Creating a Safe Space Through Perinatal Behavioral Health Screenings

Creating Safe Space Through Prenatal Behavioral Health Screenings

Melissa Lin: Now we can begin. On today's webinar, we are pleased to have Dr. Amittia Parker and Ms. Kelli McDermott presenting. Later in the session, Steve Shuman will join us as the moderator during the Q&A. Now, I'll first turn it over to Amittia.

Dr. Amittia Parker: Greetings. Welcome in this space. I am Amittia, I really just wanted to lift that I'm really excited about the conversation that we'll have today. We really do hope that it's a conversation and dialogue, where we will be able to share some information, and that we would be able to hear from you. Hear your questions, hear y'all contribute as we go along.

As a past mental health consultant and home visitor and early interventionist, this topic is near and dear to my heart. Screening and having conversations about mental health and substance use, intimate partner violence, these are things that are not unfamiliar to me. I bring into this conversation lived experience, sitting in the seats in which you all are sitting in this moment, and I'm really grateful to be with you all. I'll turn it over to Kelli.

Kelli McDermott: Hi, everybody. My name is Kelli McDermott, I am a clinical social worker by training. I'm happy to echo Amittia's sentiments about how thrilled we are to be having this really important conversation. I'm a mental health consultant, and I have worked in programs and been responsible for thinking about developing behavioral health screening protocols with folks at that level, too. I'm looking forward to hearing from you all about ways that you are incorporating screening or interested in learning more about doing as we move through this time that we've got together today.

Amittia: Thanks, Kelli. We're going to talk about the importance of behavioral screening. We're going to talk about some best practices. We're going to really emphasize some strategies to have a more supportive, helpful conversation, in which you're creating a safer space where folks can share these more sensitive topics.

Always, want to check in and create some space to connect with you all and to invite you all to think about how you are in this moment. We would love for you to share in the chat where you're joining from, some have already started that, and what you're bringing, or what work you do in Head Start programs related to this.

As we do that, I think that, for me, one of the ways that I like to begin anything that I'm doing is to pause, take a breath, think about what day it is, like literally. I'm talking about present moment awareness. What day is it? What time is it? Where am I? How am I coming into this space? Take a breath here with me and think about we know what day it is, obviously. We know that it's 6 after the hour at this moment. Let's take a breath and think about how do we feel in our bodies in this moment.

I'm going to take another breath because I didn't catch it. Then let's do one more. Deep breath in. Let it out.

It's such a helpful skill and we'll talk about this here more in a little bit to attend to your own needs, attend to your own body before you try to help anybody else. We want to invite you all to be aware that these strategies that you see here are here as an offering to you to use now as we continue to progress in this conversation, and later, when you're having your own conversation and your program with somebody about mental health or substance use or any of the things.

One thing I want to hold in mind as we continue today's conversation is the mantra that I can handle this. It's something that I told myself many a days, and I continue to do that in this moment, especially when the situation becomes more activating.

This is activating to me, to be honest, that we're in a maternal mortality crisis. It's been going on for decades, and it's a global public health crisis. Its not just something that's impacting us here in the United States and territories, but that it is a global crisis where pregnant women and women from labor and delivery all the way up until 12 months after giving birth are dying.

In the U.S., that rate is 18.6 people are dying for every 100,000 live births. This is the average. The map that you see on there is showing you a little bit more about this story. In the U.S., South in particular, and there's some scatterings along the way, but 41.9 people are dying per 100,000 births. This is unacceptable. It is devastating. The sad part is that four out of five of these deaths are preventable.

A lot of times when we talk about maternal mortality, we talk about the cardiac or health issues that are happening, we talk about the infections that people have or the diseases that emerge, we don't talk enough about the behavioral health piece of it, where 25% of those maternal deaths are due to substance use. Well, particularly overdose and death, suicide, and homicide.

The map here that you see is bringing to your attention that for a high-income country, our rates of maternal deaths are particularly high. The shading here is showing you where we compare in the globe in terms of how we're doing with keeping moms healthy and safe and making it past a year after birth. we really are struggling here, and we need to address it.

I'm just emphasizing here a takeaway from that data, which is, to me, every time I hear it, it's devastating because I think about the individuals that are impacted. I know people who have died in this period of time. I'm grateful that we're now bringing more attention and awareness on it, and in particular, highlighting the behavioral health concerns because among the things that are preventable, the behavioral health-related deaths are preventable. There are things that can be shifted and changed, supports that can be provided, conversations that can be had to shift what this looks like in our work.

One of the things I want to bring up before I move on is that one of the cross-cutting issues that we see for these behavioral health-related maternal deaths is that the folks have a history of a substance use or mental health concern prior to being pregnant. These are questions that we ask sometimes. When we talk to folks, we get to know them in their enrollment process. We need to take hold when we identify risk factors because that's one of the things that's coming up there.

Another thing I want to lift up is that there are long-term complications for not only the pregnant woman or the mother who's parenting a young child in the family, but the entire family system is impacted by behavioral health concerns. We know that the research shows us that folks who have behavioral health conditions or concerns are the most likely to have their baby early. They're the most likely to have a low birth weight baby, most likely to have a child who's experiencing a delay or disability. Then for them to have a struggle with bonding.

Now these things are very much tied to the same folks experiencing more negative social determinants of health. We're not going to talk about that as much today, but that's definitely one of the things that I would hope that you all will learn more about as we go, as these nonmedical factors where people live, where people go to school, their understanding and education of health and mental health, the community or connections they have or don't have, all these things are in many ways shaping how people are doing with their mental health and wellness.

We don't just want to talk about what the data tells us and the trends that these discouraging, unacceptable rates are happening in our community, in this land. We want to figure out if this is preventable, what can we do? We have a few things here to highlight, that among the things that we can do, we can continue to work with families. We can continue to listen to them, to observe them, to pay attention to when they tell us they're experiencing different types of traumas.

We can pay attention to their behaviors and patterns if they feel like if it seems like they're crying all the time. They're really agitated, irritated. They report that they're struggling with drugs, or they report that they're struggling in relationship. We hear these things. We see these things. We have to recognize there's already some great practices embedded in our program to help us prevent these deaths.

One of the things we can do is screen for depression and suicide risk, have a conversation, explicit conversation where we talk about how folks are doing. Some programs are doing the Edinburgh screening tool for postpartum depression, for example, that ask about feeling sad, feeling hopeless, or thinking about suicide, specifically. When we have those kinds of conversations and we engage in those screening practices with intention, we could be interrupting suicide.

Another thing, when we screened for intimate partner violence, or even beyond screening, when we have conversations about healthy relationships and we talk to families about being in toxic or violent conditions and the impact of that on them or child, family, and we help them to leave those spaces or to find safer spaces to be, we could be interrupting homicide.

When we screen for substance use and help mothers to get support when they're in recovery, to get education and get information and help them navigate the variety of different supports and services that they need to, and especially when the stressors are high, we can really help to prevent overdose and death. I just think about how the literature tells us that between six and nine months, there's an increased risk for experiencing overdose and death.

Now, we're working with families with 6 and nine-month-old babies. What are we doing there? We're giving them education and information about the child and the child's development and the child exploring and growing and learning. We ought to be talking about, how mom's doing? How is she in community with others? Does she have the supports that she wants and needs? That then we can help to reduce the risk for overdose and death.

Bottom line here is that perinatal behavioral health screening can save lives. I want us to sit with that. The more that I sit with it, the more that I think about how amazing it has been to be in this work and having those hard conversations with families. I've been there. I've been in the seat where somebody says something that you were not expecting.

You were going through the process of asking these questions, and they end up checking number 10, that they have been thinking about suicide or whatever number it is. You're panicked. I felt that feeling. Oh, OK, I did this a million times. This the first one that says that they are thinking about suicide. Oh, I felt that before. It's heavy.

Like in thinking back, what a gift that was a part of my practice to ask those questions, especially when you are interrupting something thoughts of suicide or the thoughts of hurting a baby. That's happened, too. All those things they tell you, these rarely happen. They rarely happen. Rarely, doesn't mean it never happens. I just think about how I hope that I must have did something because they felt comfortable enough sharing those things with me and then allowing me to walk with them as they accessed those crisis services.

Here's the thing, that mental health screening, behavioral health screening is important. It's helpful. It saves lives. It's not done consistently. In Head Start programs, we know that we are doing some screening and doing, for the most part, consistently. We're monitored on it. But how effective is our practice? How well are we doing it? That, I think, is a question for us. What else can we do to enhance how we are and what we do?

We know that screening can really impact families, generations of families by interrupting these cycles. It's important for us to think about who's doing it? Where is it happening? What else we can do to enhance our practice?

I want to lift up, just for a moment here, that we're not the only people that are potentially having conversations with our families about mental health, substance use, intimate partner violence. In fact, there's a task force, the Maternal Mental Health Leadership Alliance, and they conducted a study and had folks from all over the nation to participate in conversations to identify where are screenings happening? What screening tools are people using? What are the best practices?

What they found is that folks are having conversations in women's or obstetrics visits. That's why in this first section here, you see it says regularly scheduled obstetrics visits. The best practice is to at least screen one time in the pregnancy and one time postpartum.

Here are the multiple opportunities in which screening might happen in obstetrics care for women who choose to be served there, in which we help our families get a medical home. Any pregnant moms that we're working with, we're helping them to get connected. These are the spaces they may be having those conversations.

Additionally, we know that these conversations are happening in well-child visits in some spaces. Again, not sure if this is happening in the pediatric visits at your families are having, but it's important for us to be aware of.

Now, this entire two-year time frame is really important. The beautiful thing about Head Start and community-based organizations is that we are building trust and creating a space for ongoing conversation, education, and support, navigating resources throughout the entire time. We are the busy bee working across this whole two-year time frame. That's us. We're doing that work. It's important for us to know and understand what we're doing, and how we're doing it, and how we can enhance what we're doing to be the most helpful.

Let's talk for a little bit here about creating a safer, supportive space to engage in these screening practices. I say safer intentionally, because I do think that it's important for us to recognize that for some folks, irrespective of whatever we do, they may not feel safe in conversation about mental health, substance use, or intimate partner violence with us.

I've heard many times, folks being very worried about someone coming to take their children because of how they're doing. Well, this is huge. This is the space that we are in and occupying, and we can't ignore that. We can't ignore that when child welfare sometimes comes into folks's lives, people's children are taken, and their lives are forever changed.

One of the best things we can do is be self-aware and be as aware as we can of the context that we're operating in, these fears that families are bringing into the conversation, our own fears that we're bringing or worries or just the process of making sense of the moment and what needs to happen. We're bringing a lot into these conversations.

One of the first strategies that I will illuminate is the importance of you regulating yourself and engaging in a reflective practice. How are you? Literally, how are you in these conversations? I think is something that I would love for us to sit with and think about recognizing that some people come in very anxious, worried, fearful.

What if somebody says that they're using substances? Or what if somebody says they're thinking about suicide? What will I do? What if they tell me about all these traumas and things I'm not sure that I can hold? We bring a lot in with us. The more that we engage in a reflective practice, the easier it will be for us to hold these things and to reflect on them and how it's impacting us.

Regulation really does matter. I'll just emphasize here a point, too, that the more that we engage in a practice of regulating ourselves and noticing when and how we feel dysregulation in our bodies, how that impacts our thoughts and feelings and emotions, and especially how that shows up when we're stressed, the better.

We practice pausing. We practice deep breathing. We practice movement in using music or whatever it is. We practice all these things that then when we're in a moment and we become activated, we know how to hold it. We know how to manage. When I'm activating now because of the practice that I've been engaging in, it's like I instantly start to take those deep breaths.

I think that I'm doing that because I know that without it, I can't think. If I can't think straight, I can't help you. I can't help me. I know it's all connected. It really is important that we emphasize regulation as one of the key strategies to creating a safer, supportive space.

Dysregulation in a dysregulated space with a person who's not in a more calmer space, it's just not the conditions in which people will feel safe sharing those kinds of things. There is a felt sense of safety that emerges when a person shows up mindfully.

I want to illuminate mindfulness practices as really one of those key go-to strategies for creating a safer space. This is for us and for those who we are with. I want to invite you all to think about engaging in this practice of facilitating a space where you are either going through a screening process with somebody, or you're building a policy or procedure around it, but to choose to engage in it very mindfully, open, curious, creating some pause and spaciousness around that and see what it feels like to do that.

The pause. I know you might be wondering, ah, get to it. When are you going to get to the stuff? This is the work. This is one of the most essential and foundational pieces to creating a safer space, is to be able to know when you need to pause, to be able to know when those you are with need to pause, to slow down, to ground oneself, to reflect on what's coming up for you, and to choose to regulate.

The pause is really powerful, and I can't help but overemphasize it as being foundational in terms of what's needed to be able to reflect on, what we are already doing, how we're already showing up, how that's working or not.

The spaciousness allows us to self reflect. This self-reflection before, during, and after we're holding space, we are executing our task, we're doing the things. We need to not just do the things, but think about how these things, like engaging in this screening practice, impacts us. To think about what we might do differently.

We hope that as you leave this space that you will be engaged in a reflective practice that will allow you to think about what you're doing, what you want to do more of, and figure out when's the next time that you can check in with yourself or check in with others about what you're doing, how you're doing it, and what you want to do differently.

One more thing I'll highlight here is that there's lots of things that we bring into conversations about screening, and it's not just like we're a machine that comes and asks these questions, or we give a person a piece of paper or we give them a tablet, they answer these questions, we look over them, and then we just literally do whatever the policy says is next. We do these things, but we are human beings.

We bring our own values and beliefs and experiences, what we learned through our education and background about mental health and substance use, and what is the right or the best way to respond. We sometimes gain a sense of what we think other people ought to say and do in those spaces. I think it's important for us to bring that into the fold as we think about creating safer spaces for behavioral health screening because it's there in how you are, in what you say in what you do and what you don't. It's present.

I've given you a lot to think about here. Let's see what you all think about in terms of, what are the ways that are really helpful to you to regulate, to show up, to be present in conversations about mental health and substance use in your work? You probably don't have time to go into what are you bringing into the conversations. Even if you could just lift, what are those successful strategies for regulating? This is before, during, and after. Before you go in.

Before I would go in, I would generally do something with some... music does every music is my thing, I'm telling you. I use music to help me get excited, to help me think, to help me breathe. The songs literally tell me to breathe. I choose to listen to those on purpose, especially when I think I'm going into a conversation that might be activating. What do y'all do? Music, breathwork, mantra.

Mindset. Getting out of the thought process of you're going to fix somebody or their problems. Yes, I see others who agree with the music and the breathwork. I see folks saying that they might pray here in the chat, trying to be nonjudgmental, taking that walk, change of scenery, fresh air, clearing one's mind.

There's a lot of great strategies that are here. Thank you all for sharing that. Maybe there are others who are witnessing what's happening in the chat, and they might take away some other ideas, I just want to illuminate that screening is a really important time and moment, and I honestly wish I took it I took it seriously, I wish I knew that that conversation could help save a life.

Now, I imagine y'all want to hear about more logistics. Kelli, let's help them understand a little bit more about when to screen? How to screen? What to screen for? Some more strategies.

Kelli: Yes. This is the official pivot into that part of the conversation. Thank you, Amittia, for grounding us and for helping us feel ready to dive in.

Amittia brought up several different types of screenings that might be used for perinatal behavioral health. You have examples here on the slide. In our conversation today, we're really going to focus on depression and substance use. You can think more deeply about other areas that might be beneficial to screen, depending on the needs of your own program. That's totally fine. But for the sake of just not having as much time as we wish we did have with you today, we're going to home in on those two areas for now.

That said, a question we are often still hearing from folks at programs is, why are we thinking about this in Head Start programs? How is it relevant? The good news that I can see already, just by tracking you all in the chat, is that you can probably answer this question, but it's really nice for us to be able to internalize that answer that we can respond when we receive that question.

In Head Start, we are walking alongside families as they celebrate wonderful things. It might be a baby; we're talking about perinatal health here. It might be things that are hard or things that they're stressed about. We are really skilled at Head Start in developing relationships through all of those experiences.

Unfortunately, Amittia did share that there are lots of different places where screening might be happening for families. Unfortunately, we might be the only people who are actually talking to families about their behavioral health. We do not want that to be the case, of course, but in an effort to prevent families from slipping through the cracks, the more we universalize our screening processes, the more likely we are to catch families early on when they could benefit from support.

I'm going to walk through a handful of really good resources that are available to you on headstart.gov. One of them is called Understanding Depression. This is a one-on-one resource where you can learn about what depression is, the fact that it is common, and ways that you might be able to identify some symptoms in yourself or in somebody else. This is a nice place to start with some training, especially as people are maybe learning about things that might be screened for in programs moving forward if it hasn't been as common already.

There were some questions in the Q&A about actual screening tools, we wanted to give you a list. It's not guidance by any means to say that these are things that you should be using in your program over other things. They're not in any order based on value. This is just a list of depression screenings that you can find at no cost online.

Take a look at these, see if it feels like it might meet the needs of your program. There are different ways that questions are asked. There are different languages available in different screening tools. As you consider, like I said, the needs of your program, the population that you're serving, and what might make the most sense to be responsive to those groups, this is a nice place to start digging in.

Another resource that you can find on headstart.gov is this five action steps to address maternal depression. Not only do we want to know what depression is, we want to know what we can do to support folks who are experiencing depression.

As you will see here, top of the list is using validated screening tools to identify families who need support. That's really the name of the game in our conversation today. We want to make sure that folks are being identified early in ways that feel supportive so that they are able to access resources and support to prevent depression, in this case, from manifesting or persisting without support and connection.

Other things you'll notice here are here our training staff about depression, really engaging in reflective supervision when we're thinking about the way that we're supporting families. We'll talk about reflective supervision in a moment again. We want to think about connecting families with community-based support services.

Nobody in this room, well, that's not fair to say, many people in this room who might be doing the screening are not going to be clinicians themselves. It's important to know that screening tools are not diagnostic tools in this conversation. This is just a way that we can have a guided conversation with families and understand whether or not they might benefit from additional support, additional evaluation, and screening from a mental health professional.

The more that we have conversations about depression, the less stigma will persist. We know that mental health is still incredibly stigmatized, despite how much effort we have put in to destigmatizing the experience of depression and other behavioral health conditions. Amittia brought this up earlier.

One of the things that we can do is use a poster like the one that you see on this slide in programs that just say, hey, this is something that happens to one out of every eight new mothers. Symptoms of depression are common postpartum period. We know that. We know how to talk about that. If you need help or resources so that you can feel better, we can provide those to you.

We transition to thinking a little bit more specifically about substance use disorder screening, I wanted to uplift this Head Start resource as well. You can find it on headstart.gov. This is actually about screening for substance use disorders. It is not specific to perinatal populations, but a lot of the information in here is pretty universal and can definitely be applied when you're thinking about pregnancy and postpartum periods.

Within this resource, there are some considerations that are really helpful and pretty consistent with what you've been hearing from us all along today. Screenings are most effective when they are standard practice for all families. We're thinking about universal screening. We never want a family to feel like they are being handpicked or singled out for a screening based on just how they look, what we think about them, how our relationship is.

We want this to be a transparent and consistent process for everyone. It's easier for staff to enter into a screening conversation when that's the case. We'll talk about some opening lines in just a minute. Overarching protectiveness and prevention for really sad outcomes that Amittia talked about earlier relies on universal screening.

We know that the earlier we screen, the more consistently we screen, the more likely we are to have early detection of substance use concerns. Amittia mentioned that substance use overdose, relapse and overdose are most common between six and nine months at the postpartum period. Knowing that can help to inform when we want to do screenings and thinking about ways that we can have conversations earlier than waiting for there to be a bigger problem.

Conversations should be reassuring and compassionate. Like we want conversations about depression to reduce stigma, we want that same experience for folks when we're thinking about substance use screenings. We're going to click through another couple of resources that you can find on headstart.gov that go a bit deeper into addiction and into stigma related to addiction.

The first is this understanding addiction resource, and it gives high-level information about the impact of substance use disorders on children, families, and staff. It gives some statistics about addiction, overdose, and treatment. It points to some things that support recovery. It talks about ways Head Start programs can affect, sorry, can support those who are affected by substance use.

These are some specific examples that are pulled right out of that resource. The first is to support families by using screenings to talk about drug or alcohol use. Encourage family members to think about the medications that they're taking, and if they have questions about whether or not those are safe, especially during pregnancy and the postpartum period, to talk with their health providers about that. Then, of course, we want to think about sharing resources with families about how to dispose of unused medications safely as part of conversations that we have about substances that are in homes.

A continuation of that resource, kind of a part two, is this understanding substance use stigma. We know that recovery is possible. That we know that it's much more likely when people are doing things that you have uplifted in the chat, making spaces feel nonjudgmental, making sure that we're finding ways to show up in a supportive environment. We know that when we hold hope and bring that hope into conversations with folks, they are more likely to experience supportive and safe conversations with us.

Similarly, this resource is set up to give you really concrete ideas about what you can do to make a difference. On this one, there's learning the facts about addiction and speak out when you hear something stigmatizing. Question people's misunderstandings and stereotypes. This is especially important during the pregnancy and postnatal period. We know that substance use conversations are always activating. They always bring things up for folks around judgment and conversations about right and wrong.

When you add in pregnancy as an additional layer, it stirs up even more things for folks. Making sure that we're paying attention to how that is sitting with us as we prepare for conversations or as we are engaged in conversations with our colleagues, can make a really big difference.

There are lots and lots of resources in this slide deck that you can return to later, but we wanted to be as concrete as possible with the recommended best practices to support healing and recovery in both depression and substance use disorder Impacted? Families. But this can really extend to just about any issue.

We want to use nonbiased language, really combat social isolation by finding ways for families to connect with staff, with each other, making sure that we find space to acknowledge strengths of the folks that we're supporting. We're going to talk a little bit more about this one but knowing the support options in your community. As we think about how we're going to not just prepare for these screening conversations, but then actually do the conversation, this is a place where we need to invest a little bit more time.

As we are starting to think about planning the program screening process, there are some things to do in advance. Our recommendation is not that you sit through this hour and then turn off your computer, turn around, find a family, and administer a screening. As much as those might be well-intentioned approaches, that's really not where we want to land.

We want to put some things in process in practice, of course. But before we do that, we need to figure out our protocol and our process. The most important thing to do is to screen more than once, to do it universally, and to stick to the time frames you have established. Many times the question that I receive is, but Kelli, tell me exactly when I should be screening for what?

The truth is, we can give you some recommendations, there here on this slide. But the most important thing is for you and your program to pick a schedule and to stick with that schedule. The American College of Obstetricians and Gynecologists, or ACOG, you might know of them as, has some timeline recommendations for mental health screenings. They think about early in pregnancy, midway through pregnancy, and sometime after birth during the postpartum period.

This is not super rigid in their recommendations. You have some leeway here. It's worth talking to the team who is going to be putting together your protocol to decide what makes the most sense, considering your population specific risks, like risks for substance use setbacks and overdose being between 6 and 12 months postpartum as an example.

One of the things that we want to uplift here is that screening protocols for perinatal behavioral health are not relevant to only early Head Start. We know that you cannot walk into a Head Start program and not bump into someone who is expecting a baby. We're thinking about behavioral health screening during the perinatal period, if you have an enrolled Head Start child and a family member is expecting a baby, our hope is that you will consider utilizing a screening protocol for those families.

The first thing that we need to do when we're adopting a screening process is make sure that folks are ready to do it. Amittia used the example earlier that she had done many, many screenings. Then one day somebody said, yes. Oh my gosh, I asked a question and they said yes, and now I need to do something about it.

There's some themes that are similar in the Q&A, and I've seen a couple in the chat. Before we do any screenings, we need to make sure that we are prepared to respond in the case of somebody endorsing what we're screening for. This comes back to knowing what the resources in your community look like. In the same way that we know where the food pantries are, where the housing resources are, we want to know where the behavioral health practitioners are and where the community supports are. We'll have another slide in a few minutes that talks about really creative ways to think about that.

We want to make sure that staff are trained and that supervision is considered a part of the screening process. When somebody is providing a screening, they have a go-to person that they can connect with after that screening. Sometimes conversations feel really challenging, even if nothing on the screening is endorsed and we want staff to feel like they have the support that they need just as much as we want families to have the support that they need. When somebody does endorse something on that screening tool, our hope is that we are able to follow up and to keep that information confidential.

We talked a little bit about this. As you're thinking about screening tools, like I said, you can use some of the examples in the substance use screening resource or in this slide deck. Thinking about what would be the best fit for the population that you are serving within your own program is really important. Making sure that the tool is valid and reliable all of the ones we have shared are that it is available in the languages that you need.

It is best practice for folks to be screened in their home language, that staff feel comfortable with administering it. Most of the time, they're just a small group of questions and they're really simple language and that helps. Then we want to think about integrating screening into existing processes. A home visit that you have scheduled already, maybe this is just an addition to the conversation that you're having.

As we are preparing for the screening conversation to take place, like I said, there are that goes into this. We want to just make sure that we have this little checklist in place, too. We know what to do if somebody says, yes. I know I've brought this up many times, but is the number one anxiety that I hear from folks who are doing screenings, what do I do if they say that they are worried about something? They endorse a symptom that I'm worried about? Making sure that there is a plan to check in with some other colleague, hopefully a supervisor, to receive support.

Here are some examples of pathways folks might utilize for healing and recovery. Many of these are formal supports. Many of them are informal supports. We can think about peer groups. We can think about elders in the community. We can think about mutual aid groups, just as much as we can think about licensed and credentialed professional support.

We are not here to put a value judgment on any of these things. We are here to say it's great to have a robust list of options for folks that are available, either in your community or maybe online. We're seeing lots more availability for folks to access different kinds of support and different ways that when we have conversations about connecting folks to support, they can choose what feels like the best fit for them.

Then we get to the actual conversation. All of these things have already taken place. They're all in your back pocket. You know what your protocol is. You know what your time frames are, and then you actually have to talk to somebody about the screening tool.

There are many ways that you can do this. One of the asks that we often get is for a specific script or starter script for what to say to open the conversation. We've given you one for depression and one for substance use. What you'll see in both of them is a theme that is transparency. We're talking about why we're having this conversation and universality. We're talking about the ways that we do this with everyone who is expecting a baby in our program.

We didn't just single you out because it looked like you were having a bad day. This isn't some underlying concern that we have. It's just something that we do to make sure that we're providing the best support to all of the families that are in our care.

The next step is to actually make sure that you can have that conversation, soliciting permission. A lot of these strategies that we're going to talk about are pulled from motivational interviewing principles. We'll talk about that, too. But if they feel familiar, that's why.

All of us have had an experience where we were willing to have a conversation but just didn't really want to have it at that time. Giving people the opportunity to say, just please, not today, or can we talk about this instead because it's a higher priority on my list than your screening tool is definitely recommended and best practice and can help to make the conversation feel more supportive when it actually does happen.

Reflective listening is highly recommended. This is really just sitting with the intention to understand and less with the intention to respond. Like somebody put in the chat already that they don't go into these conversations trying to fix. They go into these conversations to hold space. These sentence starters support that idea. We don't necessarily need to offer our own wisdom or our own expertise or our own problem solving, but really, we want to make sure that we're understanding the experience of the person who's sharing it with us.

The other piece is these unspoken communication rules. Everybody who's part of a conversation is impacted in that conversation in different ways. We leave conversations feeling all sorts of things, maybe hopeful or open or just really tuned in, or if they didn't feel so good and supportive, you might feel nervous or shut down or defensive and less likely to want to talk to that person again moving forward. We've all been part of conversations where we can say, yeah, that was me in this situation or that was me in that situation.

What we know is that in these conversations, program staff hold the power. We have heard in lots of different ways about stigma, about wanting people to feel comfortable opening up to the fact that we are asking about things that might feel really personal or might make someone feel really vulnerable is significant.

As we have these conversations, it can be really helpful to say that it's potentially uncomfortable to talk to us about these things and that we know that that's true, and reiterate the reason why we're having that conversation, that we are coming from a place of support, and that the potential outcomes from this conversation could be that we revisit it at a later date, that we connect to a resource or a support if that feels like it would be helpful, or just to continue to engage in relationship together.

Many of the things that we talked about today are found in motivational interviewing practices. If you want to think about this more, there is a whole suite of motivational interviewing strategies and information on headstart.gov. There's also a specific videos that you can look into that highlight a conversation about depression screening, actually. I would definitely recommend that you check it out if you haven't already. It can be really helpful in guiding conversations and deepening your practice.

Steven Shuman: Wow, thank you Amittia and Kelli. There were so many questions that we don't have time to get to. None of them were easy questions. Amittia and Kelli were answering some by text, but we tried to respond by giving you the email address of the National Center on Health, Behavioral Health, and Safety, that addresses in the chat, health@ecetta.info. It will also be in the follow up email that you get with the recording and a link to the handout and the evaluation.

For those of you that asked about the certificate, there's a certificate link on the handout and a certificate pops up when you submit your evaluation. Those are how they're connected. We don't mail certificates, unless you have some kind of difficulty accessing it in some other way. With that, I'm going to turn things over to Melissa to close us out. But please consider the National Center as a place for answering your questions.

Kelli and Amittia are among our finest presenters, but we have a great deal of expertise to try to respond to your many questions about this very important topic.

Melissa: Thank you so much, Steve. I want to give a big thank you to Amittia and Kelli. Thank you to everyone for participating today. Again, you can go to my peers or right to health@ecetta.info your questions. On the slide, you'll see the QR code and the link. It's going to be in the chat box, and after you log off from the Zoom, please complete the evaluation. We really value your feedback, and it helps us to improve future offerings. After you complete the evaluation, you will get a link to download your certificate.

Thank you for spending a part of your day with us. We hope you have a good rest of your day. If you have more questions after today's webinar, you can reach us at health@ecetta.info. You can find today's resources and more in the health section of the Head Start website. Subscribe to our monthly list to receive the latest resources. Thank you all, we really enjoyed being with you.