this epigenetics, which means above the gene. It's actually the bath That your genes are swimming in so all of the substance that says that you take into your body The exercise that you do the good chemicals that are released when you have a good breastful sleep all of those things add to this Healthy or not bath that your genes are swimming in So when we talk about risk versus benefit Risk is involved when you put a substance in your body that could negatively affect a gene the way that it expresses itself Okay, so what you want is that gene that bath to be as healthy as possible You want the best bath? So all the so the the thing about this right is that when you're under stress your body is releasing cortisol and adrenaline and these and and Hormones that are our toxic to your cells. They're they're hurting your cells So that's not what we want. Obviously we want nice healthy cells but this when you think about having this conversation and You're stressed about it your that's a nerve cell in your brain under stress And this is what it looks like normally so normally our nerve cells are all touching one another like a tree Right, they're all connecting all of our synapses. They're talking to one another Your your messages are getting from one end of your brain all the way to your prefrontal cortex, but under stress This is an effective cortisol Your your nerve strength and they're not connecting. So you're not thinking clearly you're not using all your brain cells to have this conversation and It's you're going to notice so you can tell right when somebody's reacting If you if you jump to a conclusion or or you can tell that there's like a Stress response versus a relaxation response. It's really It's it's it's evident you can tell when your kids stressed right you can tell when there's when they're reacting You just say one thing and and they go off. That's that's a reaction and we do the same exact thing as adults Do I have a minute? What do I have five minutes? Ish All right, well, let's do this exercise if you don't mind. It'll only take a minute So if you could just Just say yourself in your chair in a way That you're your feet are flat on the floor And you're sitting, you know feel the weight of yourself in your chair But then you don't have to close your eyes if you want to go right ahead but if you could just stare at a place on the floor about three feet out that's you know, not very entertaining just something sort of boring and What I'm going to have you do is Just take some deep breaths Let yourself relax into your chair feel the weight of yourself in your chair and what I'm going to have you do is You don't mind just picture yourself on a swing Swinging back and forth as high as you can go You're it's out in the middle of a field. You can see the grass is sort of blowing in the wind It's a beautiful blue sky The clouds are floating by, you know, maybe you can hear some kids playing in the background Okay, now wipe that away I want you to picture yourself standing on a bridge a small wooden bridge and underneath you there's a stream that's flowing from behind under the bridge and Out in front of you and you can see it just the floating way and there's actually a leaf That's bobbing on top of the water and it's hitting the rocks and going farther and farther away Now wipe that away and I want you to picture a ping-pong table with Ping-pong balls and two ping-pong battles crisscrossed over each other on top of that ping-pong table So could you picture those things? Could you Move from one image to the next image to the next image So the point of this is that you have control over what you think about about you focus on like this is in your control And sometimes it feels like we get sort of flooded with thoughts and those thoughts rule our lives But really we have an opportunity to sort of focus on what you want to focus on And if I if one thing like Cat was saying if you could take something away with it with what she had to say to you I would say the one thing that would be most important about what I have to say is focus on what you want Focus on what you want is the end game Not necessarily the behavior. There's a lot of work around About making Compassionate connections what that feels like and it's always about not so much about the behavior But what is that underlying need? What is that kid really looking for? So if we can focus on what's the underlying need Both of us will win, right? We're all we're all on this together because kids also want to be happy So this is the difference between simply reacting to a stimulus And having this mindful pause Before reacting and it's just practice literally practice So it's also our choice about how How what the style is like working with it with a child right is they're looking for warmth But also working for structure looking for structure. So this way of you know Being authoritative and you know still showing them the love one thing that we do in compassionate connections is called heart head heart You probably heard it in other ways, but it's really about saying something to the child. That's very heartfelt Then you lower the boom with whatever it is And you know you want them to do or you don't want them to do and then wind it up at the end with something That's very heartfelt is like structure and warmth at the same time. So it can be really powerful And then this idea about how to how to have these bonding opportunities is You know what what opportunities exist and and then building these skills and then recognizing them for the skills that That they're excelling in it's just a really great way to to bond So in our in our books, there's actually these are pretty clearly written out because i'm coming up at the end of my time on page 10 and page 11 So getting in the right frame of mind to set the stage for this conversation So keeping an open mind think about the underlying need and not so much the behavior, you know really what is this kid looking for Being empathetic putting yourself in their shoes. So compassion is Is empathy, but it's a verb like compassion is it is actually doing something about it, right? It's not just I can put myself in your shoes. It's It's um, it's really doing an action that shows them that you how much you care how much and how much empathy you have To be clear about your goals and again with the end game in mind You know you want your your kids to do all those things that cat was talking about is you know finishing college Maybe and and and making these these life choices being able to be employed and all those that that's the end game Being calm and relaxed this mindful pause Being positive not necessarily lecturing finding um a good setting and uh good timing So in the moment when the heat of it may not be the best time to have this conversation, right? You just give yourself some time to in a in a neutral place where you can Where you can have this conversation and then just be really Careful with your body language because You know if you're standing and the kid is sitting, you know, there's this power thing um, try to keep your your posture open and but that's all In your in your book as well so you can look back at it So then to go back to the beginning the risk versus benefit of building resiliency Anything that we can do to To help build this again healthy path, right? All of these things help to keep that place that your genes are living in as healthy as possible So healthy food getting restful sleep. We could talk about that all day um physical activity had it's good for all kinds of things but relieving depression and An anxiety and we can also talk about that all day these stress management strategies about really noticing the reactivity that that we all have managing screen times and social media because your your brain believes it to be true whether it's a video game or not Your your brain is malleable that way Tending to relationships, right? We want this this unit We want this to be a healthy relationship and then to avoid any kind of substance That when you add it to this bath could hurt your genes, right? Because we don't know, right? We don't know it yet