 So, it seems like people are coming back to their seats and wrapping up conversations. I appreciate that. While we're doing that, I just wanted to take a moment to honor Toni Kane and her story. I hope Toni has gone off to the airport at this point. But the incredible power of what she shared was not lost on any of us, of course. The emphasis on finally encountering entities that could say what happened to you, Toni, and not what's the matter with you or why are you the way you are, but what happened to you. Her strength to heal. Of course, her story is unfortunately rare, I think, surviving what she has survived and then taking it to where she has taken it. But I was so struck by her power to heal and then the idea of breaking the cycle, right? So it wasn't just her as an individual, but it was her sort of saying, this stops now and I'm going to start a new chapter, was quite remarkable and amazing. So we're going to move from that grounding that we've had and move into our first panel, which is called On the Front Lines, The Provider and Educator Perspective. And the idea here, of course, is to hear about people who are out in the world trying to bring these ideas to fruition and, as I asked our first speaker, not just have it be an academic discussion, but okay, how do you take what you know and put it into practice. So let me just, what I'm going to do is introduce people and if they could come up as I'm talking about them, that would be great. So first we're going to have Dr. Doug Newton, who's right here, is the National Clinical Lead for Pediatric Behavioral Health at Kaiser Permanente's Care Management Institute and the National Physician Lead for Mental Health and Wellness with the Thriving Schools Project, which I mentioned in my opening remarks. Doug is also served as Regional Specialty Chief of Integrated Behavioral Health and Chief for Child Psychiatry for Kaiser Permanente, Colorado. So Doug, come on up. You get seat number two. It's like a little like a game show host, right? Sontoie Trotter, and Sontoie I haven't met yet, so hey, did I say your name right? Excellent. Yes. Is the Program Director of School-Based Behavioral Health Programs at the University of California, San Francisco's Benioff Children's Hospital in Oakland. And Sontoie brings over 20 years of experience providing services to adolescents and families, including practice at school health centers, residential treatment centers, inpatient psychiatric units, and youth development programs. So a tremendous amount of clinical experience you're bringing to our panel. Come on up. And you get to sit next to Doug. Jennifer Cubista, hi Jennifer. Jennifer is the Superintendent at Central School District in Independence, Oregon, where her educational mission, vision, and philosophy is focused on the learning and achievement of students, effective teaching, and learning by staff, and the opportunities to partner with families and community for the best interest of every student every day. And Jennifer, independence, it's a fairly rural district, right? Okay. So I mean I think we tend to think maybe in kind of an urban model, but we wanted to bring in the rural aspect as we've already heard these issues cut across our society in every way that you might cut across it. So Jennifer, welcome. And then finally we have Chelsea Prax. Good morning Chelsea. Chelsea directs children, health, and well-being programs at the American Federation of Teachers. She supports affiliates with research, advocacy, strategic partnership, and more to address union members' priorities, which include mental health, access to healthcare, and food security. Her recent work includes preparing cohorts of school-based trainers to adopt and scale trauma-informed practices. So welcome Chelsea. And I think Chelsea's going to help us continue this theme of this is not just about the people who are suffering traumas, which is incredibly important, but also those people who are interacting with them, whether it be teachers or police officers or what have you. So thanks for joining us and now I'm going to hand things over to Doug. Thanks Don. So I really appreciate this opportunity and actually I'm not going to even probably use my whole time that have allotted because I think there's going to be such great questions that are going to come out of this panel and I want to make sure there's plenty of time. I know that we've already heard amazing, compelling stories this morning as well as again sort of the background that I'm going to get into a little bit as far as the perspective as a clinician working with youth and their families in the clinics. Again as a psychiatrist or for those of you that don't know the difference between a psychiatrist and a psychologist or a therapist is I did go to med school and so I have the power of the pen as they say, but all too often with the power of the pen comes a sort of responsibility that I think is not always had in certain ways or the ability to have that opportunity to actually inculcate what I'm going to talk about in certain ways. So I think what comes with the ability to prescribe also comes with some of the responsibilities I'm going to talk about and sort of hopefully a perspective. So I think that's kind of the more narrowed focus I'm going to have right now. To that end I think there's maybe a couple slides and do I advance that or how does that work? Great. Thank you. Doug if you want to stand at the podium. Is that better? Yeah. I think that's probably better. That was part of my job. I just failed to do it until now. Well this works. Now I can see it better actually. There we go. This is actually the slide. There's a lot there and I had an old attendant that said, you know, death by power point. So there's a lot going on with this, but I want this as sort of a reference point for folks if they want to take a look at it later. And this is also a bit of an ode to Dr. Nadine Burke Harris. She actually has a very similar slide that she uses and she's part of the Center for Youth Wellness. I know she couldn't be here today, but thought why not, why don't we throw some of this up there. So what this is, is actually taking a look at, you know, again, there's ACEs, there's toxic stress, but there's kind of levels to it. It's not only sort of as far as frequency, but also intensity that we look at, especially in the clinical sense of what folks are dealing with. Not all stress, not all trauma is bad actually. And so what I also want to look at is sort of not just a deficit model, but a strength based approach. And all too often, again, that is something that we don't look at maybe the way we should. So what I mean by that is, again, there's sort of this positive stress, tolerable stress, and then toxic stress. Kind of a couple of things around positive stress are things like, you know, studying for an exam and, you know, worrying about that and trying to prepare, getting up in front of people and having a conversation like I'm having. You know, these are sort of stressful things, but you want to, you know, you learn from them. There's sort of the tolerable stress, again, the next level up. Unfortunately, something like apparent dies, right? And as long as there's a supportive person behind that, oftentimes they can come out really well and then, again, back to that sense of resilience. And then there's the toxic stress, right? Overwhelming stress, again, you know, this is what we've been talking about quite a bit this morning already. And then as you see this, it's sort of this early and persistent and really overwhelming stress across this sort of continuum, as you can see with the one orange arrow. But what I think is really important and what we as clinicians are always looking at is where are our opportunities for us, right? So how can we accentuate the positives? How do we build these strength-based approaches? And some of it, when you see with some of those green arrows, depends upon the age as well, right? Because there's sort of developmental spectrum that we're talking about here. And again, without getting in a lot of detail, we've already had this discussion, especially in earlier ages, of attachment, bonding, and trust. And that includes that sort of what we call two-generation or intergenerational approach. How can you mitigate that? Again, so powerful earlier this morning, you know, I think you all understand that. And then as they get a little bit older, there's this concept of mastery, right? Of confidence and competence. What's really interesting, and especially in sort of this tolerable stress, even though it's still pretty significant stress, there's actually studies that have shown that, you know, six to 12 of these sort of events actually allow somebody as long as there's the supports and there's sort of that mastery that takes place over time for them to actually do better in their life in the long run, right? So we don't want to expose, sometimes called inoculation unnecessarily, but at times, through the proper therapy and through the modalities, not just in the clinic, but again, the community, the schools, again, helping the family. These are ways that folks can actually learn from that and move forward. So that's just a bit of it. It's called the Goldilocks principle. Again, we want to sort of have a little bit of stress in one's life, but not a lot. And that's actually where, and I'm going to go to the next slide here, kind of the principles behind some of the therapies that we employ, which is including cognitive behavioral therapies, family-based therapies, or in the case of trauma, trauma-focused therapies, is again, is trying to accentuate the positives, learning from that, and being able to move forward and finding out who are some of those supports that are there. Identification and access to care is also a big part of this, right? If you don't ask, you're not going to know. And I have to say, I'm going to be the first one to raise my hand as much as I am out there talking about this. I have missed it, right? I have missed it when a kid has had trauma or there's an abuser neglect in the home. It's a horrible feeling. And once you do understand that, it puts everything into such perspective as far as when you're dealing with a diagnostic kind of spectrum. How do we move forward? So again, with identification comes access to care, right? So that's another big part of it. Huge piece of this, again, is the coordination with the systems, right? Not only the family systems, which can include the nuclear family, but larger than that, but also then the schools and the community and the school community concept that goes along with some of this. And then support positive outlets and relationships, right? So this gets back to some of the resiliency. We know that as long as there's a couple or at least one support of adult in one's life that this child has, the outcomes are so much better. And so when we're in clinic, we oftentimes are looking for who else is out there. If it's not a parent, then whom? If it is a parent, then who else at the school can help benefit? Doesn't always have to be a counselor. It can be a teacher and others. Again, everyone's very busy. Coordination is very difficult as everyone in this room probably can understand with the schools, but it's so necessary. And so when we can, we really try very hard to do that. What I want to talk a little bit about is, too, is just, again, some examples, not only of what Kaiser's doing, but some of the partnerships that they have. And again, we in Kaiser, Colorado, and a couple of the regions are really focused on, again, screening. And especially in the sort of peripartum, perinatal kind of area, again, that two-generation approach. How do we really focus our efforts to screen and then also try to lead folks down to further assessment and needed care at times? That includes also, again, their social needs. One of which, again, I'm calling nurse-family partnerships out only in the sense that it's across many states. It doesn't mean that it's the only partnership that we have in Kaiser, but it actually is a really good one. And it gets down to actually having folks coming into the home doing basic things, including attachment and bonding and other things that they're able to do with that mother, with that child. And again, these are at-risk mothers. The other component, and working with the National Council for Behavioral Health, there's a focus on mental health first aid, as well as looking at what's called trauma-informed care, which they're calling the change package. And within that, we actually have some opportunities and already things that are under flight around actually training some of our staff and soon to be some of our physicians to actually employ this. Again, back to that model, I thought that was really great by Dr. Dorado of looking at an organization that's having stress or duress or trauma itself in this vicarious sense of trauma. It's not just their teachers, but it's our clinicians as well, and they feel it. And so how do we train them to do that, to recognize it in themselves as well? And then there's, back to some of the social needs work, there's this area of what's called clinic to community integration and looking at more specifically right now, food insecurity, but other resources that it might be available to actually help move this along, right? This is, as physicians, we always are trained to do a biopsychosocial approach. Oftentimes, we get pretty stuck in the biological, medicines and other things. But how do we start moving along the psychosocial components? And again, the CCI work is another example of that. And then lastly, and I'm not going to get into this too much, but just a call out for the resiliency and school environments, and again, the various programs, including social, emotional, wellness, trauma, and form care that is happening across many of the schools. And again, we'll get into that later. So anyway, just a background, so thank you. Great, thank you, Doug. And Santoy, if we can have you come up. Hi, first, I just want to say I'm very honored to be a part of this conversation of how do we address trauma in schools and create schools to be healing places that foster healing and resiliency. And I want to just give you a sense of where we're coming from, so I'm from Oakland, California. Oakland is a port city. It's actually one of the most diverse cities in the nation. There are over 55 native languages spoken in the homes of Oakland Unified School District students and in their family homes. Oakland also has a history, long history of social activism in community organizing. It's the home of the Black Panthers. And what you see here is that Oakland really has a history and a legacy of how do we address some of that historical trauma that we were talking about earlier, the structural oppression and racism that is also a trauma and a threat to many of our students and communities where our schools are. Oakland also has over 2,000 acres of redwood trees. It's one of the most beautiful places I know. And it's a place where I often go for my own resiliency and restorative restoration. It's also a place where we start to bring students now to the Oakland redwoods and also to nature within their own schools, school gardens, and farms to support their own healing and to access that resource. And what you see the last corner picture there is actually a picture of homicides in Oakland. It's actually 2011. And the homicide rates by zip code. And that deep, dark, dark red on each side, one at the top there is West Oakland, where our Chappelle Hay School Health Center is. And the other one at the bottom is in deep East Oakland, where our Youth Uprising Castlemont Health Clinic is. So that's where we're located. Lots of resiliency, lots of trauma in where we're doing our work. And I want to talk a little bit. I'm also on the board for the National School Health Alliance and talk about school health and the purpose of school health centers and schools. And one purpose is not only to increase access where there are greater health disparities to quality and comprehensive health care by being located on school campuses or next door to school campuses, often in communities where you see are negatively impacted by social determinants of health, but also it's not only location that supports that access, but it's also a deep collaborative partnership and integration with the school system. And one example of that is the coordination of services team meetings cost, if you've heard of that, where we have school administrators, a staff member from the School Health Center, providers, mental health providers, school social worker, teachers, and other community partners that all sit together once a week in a meeting and look at every referral for a student who shows up with needs. And so that might be a behavioral need. It might be a mental health need. It might be an academic need and really match the needs of that student with the resources that are on that school campus and track that student's process. So I think about stories that we've heard today. What would happen if that student could come up in a cost referral and that a whole team approach really looks at what's happening with that student and what resources do they need? The other piece is that school health centers are not just there for individual providers for students, but also for the health and wellness of the whole school community. And so I'll talk a little bit more about that. Here we have a picture. You see Dr. Barbara Staggers and our West Oakland School Health Center opened in 2005. And probably in 2004, 2003, Alex Briscoe, who at that point was a volunteer social worker at McClimey's High School, who had just kind of rode his bike by one day and saw that school needed some support and asked the principal if he could volunteer. And they said yes and gave him a closet to do school-based behavioral health. He was working there and had a sexual assault on a Friday at four o'clock and started calling around providers, calling doctors, who can I talk to, and spoke to Dr. Barbara Staggers, who actually started the Adolescent Medicine Department at Children's Hospital Oakland. She had the wisdom at that time to say, adolescents aren't just tall children, and in children's hospital system, we need to address their needs. And through providing care for that young person, there became a deep, long-lasting partnership between Children's Hospital Oakland and the West Oakland community and McClimey's High School, and including not only the partnership, but also community students really calling and asking, saying that they had a need, and then working with the San Francisco Foundation, Oakland Unified School District, and Alameda County to start the McClimey and Chappelle Hay School Health Center, and then a year later, the Youth Uprising Castlement Health Center started as well. And the picture there is Dr. Sue Park, who really was a pioneer in school-based behavioral health and did so much to decrease stigmatization of accessing mental health services. Through being at registration and talking to young people, I was like, hey, I think you need a therapist. I'm just really through her personality, but also by showing up when there was a crisis, creating candlelight vigils, showing up and supporting administrators, really worked to de-stigmatize mental health services on that campus. And I also want to give a shout out to the Alameda County Center for Behavioral Health and actually Center for Healthy Schools and Community. So one of the things, there was a question earlier about how do counties support school health and school-based behavioral health? And the center actually brings together all the school health centers in the county and also all school-based behavioral health providers to share best practices, to share our victories, to think together through problems. And so that's been a great asset to our school health centers. And so this is just an image, if you can see, maybe not. But I'll talk you through it really quickly, is all the services that are provided through our school health center. And this is particularly for our newcomers, was created for our newcomer services. But actually, every student who walks into our health clinics or into a school with need has access to our services. So we provide psychiatry services at least twice a month. We provide integrative behavioral health care, also referrals to legal assistance, group therapy that is culturally responsive and evidence based by providers who often match the communities that we're serving. Also, consultation, mental health consultation for administrators in schools and training, and also crisis management. So how that looks in our schools is, this year, one of the things we offered, Castlemont High School, is let's imagine if this really was a healing school, what would that look like if we were able to apply those trauma-informed principles? And what we know is that we need to integrate the leadership of the schools. And principals are often so busy, and there's not time. But we've been in this conversation for at least 12 years. And we had the principals at Castlemont High School commit to his administrative leadership team to meet once a month for a healing schools trauma-informed consultation. The purpose of that consultation was to provide a reflective space, provide a place for their relationships to come together. And they said, oh, we have good relationships with one another, but not only good relationships, but to deepen the authenticity of those relationships so that they could turn to each other in terms of crisis, that co-regulation that Joyce Dorado was talking about earlier, and then to think through the trauma-informed systems principles, and how are they applying those in their policies and in their practices and with their school teams? And so I met with the principal team once a month and then individually with the principal once a month and saw how that actually resulted in action when there was a crisis. There was a shooting that happened related to our school. And so how they were able to apply that both in their understanding of the staff and their reaction, the need for safety, the need for transparency and collaboration with their team this year. In addition, we also provide trainings on trauma-informed stress and trauma how it impacts the learning collaboration at Oakland Unified School District in Joyce Dorado. We provide consultation for teachers. One of our providers provided wellness for teachers, including sound meditation, mindfulness. I used to lead a yoga and meditation group at 7.30 AM at schools. We know that students often come to our schools and seek them as a sanctuary. So they're there way before the first spell and way after the last spell. And so I would walk around the school at about 7.30 and gather students and staff and everyone was there and offer yoga and meditation class for anybody who was willing to come. And then we also provide that same training for parents. And I noticed that often when we provide that training for parents and caregivers, they're realizing for themselves their own impact and not only for their students and their children but also themselves and the impact of trauma. And Joyce already talked about the principle so I'm gonna skip past that. But really our work is rooted in how do we foster resiliency, hope, how do we support young people to get across that stage and into their next stage of life because we know that if they graduate, their life outcome and expectancy is longer, their health practices are longer and we actually have, as Joyce said, a better world, a better place that we're living into. And we have many stories that maybe I'll share later because I don't want to take up too much time. Just of supporting young people and supporting them to graduate from high school. And I just wanted to end by sharing this is our team so therapists also have fun and this was a year in reflection that we did with our clinical team this year. Thank you. Thank you, Santoya. I love that image of you sort of walking around the school gathering people up at 7.30 in the morning and not just teachers and staff but everyone and that idea of school as community, as social home. So I hope we do get to talk more about that. Right, Jennifer. So running a rural school district, how are you thinking about these issues? Good morning. And I'm going to actually talk a little bit. I actually came, this is my first year, I just finished my first year as the superintendent in rural and I'm actually coming from urban serving, second largest school district in Washington and Tacoma school district. So I'm going to talk a little bit about both of those and some of the work that we've done. I'm going to start a little bit. I am a non-traditional educator. I was not a teacher, was not a principal. I actually came out of the business world and also have been in education for 16 years. I had to learn what good teaching and learning look like. I spent a lot of times in classrooms working with teachers, asking a lot of questions so I'm excited to hear our next speaker as she talks about this as well because as a superintendent, my job is to listen, to get barriers out of the way for the teachers and staff who are on the ground doing the work. That's what's important and how you go about that is really listening to your staff and really making sure that you're taking care of them in those ways. I think leadership becomes a big part of this as we have this conversation about trauma informed. Like I said, I am just finishing my first year in Oregon, my school district is 3,200 students but very diverse and having urban types of issues that we have going on that rural school districts are not used to having an understanding and equity becomes a big part of that conversation. So I wanna talk a little bit about Oregon to start. So in 2016, House Bill 402 was directed to have the Department of Education and the Chief Academic Office to really jointly focus on absenteeism which we've heard a little bit about today and really working with this plan was in development with the Oregon Health Authority and the Department of Human Services as well as our early learning. And we really focused in that House Bill really for them to pilot in two school district trauma informed practices. So they picked a urban school district as well as a rural school district which was my current school district in central. And the approaches were focused on education, health services and intervention strategies. So you've heard that, how do you do multi-tiered systems of support in education as well as having that trauma informed lens. In 2017, there was a Senate Bill passed 183 which again directed focused on graduation equity but really what it did is gave additional two years of funding to focus on trauma informed practices. So we're really excited to be moving forward with that. The pilot started at the high school. The high school, right? You usually think let's start early. I've had lots of conversations in my first year being there working with them to really say how does that work? So we really have been doing this two years in the high school, we're going into year three and are just starting the awareness with our K-8 schools and really working forward to that. There are nine domains that we are focusing on when we talk about the trauma informed. They are sustainability and committed leadership, professional development which is a huge part of this. Policy procedures and practices and how they align. Behavior response supports equity obviously and diversity organizational culture and climate cross sector collaboration which you're gonna hear that theme throughout today. Student caregiver education engagement, the parent, the families involved with that and then obviously academic instruction and assessment are keys to that piece of it. I think what's also important is the development of the whole child and so I have been dedicated into coma previously for the last eight years focused on how do we really develop whole children? So again, you can see here it takes a village to raise a child but I think it's important but it takes the development of the whole child to build sustainable, adaptable schools and communities. So what does that look like? Whole children need to know how to read, write, do math, have art, be physically fit but they also need to know how to self-regulate and I loved it co-regulate because I think that's a huge part of what we're doing in the school system. They need to know how to build healthy relationships. They need to know how to critically think because they can get most information in their hand on their devices now and so how do we do that? They need to be socially aware. They need to be good decision makers. So all of this is encompassed now in developing the whole child. How do we do that within the educational systems because those really develop a whole well-rounded person that is learning and growing constantly and that's what's important. Students need to have environments that they're healthy, they're safe, they're engaged and they're supported and challenged. That is a huge part of what we need to do in education. Student voice becomes very, very important in this as well as teacher voice and staff voice. I learned more from seven year olds by just being in the classrooms. I think as a superintendent, that is part of our responsibility is being and seeing with what we're doing and how do we work towards moving in those environments. And so really as you build these plans, we're starting to use data a little bit more in education that has been not something that we have been good at. That's both quantitative and qualitative because I think as we've heard, sometimes we have to hear why is this happening? We have the understanding that students are absent but we also know that why are they absent? What are the things that we need to look at a little bit differently in those pieces? And then one of the things I just wanna talk about just the difference in approaches. So again, central 3,200 kids, Tacoma, 29,000. But when you look at the demographics, in central I have about 50% students of color of that 42% of that are Latino, Latino. In Tacoma, their population of students of color is about 60%. My economic disadvantage in my rural community is 66% Tacomas 58. So again, the rural areas are starting to see a little bit more of things that they probably haven't had to work through in the past before. One of the things that is important to me and my staff sort of look at me with like I have eight heads is I think relationships is one of the most important points. So I tell them spend time to gain time. Both in central and Tacoma we use and you've heard it, we have approaches tied to PBIS. We talk about how do you embed social emotional learning in the classroom? Yes, can you do math and social emotional learning and positive behaviors in one lesson? Yes, you can. It actually works really well and kids learn and grow. It's pretty amazing to see. And so you're seeing those approaches that we've used both in central and in Tacoma. The difference with central is we, in conjunction with the pilot program, we have a school-based health center right across the street from the high school. Our students can actually go and leave class, go into the health center if they need mental health supports, if they just need to just get checked because they're having the flu or whatever right across the street in our community that is where we have those pieces. We're excited also because this year we actually received a grant from Kaiser in the Oregon area to focus on tiered intervention specifically in the tier two area, the students that have tier two needs because that becomes an important part of how do you work together within your communities to build and sustain those pieces? And so I think that's a huge part of what you're seeing. One of the ahas that we've had within as we've gone into this is how much public education and public health need to do together. What does that look like? How do we build those partnerships together? How do you take all the frameworks, multi-tiered system framework, your instructional framework, the PBIS framework, the cell framework, the public health frameworks and tell your staff with them working in conjunction because teaming is huge. Here's how they all work together and then it's not each separate that we start to show the alignment. So teachers go, oh, that makes sense. It's still hard. What teachers do is extremely hard. I tell CEOs all the time, come sit in the classroom, you won't survive. They're like, yes we will. And I'm like, no you won't. But again, I think it's important that people understand the work that our teachers are doing to really support because again as you implement the frameworks together that becomes a huge part of that and we'll talk a little bit more and answer any of those questions. So I'm excited to hear it listened to you as well. Thank you Jennifer and thank you for the work that you're bringing to your school district. And now we're gonna hear from, oh, sorry, from Chelsea. And Chelsea, we look forward to hearing your perspective from the American Federation of Teachers. Thank you. All right. So I have the benefit of having listened all morning and I'm actually gonna ignore some of my slides because I think I have some things to say that maybe fit a little bit better and hopefully are less redundant. So I'm gonna start with this mandatory slide. This is the AFT's mission, feel free to not read it. We'll go on. All right. By the numbers. So the American Federation of Teachers, a lot of folks don't actually know, covers tons of people in the health and education sectors and I wanna correct some correct or gently nudge people especially in this room away from only thinking of teachers. Lots of other people work in schools. The AFT covers all kinds of them. Whoops, I moved I think a little too forward there. Okay. So especially within the AFT and within schools, we need to be thinking about our paraprofessionals, about the folks who are driving buses, about the folks in the front office, about coaches, about after-school coordinators. There is an entire community and I think if we do a rough crunch of the numbers, one in five Americans spends most of their day in a school setting. One in five Americans. We are not just talking about teachers. That includes a lot of young people obviously. So I planned to share a few of these things. Like I said, I'm gonna skip through them. I did come to this podium in a somewhat more traditional way perhaps than our last presenter. I am a former teacher. I got a master's in public health and I really try to straddle the line between public education and public health and I try to be a good listener in both spaces so that I can share the voices of whoever isn't currently in the room. So I'm gonna try to do that. Here are some of the voices of AFT members. When I first got this job, which is now I'm headed into my fifth year with the AFT in this position, the first thing I did in creating this new portfolio was to ask AFT members what they wanted me to focus on. Within 15 different issue areas, they said mental health is number one. I forced them to do a ranking. I think if I had let them write in, they would have said it's actually number two and number three. It's all we want you to focus on. And increasingly when I am out in the field, whether it's listening to folks, it's offering workshops, it's fielding questions, it's taking technical assistance requests, it's doing research. It's very clear to me that people want to understand more. They really want to know what research means for their day to day. How do I translate this into specific skills? And who are the people who know better than me, who should be working in schools and are currently not working in schools who could actually do this work better? As I think some folks have said, teachers do want to build their skills. Paraprofessionals really, really want to build their skills. They don't have nearly as much training, but they know they can't do it all and they're not going to pretend to do it all. So they would really love more mental health professionals. The only thing I'm gonna highlight here is this top point. Most of the children who receive mental health services in the United States get them at school. And so a lot of what I try to do in listening to folks who work at school is what about that is working well? And we do have some research that schools are doing really significant work. Towards the bottom here, there was a recent study that came out of, I believe, the University of Florida that said schools do pretty well, right? They build kids' skills. They do help children connect to supports, but school personnel themselves are not at all satisfied with how much schools are being asked to do. And what they're asking for is, again, better skills. They really want new staff and they want students to be able to access additional supports beyond the community. So school-based health centers, for example, when they're right there are a fantastic support in a lot of places those aren't available. I get all kinds of questions from educators across the country. The key theme among their questions is who should be doing what and when? What am I really responsible for? If I'm a paraprofessional, how much is really within my job description? And when is it the right time to turn someone to the counselor? And the counselor says, well, I had five kids in my office all day because they were all dysregulated. And I spent all of my professional energy with those five. And then someone wanted to send me three more. When was, you know, when will someone be helping me out? And the school psychologist who works for the entire district says, look, I got seven kids, one from each building. That's already a full case load. It's not realistic for me to take on more. So a lot of them are really trying to figure out how to make these tiered systems work. And I wanna share what I have along the side here as more of a cylindrical approach. Really consistently, public educators tell me the public health pyramid feels like a lie to them. The idea that there are more kids that need services that are universal and a lot less kids that need acute services does not resonate with them. They say the buckets are equally sized. We get that we should be doing universal supports for everybody, but the top doesn't actually feel much smaller to me than the bottom. That's in their voice. So just a different way of thinking about the same sets of services. Okay, so what do we do about all of that? The American Federation of Teachers, I do research, I do technical assistance, I do workforce development, I do sort of whatever is required. This is actually the work of some of my colleagues. It's the Educator Quality of Work Life Survey. There's an organization that really is grassroots from across the country called the Badass Teachers Association, or the BATS. If you haven't heard of them, look them up. They're very active on social media. They really got hip to an unfortunate trend in 2014 of teacher suicide. And they reached out to their unions, both the NEA, National Education Association, and the AFT, and said, what are you doing about this? We want to understand this. And it spurred the development of the first wave of surveys. It was 80 questions long, and within, I think, five or seven or so days, 30,000 people had answered it, which told us our workers have a lot to say about workplace conditions. They are not delighted about their workplace wellness. And consistently, they're really reporting both their mental and physical health as not particularly good, even benchmarked against other worker populations across the country. So that first wave of survey then inspired a second wave of survey, and we continue to really try to follow up. It's not just focused on suicide as an outcome, but it's really trying to think about how folks are doing. So out of this work, some of what I do is to help schools and especially school personnel think about staff wellness in a different way than just self-care. In particular, I am concerned that self-care often sounds like a blaming thing, that Chelsea is stressed out, and so Chelsea must not be taking good care of herself. Chelsea isn't managing her 80-hour week very well. Chelsea isn't deep-breathing enough. Chelsea isn't meditating enough. Well, Chelsea didn't create the school. Chelsea didn't create racism. Chelsea didn't create sexism, and the list goes on. And so in taking care of our staff, we need to make sure that we're not just doing self-care but really promoting staff care. The other big things that we are doing are supporting skill development. So I could talk at length about a workshop that I just came out of. It was 30 hours of training of trainers. You'll ask me questions if you want to know more. And again, really trying to make sure that things like Medicaid and schools support robust staffing of health professionals who can do the work better than folks who are just trained from a pedagogical perspective. Lastly, I will highlight two different unions or bodies of groups that we think are doing a really great job. The St. Paul Federation of Teachers has done an immense amount of work. I've tried to make it really short here, convincing their school district to make systemic investments in schools that really need additional staff, additional training, additional partnerships. And consistently, the district is investing as well as the union. And the last one I'll highlight, this one has a website attached to it. Partnership number four, resilience, is about seven school districts and their unions. So superintendents and union presidents working together to make sure that school districts in the south suburbs of Chicago are not just understanding how to be trauma-informed but building skills to do that work as well. Thank you. Thank you, Chelsea. Thank you to all of our speakers. So you were all really good and kept to that sort of eight to 10 minutes, which means that we have 15 minutes for conversation and discussion. And what I would love is, for most of it to come from the audience, so I hope people will stand up and use the microphones and ask questions. I would also ask our panelists to think about asking each other questions so that we're having a conversation. What I noticed, and apologies to Doug, who's a physician and works in a sort of traditional medical setting, is that this is really about schools. I know you're involved with thriving schools, so I'm gonna focus us on the school setting. The striking, Chelsea, you saying one in five people spend their day in a school. One in five of all of us was quite striking to me. So, and reinforces this idea that schools are these central places in our communities where all the kids gather, the teachers, the other staff, a place where we can really have impact and influence. So let me ask you, I was inspired by a lot of what I heard. It was like, ah, we're doing all these great things in our communities and as much as we worry about where we're sitting right now, in fact, in Washington, D.C., there's amazing things going on. But I'm gonna challenge and ask where are the barriers still, even if you're in a very successful program, and can you think of policy approaches to those barriers or policies you wanna tear down or build up that kind of thing? And I will kick it to, Chelsea, would you be willing to kick off? So I think the primary barrier that I heard, and I previewed it a little bit, is really this clarification of roles and responsibilities that a lot of people want to understand. For example, what are the best practices of being a trauma-informed, one-to-one special education paraprofessional? And I will get all the training I need to be that person, and an appreciation that being a trauma-informed, one-to-one special education paraprofessional does not make me a psychologist. And so what are the roles and responsibilities that fit in one job title, for example, and when is it time to pass things to another person? So I think there are probably some exemplars across the country where folks have figured that out in small communities and with an appreciation that in a school district of 3,200, the staff available, for example, to answer those questions is really different than in a school district of 29,000. But what do those warm hand-offs look like and who should be doing what really needs to be better answered? I think both with educators and with health professionals and public health advocates. Thanks. Santoy, you talked about a lot of great stuff going on in Oakland. Sure, that one policy change that happened in California during my time in working in schools has been health insurance for all, regardless of documentation status. And that has been huge in terms of addressing and supporting young people to access health care and families. And in addition to, I want to say, our psychiatry service in schools, we work with many young people who, of course, their families traditionally have not access mental health services, and especially psychiatry services, and then to be able to be that bridge for young people who aren't able to sleep because of trauma symptoms, who are having flashbacks, who are having early schizophrenic and psychosis symptoms to be able to have a psychiatrist pair with young people who their families would not know until later on, until it was a crisis, until it was an emergency, to link to psychiatry services has been so important in our work. And I think a barrier is just time. Schools, as people talk about, teachers are overwhelmed and over busy, administrators are overwhelmed and over busy. Like the whole system is not only their histories, but also just in this reactive place. And so how to, that's why what felt so important was to have the administrator actually carve out that time this year, and to have them, they showed up at 10 o'clock, every first Friday or whenever that was, and dedicated that time, and then found the value in actually having reflective time and sitting with the trauma-informed principals in their work. And so someone earlier said, you know, it's like you pay the time forward at the beginning and the relationships in the work, and then the school system will kind of value and dedicate that time. Can I add to that piece? I think we have to focus on prevention. Schools have been so reactive that that is a big shift to think about from a policy standpoint. When you think about we need to put preventions in that approach as you really focus on the development of the whole child. Because again, I think that's important. I think the stigma we are trying to get out in front of to work with families to say, you know, again, we are, everyone is working through some very difficult things within their family, within their communities. And so how do we have that open and honest conversation collectively to be able to do that? That's where I think some of the shifts need to change, especially from a policy standpoint in prevention and how you do that. Again, schools cannot do it alone. As Chelsea has said, how do you help teachers and staff? Because again, I think that is a valid point that our classified staff and our other unions that are the bus drivers who are, I say, probably the most important people because they're the first and the last to actually have contact with our students so they can either change a mindset or help a mindset if they're going into chaos in that evening. And so how do you really get your environments that there's this alignment in the policies and practices from your custodian all the way to your teacher? And when you get that buy-in, you just see the shifts start to happen because we're on the same team and we're all trying to support in the right way to help kids thrive and move forward. And our staff in the wellness perspective. And Doug, from the medical perspective, either as a physician or representing a healthcare organization, what can we be doing to help out these schools? Yeah, I mean, the first thing that my head goes to is this bidirectionality of all this, right? I mean, we are constantly dealing with access issues, right? I mean, this is always a hard thing. This is not a Kaiser thing. This is behavioral health. This is mental health. How do we go upstream to affect this and not just affect it in a clinical sense but affect this in a way of society and other things that have been mentioned? I do agree that trauma or seeing the stress, the type of building out beyond even aces of what's occurring is something that, we're still not gonna supply in demand, right? So how do we help teachers? And we have a, you said one in five. We know that within Kaiser, over 20% of our membership is in the schools and that excludes the teachers. How do we help the teachers? How do we do this? This is definitely a group effort. And so how do we look at when we're talking about what does integration look like, right? It's primary care to behavioral health. It's the broader sense of the community health perspective that I think is really a part of it. And again, that's not just Kaiser. It's everyone. And so again, there's that top of the pyramid or maybe an inverted pyramid depending on how you wanna look at it. But I think that's a critical piece but then it's that sort of circular aspect of it as well. So how can we be a part of that? I see Peggy moving to the microphone from our Thriving Schools program. Peggy. Hi, thank you everybody. It was really great to hear from all of you. And really great to hear the theme throughout this day so far about the importance of taking care of the school personnel so that they can take care of the kids. And I just wanna kind of restress something that Chelsea said. Cause I'm also someone that is always straddling the education world and the health world. And the education world is really hung up on this self-care language. And it rubs your public health side really wrong. So I really appreciate you lifting that up and it's sort of a challenge for all of us to think about what does more than self-care really look like and we've been doing a lot of thinking around that. How do you really create true support, collective care policies and practices that help the teachers and the classified staff feel empowered to do their job better? So just thank you for lifting that point up. Anandra, if somebody wants to respond, yeah, please. I just wanna, some of the trauma-informed system work that trauma transform, which is rooted at eBAC does, is really looking at that it's not, if you integrate it into the culture, that it's not as hard to have collective care as we think, right? So having things like a check-in, having things like a mindful moment, having food at your meetings, having things that actually take care of the biology when we talk about trauma and stress, we're all very wordy right now and thinking with our minds, but we're talking about our bodies, right? We're talking about our stress response system. And so are we doing things to take an inhale, exhale, breathe, and doing that collectively during a meeting at the beginning of the end? Are we celebrating, doing things to build relationship and that strength and that foundation of the relationships among the school and creating time? And so I just wanna name that, that there are things that we can do in our system and our culture that don't actually cost more money. And we do need resources, but that we can start to integrate that don't put the responsibility just on the individual but on the whole community. And Chelsea? I'll just add briefly. So there are four categories that I use in introducing this to union leadership as well as union membership within the concept of being well at work. So staff care is one of those and we really talk about that from a policy perspective that if everyone in the building feels overworked, for example, then that's a leadership issue and a building wide institutional change that needs to happen. That self care, we can put all kinds of things that one by one we can do into our practice. I also talk about the four different types of social support that come directly out of public health theory. And I talk about what we call comfort coping or avoidance coping. So naming things like folks using a lot of alcohol to numb and distract themselves from their frustrations at work. Those are sometimes difficult conversations to have but we usually have them really one on one and allow people to flesh out and make sure that their toolkit is full of all four types of approaches to workplace wellness, not just one. Great, thanks. And I see we have, I think two more questions. So I'd like to try and get to both of them. So please. Hello, my name is Denise Piper. I work for the National Basketball Association on both our marketing and consulting partnership with Kaiser Permanente. I have a question I think it's for Chelsea in regards to some of the research that you're doing because you had mentioned that, you know, not everybody that's working in schools is a teacher by trade. And is there anything interesting coming out of this research that has, that is coming from a fitness or like activity perspective or anything from maybe the physical education teachers that stands out to you? That's a good question. So again, it's not the research that I highlighted the educator quality of work life survey is not mine and I have not done the analysis myself. So I get the top lines same as everybody else but I just know the staff people who could dig deeper. So we can have a conversation if you wanna see if there's something around FIZED in particular. I think the big theme that we've seen is actually more that our classified staff. So our paraprofessionals and especially our bus drivers experience a lot more physical attacks at work. So when students are dysregulated, our frontline workers are facing the physical effects of that and as a union really figuring out how to navigate workman's comp for example when the student is the aggressor from a trauma informed space is tricky but we're working on it. Can I add to that? Yeah. Yes, there is research. When you talk about the brain, the brain likes movement, the more you move especially can help. And again, I'm not the neuroscience but your neurons functioning and helps to the recovery. We are working very hard at least in my previous school district and my current school district of Howard Kids Up and Moving to be able to keep that because again, the more active you are, the more your brain is engaged in the learning. And so how do you tie the health together? The mindfulness, I have several schools that to start the day we are either doing physical activity or mindful activity to set kids in a way that they're in a learning mode so that they can be able to continue to do that throughout the day. So physical fitness, emotional fitness is a huge part of where I believe education needs to continue to shift. Really focusing on that whole child. How are we healthy? How do the students feel safe? How then are they engaged in their learning and supported and challenged in those ways? Thank you. All right, we picked up a few more questions. We'll see what we can do. I think the next one was at that same microphone. And if you're able to direct your question that would probably keep it more comfortable. I don't know if I can but I'll try. All right, go for it. I mean, somebody can raise their hand. I'm Sandra Wilkness. I'm with the National Governors Association Center for Best Practices. So it's tagging on your question about policy and how to talk to policymakers about how to support some of these innovations. And I really appreciated your insights about how it's not a pyramid but the buckets are equally sized. And my question is really about, I work a lot with state policymakers and try to help them think about opportunities to think about not only serving individuals who have serious needs and trauma backgrounds but also to think about resiliency at the same time which is often lost in the conversation. So as you think about the buckets being equally sized, how should policymakers thinking about resiliency help support what's needed in the schools to address all of those buckets? Anyone? Anyone feeling brave? You can tell me later when maybe you can digest it. My short answer would be that there's a workforce shortage and every level of bucket needs a different type of worker but dealing with workforce policy could really hit every single level within a school and within the broader community. I also think there needs to be flexibility for blending and braiding funding. So when you tie workforce as well as giving us the flexibility so I can turn to one of my partners in the community and use money that I know that we can have that ability so then I can pull the workforce in that has the knowledge of which we don't and how do we use that? We're still having the accountability tied to that. Thank you. Hi, my name is Christy Brooks. I'm a senior workforce health consultant for Kaiser Permanente and my question is for Sontoy. I was very interested in your cost program and I was wondering how do you go about doing any kind of follow up and post assessment and when do you know you're successful? Thank you for that question. In terms of follow up, so many for us we receive with a cost program so you can also find the information for the cost program in a toolkit with the Alameda County Center for Healthy Schools and Communities so I want to let you know that and for our students, so then we receive referrals for tier three mental health services so whereas treating young people who have diagnosable mental health illnesses in our health center with our behavioral health team and we know there's six and we work collaboratively with that student and with their families when appropriate to develop a treatment plan to support their full functioning and well-being and so we're successful in our program when young people are able to meet their treatment goals but also in the cost program team that happens at the school, I would say that we're successful when we are supporting students to be engaged in school with both their attendance and then also being able to access resources to engage in those resources and to complete, meet their academic and educational goals as well as their relationship and social and interpersonal goals and that we're making sure that we are tracking and for students who don't, all of our services are voluntary which is very important when working with adolescents and working in a high school and so that there is choice whether you see young people may decline but then the next year that they may come back and ask for services or be open to but that we're keeping track and keeping that relationship so it may be that they aren't in treatment or one of our formal services but there is someone maybe the restorative justice practitioner at the school who's keeping a relationship with that student and following up with the cost team on how that student's doing and what their availability is for services. Thank you. So I'm going to, moderators prerogative, I think we have one more question and I'd like to try and field that and then we'll wrap up. You may be sorry that you allowed me to do that. Oh okay, we're out of time now. Right, my name is Tina Dev, I'm with the Maryland State Education Association. So I'm going to shift this conversation back to sort of the school policy piece. So know first that I'm an educator so I understand the concept of the need to take care of the whole child and I'm fully committed to that. But I am also a person who works in education policy so I understand that the word accountability is a huge thing that hangs over the head of every educator in every school building across this country. So to the degree that trauma-informed care is an important piece of the overall school climate and I believe that to be the case to convince lawmakers and others who set policies for schools trying to convince them of the need for this because it is good for school wellness, it's good for students, it's good for teachers, et cetera, does not get to, but how do I test this? And if I can't test it and I can't measure it on the state exam, then I'm not gonna pay for it and isn't this a bunch of yoga, hu-ha? And what is this foolishness? So the question I'm gonna ask is a real talk one, like how do we get this into a practical space where we talk to legislators around, this is why this is important, this is what this looks like, and connect it back to the school accountability piece that they care more of, quite frankly, in many respects, care more about and why they're spending money to support schools than they do about the overall wellness issue, which they like, but it's not the sexy issue they care the most about. I told you you'd be sorry. You did, you warned me. I'll talk my answer on my chair. So I think this is what you said is vital to our success in public education. We have to find a balance of being able to do both and when I mean accountability, I mean both quantitative test scores, attendance, our discipline is low, but then those qualitative pieces that are what I'm gonna say vital in your community. So in my community, it may be we need to focus on the importance of our culture and climate and how that looks. And so how do you balance both of what the state or federal government is wanting with also having that conversation with them about the local accountability system that is important to that piece of it? I think we have too much of a focus on the test score itself. Let's be clear that state test is one test. It's not over time to show growth. So if we really wanna have this conversation, then we need to think about our assessment systems a little bit different and say that we should be monitoring this over time, not at once at the end of the year to actually show that a student has made 40% growth even though that they were behind. That is a huge step that we're not paying attention to from an accountability standpoint. So I would love to continue this, but I know that I'm gonna get on my soapbox and I don't wanna do that. Chelsea, yeah, please. So I'll do a brief call out and for educators in the room, especially feel free to come chat with me. So one trauma as a keyword is peppered throughout the Every Student Succeeds Act and it does that truth, that the fact that it's part of the policy makes it easier to justify state plans, including attention to trauma-informed care and practices and to get funding to be able to come out of multiple programs and titles to make sure that we're supporting that. The other thing I will say is that there are needs assessments required for lots of different parts of ESSA and I've been working really closely with the Healthy Schools Campaign and Trust for America's Health to investigate the ways that health metrics, which can include trauma-informed practices, can and should be part of accountability with a big A and a small one within education. And Santoy, I think you wanted the last word. I wanna just ask Samir from UCSF to raise your hand and also Molly from California School Health Alliance because also there's a longitude study where we're looking at the data that looks at attendance, number of seats that looks at things at school. At this point, we have enough data to actually prove that the Trauma-Informed Care Behavioral Healthcare School Health actually does impact academic outcomes, including attendance and also grades. And so there are people in the room who can speak more specifically to that. But we have that hard data that policymakers are looking for at this point in time. So I appreciate everyone's indulgence to me as moderator, but I think that was actually a great question to end on. Very pointed about policy and what we need to be thinking about in those terms. So we have reached the lunch hour, lunch 45 minutes, Sessi? Okay, so we're asking people to come back at 12.45, so that's 40 minutes. The food is back where breakfast was, okay? Food is back where breakfast was. And I've been asked to announce that there was a cell phone left in the men's restroom. So all the men are about to reach to their pockets. I already did, I got mine, I think it's mine. So if you are missing your cell phone, please see security on the lower level in Kaiser Permanente, which is next door. So you go out towards the restroom and keep going and then you enter the med center space if you're missing your phone. All right, thanks everybody. This has been a terrific morning and I look forward to the afternoon with you.