 Hi, and welcome to today's presentation on the protective factors for co-occurring disorders. In the next hour, we're going to define what protective factors really are. They aren't just the opposite of risk factors. Protective factors can also fall into some other categories. We'll identify protective factors for addiction and mental health issues in the following domains. Individual, peer, family, work, school, and community. And we will discuss similarities and differences between risk and protective factors for each disorder. Now, one of the things I want you to look at is the domains that we're talking about here are roughly the same domains we were talking about in the last class on the socio-ecological model for the development of mental health and substance use disorders. So the good thing is, I guess there are a lot of different models that are using a similar framework. So we can extrapolate data from them and we're not comparing apples and oranges. We're kind of comparing apples and apples. Protective factors are those characteristics affiliated with persons who are mentally and physically healthy. So we want to consider the individual. So what is it about the person that makes them mentally and physically healthy? Biologically, physically, do they have, obviously they're healthy, they're probably exercising, probably getting good nutrition, sunlight, yadda yadda yadda. We all know what we're supposed to do. We also want to look at their peers. Are they surrounded by a healthy peer group that is supportive of wellness behaviors? And a healthy peer group that is supportive of them if they are having a bad day. We want to make sure that they have adequate, healthy social support. Then we want to look at the work and school environment to make sure it's not burnout prone, make sure it's something that maybe fits with their temperament, and also make sure it's something that provides them a sense of accomplishment and it's something that they really preferably enjoy doing. Finally, we're going to look at the community and there's a little less we can do there, but we want to look at what are the characteristics of the community that this person is living in. And this community can be expanded from just what we talked about in the socio-ecological model with the microsystems to looking at to looking at the greater things like the weather in that particular community. Certain communities have micro climates where it's gray or rainier, blah, ear, nice clinical term there. And some things about the community may also engender depressive feelings. Likewise, there are a lot of things that in communities that can engender a sense of attachment and positive feelings like parks and sunshine and cleanliness. If you've been to a community that is not so clean or even to a part of your community that's not so clean, my sense is you probably have a different feeling about hope and optimism and all that stuff in that environment versus an environment that is attractive. It doesn't have to be pristine, it doesn't have to be fancy and fufu, it just has to be clean. And this is one of those things you want to focus on, hint, hint. In prevention, what we're talking about are three different levels. Primary prevention keeps the problem from occurring by promoting healthy behaviors and protecting from risk factors. So primary prevention keeps drug abuse, depression, anxiety from ever happening, teaching healthy coping skills, ensuring a positive community climate, helping children learn how to form proper relationships as they're growing up instead of waiting until maybe teenagehood or high school. Other things also now, nowadays, are looking at prevention by helping teens and adults learn how to navigate the worldwide web without letting it impact them because it can be a very not pleasant place. And one of the things that we talk about in the e-therapy class is digital disinhibition. When somebody is not face to face with you, they tend to be more likely to say things they would never dream of saying to your face because there's no, there's no impact to them. You are just on the screen. You're a name on the screen. You might not even be a face. So this digital disinhibition allows people to be as pleasant or as unpleasant as, you know, they want to be. There's no consequence. So secondary prevention stops or slows the progression of the problem. This is when, you know, we see that there may be some things going on, bullying, for example, maybe starting to occur in a school system. So we want to stop it. We want to nip it in the bud. It already started. So how do we prevent it from progressing and becoming this huge social issue in the community? Same thing with addiction, depression, anxiety. Tertiary prevention improves the welfare of the person with the problem and seeks to prevent other problems. So, you know, we missed them on primary. They developed depression. We missed them on secondary. We didn't get it when it was, you know, a mild mood disorder. Now we're at clinical depression. Tertiary prevention would say, okay, let's stop it here and not add on obesity and alcoholism and, you know, anything else that may go along with long standing clinical depression that someone just really needs to try to find relief from. So primary keeps it from happening. Secondary slows the progression and tertiary improves the welfare and prevents it from causing a cascade effect and causing other problems. Prevention example for addiction. In primary prevention, we want to start out with things like parent education and youth education. In my opinion, and you all know I'm pretty opinionated, this needs to start when children are infants, small bits of parent education, public service announcements, handouts from the pediatrician, little bite-sized chunks that people can take that are practical that they can use. Expecting people to go to a class and sit through 16 weeks or an hour a week isn't likely and it isn't realistic for most parents. So we need to figure out how to get the information to them. This will help them educate their children. Likewise, youth education. A lot of our television programs now, I mean, I'm happy to see it. I wish they were able to get it from like actual human people, but a lot of our television programs teach communication skills. They teach manners. They teach different values that most of us would want our children to have. You know, I grew up on Sesame Street and they teach, you know, be nice and be kind and all that kind of stuff. And the new programs have taken that and are still building upon it. Youth education also occurs in preschools where my son had one of the most amazing preschool teachers. I used to love to watch her work because she was so able to understand exactly where that child was, but move him, as Vygotsky would say, to the next zone of proximal development, she would encourage him to say, okay, you know, you didn't like what he did. How do you think he felt and encourage this young child to move from being egocentric to being able to take someone else's perspective? And if he couldn't do that, she would say, okay, how would you feel if he did it to you? And then that would help them sort of start connecting the dots. Excellent preschool teachers are indispensable. Parents who have the tools to help their children indispensable. We also want to increase these protective factors and reduce risk factors in the community. We want to encourage some of the things that we're going to talk about in order to create an environment, create that community that supports the development of healthy youth and families. Secondary prevention. Remember, this is when the addiction has already started, but we want to keep it from becoming a major issue. We want to make sure we have the ability, availability of treatment for persons with addiction issues. Now that insurance regulations have changed some, a lot of people are actually not seeking secondary prevention because there is no, for most insurance plans, there is no deductible or not deductible, but no copay anymore. You have to meet your deductible before you can do anything. So a lot of people are like, you know, I don't have $6,000 for secondary prevention. So I'm just going to try to stick it out on my own, which moves us up to tertiary prevention because they're probably going to get worse. We want to educate people about secondary illnesses and problems that are going to be caused or that could be caused by the addiction. Some schools of thought would encourage if you're going to have someone that has an addiction problem, access to clean needles if they're going to shoot up, at least make sure they're not getting HIV and hepatitis and spreading that around, access to methadone clinics and nutrition and medical care availability to make sure they don't get any other sort of STDs or other illnesses. Communities vary on their willingness to use some of these harm reduction strategies, but it is important to understand that tertiary prevention really is a harm reduction strategy. So let's look at individual protective factors. For addiction, knowledge about addiction risks, well, we're all like, duh, of course, but it is important that people understand how, why addiction develops, how addiction develops, and the fact that it's not just alcohol, it's not just illicit drugs. It can be prescription medications. It can be over-the-counter medications. It can be behavioral addictions. So people need to understand that addiction is a way of numbing pain when nothing else seems to be working. That way, they can wrap their heads around the purpose of their behavior and start preventing it or understand that when they're in pain, they need to seek out some sort of assistance. Negative attitudes toward substance use and some of those other addictive behaviors, internet porn, gambling. Obviously, if the individual has negative attitudes toward it, they are less likely, and I don't say unlike, not likely at all, I say less likely to experiment with it. At a certain point, if the pain gets bad enough, they're probably going to start just trying anything to make the pain stop. But if they know the risks and they already have negative attitudes, they know it's risky, they know it's not where they want to go, then that's going to bolster the likelihood that they will seek out positive protective factors and options to, to deal with whatever it is that's going on with them. Bonding to a pro-social culture. If the individual tends to be in isolation, then they're going to be at higher risk. If the individual tends to bond with people who share a affinity for addiction, addictive behaviors, high risk taking, then they're going to be at higher risk. Pro-social culture is really very, very broad. You know, it doesn't mean necessarily religion, it doesn't mean necessarily volunteering. It could just be with the, you know, eight other people that live in your neighborhood that are trying to maintain a healthy, happy environment. But most of us, most people are not meant to live in isolation. We're not really solitary creatures. There are people who prefer small groups, you know, your introverts tend to prefer a group of two or three instead of 20 or 30. It doesn't mean they don't like people, it just means they prefer to focus their energy on a couple of people. We want to make sure that couple of people that they have available to them are promoting a healthy lifestyle, behavior, etc. Positive relationships with adults when the child is growing up. If the child has positive relationships with adults, they're going to be able to communicate with someone who is developmentally, theoretically, more advanced than they are, who can help them like my son's preschool teacher did, move them along the developmental pathway, give them good ideas because, you know, by the time you're 20, 25, 45, you've had a lot more experiences than someone who's 12. Social competence. Social support are some of our greatest buffers against stress. Healthy social support. In order to have healthy social support, you have to have a sense, a feeling of being socially competent, effective communication skills, ability to do, behave in a give and take way, good boundaries, all that stuff that goes into forming healthy relationships. But then you also have to believe that you are socially competent. There are so many people who have social anxiety now because they've spent 90% of their lives communicating with their thumbs instead of with a real person that actually getting in front of people can be very anxiety-provoking. The ability to self-regulate. We are not taught how to self-regulate. We aren't taught how to self-soothe from jump. That is something that we learn as we grow up. Now, we learn it. It's either going to be dysfunctional or it's going to be functional. Disfunctional ways would be addiction, head banging, getting into trouble, cutting. Functional ways would be more talking it out, writing in a diary, working out, something to help pro-socially get rid of that energy and then problem solve. And involvement in activities. When people are involved in pro-social activities, whether it's going to the park and going on a jog, walking your dog. I'm not talking necessarily anything huge, but there are a lot of things people will do that they won't engage in an addictive behavior at the same time. You're not going to watch internet porn while you're at the park walking your dog. You're going to walk into a tree if you do. But it also defeats kind of the purpose of internet porn. So involvement in activities that not only get you out, get you exposed to people, ideally, but are just contradictory to any addictive behaviors. So those are all addiction protective factors. Moving over to mental health issues, because as I say every time, co-occurring disorders are the expectation, not the exception. That needs to be my tagline. I just need that on a t-shirt. Secure attachment. A child who believes that his or her parent will go away and will come back is important. A child that believes that will grow up to believe that there are adults that will go away and will come back. Adults that don't have secure attachment have really dysfunctional relationships because they're constantly fighting against this fear of abandonment. An easy temperament. Now, that's a pretty broad thing there. But a child who is very, very fussy may tend to have more difficulty learning how to self-soothe partly because the parents have difficulty teaching him or her to self-soothe. It is possible. And there is that caveat there. People with addictions tend to have more difficult temperaments. They tend to have more difficulty self-soothing, which is why there's an asterisk by that because that kind of goes to both things. Now, an easy temperament is also something that is pretty subjective. Knowing what your triggers are for stress is really important. I can be relatively flexible, but I like to know what's what's happening. I love my schedules. So I don't do well in an environment where there is a lot of chaos. A lot of the clients, when I worked in residential, if we had to cancel a group, if we had to move a group, if there was a different facilitator for a group, would throw them into a complete tailspin. As people progress in their addictions, they become more needing to control everything, which creates a more difficult temperament. So helping people figure out what their triggers are for stress, how to deal with them, and how to sort of compromise because you're not always going to be able to plan for everything. Effective communication skills. This goes back for both of them. If you can't effectively communicate with others, you can't ask for help or you get angry really easily because you can't self-soothe or you've never developed those communication skills so you haven't developed healthy relationships, you see kind of where this is all a cascade kind of jumbly thing. Then you have difficulty developing social competence. There's that word again and the ability to self-regulate. Good coping skills. Well, addiction is a coping skill. It is not a good one, but it is one that people tend to employ when nothing else seems to be working or working effectively or quickly enough. So the development of good coping skills can help a person from getting to the point where they're in so much pain that they need to just numb it out for a little while. Now, this is not the only cause of addiction, but we do know that most of our clients who come into treatment, whether they've got mental health issues, they come in and go, I'm depressed, or they come in and go, I'm an alcoholic. Most of the time they don't come in and go, you know, here's the DSM. I've got everything in here. They will present with one particular complaint. And as we do our assessment, we will ferret out and see if there are other concurrent disorders, which there usually are. But good coping skills can help with both of them. Addiction and mental health issues. And even some physical health issues, because things like ulcers and gastric upset and some of those things that are exacerbated by stress, if you've got good coping skills, then those physical maladies, that somatization will not take place. And again, involvement and activity. So you see, there's a lot of overlap in the protective factors for mental health and addiction issues. The good thing is, you get more bang for your buck. In addiction, we want people to have a sense of well-being, a sense of self-esteem. Same thing for mental health. If people feel good about themselves and they're confident in themselves, then they're not looking to others to tell them, you're okay. When you start looking externally for validation, then the world can become a very, very scary place, because then you're always looking for someone else to tell you, you're okay, instead of being able to go, you know, I'm all that in a bag of chips, and if they don't like it, tough tiddlywinks. Positive future plans and achievement motivation. True for both people. We want people to want to get off the sofa. We want people to have hope that the future is actually going to be rewarding. If you don't have hope, if you're hopeless and hopeless, you know, those are two of our key features of depression. If you don't have a lot of hope and you don't have faith that you can do it, that's, we've got some anxiety going on there, hopeless, helpless, depressed, and just kind of paralyzed, you can see where this might lead someone to just go, well, screw it, I'm going to put my head back in the sand. And maybe when I pull it out next time, it'll be a different outcome. And I preach it all the time. So I'm not going to spend a lot of time on it. But for both mental health and addiction issues, good health maintenance behaviors, you need to get quality sleep so your body can repair itself so you can get back to that homeostatic level of everything. You need to have good nutrition so your body can repair itself. You're not going to ask somebody to go out and fix a house but not give them any supplies that wouldn't make any sense at all. The same thing is true for fixing yourself. You need to make sure your body has good healthy nutrition. Now, I'm not talking going overboard and suddenly cutting out entire food groups or entire things. Talk with your doctor. Find simple changes you can make. For example, drinking enough water, you'd be amazed at how many people find that that makes a huge difference in the way they feel. And that's one of those things that's pretty much not going to hurt anybody. So talk to your doctor. Make sure that you're getting adequate nutrition and, you know, I've said before, I said I wasn't going to spend a lot of time on this but hey, here we are. Good nutrition. One of the rules that one of my friends who's a dietitian said and it's stuck with me ever since is three colors on the plate at every meal. If you have three colors on the plate at every meal, you're probably going to be doing fine. And the other little tidbit, your stomach is about as big as your bald up fist. So you don't need to be taking one of those big dinner plates and heaping it high. Get a salad plate, put three colors on it, eat, enjoy your meal. And then if you're hungry, you can go back. But that gives people time to not only digest their food, multiple colors, trick your brain or let your brain know that there's actually a lot more food coming in than having one solid color. And the smaller plate tricks your brain into thinking you're eating more than you're actually eating. If you put that same amount on a big plate, you're like, oh, I want more food. Salad plate, it looks great. So let's move over to those peer protective factors. Pro social peer group and peer acceptance. Well, you got to find a peer group that's pro social and figure out a way to fit in. I encourage people to know themselves first. And a lot of our clients don't know themselves because they've been back in that category where they've been looking for external validation for so long that they've become chameleons. They are whoever someone wants them to be. You want me to be a wild and crazy drug addict? That's what I'm going to be. You want me to be a super conservative church mouse? That's what I'm going to be while I'm in your presence. Part of recovery is figuring out who you are. Part of prevention is encouraging people to figure out who they are and be comfortable with that. Develop that self-esteem going, this is who I am and that's okay. Not everybody's going to like it. Same thing with mental health issues. Access to pro social peers, if all your peers are negative, if all your peers are focusing on unhealthy trends, then it's going to be, or even most of your peers, then it's going to be harder to prevent problems. If you are surrounding yourself with peers who are, who all feel that they are good enough, smart enough and gosh darn it, people like me, Stuart Smoliesk, it's going to be a much healthier environment for a person, not necessarily even just a child, for a person to be in. And the ability to make and maintain healthy friendships. There's a lot of people who are really good at making friendships, but maintaining them is a little bit more difficult. It's like, okay, we're cool, there's a lot to talk about and then as soon as the initial lot to talk about is gone, it's like, I'm bored with you, goodbye. We need to encourage people to learn how to maintain healthy friendships and communicate with one another and find fulfillment from those relationships. Family, family connectedness, harmony and stability are essential to preventing addiction and mental health issues. You know, you don't have to be Warden June Cleaver, but that sense that everybody knows kind of what everybody is doing and is interested is important. The sense that, you know, children, you know, as they get older, they don't really want to hang out with us all the time as parents, but if they're willing to hang out with us some, that's good. Encouraging family time. So we're able to not only learn more about what's going on with them, but also just get a sense from the nonverbals where they are emotionally, mentally, physically. You can get a pretty good idea about what's going on. Family stability, not moving around every six months. And sometimes it's, you know, if you're in the military, it's not necessarily possible to have that same kind of stability, especially if you live off base, but family stability where there is some consistency of people who are there. They're not always running off and being, you know, locked up in prison or disappearing for months at a time. This is what I'm talking about. I'm not talking, again, I'm not talking about necessarily leave it to beaver because most people don't have that kind of family. But the more communication you have, the healthier boundaries you have, the healthier communication you have, the more you're modeling for children as they grow up, these behaviors so they can form healthy relationships. Positive, consistent parenting support and discipline. Being there and being aware is so important for children because they know what they can get away with, and children are going to be children. They're going to try to get away with stuff most of the time. So if the parenting is consistent and they know that if I do this, I'm going to get in trouble, it creates a much more calm environment for the child. My son, when he was, he had just turned, he had just turned two? Yeah, I think, yeah, he had just turned two when we were at my grandmother's house and nothing had been child-proofed but he knew we didn't touch the television. But we were in a new place and there were new people around. So he walks over to my grandmother's television and he looks at me and he goes, no touch. I said, that's right honey, no touch. And he looks at me and he looks at the TV and he looks at me and he touches the TV and he looks back at me and he goes, time out. And I said, yes sweetie, time out. So the consistency in parenting, he knew that if I do this, this is going to happen. He's two. It's not like it's brain surgery, I'm expecting him to do. But he was able to understand what happened and then when time out was done, he came out and everybody was good. He didn't feel bad about it. He was just being a little scientist. Living in a two-parent family has been associated with reduction of risk of a lot of mental health and addiction issues. Partly because this means that there's a greater chance that one out of the two parents is going to be there to be checking in on people and consistently supporting and parenting. You know, not that one is and one isn't. I'm just saying it's more of a tag team. It's more of a relay. So there is definitely something to be said for families, even if the parents are not married and living together, to have one parent involved at all times. Higher parent education is associated with preventing the development of addiction in children. This hasn't been replicated as much in mental health issues. One of the things they speculate is that higher parent education means that the parents are probably able to earn more money and create a situation where the environment is more positive, less transient. You know, there's less risk of homelessness. The parents may be less stressed about finances, yadda yadda yadda, which takes us to financial stability. That connection, if a child is not worried about where his next meal is going to come from or whether there's going to be a roof over their head or that kind of stuff, that's good. If a child, I mean, children are very, very aware. So if the parents are worried about it, the children may not understand exactly what the parents are worried about, but that stress bleeds down. Young children especially have very poor boundaries. So if mom and dad are stressed, they get a little stressed too. I'll give you an example. When the treatment program I used to work at, we had an IOP program, which is intensive outpatient, and people would come five days a week for three hours each day. During spring break, they would bring their children and the staff would just be very, very frustrated during spring break when they would bring their children because the children would come and they'd be fine and then all of a sudden, quote, unquote, they would start to act out. And I was doing my internship and I was sitting in a supervision session and the director of the program at the time said, you know, children are little barometers. If little Johnny is doing just fine in the room and then he starts to act out, my guess is something's going on with mom. Now, if little Johnny's acting out from jump, you want to figure out if there was something going on with mom to begin with, where he's stressed out or whether mom doesn't have the ability, doesn't have the skills necessary to teach him how to self soothe. Either way, we're getting a lot of information from little Johnny. So, yeah, I think the kids still do get to come and be present during the spring break. And they had activities they would go do. They wouldn't sit in therapy groups. That wouldn't be useful or appropriate, but it was interesting to see that perspective. So, higher parental expectations about school. Children who are pushed to do their very best tend to focus more time on schoolwork so they have less time to get involved with other less healthy stuff. And parents that model effective coping, we went over that. Other things that go into preventing the mental health issues that may underpin some addictions protection from harm and fear. If children are in scary environments, then they can develop anxiety, depression, and eventually lean towards addiction to self soothe. Opportunities to resolve conflict. If they don't know how to resolve conflict, that's one of those things you got to learn, then sometimes that anger, resentment, guilt, all those things get stuffed down. And eventually, they either come erupting out or they have to be numbed. And emotionally available responsive caregivers. These are parents that are there and they can say, you know, you're having a bad day. My son, bless his heart. I talk about my daughter in some other programs, but when he was little, he had ADD. I mean, depending on your school thought, he may still have it, but he's not symptomatic anymore. But he would get overstimulated and when he would get overstimulated, he would melt down. And as little as three years old, he knew when he was starting to hit that wall. And I remember one day we were sitting at the house and I was working on the computer, I was working on my schoolwork. And I don't know what had happened. I don't remember. It was many, many years ago. But I distinctly remember him looking at me saying, Mommy, I'm overstimulated, popping his binky in his mouth and going and sitting in his room. And he had his little toddler bed and we had one one wall in his room that was nothing but blank white. And he was just sitting in there staring at the white wall. And when he felt like he had gotten it together, he came back out like 15 minutes later. But teaching children how to identify their own stuff, teaching children how to identify when they're overstimulated, when they're tired, when they're hungry, when they're angry, is really important because those are the things that's the awareness that the children need to have and people need to have to prevent developing bad things. When we talk about with people with addictions, they'll say this relapse came from out of the blue. Well, nothing comes from out of the blue. So, what was it that you missed? What wasn't that you weren't paying attention to in your own feelings? Most of our clients have a real big, big difficulty identifying lesser feelings. They get it when it's rage. They get it when it's isolation. They get it when it's terror. But if it's a little bit anxious, they just ignore that. Or, you know, kind of blah, they ignore that instead of nipping it in the bud and going, why am I not feeling happy? So, all these things go toward helping develop people, families and communities that nurture healthy people. Work in school, we need to have a caring work climate, a caring school climate where the teachers actually care about the students, not just whether the students score a certain score on their annual achievement test, but who actually care, who actually pay attention to what's going on with the youth. Same thing at work. Bosses who actually care make it a much more tolerable environment because, you know, not everybody wants to go to work every day, but if you have a boss that actually says, you know, hey, you seem like you're having a bad day, it makes it a lot easier for people to want to be there and feel a sense of connection to work environment. If there's successes, we want to make sure whether it's at school or at work that people have successes and they are congratulated on their successes and not just corrected on their mistakes. We all make mistakes, but if the only time you ever hear from your boss is when he or she is coming in to correct a mistake, that's not okay. It gets to be, you start to dread seeing that person. Just like in school or just like in the family, high performance standards are really important because if people are trying to perform well and perform at their best, then they're going to be more focused on the task at hand. They may also ask for help. They may also find social support. Regular attendance is important for mental health and addiction to prevent this from happening. If you've got someone who's calling in sick constantly, especially Mondays, or the day after payday if you don't get paid on Friday, that's a big clue and it also hurts connection and when you have somebody who's absent a lot, not only are they not connecting with their peers, but they're also spent in the workplace at least oftentimes drawing some criticism from their peers because everyone else is trying to pick up their slack. This connection and communication between family and school is really important to prevent mental health issues in youth and teens. Children, as they start to develop their own person, their own sense of who they are, their own peer groups can behave very differently in different settings. So making sure the communication is there where a teacher may notice something that wouldn't even be demonstrated at home. Environmentally, the availability of community support services, health, mental health, housing, food and child care, we have got to take care of that, you know, Maslow hierarchy. We've got to get that bottom wrong taken care of, those biological needs. We need to make sure that children are in a safe environment. Parents who are stressed about where their kids are are not going to be good workers. They're going to be anxious. You know, we need to make sure that we're looking at not only the safety of the child, but the well-being of the parent and that parent's ability to be productive at work and be emotionally available at home for their child. Opportunities for community involvement and community attachment are huge for both. If you're getting out and you're engaging with other people, then you've got that social support. Does it mean you will never get depressed? No. Does it mean you will never get anxious or stressed out? No, but it means you've got more resources available in your toolbox when those things happen, more healthy resources. Low unemployment, if people are not stressed out about finances all the time, then it reduces the stress in a lot of other areas. Positive community climate, obviously we want to create an environment that is welcoming to all people. One that encourages people to like smile at their neighbors and there's community parks and people go out and do stuff as opposed to staying walled up in their in their apartment with the door locked in the windows and the blinds drawn. So what we want to do, all of these things are basically devoted to helping develop a person. You notice I don't say a child because this can start at any place in the age continuum. We want to develop a person with a strong self-esteem. Teach them what self-esteem means. It's feeling good about who you are. Not what you do for other people, but who you are as a person. Helping people learn effective coping skills. There are, to this very day, I read different books, I create different classes, I encounter different people, I still learn new coping skills. It doesn't, just because you become an adult doesn't mean you've learned all your coping skills. There are lots of skills and tools that you can learn along the way. I try to learn something from everybody that I encounter and I try to learn at least one thing every day. It's not always a coping skill, but that helps keep me looking forward and that helps keep me curious. Positive health maintenance behaviors. I know, broken record, nutrition, sleep, exercise, circadian rhythms, we need to take care of ourselves so our body can take care of us. A healthy support system, a system means more than one, generally. Helping people develop relationships that are nurturing that they can fall back on. And a sense of pride in and connection to their family, the community and the workplace. We want people to feel like they belong. We want people to feel like they're not only needed, but they're wanted. We want people to feel like they'll be missed if they disappeared. We want to develop a community that maintains a positive, accepting social climate and has sufficient resources to meet the needs of its residents. Now that's a big one. What does that mean? What does that mean for your client, your community? What resources does it need and how can those be developed through volunteer programs? Where I came from in Florida, you know, we had the university so we had interns coming out our ears. There were plenty of volunteers to help out with stuff and there were plenty of programs that knew how to exploit those resources. But not all communities have that. I'm in Nashville right now. You know, you would think Nashville has everything. They don't have a vet school. And I do pet rescue. And in Gainesville, we had the UF School of Veterinary Medicine. And a lot of our Spain Uters and low-cost rescue medical care went through the vet clinic. Here we don't have that. So it's trying to figure out how to meet the needs of the homeless puppies and kittens in an affordable way. So we need to make sure that we take a good inventory of what resources our communities have, what resources they need and how we might be able to make those come to fruition. It provides opportunity for engagement of people of all ages. A lot of times communities have a ton to do for elementary and younger and a ton to do for adults. But from the age of like, you know, nine to 18, there's not a lot unless you're involved in school sports or a couple of, you know, some school extracurricular things, which is fine, except for on the weekends when school's not in session and the summers and the breaks. So what opportunities are there for youth to get involved and do things? You know, it could be educational opportunities, it could be volunteer opportunities, it could just be recreation. The community needs to communicate the unacceptance of addictive and violent behaviors. And this isn't just substance use. This is also violence, internet porn, gambling, those sorts of things. Provides adequate educational opportunities to help residents prevent mental health and addiction issues. Bite size chunks. Again, I want to emphasize that, especially in this digital time that we live in, people like snippets. They don't like things that are an hour or two hours long, as I prattle on for the 47th minute. People like things in short little bite size chunks that they can get in public service and announcements, that they can get in a postcard, that they can get in a handout, that they can get in an ad that goes before a YouTube video. All of these educational opportunities, it's 15 to 30 seconds to give someone a tool that will help them or give someone some information that they can use at a different point in time. So if you've watched this and participated for CEUs, you can now log into the classroom and take the quiz. If you've watched and participated in this presentation and want CEUs but have not yet registered, you can purchase access to the quiz and certificate at allceus.com slash live-interactive-webinars. This presentation was recorded as part of a live interactive webinar. If you're watching it on replay, please remember, you can contact Dr. Snipes on her personal chat page at purechat.me slash qtvx.