 We are very excited to have our panel moderator Dr. Salem McGarion and I'm going to introduce him right now. Dr. McGarion came to Santa Cruz as the pediatric medical director Dominican Hospital in 1993. He has been active both clinically in building healthcare programs for children in Santa Cruz since that time. Dr. McGarion graduated from Harvard Medical School and completed his pediatric residency at the University of Utah. Prior to coming to Santa Cruz he was on the faculty of the University of Utah and served as the medical director for the infant toddler unit at the Primary Children's Medical Center in Salt Lake City. During his time at Dominican Dr. McGarion led the development of a level three NICU, started the Dominican Pediatric Clinic which provided access to care for low-income children and those with special health care needs and served as a first five board commissioner. The Dominican Clinic now exists as the pediatric department of the East Cliff Community Health Center, a busy and successful federally qualified health clinic in Live Oak. He led the effort to establish a multidisciplinary evaluation clinic for all children under five entering the foster care system. This was a collaboration between Dominican Hospital, Stanford Children's Hospital, Santa Cruz County Children's Mental Health, Santa Cruz Child Protective Services and first five Santa Cruz. In 2019 Dr. McGarion was given the Health Care Innovator Award by the Santa Cruz Health Improvement Partnership. This award recognized his ongoing work with substance abusing mothers and their infants. He still sees patients in Live Oak and is involved in an effort to develop a community-based integrated program for substance using mothers and their infants. Please join me in welcoming Dr. McGarion and thank you for all your amazing contribution to our community. Well thank you Karen for all those very kind words and it is an honor to be on this stage for the Calcium Symposium and it is a total honor and for the Dominican Hospital Foundation. I personally am very grateful because they supported many programs that I was involved with at Dominican particularly being a founding foundation for starting the Dominican Pediatric Clinic so thank you Dominican Hospital Foundation as well. So I do have one piece of good news and that is I'm not gonna sing because I was thinking about it because in tribute to Dr. Twenge this morning she was talking about the intergenerational connection and I thought for you boomers out there you might be able to relate to sort of our theme musical hair. You remember this is the age, the dawning of the age of anxiety. That's what it seemed but I didn't. So the other thing is we're all missing Freddie here because you know Freddie Weinstein has done a fabulous job of sharing this and somehow I'm here today doing this. So we miss Freddie but I did come in as a runner-up for the Freddie Weinstein lookalike contest at Dominican Hospital. So that's what we have so we had three new members of our panels and I'm gonna ask them to introduce some of the selves. There's Elizabeth, there's Erica and there's Cassie and Cassie is sitting closest so Cassie would you like to introduce yourself. Can you guys hear me? Okay I'm Cassie Barlow. I will be the newest member of the Calciano family in August. I'm marrying Nick. The reason I'm up here is because I am your real-life proof of anxiety. I've had anxiety since middle school. I'm gonna start with something that works for me. If I at any time during this feel like I need to step out I will and by just me saying that I'm probably gonna feel fine and not gonna need to step out. But so I've had anxiety since I was around 12 years old. I've suffered with it in a bunch of different ways to the point where it's been so bad that I couldn't go to my classes. I was calling my mom every day in middle school and saying please come pick me up please come pick me up I can't do this I can't. Finally it got to the point where I was able to make deals with my teachers and the counselors where if I needed to just like I just said leave the room and I was allowed because they have bathroom passes and things like that back then and that started to work for me. Then I started to get actual panic disorder and that was kind of a newer thing for me so I actually feel the full full body panic attacks and I know if you've never had a panic attack before it's the feeling of sweaty hands my vision goes blurry I can't really see too much anymore like the room starts a little bit spinning very elevated heart rate basically it makes it really hard to do anything that you ever want to do if you're in the middle of a panic attack. So I've kind of been able to manage my anxiety from that point of middle school on I now work in a very great corporate culture company I'm able to sit through meetings I am been promoted three times since I've been there so I am the living proof that you can start on a really low place of anxiety and feel like you can never go anywhere with it and I'm living a very full functioning life with high level anxiety so. Elizabeth. So I'm Elizabeth Howard Gibbon I'm a detective with the Santa Cruz Police Department I've been there about six years prior to that I was a student nearby at UC Santa Cruz and I worked for the United States Geological Survey over off of Mission Street Extension so I've been in this area for a while. A day to day I deal with youth and anxiety in a variety of ways we have the Youth Violence Prevention Task Force where law enforcement recently they had a like discussion group that I participated in last year where they got to where youth and community members got to have dialogues with law enforcement and talk about perceptions and the best way for law enforcement to communicate with members of the community and address their needs. We also do a Citizens Academy a Citizen Police Academy and a Teen Academy where it creates kind of a space for community members and youth to have a safe place to to basically learn about law enforcement why we do the things that we do our methods and also create a place where we can also communicate without fear of enforcement. We also have a bunch of mental health changes in law enforcement that we're trying to foster through we have two mental health liaisons that are yeah I love them too. They're members of Santa Cruz they're actually employees of the Santa Cruz County they're not employees of the Santa Cruz Police Department and they assist us on ride-alongs to help us find the best way to communicate with someone who might be in a moment of crisis. So we're I'm learning a lot just by being here today I'm sure I'm gonna learn a lot just being up here on the panel but I hope to bring a unique perspective. Thank you Elizabeth. Wonderful Erica. Hi good afternoon my name is Erica Padilla Chavez and I'm the CEO of Pajaro Valley Prevention and Student Assistance or PVPSA. It's an honor and a privilege for for me to be be up here in this amazing panel with all of you what an honor to be here in the presence of what I believe are all of the angels in our community who are doing that secret work. And so I want to talk a little bit about PVPSA and what we do. So for over 30 years PVPSA has offered social emotional supports to the largest school district in Santa Cruz County that would be Power Valley Unified School District. We do that by placing mental health and substance abuse counselors in case managers at the various schools of the district. We are very family focused and family centered because we recognize that in order to address the needs of the children and the youth we serve it requires a perspective of the family dynamic and family involvement. I'm very proud of that because that's an initiative that I my five years at PVPSA brought to to the organization from my prior observations as an administrator in the Monterey County Mental Health System. I there's emerging needs that are happening right now in our many of the families we serve. I'm very proud to say that PVPSA strives really hard to be responsive to those emerging needs things like anxiety related to immigration fears that are very relevant and present right now in our community and in the households we we provide support to as an example. I look forward to sharing my knowledge and my observations but also learning I consider myself a student first and I'm very very happy to be here. What an incredible panel. Let's get right down to it and this is not meant to be question and answer alone. It's question discussion and we'll let different people have a go at it but this is sort of going for the holy grail right at the very beginning. How are we managing the issue of reality versus fantasy. Truth versus lies. Information versus misinformation. Paul's listed on this. Would you have a first go at this Paul. All right. That's not an easy one. I thought you were going to ask me about ice cream or something. I do think I mean with with technology particularly with young people the line between reality and fantasy it gets blurred. As I indicated in my talk many of my students and the young people I work with have very very unrealistic fantasies about the work world for example and professions that they might possibly go into. They fantasize about those things because of film because of television and using media to inform themselves rather than getting out there and talking to people and engaging people in professions. I'm also on a kick right now with the people that the young people I work with about the fact that there are wonderful careers out there where you actually work with your hands and do things and build things and create things. So I think we need to interject both in our educational systems and our schools more opportunities for that to happen create more connections for young people to to real life people. Those of us who will take the time to invite young people into our offices share what we do come to things like this go to schools and talk about our activities and whatnot. So I don't know if that answers the question and would other people like to comment on that question as well. In terms of the information truth versus fantasy. Yeah I'll weigh in on that. There's a lot of information out there and of dubious quality and so ideally we want to be skeptical consumers and scientific consumers and maybe we need to train our children to be the same and not accept that at face value everything that they're seeing or reading on the internet. I think a compounding problem with that is is the issue of of cognitive bias and that we all suffer from and we're all tend to look at those things that support the beliefs we already have and to ignore those things that don't and so maybe pushing ourselves out of our comfort zone a little bit and and looking at at both sides of situations would be a way that we could ensure the accuracy of the information that we're getting. I'd like to make one further comment. I think in my work as a pediatrician this comes at the forefront and the anti-vax movement and I think that the internet has been the main driving force. It's not the information it's not the papers it is really having false news be on equal footing of scientific studies and it has the inability to really tell the difference between generally world-class refereed opinion and opinion. For instance if you do a search on vaccine safety you'll see about six or seven links to alternative ideas before you see the CDC in the American Academy of Pediatrics. It's just it's an odd question. I'm going to ask one more pediatric question and I think I want to ask it to you Gary and this was for those of us who see children on a daily basis many people in schools some of us in offices what are some very very brief things that we might want to do if we want to do some type of innovation maybe it's innovation motivational interviewing for helping people control their use of cell phones and social media brief interventions. Well thanks I tried to touch on a couple of ideas at the end of my presentation along those lines. Just I would say if you have a just a brief period of time with some maybe you're having an office visit with a with a child talk to the parent present the idea of of just little breaks let's take you know 15 minute break here and there or I love the idea of I think it was Jean I can't remember Jean or you Paul who was talking about the family dinner you know and and how that how that in many cases has gone by the wayside I think a lot of the work would be done with the parent though and and and what are what are we modeling right if we if we tell our children you know you need to do something other than be on your phone but that's all we're doing you know what what message are we giving so if we can carve out some time for let's say a family dinner and make it a a phone free a television free time to to talk and be with each other I think that will go a long way good and I think Valerie wants to add something yeah I think several of the presenters today and I discussed common sense media which is a great organization they have a plethora of resources for families and for schools and they actually have a family tech agreement so it's a contract that parents can review with their students make with their students at home they're called kids right okay um thank you um but they can make an agreement and it's a family contract it says things like at 8 30 we will all plug in our phones downstairs we will have family dinners without tech things like that so common use media is a great common sense media is a great resource the curriculum that they have is a digital citizenship curriculum and it it parts out all of those things that we want kids to know about being online and using their media responsibly I mean we give young kids a very very powerful computer to hold in their pocket and we just give it to them and we wouldn't do the same thing with a driver's license say we wouldn't just hand a kid a Lamborghini but in a sense that's what we're doing by giving kids a smartphone with no lead up or training or you know guidelines on how to use such a powerful tool so I recommend that right so Valerie there are several questions in a row that are I think have most of your name on it but let me just start with one what is the best way to implement a no cell phone policy K through 12 and do you know schools that have successfully done this here's here's what I know having spent most of my life in middle school I know that it's a lot easier in elementary and middle school than it is in high school because in at the high school level it becomes an incredibly challenging supervision issue and management issue that I don't know if high schools are able to do that unless they have a system where they physically confiscate phones on the way in the door and I know that there are some schools that are um in the Bay Area actually fairly locally that are uh piloting programs where they have the kids put their phones in a certain envelope they check them in um and they don't have them at my school we actually have implemented a no phones during the day bell to bell system phones have to be off and in lockers from the beginning bell to the end bell and what that took is a lot of conversation with our school staff to make everyone accountable so um all teachers are accountable for if students have their phones out for giving them a warning uh confiscating the phone and there's a progression there but since it's now an anomaly it really is obvious if a kid is using their phone it's very obvious as if a kid is looking down in class um but it takes everybody being vigilant and now that it's a school norm which meant we have a lot of buy-in it's it's really workable and they don't have them out during brunch they don't have them out during lunch um i know that in the high school it's a lot more challenging also teachers if we it's really hard for us to say well we can't have you do this but i'm going to go over here and check my texts so that's that's been hard but we've been doing it other commentary on that question of cell phones in schools yes paul yeah if i can just add one i think we also need to get parental buy-in for these things i mean the number of times i've heard from parents that their child has to have a phone in case of an emergency and i don't know what you guys did when you had an emergency at school but i mean none of us had cell phones at the time and if our parents had to reach us they called the school and someone came to get us so convincing parents that they need that there's a good reason for their children not to have these devices in the classroom that it interferes with learning social development and whatnot so i think there's that aspect as well the schools and working good junction with parents okay so in law enforcement we also do a lot of education about cell phones because there are a lot of parents that don't actually know what their child is capable of using a cell phone because not everyone grew up with a cell phone that guy didn't even have a cell phone till i got out of high school which is pretty rare nowadays but it's one of those things where we try to do presentations for both youth and adults on like what is possible with a cell phone like who you can communicate with what apps can do i mean what could your child be using a phone for what kind of crimes are all done through this type of thing or platforms of social media and this kind of opens a lot of people's eyes on hey you know i pay for the device i bought the device the device is mine until i give it to my child and there's a lot of laws now that protect children from having law enforcement getting into their phones even if they have parents permission because of privacy so we always encourage parents like if you're going to give this sort of device uh to a minor make sure that you understand what you're giving them access to um and how that could affect their life and how they think about themselves how they think about others and how they treat each other great other commentary yeah erica you know um somebody's going to have to help me with this but what's what i'm reminded about at pb usd is something that occurred last year or maybe a couple years ago there was i think some netflix show um and it was really arousing some suicidal thirteen reasons that's it the thirteen reasons why and at pb usd obviously we have um a lot of parents that are monolingual spanish speakers um and the school obviously through its alert system um connected to the chromebooks that they issue the students uh they they were getting all these flagging that had to do with this particular show and there was a request by the superintendent to um help her develop a letter uh to the parents and then of course uh some education around appropriate use of cell phones and we did this in spanish and it was a very interesting um feedback that i i received from some of our staff who participated in that workshop particularly around just like the stare of the parents like wait the phone does what and it does what and it and it just made us realize that uh some assuming that all the parents know even the basics of a phone right uh not a good thing to go into a workshop because we just just made assumptions about oh the parents know that this app exists in this app so we literally had to do like cell phone one on one education in order for us to get to the core of the subject um and i just wanted to share that because i think many of our schools obviously uh have a diversity of families and uh just being mindful that not all parents uh enter the conversation um in the same starting point erica i want oh cassie has a comment i just wanted to add i would just caution us to completely write off cell phones as being a complete negative just because i know from an anxiety standpoint there are a lot of positives so i do think if we're educating like you're saying people on all the negatives of it i think we should take a little bit of time to focus on the positive apps like i know there's an app called calm that i use for night time meditation free for teachers yeah it's great it's great so things like that so there are best practices where if a kid's gonna have their phone in their hand for six hours a day make an hour of that be some sort of application that'll dive into their need to hold the phone but have it be a meditation app have it be on youtube there are all kinds of videos for like relaxing yourself i know when my anxiety is at a high my fiance can attest to this all night he has to listen to someone say breathe through your body and through your toes breathe in breathe out but the phone does have certain things like that so i think if we could try to replace some of those it might harken a little bit more understanding with the kids instead of us saying we're ripping this away from you and there's nothing good on it that you are ever going to find on it because there are some good things it sounds like your commentary is trying to help us find that goldilocks spot but can you say a little bit more about what you think would be the best way for someone to be using a cell phone i think the best way to use your cell phone it's hard because i certainly use my cell phone in the ways that are not as great as well like i know with instagram for people my age in college it was so much people posting all the time like i'm having the best time everything's great there's never been a bad day and that i've ever had it's just not true if you look at my instagram when i was in college you would have thought i had not an issue not a single issue meanwhile there were times where i literally couldn't even leave my dorm and i had to have my groceries delivered to me because my anxiety was so bad so i think just knowing it's not real making sure that people know that all of that kind of stuff is not real but also finding and learning and creating sort of a need for these apps like the calm app like those youtube meditations i'm sure there's a million other ones like my fitness pal all those kind of things are positive apps if we use them more apple and all these industries have they assess the market need if the market need right now is all instagram twitter tiktok they're going to just keep building those but if we start using the calm apps the meditation things the anything else that we feel like has a positive aspect they'll build more of it so i think it's that it's educating ourselves on what the positive pieces can be as well terrific just just one thing to add you know i was struck by the slide that showed steve jobs in 2012 2007 introducing the first iphone and that's 12 years ago and just how quickly this whole thing has exploded and so what i'm taking from from all these comments is that this this happened so fast and now we have to catch up as a society and figure out okay what how are we going to deal with this and what does this all mean and how can we make this work for us problem is it's going to keep exploding even faster so how do how do we keep up but i think that's our challenge okay i need that as a segue to ask a personal question it's a little bit of an off the wall question but maybe it's not it is for the whole panel when i was seeing our first speaker dr dwingy today if she was giving that talk at the american academy of pediatrics it would have been awesome she saw this incredible decrease in teenage pregnancy smoking alcohol there was another one or two i mean things that we've been struggling at for 20 years and basically i almost thought it was causality she was talking about it was because of smartphones less pregnancy less drugs less alcohol that to me that was a huge mix smash it i couldn't make sense of that in my head well did i hear it right did those go down right when the cell phone came out was there something else that happened i i think that that was more in relation to um the the concept that i presented from a different perspective about antifragile and fragile that that we're we're overprotective with with our children and that that's had some really positive results that you're talking about but there's also been some some negatives because of that right i think the trade-off is is incredible impact on mental health so you don't get something for nothing but maybe the golden locks can can appear somehow okay here's two maybe more straightforward questions about tv is tv watching as bad as other screen or media for early childhood development and um any advice for parents on how to cut down on screen time for their children open any takers well i can perhaps say something one of the things i did not include in my presentation was the way that television studios um are designing programs particularly these series i mean i'm not you don't raise your hand but does anybody hear binge watch television series you know wait till they come out okay so just so one of the behavioral measures that i mean that that may not cause you a problem to watch uh you know 20 hours of whatever but one of the things that that the producers now know is that they design this is the form of gamification and stuff they create into those 30 minute segments a cliff hanger right at the end of the program to make you excite you get that dopamine flowing to find out what happens next and then what do you do you move on to the next you know the next thing so they actually netflix can track this and track their behavior they actually know how to design cliff hangers that work they actually have programs for they have measures for television programs and know which ones will get you hooked in one or two uh one or two programs one of the tricks to not get caught in that is to stop before you get to the cliff hanger i mean as hard as that may be so is stop before you get to the end of the last five minutes and stuff and say okay i need to go do something else and then come back to watch the cliff hanger you'll you'll enjoy the next program even that much so almost sounds like you're talking about a drug review there this is right elizabeth there's a question for you elizabeth given how are our local police officers trained to handle youth who may be having a mental health crisis so i mean obviously it depends a little bit on what the crisis is about but we are dispatched i remember on patrol i was dispatched to several different mental health crises so we've received a lot of training that state mandated so the state mandates that we do a certain amount of training per year however each individual police department can sometimes exceed that so i know that the santa cruz police department makes a point to exceed it every year our minimum mental health standards uh we're supposed to do extra training and we do with other agencies other county programs i mean we try to make partnerships with the office of education to try to figure out like how's the best way to address issues that are particular in our community um i mean we do respond to people who are having mental health crises and involve suicidal ideation threats to other people sometimes it's a dual diagnosis issue where we have narcotics involved with a mental health um diagnosis so i mean basically each officer is is given this fundamental understanding and they have to combine that with their own training and experience and so it's kind of a hard balance and that's when we really enjoy like the assistance that the santa cruz county mental health liaisons are able to help us with too because they have obviously that's their primary job is to be social workers in this sort of field so we do rely on our resources quite a bit for things like that but um on a personal level i remember having to step back from some of these situations and say okay am i escalating the issue is my appearance in uniform the presence of a weapon is this elevating it i mean how can i deal with this and there are times where you have to kind of adapt and say okay well can i get a detective a plainclothes officer to come help me with this is there um something that this child in crisis needs to help them calm down is there uh particular triggers that i need to avoid are there um like areas where they're going to feel more comfortable if we're outside and not in a confined space so you're trying to find ways to to do your job without making things worse um so i i encountered that every like almost every day in patrol not just with youth but with people in general i i don't know how many of you are completely comfortable when a police officer stops to talk to you even if they're trying to say it's a nice day out right so i think just inherently any contact with law enforcement creates a level of anxiety and just the fact that we need to learn how to acknowledge that and find a way to work with that and i think that we we are learning and we are trying to do better um so beautiful i hope that i answered it and thank you so much for being on this panel oh my god that's great can i add something to that um one of the partnerships that we have in Watsonville is with our local Watsonville police department um and i i want to uh to share a little bit about what they're doing um from a law enforcement uh and uh they do have an officer who has been trained uh who has an actually a mental health counselor from the Santa Cruz behavioral health uh agency um who goes out on beats with the police officer uh many times when they do respond to these calls if they determine that uh a service uh from our agency would be appropriate oftentimes it's not unexpected for them to walk that person over to our agency which is really nice because it's a warm handoff right makes it less scary and more likely that that person might engage in our services so i just want to give kudos to the Watsonville police department for being so proactive in that way and then also for the children and the youth in our community specifically i want to give them credit for thinking many years ago to working upstream um to not just prevent recidivism but address the multifaceted needs of the children they come in into contact with so uh five years ago the Watsonville police department developed a program called pathways to success or Camino Sacia Lexito the outcome or the intended goal was to reduce recidivism rates uh among the youth of Watsonville but what happened or has happened over the five-year span is that there is uh they have embedded case managers in the Watsonville police department when a officer um comes into contact with the youth that is committing an offense as long as it's a nonviolent offense they do get a they get screened for the possibility of entering this program we are the mental health providers and case managers for the youth referred to that program over 500 youth have been referred and served through this program 89 percent of them have not recidivated one year post graduation of the program and um 30 percent of those youth were in need of mental health or other interventions uh intensive intervention so again there i i think uh the Watsonville police department is a model agency that has figured out a way to utilize general fund uh and utilize some of the limited capital that they have to embed programs and then to stick with them right because that's always a challenge for agencies that may be revenue strapped but they may have they have made that a priority and I love it that all the officers that come in to work for the Watsonville police department they all get trained on this program it's one it's part of the uh onboarding process that they do one more example of why it's so amazing in santa cruz county and we're we're so lucky to have the the resources that we do here's a question for cassie and cassie do you have ideas for how schools could help all students to feel less anxious and are there school-wide guidelines that could help yeah so I can really speak for what I um what works best for me and um just growing up in the age of anxiety I have a lot of people gravitate towards me um to find out kind of what works for them too so I have a lot of sorority sisters that have needed my help too so pretty extensive background of different people and what works for them but I think physical activity and getting outside is huge so for me the second I feel anxiety coming on I have to step outside I either walk I do jumping jacks if I'm on the verge of a panic attack I will go to a bathroom stall and do jumping jacks and the panic attack will start to go down that's the first thing I say to anyone is physical activity and get outside so I think that if schools could promote a little bit more of that I know back when I was a kid Nickelodeon of all things used to have a commercial that said like verb it's what you do and kids used to go outside it was promoting kids to go outside right when video games were becoming a big thing um so I think just maybe taking like a small break during your lesson and taking the kids outside to go over what you're going to talk about like if that's possible at all or um trying to do more sort of field trips or just kind of breaking up the day um and making things a little bit more outdoor focused because if you think about it right like we used to all be people who lived outside we forged we hunted and everything like that we were all outside now we're indoors some people don't see the light of day for an entire day of course our bodies don't know how to react to it um and of course our minds are going crazy looking at these devices and a million other things so I think exercise is huge I also think if there was um I heard recently one of my co-worker sons goes to a school which sounds like it has a really great program of these kids are allowed to choose one sort of core class instead of like a free period or a study period they get to go through and choose different things and the examples that she gave me was there's like yoga there's a meditation class there's cooking there's all these things that are much more hands-on and physical um and then mental health awareness kind of driving as well instead of just saying like you have an hour to work on your homework in this building so I think physicality is huge very creative solutions okay um here since none of you I think write prescriptions you all have equal access to this question what is the role of psychopharmacology in severe anxiety part two is if SSRIs were released now would they be called anti-anxiety instead of anti-depressants just I'm going to try to answer that indirectly and also reflect on something that Cassie said I mean we we we talk about anxiety as if it's a disease you know it's a problem to be avoided anxiety is a natural healthy response to things that aren't working you know in our life um it gets out of control when we panic or we don't have the tools necessary to deal with it um I have as a psychologist sometimes I have a bias against psychotropic because I think what we do is we we reduce anxiety artificially without necessarily addressing the causes of them and the the root cause so I think we have to as Cassie said you know as a species we were not designed our children were not designed to sit in classrooms six or seven hours a day you know they were designed to be outside running around doing things and being active so in I think when we're working with people with anxiety it's absolutely essential to validate their experience of being anxious you know to discover you know that's part of the detective work where the anxiety is coming from and recognize that sometimes the misuse of social media and devices is a young person's attempt to deal with their anxiety and we may need to provide them with the tools in some instances as Cassie's saying it is an extremely helpful useful tool we just have to be able to teach them and ourselves how to use these things appropriately so so anxiety is not a disease I mean we we oftentimes treat it as if it is it's a warning sign that something's not right and we need to help our clients to develop more effective strategies to deal with it yeah I'll take that to one step further what would you think about this I would say ADHD is not a disease attention is a symptom there's a million reasons not to pay attention there's just some people where they're whining makes it harder and then we put them in an environment where it's about impossible to pay attention anyway and then so it causes a disease and then it has the medication and so it's sort of I mean these are sort of medical existential questions kind of kind of things but you live in the world that you do and you try to adjust it any other comments on psychopharmacology for any of these children I can weigh in on that well I was thinking more how I see psychotropics used on the college campus and and certainly sometimes if there there's an extreme panic situation or or trauma using a benzodiazepine is indicated for a very very short term we certainly don't try to get into using those as as a regular way to to address anxiety because they're they're so addictive in themselves to the other point I mean I certainly have seen SSRIs used to target anxiety specifically as opposed to depression and that's because you know aside from from the benzos there there's not a lot of great medication alternatives to address anxiety I also have a bias though to to work on on psychotherapy and we have to we have to experience the anxiety and have exposure to it in order to learn how to deal with it and and reduce it so sometimes just pulling the symptom away it in the long run doesn't really get people where they need to be right okay commenter yes Cassie so I've been on all the different things not all of them but a lot of them they essentially tranquilize you benzos especially I have found I've been to probably 20 different psychiatrist psychologists over my life and I've been to a few that opt to I get there they weigh me they ask me about what medications I'm on and they give me four more I've been to others where we go through and we do like EMDR or we do breathing exercises I love those ones I had an amazing homeopathic psychiatrist when I went to Sonoma State and she really really helped me kind of realize like okay because at the time when I went to her I was taking two out of an a day someone had prescribed to me that so in the morning I had an out of an in the evening I had an out of an I was also on 40 milligrams of Lexa pro a day if I were to watch Marley and me I would not cry kind of a thing like I had no nothing and I'm a dog person so essentially tranquilized right and I agree with what you're saying you have to be able to feel the anxiety so she was able to wean me off of all of that we used a bunch of different things breathing I took trip to fan the stuff that's in turkey to help me wean myself off of it but I think the most powerful thing for me as far as coping with my anxiety is learning to not fear it and sit through a panic attack if I can't sit through a panic attack and realize this is going to end in six to seven minutes I'm never going to be able to cope through the anxiety because it almost brings on agoraphobic tendencies if I completely avoid it so let's say I have a panic attack in a car with someone I don't ever want to go in a car with someone again if I live the rest of my life never going in a car with someone again I will never get over that fear so for me I think it's very important for me to then get in a car with someone and drive for a minute the next day maybe two minutes the day after that and not just go to a psychiatrist and have them prescribe me an out of an or his annex so totally I agree with what you're saying feel the anxiety live through it that's the only way you can get better totally well said I'll try to read this carefully I think Paul this was generated by a little part of your slide but anybody can comment here it is sexual positivity is important in the process of development I agree that porn hub does portray sex in a negative false way and it fetishizes gay lesbian relationships however masturbation is important for sexual self-discovery and shouldn't be negativized do you hold the opinion that masturbation and sexual exposure is bad in adolescence and could you expand on why those expand on that topic okay this is my fear if I use it talked about masturbation hog and does ice cream is that you would all associate me with that going forward so masturbation is a normal sexual practice I mean everybody does it as far as I'm concerned everyone should it and among young people and stuff it's normal as well I think those of us who work with young people have to be comfortable talking about subjects like that about sexuality because oftentimes it's not occurring at home it may be occurring over Instagram or other places and stuff but oftentimes in inappropriate and infantile types of ways in talking about television and social media and whatnot I think one of the most important roles that parents should have is to participate in these activities with their children to help educate them teach them to think critically about what they're what they're watching I mean I'm not advocating necessarily parents watching pornography with their children but but educate them about what's real and what's not so that they develop healthy attitudes about sex about their bodies about relationships and I really think this is a critical role for us I'm I'm actually I mean terrified might be the not the right word but the fact that our children are being educated by these pornographic sites and if you don't think that they're not watching that you're totally you know you're living on another planet and stuff and I'm hearing from the kids that I work with that they're oftentimes acting out some of the things that they're watching because they think that that is real that that's what sex and intimacy is supposed to be all about so and if you have questions about ice cream I'm your man so you have two other commentaries Valerie um so the California Healthy Youth Act that came in in 2016 really changed a lot of things about sex education in schools and we do it in our seventh grade there's also a ninth grade component but the California Healthy Youth Act really outlined things that had previously not been covered positively affirmatively health in a healthy way in sex ed previously if you remember your health ed learning in your own school I mean for some of us it was abominable but just in having really healthy discussions around body image around consent around masturbation around lgbtq affirming issues again um and I I love that that's happening but it's a program it's codified into our curriculum and I think that as we learn more and get better at these things educators have this unique um opportunity and I think I think it was Paul who said he was happy to have a captive audience again but education is you have the opportunity and the responsibility to be presenting students with representations of themselves that are healthy um for everyone in that room and so we are slowly getting there with new programs and protocols but um I really like the new sex ed programs that we have and I hope we continue to learn in that way Erica while we still have time I want you're doing some particular work on prevention with very young children under five population in terms of trying to develop resilience and coping with adverse childhood events yes we have um a few specialized clinicians who for over five years have been working in tandem with an initiative in the Monterey County behavioral health system of care um primarily uh to address the emotional needs of parents caregivers and their um their their babies they're zero to five babies babies within that age group and um for for over five years the Monterey County first five uh a group has been really identifying training opportunities to um to clinicians who are interested in working with this this young population and their families and uh we've been partnering um with first five Monterey County for many years now we've used the ACEs in in our assessment uh process um we're expanding it trying to expand it into Santa Cruz County and we've partnered up with Salud para la Gente a federally qualified health center in Watsonville to try to see if we can be of support to the children that seek medical care through their clinics we call that program moving healthcare upstream because we understand the impact and the long-term positive effects that children and their families can have when we interfere at an early age uh we're really excited about uh our our effort to expand care for the youngest in our community uh because as we've all read and and continue to read and we have Dr Burke now at the state who's pushing the ACEs we all understand right uh what that means in the long term it's also from a fiscal perspective total wise investment right not just in the overall health and uh maximizing opportunity for that child but let's face it we have a lot of work to do to shift our system so that we are preventing right the things that then we're spending so much money addressing as they grow up and become adults so uh yes we're very very happy to be working in this effort great yeah thank you Gary and I'm thrilled to hear that that you're doing that work and there are countries in Scandinavia where they're uh they're teaching emotional intelligence to second graders and that's what we need to do because I'll tell you college is too late so you know we're just playing catch up and we're never going to get there and the time for for people to learn about how to how to regulate their emotions is uh is in primary school and and this needs to be built into our curriculum in a very fundamental way and if we don't do it there's going to be significant consequences so please go do that yeah Dr Dunn but one more brief commentary this is just slightly off topic but of quite a bit of interest that the graduate student strike up at UC do you think that there are mental health issues associated with the rent burden and financial impact uh for students there is some interest in this I look at it as a as a hierarchy of needs issue uh that if you're struggling with uh with basic security of of food and housing you're not even at a point where where you can be thinking about your your mental health you're thinking about your survival so um so I for for many of our graduate students that is the case now well well does does it have an impact on one's mental health if if you're worried about these things absolutely um and you know as does uh it frankly it's causing a myriad of mental health reverberations throughout campus uh you know students who are feeling undergraduate students who are feeling conflicted they they support the graduate students but they're also trying to complete their education and and what what do they do uh graduate students who maybe support the the movement but are are involved in research protocols where they really can't step away uh otherwise they'll lose their funding so so there are are many it it's a multi-layered issue well thank you thank you for commenting okay I think we're coming close to the end of time and here's a little bit of a general question is the amount of uncertainty stress and anxiety in society greater than in the past greater than ever or or or not and what are the factors partly related to that is um in the current political landscape would break down a protection for immigrants minority groups and building a border wall uh what about the levels of anxiety related to those issues and I am surprised that nobody has mentioned anxiety associated with the climate crisis yeah so what do you think about these political issues and global anxiety I guess beyond technology and cell phones let me let me touch a little bit on on the topic of immigration because I know I referenced it in my my introduction um when we had a change in leadership at the federal level um the following days leadership um the following few days after that the attendance at our local schools dropped and I'm sure that probably happened in many schools throughout the county um the superintendent and I uh uh had a discussion about okay what can we do what can we do because this seems to be a impacting uh many of the families and the children in in our school system and so we said oh why don't we why don't we organize a community forum so that we can um have parents show up we'll offer childcare and we we can have an open discussion to alleviate some of this anxiety because we recognize that it was anxiety right and we really thought it was going to be on a sunday right because we know that's when a lot of the families um are off of work or have time and we expected 50 families right how many families Erica do you think will come she asked I said yeah about 50 right it's a sunday uh about 50 we had 500 and uh let's just say this we were both looking at each other like oh boy but we I share that because it told us the communal anxiety that was existing with the many families and students that attend the local schools and that set up a need for us to develop a system within the community of Watsonville to address the multifaceted issues that have since uh resulted due to this topic being a focal point of discussion at the policy level I hate to say that things have gotten better I think to some degree there's a little bit of uh uh desensitizing that's been happening but the truth is the issues have gotten deeper the the amount of anxiety that we see not just with the children we serve but the caretakers uh is our clinicians are constantly having conversations with each other about the manifestation of what they are seeing so it's almost like we're learning together um but I do want to make that a point because I know that in north county we also have a very uh uh strong immigrant community who is in need of support and I can tell you we did have raids in our community and I can tell you that there were caretakers and parents who were removed from the home and I can tell you that the aftermath of that is um things that our clinicians can frankly what did they call it the other day I feel like we're just patching up things all the time but we can't really get to the root of it because this is a problem that we're somewhat not able to solve right at the moment we do have an opportunity coming up uh to do that uh but but I I want to highlight that because we are a diverse county and we do have immigrants uh who contribute greatly to the beautiful fabric that we are as a county and this is a topic that I want to encourage all of us to elevate because it is happening to our families it is present in their anxiety it is present in the discourse that they're having in their homes I just think we have a lot of room for improving the way we're responding to that and if I could just touch on that really quick I mean that is a huge problem that we have had in law enforcement or people are victimized serious victims of horrendous crimes and they're afraid to report because of the immigration issue I've had to reassure victims of sexual assaults or domestic violence that I don't need to know your immigration status these are not things that I need to know as part of my investigation so I'm not going to ask them and then we've I mean we've had to dissolve partnerships that we previously held with other organizations because of you know because of the sense of topic I mean that we are we are minimizing a lot of our federal involvement in our own office over the past few years because of this sort of issue we want to be able to serve a community that that we're trying to protect and if they don't feel that they're actually going to protect be protected we had to look to that relationship so I can see how that would be a very valid fear and a cause for great anxiety in our community I think that the fact that we're able to talk about it though shows a lot because it's very difficult in the past for people to talk about mental health about anxiety about depression about bullying about any of these topics previously it was much more difficult to talk about it because people don't want to admit that they have some sort of problem right I mean I as an officer struggle with PTSD sometimes or anxiety or depression just from the content of my work previously we would never talk about that sort of thing so I do think that I don't know if there's been more anxiety in the world but it may be that it's easier to talk about I'm going to close with one last very heartfelt question there are so many of you that are in the schools and I think all of us can think of this I teach five to seven year olds in public schools I've seen an increase in anxiety perfectionism in young kids can you give me tips for working with these kids and also tips for me to tell parents on how to support their kids I think that open or Valerie looks like you're ready to comment that makes my palm sweat yes I I think that we have to explicitly teach our kids how to fail how to fail well and it's a little bit in response to the comment about being anti-fragile and this is a parenting trend it's a it's a societal trend and and the presenters today kind of touched on it in a variety of different ways but our kids are mortified to fail to not achieve to not get ahead to not have and if we if I could say one thing as an educator and as a parent it's to teach kids how to fail and recover and fail and recover and build that resilience that they're going to need in everything okay let's give it up for this panel amazing