Estrés y trauma: Cómo mitigar el impacto de la pandemia

(En inglés)

Stress and Trauma: Buffering the Impact of the Pandemic

Steve Shuman: Now we can begin. And if you were here for part one, you know who we have as our speakers. Dr. Vilma Reyes, the assistant clinical professor at UCSF, the University of California San Francisco Child Trauma Research Program. And Dr. Karen Gouze, the director of training and psychology at the Ann & Robert H. Lurie Children's Hospital of Chicago. I'm going to pass along to Vilma and Karen.

Karen Gouze: Well, greetings. And thank you everybody who was here on Tuesday, welcome back. For those of you who are new, please do take a moment at some point to see the first webinar, because these really are meant to be a package. But we're happy to have you. Let's start with just talking a little bit about what our training objectives are for today. They're here. First, participants will be able to identify three strategies that can be used in early childhood classrooms to ameliorate the impact of potentially traumatic events, including the pandemic. And keep in mind one of the things that I think is important when we're talking about trauma- informed care, that a lot of the strategies – probably most of the strategies – that we'll be talking about are really just good care and are familiar, at some level, to early childhood care providers. Second, participants will able to identify three strategies for self-care that can help reduce pandemic-related stress in themselves. We've all had a very difficult year. And we want to think about self-care, both in the context of taking care of ourselves, but also enabling us to be available for those who are working with. And finally, and actually this is the first thing we're going to talk about, participants will be able to identify three strategies for creating a culturally safe and equitable environment. And we are talking about this because we don't think that we can really separate issues around cultural safety, equitable environments, and racial equity from issues of trauma.

Just a reminder, if you were here last time, you know that we always have a self-care alert. We want you to know that we understand this content can sometimes be difficult for certain people, or it may just be a hard day for you, whatever. If you need to, pause and take a break, keep your own counsel. Nobody is going to judge if you need to reach out to somebody. Do some deep breathing. Stand up and stretch. Do whatever you need to take care of yourself.

First, we're going to talk about trauma in context. And we're going to start with the conversation about race, racism, marginalization, because as we said on Tuesday, historical trauma plays a large role in affecting that invisible backpack we talked about, that children we serve bringing with them every day. It's impossible for us to talk about the pandemic without also talking about the disproportionate effect and impact that it had on communities of color and those who have been historically marginalized. As we noted last time, we were all affected by the pandemic. We were all in the same storm, but we weren't all in the same boat. Some of us were in yachts, and some of us were in dinghies with holes. In order to just bring home the point that in our work, we really want to be thinking about racial equity and communities that have been historically marginalized. We want to talk about a couple of concepts that are really critical when we do our work.

And the first of these concepts is implicit bias. And many of you probably thought about and talked about implicit biases a lot in the media about this over the past year. Implicit bias basically refers to the attitudes and stereotypes that unconsciously affect our perceptions, our actions, and our decisions. These are things that we aren't always aware of. We all have implicit biases. They tend to be pervasive. Everyone possesses them. And they are often at odds with our explicitly stated beliefs. No matter how much we have read, we've thought about these issues, we have explicit beliefs that we hold dear, that are very different. We all have implicit biases.

These are the implicit associations that we've learned from the time we were very little children, are formed in our families, our communities, through the media. And again, everybody has them. One example of a pandemic-related implicit bias might be, for example, blaming communities of color for the higher rates of COVID in those communities. Some sort of implicit notion that, “Oh, they weren't doing something right,” or “It's their own fault that they had higher levels of COVID.” I'll give you an example. My son lives in Japan, and he's Caucasian. And he came to an elevator just the other day which had a sign on it which basically said, “Foreigners, please do not get into this elevator with Japanese nationals due to COVID-19.” The implicit bias there, or assumption being that because my son was a foreigner, he was somehow maybe more likely to carry COVID-19, or we're somehow more dangerous. There are many examples of this in our society.

I think when we're talking about school – preschool – it's really important to notice that teachers, all the people who work with young children have these implicit biases. And one of the most interesting studies in this regard was this Yale study done by Gilliam in 2016. In this study, teachers were basically shown videos of children in a classroom setting. And each video had a Black boy, and a Black girl, and a white boy, and a white girl. Teachers were told that the researchers were interested in learning about how teachers detect challenging behaviors in the classroom. They showed the educators video segments of preschoolers engaging in a whole range of activities. And some of those behaviors they were told might be challenging, some might not be challenging.

They were told that their job was to press the Enter key while they watch these videos every time they saw a behavior that could be a potential challenge. What's interesting about this is that in fact, none of the behaviors in the videos were considered challenging. There were no challenging behaviors. Nevertheless, when teachers were asked which children required the most attention for these challenging behaviors, 42% of the teachers identified the Black boy. And they even used eye tracking technology to see where teachers were looking. And they noted that the preschool teachers showed a tendency to more closely observe the Black students, given the instructions they were given. This is an example of implicit bias. I think if you had asked those teachers, they would have all thought they were treating children equitably.

This brings us to a discussion of marginalization, OK? What does marginalized mean? It means to relegate to an unimportant or powerless position within a society or group. How do we think of this in our society, or how do we see it manifest in our society? Well, for example, in school, children of color tend to be marginalized. We know that Black boys are suspended three times more than white boys in school, and Black girls are suspended six times more than white girls. When we do that, we're marginalizing those children. And we know from the previous slide, that very often, these suspensions are not going to be for behaviors that we're any different than other children are showing. In the larger society, people are also marginalized. We know, for example, that one in 17 white men have a lifetime likelihood of imprisonment, whereas one in three Black men, one in six Latinx men have that same possibility. We know that there are much higher rates of incarceration among people of color. That's not news to you. But I think sometimes looking at the actual numbers are pretty staggering. For women, there are one in 111 white women who are incarcerated in their lives, and one in 18 Black women, one in 45 Latinx women.

Marginalization tends to affect communities of color and those with fewer resources for COVID-19 as well. These communities had less ability to stay safe during COVID. And why? Because these were communities where people had jobs where they were in, perhaps, service jobs, that had to go to work. These were people who had to use public transportation to get to work. There were all kinds of reasons why communities of color had higher rates of COVID-19 during the pandemic. There was more food insufficiency. There was more economic stress in these neighborhoods. These children when they come back to school, keep in mind, have experienced over the past year a huge load in terms of feeling marginalized, perhaps being exposed to potentially traumatic events.

And last, I want to talk about the difference between intent and impact. Even though nobody, I think, or most people who are thoughtful, don't intend to marginalize others or intend to be racist. Like those teachers in that Yale study, they didn't intend to be racist. What we really need to be thinking about is the impact of what we do on the people we work with in our centers, the families we work with in our home visiting, the children we work with in our classrooms. Here is a swimming pool pamphlet. This is a safety pamphlet. It's a real pamphlet, that was distributed by actually a very well-known humanitarian organization. And it says, be cool, follow the rules. This is a pool safety poster that was put up in public pools around the nation. I'm going to give you just a second to look at this and see what you notice. Just look at it for a few minutes.

Basically, if you're looking, what you see is that the various cool kids – cool kids – are following proper water safety procedures, while the not cool kids are engaging in risky behaviors. But if you look more closely, what you see is we have a cool blond girl, who waits her turn by the diving board. A cool fair skinned dad is minding his small child. The vast majority of the not cool behaviors have brown skin. For example, we have one little boy who's running through a puddle. We have another child who is diving too close to a swimmer. And finally, we have a little Black girl at the bottom of your screen, bottom right-hand corner of your screen, who's actually pushing a white girl into the pool. The point here is that we all have blind spots. The organization that put this up is not an organization that's known for being racist. It's a huge humanitarian organization. To their credit, when this came to their attention, they took these down everywhere. But this just gives you a sense both of implicit bias, how it gets manifest, and think about the impact of this on kids who see these posters every day.

There are many of these sort of visual renditions of equality, equity issues. I like this one. We tend to use it because we think it best represents the differences between equality, equity, and what actually is happening in reality. If you look at this picture, you see that in the first image, everybody's being treated equally. Nobody can see over this fence, but they all have the same size to stand on. That's equality. In the second panel, we have equity. In this panel, what we've done is we've compensated for the differences between people. The tall person who can see without the crate is standing on the ground, whereas this little guy needs two crates to see over the fence is standing on two crates. The third frame tells what is it really like. What it's really like is that people of privilege are on multiple crates. They're not just able to see there's not just equity that's happening here, that person has real advantages. That is a kind of representation of privilege. Whereas this little guy – the guy who needed two crates – he is actually stuck in a hole. He is stuck in this large divot.

This represents years and years of inherited disadvantage and privilege based on race. In some of these renditions, the fence is down, and people call that liberation. I think there are many ways to think about these issues. But I think it's important to note that Head Start strides very hard to ensure equity, including as children grow. But the extent to which children we serve are in that big hole, I think, became even more apparent and exacerbated during the pandemic. And it's going to take extra thoughtfulness on our part, extra commitment, and extra work for us to bring this little guy up to the point where he can actually see that ball game.

We'd like to move this discussion to a more optimistic note. This is the way things are. They've been this way for a long time. I think there's greater awareness. One of the things that happened during the pandemic – in addition to the pandemic, and I don't think these things can be separated – is that we had a summer of a lot of racial tension due to the George Floyd murder and other police brutality incidents that happened. I think what we want to think about is, how can we make things better? How can we heal? And as we move towards this idea of healing-centered environments, I think we have to focus on issues of race, equity, and culture, especially post- pandemic, because of the unequal effects of the pandemic on different communities.

It's very important for us to equip our workforce in Head Start – the people we work with – to talk with our families about things that can help them heal. The three critical factors to healing are passion. Passion is the level of connectedness each of us brings to this race inequity work. It has to be strong enough to overwhelm the resistance to change you will encounter, because people are very resistant to this kind of change. If you're following the media and all the discussion about school curriculum and critical race theory, you know that you're going to face resistance. We need to practice. The actions of each of us must be to practice effectively to engage all children all the time and all families, especially children and families of color. This is going to take extra work. It means engaging your knowledge base, what you know, being self- reflective, so that you understand the impact of your actions on others. And finally, persistence is critical. We need to have patience and urgency as we move forward in this work. The work basically starts with you.

We want to acknowledge the historic and present-day manifestations of racism and inequity. We want to acknowledge that privilege exists and that some children have tremendous advantages over others. We know, for example, that preschool children of privilege start school with a lot more skills than children who come from marginalized and historically racialized communities. That's what Head Start's all about. We're all in this space working together. It's especially critical, again, after the pandemic, and the George Floyd murders, and all these instances in which children from these communities got messages about themselves, that maybe things aren't so great in the world.

We want you just to think a little bit about what are you grappling with? Where do you need to grow, and learn, and evolve? How do racism and inequity manifest in your work and your life? And who, in your world, has the power? When you think about the children and families you work with, do they feel disempowered? Why is that? What is it about? What can you do about that? And let's think about the fact that we're all sometimes grappling with discomfort, guilt, and anger around these issues, potentially our own trauma backgrounds. You need to give yourself some compassion and kindness. And we'll talk about that a little bit later.

And prepare to work hard to achieve racial equality in programs and practice. How do you do that? You engage your spheres of influence and find your allies. We talk a lot about the importance of connection. Vilma is going to talk about relationships and how critical they are for helping us in the classroom promote children's health and well-being. That's true in this work as well. This work is hard. You need to be connected to people who are also interested in doing this work. And you also have to acknowledge the risks that may be involved in acting.

In terms of realizing and recognizing an equity lens for Head Start staff, I think there is some strategies that we can think about. We can work hard on creating a culturally safe environment. This is both virtually and in-person. And again, Vilma will be talking about some specific strategies for this. We can infuse cultural diversity into toys, and books, and images, into the things we put up in our classrooms, the things we talk about. We can acknowledge these things when we do home visits with families. We want to create culturally-safe environments and environments in which we are accepting of all kinds of people and all different kinds of backgrounds. We also want to commit to continuing education for ourselves on cultural humility and self-awareness.

And we want to help teachers understand that dealing with behavioral issues in the classroom, dealing with racial disparities in discipline is something that they need to be aware of. We want to always consult with teachers to provide increased support and guidance on how to manage these behaviors that might be disruptive. Trauma-informed care includes self-reflection, reflective listening, building relationships – we're going to talk about all these things – and putting in place strategies and practices to reduce the need for discipline and disparities in disciplinary practices. We want to be proactive.

At the organizational level – because this isn't just at the individual level – at the organizational level, we want organizations to begin to recognize the current issues facing children and teachers, communicate safety and respect, provide cultural competence learning to staff, recognize cultural differences – things like recognizing people's holidays, for example, and allowing people to have time off. Employing individuals who are representative of the children, families, and communities that we serve. This is really critical. People like to see people like themselves. And definitely, to employ individuals who speak the same language as the children in your center. There are different ways that individuals address tragedy or hardship. And understanding that, understanding parents and families willingness to share or not share in the context of their cultural backgrounds is really important.

Finally, asking questions about things like preferred pronouns and language, and building on culturally specific, help-seeking behaviors is really important. When you talk to children about race, be honest, embrace curiosity, broaden their choices, foster pride, lead by example. Children may have heard more or less about what's been happening over the past year. You don't know what they're hearing in their houses about things like the incidences on the news. We know that as early as 6 months, babies are noticing racial differences. By the age of 4, children have begun to show instances of racial bias. Start by being honest. It's not OK to say people aren't different. People are different. Acknowledge those differences, be open about them, be accepting. Remember, children and families are going to model what you do in your work.

OK. With that, I'm going to move to Vilma who is going to talk a little bit more about taking these culturally sensitive, trauma-informed strategies into early childhood settings.

Vilma Reyes: These three essential components we strive for in programs. Safety in the environment, building relationships and connectedness, and supporting and teaching co-regulation, emotional regulation, are only possible if we have the buns on the hamburger. Caring for yourself and your community and each other, and holding the lens of culture and equity, as Karen just introduced, in everything that we do is what really holds this together. Karen spoke about this image yesterday as a metaphor of the lens in which we use to inform programs. And not just what we do, but who we are, and how we think, and how we respond to children and families, and what we consider, and what we hold in mind, what centers us, what anchors us – are these things. It's what makes the work possible. It's what makes it sustainable.

Safety, starts with safety. What are all the layers of safety? And again, we do all of this. In its heart, it's communicating to children, “You matter. Your safety matters. You belong. I care.” And we communicate that through all these ways. Physiological, meaning having access to a safe, clean water, opportunities to move, correct lighting, temperature. How are you setting the classroom environment to show physiological safety? Physical safety, similarly, with the flow of the classroom, the furniture, the daily routine that they can count on that's posted. It's safe to explore.

Behavior safety is letting children know, and truly believing that you understand that they are more than their behavior. That we want to give you a consistent container with clear expectations. Apply restorative practices when we need to help shift behavior. But at the end of the day, the children are much more than the tip of the iceberg behavior that we see. That we know that they're more than that. And we are curious to understand their behavior, not just to change it, but to understand it, to hear them, to see what they're trying to tell us, to know them. Educational safety scaffolding, offering choices. We can't stress how much choices matter, even the small choices. They really prevent power struggles. And especially for children, even developmentally, so much of what happens in the world is outside of their control. If you can give them a sense of agency, and even the small choices in their life, that makes a big difference. And it gives them practice with decision-making.

And social and emotional, which is a lot of what we're talking about today, is essentially expanding their capacity to identify, to tolerate, to express feelings in an appropriate way by modeling it, by practicing it. And especially coming out of COVID, children might have had less exposure socially. They might need more practice managing feelings. And really, at the end of the day, as you're helping shape people, what makes people most successful as adults is really the social-emotional world, and us being able to modulate our feelings, and who we are towards each other. You play such an important role in this. And all of this is towards safety, and all within the context of relationships.

We have so much research that shows the positive outcomes that we know we're all hoping for in the children you serve are connected to secure attachment, secure relationships. And really there's so much that we do for young children as teachers, including learning and academics in so many areas of development. But at the end of the day, the most powerful thing you do for kids is if you can help promote a model of secure relating. That is really the most influential thing that you can do that sets them off in their life trajectory. And I don't just mean the relationship. We'll talk about all the relationships within what I mean with relationships, not just the one you build with them, but the relationship that they have with their caregivers, and ways that you can also help heal, restore, and promote that. I think that's all with this, Karen.

Let's start with the teacher-child. What kids will take away from their time with you is how you made them feel, how they feel with you. And we will be talking that this why self-care is a big part of that container here. Because, I've been a preschool teacher myself back in the day, and you have a lot of really great intentions and education. And you want to do all these things. But what makes it hard is at the end of the day, when we're stressed ourselves, we've also been impacted by COVID in a universal level in some way, it gets hard to implement it. So these are good reminders. None of what you see here is anything you don't do, or that you don't know you should do. It's really more about can you keep your heart open and genuine because kids sense that. Can you find something that you love in every child because they can sense that. And that's really at the end of the day, what they need, is to know that they're cared for by you. And if you don't feel that way, that's OK. Bring that to the other teacher in the room, to your supervisor, or to your team, and say, “When this child does this thing, that really irritates me.” Talk about that, because otherwise, it will impact what you do, and they will feel it.

Being warm, paying attention to the tone of your voice, being at their level, all of these things that you've been trained to do go a long way in children feeling seen, heard, understood, cared for. We can go to the next one, which is a continuation of things I've already talked about with choices – seeking the benevolence underneath the most, sometimes harder behavior to understand is the aggression, the rage. Trying to find the suffering underneath the rage. That's a secondary emotion to something else. They more likely feel threatened, feel afraid, feel disconnected. Seeking that benevolence, remembering what that behavior means will help you in maintaining compassion. If you need to take a break, take it. That's why we work in teams. Take a break, come back to that child later. But really, honor that the main thing you're doing for them is you're giving them a model of a relationship. That really is beyond all the academics that we hope to provide to prepare them for kinder. It really is the main thing that will set them off in a successful course.

Peer-peer strategies. I thought what I miss the most about being a teacher is you have such an exciting opportunity, that you have a microcosm of the world in your classroom. And there's so much opportunities there to create the world that we want – that we all want. Creating a culture of compassion, of equity, of inclusion. How you're helping them relate to each other. And as I said, with COVID, it's likely they've had little practice. If there isn't a lot of siblings, or cousins, or neighbors, it's possible that you're seeing children that haven't had a lot of peer-peer interactions in the last year and a half, which is really key in development when you're 3. Some of the 3-year-olds who are coming in don't remember life before COVID. And there may be some hesitancy. They've had messages of people that are on stage, “Don't get too close.” I see this even now as we're re-entering in public spaces. Parents telling their kids, “No, don't touch that kid, don't get too close to that kid.” How has that impacted their social world? I don't think we'll really see all of it until years to come.

It's very unique. This is the first global pandemic in our lifetime, Karen and I, so we're here. We are relying on what we know from our field to help inform the future. But we also don't have all the answers, because COVID is happening right now, and it's new to our field. Be observant. Be noticing how has it shifted how people relate to each other. Are they more conscious? Do they need more help? And all these things that you've already been your bread and butter. Turn taking, and being collaborative, and all these things will come up, on top of probably some new things that you'll be noticing, like maybe fear of germs, or fear of being close, or just not a lot of exposure to what you would expect to see in 3 and 4.

Parenting is by far the most difficult thing I have ever done in my life. It's the most humbling experience, like bring you to your knees humbling experience. If you're not a parent, I'll let you in on a secret here. Parents, we are constantly living in guilt, or fear, or out of shame just under better circumstances. And especially with COVID, we all worry how our kids have been impacted. Did we do good enough? Are they OK? Now, you put that on top of exposure to trauma, both the systemic trauma and personal trauma that many parents might have experienced, and you have a toxic brew of shame, and doubt, and guilt.

When you're working with parents, and some caregivers are harder to engage. Those are the ones that need you the most. Those are the ones that are so riddled with guilt and fear that they avoid you, because they're worried they're going to hear, “Something is off with my kid,” or that “You need something for me that I can't do,” and “I'm juggling three jobs,” and “I can't meet with you for this conference.” Those are the parents that need you the most. Stay optimistic and compassionate with caregivers. If you want to help a kid, help their caregiver. Research supports it. The best mediating factor for kids, especially after traumatic events, is their caregiver's ability to manage the traumatic event.

If anything you do, don't give up on engaging caregivers. And I love that about Head Start. It's always been a model that engages caregivers. In everything that you do, be consistent, continue to try to meet with them, to get to know their world. How has their life been the last year and a half. If you're doing home-based, this is your bread and butter. You're in their home, which is the most intimate, really context in which to know anybody. All that you have, in terms of humility, and respect, and coming in to learn from them is so important. And if there's any little part of you, or a big part of you that feels a little judgmental towards a parent, or doesn't understand why they responded to their kid in that way, or why they discipline their way, reflect on that. Bring that to your teams. Think about it so that it doesn't affect you, because parents are already feeling that. And if we bring that forward, it's just going to make them so much worse. They're already so sensitive to it. It's like they smell judgment on you.

Best intent always, and keep trying. I'm going to move a little bit quicker on these next ones. But I feel like we refer to it at different times. And I feel like you already know this. You're so good at this. You've already been doing it. Let's just think about now what differences you're seeing in the classrooms, and what you need to do to help support them even further. But all the things you do of structuring the classroom in a way that creates this culture of how they are with each other, and respecting and celebrating each other and their differences is so important to create a different world.

Triggers about trauma are really intense, and often, not easily identified. There might be some obvious triggers in your classroom. Like if the fire alarm goes off, you could expect that kids might be hyper-alert, might experience an alarm from hearing that internally. There are other triggers that are less obvious. Like for example, you might be serving lunch, and this kid throws the spaghetti against the floor, and you think, “Where is this coming from?” Let me make it as simple as possible. If you see any behavior in any children or their parents that you don't understand, that doesn't make sense to you. I guarantee you it does make sense. You just don't know the full story. That kid might have been triggered by the spaghetti because last night, their parents had an argument, and somebody threw spaghetti against the wall. And all of that came back to them, and they felt scared. And that's sometimes hard to understand.

Bottom line, if you see something that you don't understand, their reaction doesn't seem to match what's happening, it means you don't know the full story. They can be triggered by the weather, by the color, by the tone of your voice, by the eyebrows that you have when you … Maybe you're thinking of something else, but they think you’re upset with them. Those can all be triggers. And just remembering that that's how our brain works. Our brain wants to keep us safe. If we think that there's a threat, they're going to go into a stress response. Even when to you, it seems like a perfectly safe situation.

I feel like this maybe goes inside. In the moments that I just said where you need a break, it's OK to model that. It's OK to say, “Oh, I need to take a breath. Maybe we can take a breath together.” Notice the tone of your voice and model coping strategies as you also need them. Always trying to infuse empathy and compassion in everything you do, of course, and how you are with kids. Young children cannot yet regulate their emotions, which is why we call it coregulation, and that is probably the biggest task you have. You're essentially letting them borrow your neuropsychology, your neurobiology. You're letting them borrow your calm temporarily. When a child is upset, they don't have any of these skills yet. You're trying to build those strategies. And these are some of many other ideas of how to build emotional intelligence per se, of like … “We talk about feelings in this classroom. We give you practice with identifying feelings. This thing you're feeling – it's upset, it's angry, it's sad.”

And we help them tolerate that. We're not trying to change it. All feelings are OK. We don't need to just change the sadness, just let it be. Help them be able to be with feelings, and tolerate them, and identify them. Really, this is the main thing we all need as adults. Like a lot of problems that we get with adults trying to numb out or escape feelings. If you can help a child just tolerate with what is in a mindful way. You're giving them such a gift. You can do these through charades, so many creative games that I know you have, puppets that have different feelings. Make sure that you prioritize that all things are OK. They're not good feelings, and bad feelings. You can build in some stories where people have sad feelings that go away. And happy feelings go away too. They all pass you. And they all happen within the relationship of – you can stay here – of coregulation.

We can go to the next one. All of these great strategies, and there's so many more, will not work if you're not calm. You are their go-to person. They need an adult to help them do it. It's not just the skill, it's how it's done. It is, “I need to be calm so you can borrow my calm, and we can do it together.” The magic is in the relationship you've already built with them, that you're leaning on in this moment. The magic is not in any of these curriculums. They're helpful, and there's many out there. And there's all these apps now, with like GoNoodle and fun videos. Go to town, that's great. But none of them will work if you just give them the strategy. They need you to do it with them. They need a calm adult that cares for them to do it with them. We, as humans, eventually internalize. And someday, most of us can maybe do it on our own sometimes. And that's self-regulation. We all still coregulate. We still go to our partners, our loved ones to breathe with us, to tell them about our hard day. When you're thinking about feelings, it's in the context of relationships. And we have great strategies that you can use too.

 But pay attention to how fast your heart is going when you are helping them calm down. Problem solving begin as well, and part of emotional regulation of practicing, giving them the words when they don't have it, and having them practice asking for what they need. And part of regulation is also sensory integration, which can be having play dough or sensory activity, things that provide sensory integration. I, again, think it's how you present it. I've seen amazing calm corners. But sometimes, they're used kind of in like a consequence way. Like, “You're really out of sorts. You need to go to your calm corner.” Try with all your might to use it as a choice. It's a place where they can go to have maybe less stimuli. Maybe you can sit in there with them if they want someone there. It's a choice and not a consequence. But be thinking about how do we help them through those moments, including what they need in terms of their sensory integration, and entrusting that the moment will pass.

Karen: Thank you, Vilma. Vilma talked a lot about the importance of the relationship. She talked about the importance of coregulation. She talked about the importance of adults staying calm. The truth is it's hard for us to do this when we are not in that space by ourselves. When we're not taking care of ourselves. We've all been through a really difficult year as well. Everybody you're working with has been through a difficult year. In order to be there and do the kinds of things Vilma's talking about for the kids in our classrooms, for the families we work with, for our co-workers, we need to be able to take care of ourselves.

Many of you have probably seen these terms – compassion satisfaction and compassion fatigue. We all work in this field because of the pleasure we derive from being able to give to others, to take care of others, to be with others, to be in caregiving systems. That's compassion satisfaction, and we all feel good about that. But along with compassion satisfaction, often comes compassion fatigue. And basically, what this means is that sometimes, taking care of others can be exhausting. And it can especially be exhausting when the people that you're taking care of, or that you're working with have experienced their own trauma, or been through very difficult times when they bring that into the classroom or into the work setting. You've probably heard other terms that are often used along with compassion fatigue, like secondary traumatic stress, vicarious trauma, traumatic stress, burnout. All of these have slightly different meanings. I think what's important to note is that COVID was exhausting for all of us. And the children and families that we're seeing may be coming back with even more experiences of trauma, the work is going to be hard. It's going to be exhausting. And as rewarding as it's going to be, we're also going to need to take care of ourselves.

And I want to note that today, we're talking about individual self-care. But it's really important to note that we're not just talking about you taking care of yourself. We believe deeply in the notion of collective care, that we need our organizations, our communities, the power structures that we work within all to be aware of the need for care, for self-care, and for helping lift us up. In terms of self-care, we basically are talking about the rituals or practices that we use to reduce stress, to cope with the challenges of work. That moment when you're in the midst of a very difficult situation, like the kid who threw spaghetti against the wall at Vilma's lunch table, and you can stop and take a deep breath just to calm yourself. Enhance your subjective sense of well-being before you respond to that child. There are many ways we use to replenish our own energy levels, and we need to be aware of those.

What are the ABCs of self-care? First, self-awareness. And self-awareness is something we've talked about throughout both of our presentations. Be self-reflective. Think about how you're feeling, what your stress level is. Are your behaviors consistent with who you want to be? When you find yourself acting like somebody you don't recognize – yelling at your kids, yelling at your partner, maybe acting in the classroom like you don't want to, or with your coworkers like you don't want to, then you need to say to yourself, what's going on here? Why am I acting like this?

Find balance in your lives, balance among different activities. And that was really something that was hard during COVID, and I think related to the stress of COVID was that people – there were only so many Zoom family events one could attend. It's important to bring your personal life, your family life, rest and leisure into your world, as well as work. Many countries in Europe are moving to a four day work week because they're saying they're getting more productivity out of their workers when they give them more time for these other things. You're going to need to do that for yourself, demand it of your communities and organizations. And finally building social connections. That's the other way, I think, in which COVID took a real toll on all of us. It was harder to be with the people that we cared about. It was harder to get physical contact with people we cared about – hugs, just being close to people, and laughing together.

What are some of the indicators of stress? I'm going to run through these quickly, because I do want to save time for questions at the end. The physical ones are headaches, stomach aches, feeling sleepy, lethargic, not being able to sleep, cognitively having trouble concentrating, being preoccupied with what's going on in classrooms or at work, emotionally feeling either numb and detached, or showing a lot of irritability and anger. In its most extreme form, you might experience these things as anxiety or depression. Personally, think about how you're acting. Are you isolating yourself? Are you being irritable? And then, in the workplace, are you happy when a certain student doesn't come that morning because that kid's stressing you out? Are you avoiding certain students? Are you coming late to work? Are you avoiding certain appointments or obligations? Those are signs of stress.

Think about balance and connection. I think this is you, Vilma.

Vilma: Balance, that is a good one. And I like that word. I think really, at the end of the day, that's what it is. If we can apply these mindfulness strategies that we know work, and we have so much research around it. We're helping kids grow these mindfulness strategies, but we can also grow in our practice of them as well. And I think that's, for me, where it comes down to balance. Is that when you are with a classroom full of kids, and you're feeling overwhelmed, you are present, you're in it, you tried to tolerate it, you find strategies to help you with that. And when you are at home with your kids, or your loved ones, or your friends, or enjoying the sunset, that you are present and engaged with that as well. And that you have a plan of finding balance in your life in all of these areas. In the physical, and the emotional, and the personal, spiritual, and in workplace, and in every area of your life, you're being intentional and mindful, and you prioritize. I know I do better if I sleep this amount of hours. I know that eating well and movement is how I can be my best self in all areas of my life. And making a commitment to that. That you are prioritizing that as what's necessary for you.

And I love this line of moving more from putting all of the responsibility on us as if we live in a vacuum of self-care and moving to community care. The same example of how we hope that we don't tell children, “OK, you're out of sorts. Go get your act together, and come back to me when you're ready.” We don't want to do that to each other either. I mean, sometimes people, that is what they need. And we should honor them and give them the space and time for that. But I think a choice of like, “I know you're having a hard time. I noticed that when you get stressed out, this happens. We have accountability for each other. We got your back. We're in this together. How about we take walks during lunch together? I know that that helps both of us.” Or “I haven't heard from you in a while. Why don't you have lunch with me? I mean, lunch in front of the computer.” We're responsible for each other. We're caring for each other. We're in this as a team.

Yeah, there you have it. And this is it too. As an organization and in all levels, individually, we're responsible for ourselves, but also for our colleagues, for the types of culture that we want to set in our centers. And we are all responsible for creating an organizational culture, where we value wellness and care. And this isn't just for the families. If we want to provide this for families, we have to do this for ourselves. We invite you to think about, from all the things that we've said, maybe one area that you have noticed. Look your ABCs, start with awareness. Take maybe a few seconds. Did something pop up in your mind as like maybe a sign that you need to pay more attention to what you need. And identify one concrete thing – one specific thing that you would like to do differently that you want to apply. And put it on the chat if you like. Sometimes, it's nice to have some accountability to say this is one thing I'm going to apply. One thing that I will do. And I'm going [Inaudible] for questions.

Amy Hunter: All right. Thank so much, Vilma and Karen. We do have some really great questions that I'm happy to send over your way. The first question, someone wrote in the chat actually alerting us to the implicit bias tests that exist. They mentioned one through the Southern Poverty Law Center. And I know Harvard has an array of implicit bias tests. And the person who put in the question wondered about your thoughts on using those, when you were mentioning implicit bias in the beginning of the presentation.

Karen: I'll take a stab at them, and if you have anything to add, Vilma, you can. I would say that in general, I think like all tests, they have their limitations. And there seems to be a fair amount of controversy over them. I think that what's important is they do make you stop and think. I think if you take these, they cause self-reflection in a way that's really important, I think. And I think that sometimes, you're surprised at your results. I do think there are exercises that have some value. But I also think that there are so many complex ways in which implicit biases come out that aren't captured by the test that's just looking at where you direct your attention, for example, which is one of the things these tests do that don't capture the self-awareness that we need to be thinking about in the many situations we are in our lives.

I would say they have some value. I think the value is somewhat limited. I think they are controversial in their usefulness. I think that they can make you think about where you are around certain things. And I think that they will surprise you. I've taken several of them myself, and I'm always surprised. I think they make you think. But I think it's more important, frankly, to just start being more aware of your actions, and interactions in multiple settings. And be open, and responsive to people's feedback, and how they're reacting to you.

Amy: Thank you so much, Karen. Vilma, did you want to add anything to that?

Vilma: I thought Karen covered it. I wanted to flag a question, Amy, if it's OK. I tried to answer it in the Q&A. But I wanted to see if Karen wanted to add anything because this was your slide on strategies for emotional regulation. Someone said that they would like more information on those curriculums, the Care Curriculum, and there's some others on that slide. Is there anything else you wanted to add, Karen?

Karen: Yeah. I mean, I think the PATHS curriculum is empirically supported curriculum. I have mixed feelings about it. It's kind of like what you said, Vilma. The problem with all these curricula is that they are designed to be taught in a certain amount of time. You spend an hour a day doing the PATHS Curriculum. And the truth is, these things need to be diffused throughout the entire day and throughout all our interactions with our children, and coworkers, and classrooms. That said, I think things like the little pictures, like the CAD, and the job breakers, that's from the Bounce Back curriculum. Bounce Back is a downward extension of the CBITS curriculum, which is curriculum for kids for trauma in schools. And I do think those specific things, like those relaxation techniques, can be really helpful. It's sort of like what Vilma was saying. There's lots of apps. There's lots of techniques. There's lots of curricula. And they give us tools to use. But they're only useful if you use those in the context of a larger orientation towards thinking about how you can use your relationship and the space that you're in to promote positive health, and well-being in kids.

Amy: That's what I see in the chat. Many people have chimed in around early childhood curricula, or really even approaches. Things like Second Step, Conscious Discipline, Pyramid Model, Incredible Years – all of these wonderful approaches that help children promote social emotional development. But your points are so well taken about – it can't be one half an hour circle time. These are really how we are with children, and families in our programs. Touch points I say to, amazed. And there's so many wonderful programs out there. I am conscious of the time. I think we have about two more minutes. Steve, should I turn it over to you? But before I do that, I just want to thank Vilma and Karen so much for your expertise. You're getting all kinds of accolades in the chat. Unfortunately, we had some questions that we weren't able to answer today. But we will try to strategize around how to get those answers to everyone. Thank you again, Karen and Vilma. Steve?

Steve: Yes, thank you. Thank you, Amy, too for moderating the questions. This is a link to the evaluation. It's been put into the chat a number of times. The evaluation is important for us to get your feedback. Once you hit submit, you'll see a new URL that will take you to your certificate. It's all also linked on the handout, and will appear when the Zoom platform comes down. Next slide, please.

We want to thank everyone all of you who attended and gave us such wonderful comments in the chat, interacted with each other and with the presenters. And then the next slide, we do have a website on ECLKC – web pages on the ECLKC. And we're always prepared to answer your questions at this address and this phone number. Please, don't think this is the last time you're going to interact with the National Center on Health, Behavioral Health, and Safety. We want to hear from you, and we'll be happy when you hear back from us. Let's keep the conversation going. We also have a number of communities on MyPeers. We have the mental health community. We have a health, safety, and wellness community. We have so many opportunities for you to interact with each other and with staff from the National Center.

Thank you all. And especially thank you to Vilma and to Karen for just incredible two days of presentation on this really valuable topic that really, I think, resonated with our participants today in a big way. And to Kate Hamby- Hopkins, to Livia Powers, and Amy Hunter, all of who helped out making today's webinar happen. Thank you all. We'll keep this platform up for just a few minutes, and then the evaluation link will pop up. Thank you, and stay safe.

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