 Perfect. With that, I'd like to introduce, if I may have your attention, I'd love to introduce our next speaker this morning. Dr. Lisa Gutierrez-Wang is the Director of Children's Behavioral Health for Santa Cruz County. She holds a PhD in Clinical Psychology and an MA in Counseling Psychology from the University of California, Santa Barbara, and completed her pre- and post-doctoral fellowship training at the Child Trauma Research Program at the University of California, San Francisco. Prior to joining Santa Cruz County Behavioral Health in June 2019, she was the Behavioral Health Director of Clinical Innovation and Research at the Center for Youth Wellness in San Francisco. Working with now California Surgeon General, Dr. Nadine Burke Harris, treating children and youth exhibiting signs and symptoms of toxic stress related to exposure and early life adversity. Lisa's work is focused primarily on the assessment and treatment of the effects of complex psychological trauma in ethnically and linguistically, linguistically diverse populations. Please join me in welcoming Dr. Lisa Gutierrez-Wang. Thank you. Great. Good morning. Thank you for that introduction. It's so nice to be here. So I was asked to take a few minutes to introduce the services that we offer to children, youth, and families through Santa Cruz County Children's Behavioral Health. So to get us started, let's see if this will advance. Let's try this. Ah, here we go. All right. I'm going to put that clicker down. So I thought I'd start with reviewing of our mission. So we work with families and youth in our community to help them stay at home, in school, out of trouble, and support a healthy lifestyle. And we strive to do that by providing comprehensive, strength-based, accessible, culturally and linguistically appropriate services to help these youth and families reach their own goals. So we provide services primarily to medical beneficiaries who have moderate to severe behavioral health needs. And the way that children, youth, and families access our services are through four main points of entry or gates. The first is our community gate. And just by a show of hands, how many folks are familiar with our 1-800-ACCESS number? Let's see. Oh, fantastic. All right. So the 1-800 number actually allows individuals to call and request services across our behavioral health service system, which includes our adult specialty mental health services, our children's services, which I'll be talking more about, our substance use disorder services, and also allows access to our mobile emergency response team, which now functions seven days a week from 8 a.m. to 7 p.m., which we're really excited to be able to announce. Yes, exactly. So I have an eight-year-old, and I live here in the community, having moved from San Francisco recently. And so if my child was experiencing behavioral health or had behavioral health needs, I could go ahead and call this 1-800 number. I would go through a process of some screening. They'd collect information. And depending on that information, they would then invite me in for an intake, which would be a comprehensive assessment of my needs and then be able to offer me services. If my child perhaps had more mild to moderate needs, the access team would be able to also help link me to other services outside of the county behavioral health system. So that is our most common kind of way for individuals in the community to be able to access our services. In addition, we have children and youth come to us for direct service through the school gate, and that's primarily in partnership with Parro Valley Unified School District and also the county office of education. We also have really strong partnerships with Child Welfare or the Department of Family and Children Services, where Child Welfare workers would be making direct referrals for our mental health services as well as through juvenile probation. So once an individual is through these points of entry, what are our core services? So we provide case management, individual, family, and group therapy, and then also depending on the need, we can offer psychiatric services, intensive care coordination, in-home behavioral health services, and then through partnerships, we can offer therapeutic behavioral services or TBS, and that's in partnership with Encompass, or also help link the family with a family partner, an individual who has lived experience. You can really work with the parent and caregivers to help navigate systems, not only the behavioral health system, but also perhaps systems like the education system, requesting an IEP. How do you advocate for your child's needs? These family partners can also be really helpful in helping caregivers link to their own services, and so we really do offer a ray of comprehensive services through Children's Behavioral Health that we're very, very proud of. And another thing that I'm very, very proud of is the team of clinicians that we have at Children's Behavioral Health, several of whom are here today. So I'm going to ask them to raise their hands. Clinicians that work within behavioral health are specifically Children's Behavioral Health. Let me see. Where are you guys at? There you are. Fantastic. So this team of dedicated clinicians, I've just been so impressed with them having started in my role in June, so it's been about eight months now. But one of the most exciting things when I came in was really wanting to learn about the work that we were doing, the services that we were offering, and what types of treatments we had available to children and families in Santa Cruz. I learned about the evidence-based practices that we were able to provide, the training and the expertise within our own team. And here's just a list of some of the expertise that we have within Children's Behavioral Health, and I'll just mention a few, like trauma-focused cognitive behavioral therapy, or child-parent psychotherapy, which is a specific evidence-based practice for children zero to five and their caregivers. And oftentimes, access to services for very young children that zero to five age range is really lacking. So to know that we have a team that has received training in that, and supervisors who can continue to support the growth in the area of this really early childhood mental health is very, very exciting. In addition to that, we have a really robust team of folks practicing and consulting around narrative therapy and internal family systems, just to name a few. All right. So we as a system are striving to become a trauma-informed system and provide trauma-informed care. And really at the core of that is understanding how early life adversity can have an impact on health and well-being. So this figure here really just illustrates that early life adversity can have an impact across multiple domains, including mental health in the presentation of anxiety, depression, suicide and PTSD. So some of the conversations that we're starting to have is really around adverse childhood experiences. We, or most of us, most likely know that there's a big push in the state of California around the ACEs-aware initiative that our Surgeon General, Nadine Burke Harris, is very much promoting. For her, the idea that early life adversity really is the root of the root and that we need to start screening youth and also adults to better understand how adversity is impacting health and wellness. And so these are the traditional 10 ACEs that we most often talk about that fall into the categories of abuse, neglect, and also household instability. So we know that when children and youth are exposed to physical abuse, emotional neglect, or factors like caregiver mental illness or caregiver substance use, that they may experience an overwhelming amount of stress that will ultimately impact both their physical and behavioral health. So we also know that not all stress is bad, that there can be stress that's actually quite positive and activating, like getting ready for a big test or a big game, or presenting in front of a large crowd. And that with the appropriate coping skills, knowledge that individuals can actually overcome those challenges and really grow from them. And that there's also tolerable stress, perhaps those stressors that are more significant, but because we have the support of others and additional tools we're able to overcome. That might be something like experiencing an earthquake or maybe being in an accident. And because we're wrapped around and supported, we're able then to grow through that or move through that. But we also recognize that there are some adversities or stressors that really do overwhelm our ability to cope. Things like abuse and neglect that very much are long term, are often times within the context of caregiving relationships. And that those stressors can actually activate our stress response physiology. And so in some cases that stress response physiology, that ability to get ready to fight or freeze is really necessary. But that when this is in the context of things like childhood abuse or adversity, things that are ongoing, without that supportive buffer of protective relationships, that ultimately that is the mechanism that we are proposing leads to these long term health consequences that we're seeing. So in this particular figure, it's just really illustrating kind of the recognition of this biological mechanism of toxic stress. And why we're so interested in identifying and screening for adverse childhood experiences, to better understand what types of adversities individuals have experienced, what the protective factors might be that we can build upon. And ultimately, how stress might be impacting the youth who's walking into our services, presenting with depression or anxiety, we want to be thinking about that in a holistic way, not only just the psychological symptoms that we're seeing, but also physical symptoms and how then we can partner with primary care and other partners to make sure that we're bolstering the individual's coping strategies, and then also helping to bolster families to be able to support children and youth and be effective buffers against the ongoing stress. All right. And so we also know that not all individuals who experience adversity will have toxic stress reactions. So once again, we really are looking in children's behavioral health to see how we can increase those positive supports. So our services are very family focused, recognizing that we do need to see that child within the context of the caregiving relationships. So how do we, as a team, as a system, help protect against ongoing exposure to adversity, and then really build up those individual coping skills and the family's capacity to buffer. And overall, mental health, obviously, is one component of these domains that can really counter the effects of toxic stress. But we also want to be thinking about for ourselves as staff who are working with families who also experience our own levels of stress, how we can be thinking about supportive relationships and what those look like within our work environments. We want to be talking to everyone about the importance of sleep and being able to regulate stress response. Thinking about nutrition, regular physical activity, how do we continue to develop opportunities for mindfulness and reflection in our everyday lives? So these six domains of wellness are really just common sense stress reduction strategies, but I think so essential as we're both talking about our work as providers, but then also what families can do for themselves, what our partners can do in schools and other settings. So I wanted just to leave you with that information as an overview of our services through Children's Behavioral Health and a snapshot into some of the conversations that we're having to better serve our children, youth, and families throughout the county. So with that, I will say thank you.