In the interest of efficiency, it is 345. We're going to go ahead and get started. If you can hear my voice out in the hallway, we have open spots. Please come join us. My name is Christopher Chunseely. I'm the program director for school and justice initiatives for the APA Foundation. Before we get started with our tips, tactics, and training to improve youth mental health, we want to start with a two-minute guided mindful meditation just to kind of get everybody a little in, again, a learning, educating mood. So, if you've never done mindfulness meditation in the past before, heads up. Sometimes it can be a little anxiety producing. So, if you've never done it before, just a little, you know, heads up that sometimes our thoughts can become overwhelming if you've never done it before. So, if you can please get in a grounding position. So, usually that means two feet flat on the floor. Just have your hands in the most comfortable position for you. That is on your thighs, just completely relaxed. If you feel comfortable, I will encourage you to close your eyes. If you do not feel comfortable closing your eyes, that is completely all right. Please just focus in on my voice. So, I want you to just take a couple of deep breaths in through the nose, the count of four, and then out on the count of four. Again, in through the nose, on the count of four, and out through the mouth on the count of four. Do this a few times just to center yourself in the room. With this next breath in, I want you to think about releasing the stress on that exhale. And again, breath in through the nose on a four count, and release that stress out on a four count. Now, with this next breath in, I want you to find where you're holding your stress. It could be the shoulders, your knees, your chest. And with that relief, send it to that place. That's where you're sending your stress relief. Send it to that place. That's where you're sending your stress relief. On that in breath, and then breathing out the stress on the four. Now, I want you to focus on the top of your head. Start to relax that. Slowly moving to your forehead, into your eyebrows, down your nose, into your cheeks, down into your chin, and slowly moving into your neck. Remembering to take that four count in through the nose, bringing in the stress relief, and exhaling the stress on four. Now, continue to do that, and relax your shoulders, moving down your arms, slowly into your wrist, and into your fingertips. On this next breath in, relax your chest. And as you exhale out, move that relaxation down into your stomach, remembering to take that four count in, and exhale out on four. Now, move that relaxation down into your legs, starting with your thighs, moving into your knees, and slowly into your calves. Maybe roll your ankles, relieve that stress of all this walking at the annual conference, and move into your toes. Now, again, with this last breath, find where you're holding your stress, and send that stress relief there. And then take a few moments to come back into the room and rejoin us with your presence. All right. Is everyone relaxed? All right. Is everyone ready to learn? Is everyone ready to improve youth mental health today? All right. That's what we're here for. So, actually, let me advance the slide real quick. I just want to give you a brief overview of our agenda. I'm going to do some introductions. We're going to play a little trivia. All right? We're going to test your knowledge today. We're going to do an overview of the youth mental health landscape. We're going to have Dr. Gabrielle Shapiro touch a little bit on tips. Then Dr. Latoya Froloff will touch on tactics. Excuse me. And then I will come and talk to you a little bit about our Notice, Talk, Act at School training. And then we'll wrap with a few questions. I'm proud to introduce our chair for this session and a great friend to the APA Foundation Schoolwork, Dr. Anish Dube. Dr. Dube completed his general psychiatry residency training at the University of Connecticut, his child and adolescent psychiatry fellowship at Brown University, and his forensic psychiatry fellowship at the University of Pennsylvania. He's a corresponding board certified in general psychiatry, child and adolescent psychiatry, and forensic psychiatry. He has a master's degree in public health from Brown University and just, and when I say just completed, last week, last week he obtained his master's in legal studies from UCLA. So, big round of applause for that. Presently, he serves as the program director for psychiatry residency training at Charles R. Drew University College of Medicine Department of Psychiatry. Dr. Dube has a particular interest in psychiatric graduate education, the intersection of human rights, public health, psychiatry, and the ethical issues that outrise out of the ordinary practice of medicine and psychiatry. To this end, he has participated in talks at the local and national meetings on topics ranging from the national state's role in psychiatric department and psychopathology to adolescent decision making capacity, integrated care, false confession, this is a tough word for me, I'm not sure if I'm going to be able to say it, phenomenology, see, and the effects of parental separation on children and youth. Dr. Dube's current organizational involvement includes serving as the chair of AP's council on child, adolescents, and their families, deputy representative for the area six APA assembly, selection committee chair for the APA Foundation's Child and Adolescent Psychiatry Fellowship, and he maintains membership to the AMA, the American Academy of Child and Adolescent Psychiatry, and the American Academy of Psychiatry and the Law. Thank you, Dr. Bae, for joining us here today. Next, Dr. Gabrielle Shapiro, and current APA Foundation board of directors member, and just a round of applause for Dr. Shapiro's commitment. This is her last act as a board member for the APA Foundation before she transitions to the big board of trustees for the APA, so just want to give her a round of applause for her work with the APA Foundation. Dr. Shapiro is a general child and adolescent psychiatrist who has dedicated her 30 year career to the care and advocacy for underserved children, adolescents, and their families. She's committed to understanding and responding to both the biological and social determinants of mental health, with a focus on eliminating disparities and mental health services for underserved communities, including communities of color, Native Americans, LGBTQ+, immigrants, and others. Dr. Shapiro is the professor of clinical psychiatry at the Aitchin School of Medicine at Mount Sinai at New York, in New York, sorry. Dr. Shapiro has also served at the faculty at UCSD, NYU, and Bellevue Hospital. She is a bilingual Spanish psychiatrist who has served her entire career in the public sector. She currently practices in Harlem and the Bronx in settlement houses, collective care settings, and provides care to immigrants in New York and California. As a distinguished life fellow of APA and distinguished fellow of ACAP, she is currently serving as the secretary of the APA Foundation board, member of APA PAC board, child and adolescent council, Hispanic caucus, women's caucus representative to the assembly, MUR committee, and involved in the APA en Español. Congratulations again on your next step as secretary of the APA board of trustees. Thank you. And next, Dr. Latoya Frolov, who, and I will mention this again, but is a former fellow as well of the APA Foundation. We are foundation heavy on this panel here today. Dr. Frolov also has her master's in public health, is an assistant professor of psychiatry at the University of Texas Southwestern, and adjunct clinical assistant professor of psychiatry at Weill Cornell. She has a background in public health and completed her medical training at UT Houston medical school, followed by a psychiatry residency here in the Bay Area at UCSF, where she served as chief resident and received distinction in cultural and public psychiatry and women's mental health. She then trained in child psychiatry at New York Presbyterian Columbia and Cornell, which she was APA diversity leadership fellow for, and was fortunate to start working with the APA council on child adolescents and their families, which is where I got connected with Dr. Frolov. She works as a child and perinatal psychiatrist in a fun variety of roles, including as assistant medical director of the UTSW Perinatal Psychiatry Access Network, or PeriPAN, in a county perinatal psychiatry clinic and working with children and their families on child psychiatry consult services. Oh my gosh, and this whole time, I didn't have the photo of Dr. Frolov of her as a baby, and now. So, and before I go to, I guess, introduce myself, the reason that we did this, right, we all started as kids, right? At some point, we were all kids, and our life journeys all dictated where we went, and sometimes we don't all have the same access to things and opportunities and support systems. So, just a friendly reminder again, and when we're talking about youth, we're talking about the kids, right? We're not talking about the adults. We're not talking about people who are fully developed, but their brains aren't fully developed yet. They're able to make mistakes. How do we continue to think about supporting them? And then me, program director, School of Justice Initiatives. I'm gonna make this short because we have more important experts up here, and what I just wanna share is, though I work for the foundation, I'm also a community member with lived experience. As a kid, my first suicide attempt was at the age of 12, and I've had, seen the personal impact that mental health access and support can have on my own life and the lives of my loved ones as well. And then, again, I just wanna remind everyone that we all started out as a child in trying to navigate this world, which is why we picked some baby pictures to include as well. So, it is my pleasure to hand it over to Dr. Dubé, who will start with a little trivia. So, hopefully, y'all are ready for some engagement. All right, so thank you, Chris. First of all, I wanna say that Chris is way too modest. He is very involved, he's also a big proponent of the Notice, Talk, Act. Just by hearing his voice, if you haven't already picked up, he has a radio voice, so for any of you who like podcasts, I'm gonna put a plug in for his Mentally Healthy Nation, which he hosts, so. I have no relevant financial disclosures to share with you, but I just wanted to let you know I have no relevant financial disclosures, and I will start. So, let's go ahead and get started with this. So, the first question, actually, I can do this, right? Let's see, by a show of hands, what percentage of adults agree that it is important for schools to provide mental health training for staff? Is it A, yep. Sean, you said Sean, I thought Sean was agreeing. Is it A, 20 to 30%, is it B, 80 to 90%, is it C, 60 to 70%, or is it D, 40 to 50%? So, I'm gonna go ahead, one more, actually, I didn't catch that. A, anybody raising their hand for A? Yeah, a couple, okay. How about B? All right, C? And D, so it seems like B, C, and D are pretty even, although I think D seemed like the most number. The correct answer is actually B. So, that's encouraging, right? A lot of parents find it important. So, the majority of adults, 83%, agree that it's important for schools to play a key role, and for mental health training needs to be done for staff. Now, what kind of training, whether it's a specific topic that they're gonna be talking to the students about, whether the staff should be trained in the basics of mental health itself, or connecting students to mental health resources, all these, when you're looking at it, it's all above 80%. So, when you talk to adults about having mental health embedded in school, most adults will actually agree that it's important. All right, true or false? Most parents would be comfortable referring their child to a mental health professional. True? False. I'm not raising my hands. Okay. Well, again, it seems evenly split, so we have a room that's a little bit either shy or ambivalent about some of these. The correct answer is it's true. And it's about 70% of parents, a little bit more than 70% of parents, would be comfortable referring their child to a mental health professional. Now, it does, there is a nuance to this when you're looking at parents of color. So, for example, 54% of black parents are, the number goes down to 54%. So, it's not as common for black parents to want to refer their children to a mental health professional. There's a slight skew also by gender. So, moms are much more likely, not much more likely, but they're more likely to refer, as opposed to dads. Go for it. Self-referral or expecting to do self-referral? Good question. So, this is a referral from the school that's going, you know, that if there was, I mean, I think it actually does refer to self-referral too. That's a good question. I believe the question, so these were put out, this was put out through a national survey for the APA Healthy Polls. So, this was actually about the parents, like whether or not the parents would feel comfortable referring their own student to a mental health professional. So, what percentage of adults believe that it is important for schools to connect students to mental health support? Is it A, 84%? Is it B, 67%? Is it C, 59%? Is it D, 93%? All right, we're not, the number of hands seem to have gone down. We're not getting as much. The correct answer is A. It's 84%, so there's, yeah. Parents tend to believe that it is important. Hopefully that's getting clearer. And finally, this is probably something that we encounter, and I'm actually, when I say we, how many child psychiatrists in the room? Okay, and the rest, general psychiatrists? Trainees? Allies? Okay. All right, so what is the average number of years between first signs and symptoms of a mental illness and connection to care? Is it A, eight years? Is it B, nine years? Is it C, 10 years? Or is it D, 11 years? So, there's a split between C and D. Correct answer is D. And that's scary, right? It takes 11 years when you're looking at, from diagnosis to actually getting treatment. And that's the part that we're concerned about, especially as psychiatrists and child psychiatrists. So I'm gonna talk a little bit about the landscape of mental health even before the pandemic. And then we're gonna go into some of the nuances of what's changed a little bit. I'm not gonna go too much into it, sorry. But, so you can see 20% of young people. And when you're seeing the ages, when you're looking at these studies, you have to be careful about, different studies look at different ages. And they're gonna use different definitions as well. I usually use the phrasing young people when I'm talking about minors, but if you're talking about adolescents or teenagers, you know, there's gonna be different definitions as well. But 20% of young people between the ages of 3 and 17 had a mental, emotional, developmental, or behavioral disorder. You see that half of teenagers have had a mental disorder at some point during those years, diagnosable, and then you're looking at 10% that, where their symptoms of depression were so severe that it was impairing their ability to function in school, home, family, or their social lives. 60% of young people with major depression did not receive any mental health treatment, and so this is not just access to a psychiatrist, this is not access to any mental health treatment at all. Are these numbers surprising for folks? Anybody surprised by these numbers? I see one nod, a couple nods. And what trends do folks think as far as where, you know, this is before the pandemic, does anybody have any ideas about what the trend might look now? Has this gotten better? Has it gotten worse? Has this gotten... Yeah, so there's a lot of things that are going on and, you know, it's a multifactorial issue that's going... there are a lot of theories and there's a lot of research coming into play about what is going on even before the pandemic, but there's likely a big psychosocial component to it as well. There's been a lot of shifts in society even before the pandemic, and the pandemic has either accelerated it, exacerbated it, and there have been additional things that are coming into play in children's mental health. Okay, and so this... I'm going to talk a little bit, you know, for the four years I worked in juvenile justice. I don't know if anybody in the audience has worked in juvenile hall or is a field... are working with young people that are involved in justice. Anybody? Anyways, we've got a couple people who've worked with young people in the justice system, and so these numbers are probably not going to be surprising for those of you that have worked in the justice system, but 70% of student arrests or students referred to law enforcement are of color, black or Latinx, and this is obviously far overrepresenting their communities wherever they are. Now, some states and some jurisdictions have looked to address this. So, for folks from California, there is a Senate bill that's not exactly this, but there's a Senate bill that is currently being reviewed that looks to get rid of willful defiance. So, for a lot of folks who willfully defy their... the young folks who willfully defy their teachers, you know, this could result in suspensions, and then suspensions could result in getting kicked out of school. That could get... or they could get... have the legal... the justice system called in, and so there is a law being considered in the California Senate right now that looks at taking that away. It is already banned from kindergarten to fifth grade in California, and they're looking to extend it all the way to high school. Again, these are not surprising, but students suspended or expelled for a discretionary violation are three times more likely to be in contact with the juvenile justice system in the following year, and this, sadly, you know, for those of us working in this field is not shocking, but it's still infuriating that the most significant indicator predicting which children will be suspended, it's not the type of offense, but it's actually the color of their skin and their special education status. One of the things that I found working with a lot of these young people, when you ask them to do basic reading or when you ask them basic arithmetic, a lot of them, by the time even that they're in a high school level, nobody's picked it up. They might not even have a diagnosed learning disability, but it's quite obvious that they have something, and I've also seen the flip where you have some very, very bright young people in the system where their talents and their abilities were never materialized because of the environments that they were in. One of the most rewarding patient encounters that I've had was a young man who was just about to be released, and I remember talking to him about his experience in the justice system after being in juvenile hall for about three years, and he had related how one of the surprises for him being in juvenile hall was he learned that he liked reading and that he enjoyed reading, and this was something that he was grateful for, having been in juvenile hall. Students with disruptive behaviors are the ones that are most in need in trauma-informed practices and environments. There is, again, there's, depending on where you are, I think there are a lot of, there's a push for trauma-informed practices both in the adult correctional system but also in the juvenile justice system. The foundation does some work even with judges. There's a judge in Ohio who does a lot of work in this area as well, so there is a gradual push, and the trauma-informed practices, it's not limited just to the mental health folks. The push is to have the entire system be trauma-informed, so that's one of the encouraging things when you think about these, but again, it's not surprising that the psychosocial factors are overrepresented in a lot of the folks who become involved in the justice system. There are often histories of poverty, disabilities, abuse, or neglect. So this is going to give you, during the pandemic, and for those of you following the CDC report that just came out I think a month ago now, a little bit, you'll know, and our Surgeon General has also talked a lot about loneliness, being the epidemic of loneliness. You're seeing, especially in young girls, reporting sadness, increased sexual violence. The period that they're talking about is not just the pandemic, but at least the data is showing that the pandemic has caused a spike in that as well. So when you're looking at young boys, you're seeing one in three experience poor mental health. With girls, it's nearly three in five teen girls that persistently felt sad or hopeless. You're seeing that one in five boys seriously considered suicide, and that's one in three when you look at girls. So the numbers are quite frightening, and they're, despite the fact that we're looking at this, and there's bilateral support in looking at mental health, the crisis, it's reaching sort of an apex. It's continuing to rise. Now, for schools, this is part of the pitch, is that the schools are where kids spend most of their time, and this is also where they may be able to access that one supportive adult figure in their lives. Social skills, education, all that, it's a vital place where we can address their mental health, and oftentimes, if we're thinking about preventative mental health, let's face it, when we're thinking of the number of child psychiatrists in the country, even if we doubled or tripled or quadrupled them right now, we still wouldn't have enough child psychiatrists to see the kids that need to be seen. So we do need to look, as psychiatrists, as mental health professionals, we need to start looking at preventative ways to address this crisis. And one of the ways is to look at schools and how do you address some of these things at school. And we also know that folks who are engaged and connected at school and who are attending tend to have better outcomes, not just mental health, but also in their lives. I'm going to turn it over to Dr. Shapiro for a few questions. So I kind of want to feel out the audience, who works in a school? Could you raise your hands? Okay, so no one works in a school. What about, oh you do. Okay, and you're a psychiatrist? Oh great, okay, my daughter's a nurse. So, and who's on the West Coast and the East Coast? Who's West Coast? East Coast? Anyone in like Florida or Texas or any of those places? Okay. So for me, the things that I want to talk about are just basically what can we do to make a difference and what we, what what can we do to help. And one of the things that aren't up there but that concern me is that the schools have always been a place where kids can get help, where teachers and others can recognize that something's going on and notice, talk, act like we we do in our program, which is the APA Foundation Program. So what it's about is, you know, giving tools and training to teachers about what to notice and, you know, to talk about it with the student and sometimes the parent and what to do and when to need to do something about a problem they see with the student. So one of the concerns I have also is that right now we're being shut down as a society about letting kids even talk about things that they're curious about, that they're feeling inside themselves and that is really troublesome to me. Also the curtailing of being, having access to certain books that would be another avenue that these kids can find out about. What, why am I having this gender dysphoria? Why am I feeling sad? I mean, so many things are being shut down and freedom of speech is being attacked and, you know, I don't think it's about politics for me. It's just about access to information and access for kids to have a lifeline because I have seen so many kids just so lost and so they feel, for instance, I work mostly in Harlem and the Bronx and I used to work at in San Diego on the borders and, you know, culturally talking about, you know, being depressed or sad or whatever, you know, with an immigrant family who thinks that they have it made with having, you know, a roof over their heads and food in their stomachs and their parents are working three jobs, you know, when they hear their kids saying, you know, I'm sad and I'm depressed, they're like, why are you depressed? So they don't understand and we need to educate them and the schools are places where they, they used to be able to get access and things are getting better because, in some ways, because our society is more open to discussing mental health issues and, you know, we are, and I don't like to use the word stigma anymore, but I think the stigma is going away and I think, you know, mental health treatment works and we're gonna have a new campaign at APA about that and we're sort of doing a trial run through the APA Foundation in certain areas, you'll hear about it. But anyway, so for me, what I think is really important is having that access to care and I think all of us in this room can help to train anyone we interact with to get them to the right place to get kids help. So what do we know about treatment modalities that work for, let's say, depression? We know that cognitive behavioral therapy has been shown to be very helpful for youth and adolescents and adults with depression. We also know that multi-dimensional family therapy has been proven scientifically to work and many of us who are, you know, prescribers in the room know that pharmacotherapy also works. But for me, the key is to have all of them work in tandem with one another. So, you know, for me, usually if I have a child that's severely depressed or an adolescent, you know, I'll try CBT and if it's not working I might try an SSRI or something in order to get them to sort of be able to receive the therapy in a better way and be more open to it. So when you see severely depressed adolescents and you have to have the family involved. So for me, I mean, I guess my role here today is just to talk about, you know, what to do when you identify a kid that's depressed or that looks like they're struggling. So does anyone want to maybe bring up an incident or case that they have that they're struggling with or, you know, don't know what to do about with a child or adolescent that's depressed? Don't be shy. Sure. Tell us. We'd love to hear. This is off the cuff, so forgive me if I forget some specifics, but thank you so much for your work, Dr. Shapira. I also work with a Medicaid population. Recently met a 15-year-old girl who comes in psychomotor retarded, very depressed, very flat affect. Shared that father had a history of getting intoxicated with alcohol at home, loud arguments, no violence, but frightening for her. Got connected with the therapist first at my agency, then got referred to me. Mom seems warm when she, you know, and clearly interested, right? Actively asking me, how's my daughter doing? What's going on? How can we help? So she's doing weekly therapy. I've started her on an SSRI, you know, gradually, incrementally going up, but, you know, at like 30 milligrams so far, still hasn't quite, I mean, we've definitely seen some incremental. What are you using? Fluoxetine. Okay. But incremental changes. She can endorse little tidbits of increased energy, little improved mood. How long has it been? Two, three months. But the affect, like we're getting some response, but the affect is still so flat. And then when you talk to her and get to know her a little bit more, it's like has no friends, walks around at school alone around at lunchtime on the track. You know, she feels suicidal when she feels lonely. What grade is she in? What grade is she in? Like ninth grade. Okay. Have you interacted with the school personnel? Do you have a consent to do that? Because, you know, maybe if you let the guidance counselor at the school know, they would help. And if she's in high school, maybe we could look at whatever groups and after-school activities and clubs are allowed. Are there gender identity issues with this child, with this kid? That I can't remember off the top of my head. But so the flat affect is a little concerning, because are we looking at something that's like, you know, is there something else there more than just a retarded depression? So one of the things is, is I would look at family history. And sometimes you don't get to hear that when the kids in the room. So actually, I do a lot of telepsychiatry these days, because the people where I live, oh, I mean, you can hang out, but people where I live in Harlem, they usually have three or four, you know, a lot of kids. And to come and schlep by bus to see the psychiatrist for a half an hour, even the therapist is sometimes really hard. And I'm just loving doing the telework. In many ways, it's very useful. So, but in this case, you know, I would try to speak to the mother and really get a good history of the genetic background of the family to see if there's, you know, first-degree relative with schizophrenia or depression. I try to find out from school, get collateral information on that. Try to find out what kind of music this kid is listening to, if they're listening at all. Because, you know, you can learn a lot. I mean, I listen to a lot of rap, so I can understand what my kids do. And, you know, not just my kids, I mean the kids I treat. And my kids are now aging out. They're 28 and 30. But yeah, so I mean, I try to listen to and try to find something that she enjoys doing. Sometimes art therapy with the therapist you're working with, you know, can be helpful for these kind of kids that you can't break through with. And, you know, it sounds like walking on the track relaxes her in some way. But, I mean, it's really concerning. I think there must be bullying for this child, you know, I mean, or a history of it or something. How does, how does the child appear mental status-wise? I mean, are they attractive? Are they funny-looking? Did they look awkward? What's their cultural background to it? She wants a new guitar. Wow, amazing. She needs a guitar because she wants to learn how to play. So this is some of those incremental changes, right? We really are seeing improvements. She is looking better now compared to when I first met her. But that hasn't changed much. Actually, I had a conversation with a second care doctor even when she was really little. She was just very quiet, didn't say much. And the peeping came out of the pot. I remember I was asking little to little, Hey, how are you doing? And there was no energy here. I was like, I need to go to the bathroom. No thyroid disorder, no vitamin deficiency. I've been asking, Yeah, actually I contacted the primary care doctor to get the primary care doctor to send me to the lab. Oh, that's right. Now I remember. They did send me to the lab. Everything was normal. Okay. Again, I just wanted to sort of hear about a case because I think we all struggle with what to do with some of these cases. And you're doing all the right things. We can hear that, right? So, yeah. So, tips. Just look at all the multi-dimensions that you see a child in, in terms of their functioning. Are they depressed just when they're at school? Oh, academically. I didn't ask what the grades were. So I can't remember. But passing? But she's doing better. And of course, you know, many sort of immigrant families don't know what an IEP is. Everyone knows what an IEP is in the room, an Individual Educational Program. How to ask for it. The school usually says, Oh, you don't need to do that. And you have to tell them you need to write it with the date, your name, your kid's name, sign it, and put it in physically. Even e-mails sometimes, you have to put it in. Even e-mails sometimes aren't accepted. They say, Oh, you never got it. So, yeah, that's important, too. So, yeah. So, my thoughts are that it's really important to look at the kid in many different spectrums of their life and find out if their functioning is good at home, find out if she has a lot of chores. Many cultural groups with multiple children in the family, if it's a female, and they're the oldest, they assume a lot of Cinderella roles. And that's really hard because that's not what our culture, you know, really is about. And kids have a lot of homework, and they have a lot of challenges and responsibilities in school if they want to do well. And so you have to sort of work with the family to let them know that, you know, we know that you have three kids, but, you know, you really need to let this adolescent, you know, thrive and explore on their own. And I would explore more of the identity, gender identity stuff. So, I guess it's... I can make a comment, too, while we transition to Dr. Frolov. You know, my suggestion, thinking about the time that you spend, right, if your clinical hour, right, what if the first 20 to 25 minutes you invited this person 20 to 25 minutes you invited this youth to bring in that bass guitar, show you some of the skills, teach you some things. That's one of the tactics that I... or tips that I've always kind of used even when I do trainings with schools is when you find that interest, you have a finite amount of time, but if you give them time to allow them to teach you, they're way more open to that reception of when you're giving that information back to them. And also thinking about, you know, what is the clinical setting? I think, Dr. Shapiro, you alluded to this. If the child is getting some sort of stress relief from walking around the track, is there an opportunity for you to just walk through a park or walk through somewhere or just go on a walk together so that there's not that, you know, sometimes being in one room where you're looking at the same thing over and over again, maybe it's additional stimuli that helps that student to get out. And just thinking about how you make it interesting and engaging for them to come so that they look forward to it because they're giving you information and they're also taking in that information. But also, I mean, I think we forgot to just look at the domestic violence piece or at least the emotionally violent domestic situation there. I think interviewing the mom on her own, like, that's why I like sometimes virtual because you can talk to the parent separately, like, while the kid's still in school, and then sometimes I sort of break the rules a little bit and call the kid later when they come home from school and sort of put it together as a collateral visit. So that way you can get a more sort of open, you know, sort of conversation with mom. Yeah. You had a question? And that's a perfect lead-in. Perfect transition. Yeah. Wow. We couldn't plan that. Perfect transition. We planted her. Thank you. Thank you for that. So the goal for this section on tactics is that hopefully everyone will walk away with at least one tactic to improve access to care in your communities, okay? So you were saying, hey, we need to be screening for ACEs, and I completely agree. One of the first things I want to talk about is just encouraging screening and assessment. And I'm sure I don't need to actually encourage anyone in this room to be doing screenings and assessments. But really, I'm talking about our pediatricians, our schools, the carceral system. And I'm just going to move on to, well, as everyone knows, October 2022, the U.S. Preventive Services Task Force recommendations came out saying, hey, everyone should be screening adolescents 12 and up for depression, right? And adolescents, children and adolescents 8 and up for anxiety, okay? So it's important, right? And as you were mentioning, we need to be screening kids for ACEs, right? Screening families. So I encourage everyone to look at this APA resource document that was just released on the social determinants of mental health in children and youth. And there are so many great parts to it. I won't go through all of them. But one thing I want to point out is that there's, you know, everything from recommendations for screening for ACEs to looking at, and I just pulled out one part, using the pearls. Oops. Emphasize that. So check that out, okay? And then how do we actually, I feel like I've talked to a lot of pediatricians who say, you know, I just didn't know what to do. You know, we've been waiting five months to get them into a child psychiatrist. And when I hear that, I say, well, I encourage you to screen and treat too, right? And if you have any questions about how to do that, there are so many child psychiatry access programs. And if you look at this website, they can tell you exactly which programs are available in your state. I'm just going to take a few minutes to highlight the one that's in my state, the Child Psychiatry Access Network. But look at this. I mean, they're everywhere, seriously, pretty much. So the Child Psychiatry Access Network, CPAN, usually involves a 30-minute or less response. So for example, if a pediatrician has a question about medication, treatment, what to do, they can reach a child psychiatrist directly. And they can also get consultation about therapy and other interventions to use. And for people who are saying, well, you know, the closest psychiatrist, what I'm finding is they don't have availability for five months. This is also a resource to use to say, well, what else is available in the community? Are there therapists that are available that you just haven't heard about or a psychiatrist? Sometimes there are general psychiatrists, too, that will also treat adolescents, right? So helping them kind of think through that. And the great thing about some of these access networks is they really emphasize education, right? Not just education over the phone, talking to the pediatrician, but also often what we call the Project ECHO series, and you can look that up. I see some nods in the room, so I think people have heard, great, great, excellent. I'll move on then. And I just want to point out that there are so many great resources online at the APA and ACAB. This is just one of them, discussing some of the collaborative care models, how to set them up if you don't have one available where you live. So I think that's helpful. And also, what I really love about this document is that if you go through it, there are links to all of the screening scales that we like to use, which I think is so helpful, right? So PDFs are available, and those are just a few of the screening scales. And I won't even spend that much time on this, but this is just an example of another program that's called the Behavioral Health Integration and Guidance Program, BIG, that's actually being promoted in Dallas, Texas right now. So it involves basically a collaborative care clinic, right? One of my friends is a child psychiatrist in the clinic. And they are taking some of the toughest cases on, really. One, they're educating primary care physicians on how to treat, screen and treat. But if they're running into issues, they have questions, they could even do one-time consultations. Or they can even come into the clinic and observe how a collaborative clinic runs, which is, I think, really helpful. So there are also online training courses as part of this, small group case discussions. I know that I'm breezing through some of this material, so if anyone has questions about what this program entails or wants to get in contact with any of these people, I'm happy to connect you, okay? And one program that I also want to point out that I think is particularly great is the Texas Child Health Access through Telemedicine Program. And I think this connects to the Notice, Talk, Act portion of our session today. And that, well, I'll just show you this part. It includes up to four virtual therapy appointments. And the great thing about them is they happen at school, right? So hopefully they cut down on some of the barriers that we run into. And that the timing, right, the transportation, the availability of the caregiver, right? And we want, of course, the caregiver has to give consent, has to be available to some degree, right? But this is a great free program. And then, as I mentioned, there are so many resources available, APA, ACAP. Those are some of my favorites right there. And I think the key, and I told you I'm a huge fan of this T-Chat program, the key thing though is that it requires someone to really recognize that there's an issue, right? And so Notice, Talk, Act is helpful for that piece. So I'm going to hand it over to Chris. Let's give a round of applause for our presenters so far, please. All right. So y'all have heard it, Notice, Talk, Act, multiple times now. You're probably wondering, what are they talking about? Right here, Program Framework. It is our public education framework for the APA Foundation, and this is what it's all about. Notice, when a student shows early warning signs of mental health concerns, what we train staff members, when you see a disruptive behavior, could be a sign for additional support services. You don't know what's going on, that's why you got to talk. Same with withdrawn behaviors, right? Disruptive behaviors, extreme, force your attention. Those withdrawn behaviors, we know are patterns that take time. So how are we collaborating as a school together to notice those? And we talk with students about mental health to engage and support them. But more importantly, there's always an action. There's always something that you are going to do to refer students to the right kind of resources they need and can access in your school community, or you're acting to build a relationship, or you're acting to gather more information, or to share information with others. We piloted the program, redeveloped the program in 2018, launched the redevelopment in 2019, and we were almost at the end of the first school year when the pandemic hit. These are the potential impacts in the training that we were seeing within the schools that we trained in. Notice, talk, act before the pandemic hit. 70% reduction in truancy, 89% reduction in discipline referrals, a 99% reduction in major mental health events, which we have labeled as suicides, and a 171% increase in referrals to support services. Truancy, school culture, also schools are really, really interested in making sure their students are there on attendance days, right? So how are we showing them that this is a valuable training for them in general? Reduction in discipline referrals, Dr. Dube talked about it, the school to prison pathway. It's very real, and how are we reducing how those disruptive behaviors, especially for our students of color, are getting directed to support services and not handcuffs of the juvenile justice system? Suicide is the second leading cause of death among youth right now. What we've seen in one of the schools in particular is that their PHQ-9 screenings increased dramatically. They were able to see students, get them screened, and get them to resources sooner. That support services referral, it's not just about mental health, right? We're a mental health organization as the APA, as medical leaders, the foundation being public health, public education and mental health. We know that it's not just mental health that impacts a student's ability to show up and be their full selves, and a lot of times what we're experiencing now is the crisis at the end of it. How do we get up sooner, right? So if you have housing resources, clothing resources, what resources do you have available for students that we can inform your staff of? One thing, one of my favorite resources I love to talk about, transportation. You have a transient family that's constantly moving couches, hopping, splitting up the family, moving here and here, different bus routes. When you move bus routes, sometimes there's an increased cost, it's a financial stress. Sometimes students really wear that to school. One of the schools that we trained in, they didn't know that they had bus tokens for those students, and it was one of the biggest things that they increased in because students were talking about that stress, and they could, hey, did you know we had free bus tokens for you? We're going to give you a bunch of this person who has resources. They can do it on the low, it's not a big public thing, it's, hey, here's resources that can help you out right now, this is going to help you come to school, be less stressed about this financial thing, and really dedicate yourself to what's going on. Program framework. So Notice Talk Act is the key to the training. This is how we do it. It's a three-step process. Step one, online, 30 to 40-minute self-paced, excuse me, to establish a baseline of knowledge. We know when we, mental health professional development, every staff is a little bit different with their mental health knowledge, right? So how do we get them all on a very similar baseline so we can focus on skill building? I'll learn about those mental health facts, early warning signs, why are you taking this training? Why is it so important for your role to notice, talk, and act? And get introduced to the effective motivational interviewing technique, right? So this is an evidence-informed training. We pulled from motivational interviewing that ORS, open-ended questions, affirmations, reflections, summary, that is a skill based off research that no matter your education or professional level you should be able to deploy. Why is this important for the school? We collect data during this pre- and post-test phase to figure out where are additional areas of support that they might need, are there specific scenarios that that school is struggling with? Step two, in-person curriculum tailored to that individual school. So every school is different, right? Even if you think about the area code that you might live in, the access to support services in an individual school might be a little bit different. So really getting to understand, A, what are the student demographics, what are the concerns from staff, what are those community traumas, right? When we talked about trauma and trauma screening, well, guess what? If there's community traumas that are happening to the students, the staff are bringing it to that training, too. So if we don't understand that, we have an ability to potentially trigger the staff during that training, and then it goes off the rails, and now we're not actually focused on the student's mental health and how do we get them there. Discuss the unique challenges and opportunities at communities related to racial and ethnic disparities and barriers to care. We have a team of seven from NTI certified trainers, so myself, Joy, Rachel, if you want to raise your hand as well, currently in the room. We're also training fellows. We're doing a lot of different to really build up our training, and that's why we need more of you to get involved with this work as well so that we can continue to build our capacity to deliver this. Step three, ongoing support tools. One thing that we found within the redevelopment of our program is a lot of mental health professional developments are one and done, right? You come, you do your eight-hour training, your four-hour training, you wipe your hands clean, you check a box. I'm a social worker. It's not going to fly with me. I want to do the e-learning. I want to do that classroom portion. And then I want to check in. I want to make sure that you're actually using my Notice, Talk, Act framework. I want to see if there's additional courses, additional resources. So we pull that both from individual schools, but then we're also looking at the larger picture. Joy and her school fellows created some resources for parents around ORS. We're training school staff in ORS, but is there a resource that we can create for parents that's going to help them engage in some more of these difficult conversations? And again, that customized, we want to make sure that they're really using Notice, Talk, Act and really engaging in it. Why? Why do this? Y'all are mental health professionals, clinicians. Every school staff member has a specialized role. Teachers got to teach. Food staff got to feed those bellies. Custodial staff got to clean the hallways. Everyone's role is to Notice, Talk, and Act. And our goal is to empower the staff members to understand that you already care about kids. That's why you're here in the school. That's why you're probably in this educational environment. You already know how to build relationships with students. You're just maybe a little uncomfortable engaging in these difficult conversations. So how do we make you more comfortable? How do we give you that skill set so that you know, when I hear this or when I see cuts on a student's arm, I don't have to ask questions. I've gathered enough information to refer that student. Or if I see their hygiene dropping, I don't have to re-traumatize them and ask them, well, why are you smelling bad? No, no, no, no. I've gathered enough information to know that that's a decline, and I need to refer you to the people who have been trained to do that. Ensures that all students with unseen needs and other barriers have the same access to in-school mental health care as everyone else. Again, disruptive behaviors tend to really gather our attention, but how are we working together as a school community? Notice that when that student is walking through the hallways and not engaging in class, and you're the third staff member to notice that in one day, we can do a little bit better of getting some wraparound services for that student in general. So I can brag all about the work that we've done to redevelop the program, to put together Notice, Talk, Act, School. This is what educators who have been trained in the program are saying about it. Thank you for allowing us to be a part of this training sessions. This was, without a doubt, the most useful training of my teaching career so far. So happy and thankful for the grant and program. Looking forward to more training and follow-up. One of the better trainings I have had in my career in education. Useful, practical, and important. Emotional wellness of the students is critical for the development and for the culture of the school as a whole. I really enjoyed the training. That's a PE teacher and basketball coach, right? So you need to think about who this is impacting, right? Thank you for further empowering me to become an even more effective, impactful educator, right? SAMHSA provided us with just over a half-million-dollar grant last year for the next five years to help us to deploy this to these target areas. Atlanta, Kings County, New York, so Brooklyn, the state of Iowa, Los Angeles, and just, I won't say just down the road, we're in California. It's a long drive, and Oakland County, Michigan. And how we're going to do, how we're going to impact those areas is we're going to provide our training in either one of two ways. Through direct delivery, so again, certified instructors, work with that school. When we're talking with school districts, what we usually say is, is there a school in your district that really needs some additional support, right? Because the most effective delivery model is the train-the-trainer. How do we build up the capacity of those school mental health professionals to take this curriculum and really own it within their school district, within their individual school? In their individual schools, so that they can really take this. And again, it's not a one-and-done training. A lot of what we do, especially in the classroom portion, is to make sure we're identifying, well, you're an expert in open-ended questions, but you kind of struggle with summary, but this person's really good at summary, and they kind of struggle with open-ended questions. How can you collaborate and continue to learn after you leave this session? How to engage with us. So we encourage you to visit apfdn.org slash schools. Contact us to ask questions at schools at psych.org. Or you can schedule a meeting. I believe, is that the Calendly one? No. Or schedule a meeting with us as well. So I know we talked about the SAMHSA areas. We're also looking for other areas to deploy this, right? So please feel free to reach out to us. We are trying our best to make an impact. Our goal this year is to train 4,800 staff members with this SAMHSA grant, with a 10% increase each year of the grant. So it's a pretty lofty goal. So we need your help, and we need your support. If you'd like to contact myself or Joy, Joy, would you like to raise your hand? Joy's my wonderful program manager and helps to deliver the program and actually oversees. Dr. Frolov was a fellow on the Child and Adolescent Council. We have a small group of fellows that help us to create resources for our school-based work as well. So she oversees that, which is great. And I would like to just open it up to questions now. Dr. Dwyer, do you want to close out and then open questions? We can open it up to questions, but I do want to thank our panelists for the expertise that they shared. I can tell you, in particular, working with Chris and Joy, their energy, their passion, it's infectious. It's inspiring, and it's been an honor to be able to work with them in this space. I also want to thank you guys for showing up. I recognize and I sometimes know that it's not recognized that the work we do is hard, especially working with young people, their families, with teachers, and the entire system. It's not easy. There's two major takeaways that I'd like to leave you with before we open it up to questions. And I think, hopefully, some of these are obvious. One of them is that we're reaching a crisis. And I keep saying we're reaching, because it feels like it's not yet getting better. So the mental health crisis in young people is very real, and it's not going to be just one solution that's going to fix everything. It's going to take all of us. It's going to take psychiatrists, parents, the young people themselves. Maybe not popular in this room, but even lawyers. It's going to take the entire system, educators, social workers, public health professionals. It's going to take all of us to work on this. And then finally, programs like Notice Talk Act are at least part of the solution, and they're going to help with the problem. Thank you. I wanted to add that some states were instituting, some states are instituting social-emotional curriculum, which is really amazing, because you're actually teaching the children how to recognize themselves when their peers are feeling depressed. So it's kind of giving them psychoeducation from kindergarten on up. Of course, we have that in New York State. They're doing it. But then we have places where you're not allowed to even discuss these things. So we really need to work as a system to advocate for this through the educational system, through our expertise as mental health professionals. If you run into resistance for social-emotional learning curriculums, soft, employable skills. Every single parent wants their child to be employed at some point in time. Soft, employable skills. It changes the conversation on what we're talking about, and it tricks them. Sometimes you just got to trick people. And that's kind of some of the conversation we're having with schools is, why don't you call it a soft, employable skill? Because that's really what we're talking. I don't know. I went to grad school. We have a lot of medical students in here as well, graduates. How many group projects have you done? How many group projects do you continue to do that's about collaboration, compassion? All of those things are employable skills. Again, we have to understand the underlying of why we're doing those things. Sometimes it's just a phrase, and that's what tricks people. I want that. OK, cool. It's social-emotional learning curriculum behind the scenes, but we'll call it soft, employable skills. Questions? Feel free to come up to the mic. It's recording, so we want to make sure we grab it. Thank you for all the information. We'll start with that. So my colleague and I, I'm going to call her out, literally were just in a community partnership meeting where this concept was discussed as a dream that we wished could come to fruition in our community. Literally. So I was like falling out the seat as you were talking. So my question is, as a way to bring this to our community in Virginia, is this initiated through the community mental health sector, or must it be initiated through the public education system? And if the community mental health sector is the only ones that maybe see the value in it, give us some tips on if the public school system must initiate how to do that. We will initiate anyway. So I'm glad you brought that up. So Oakland County, Michigan is going to be the example that I use currently. The Oakland Community Health Network, Dr. Pozios, who is the speaker-elect of the assembly, we have a really good relationship. And we've actually been working really hard to, we went out and delivered a presentation to the entire community, the FBI, everybody who was a part of it, and said, if you're interested in partnering with us, we're ready. We worked with the Milwaukee Archdiocese, and they had a mental health training collaborator who was trained in mental health first aid, all the other professional developments. We trained her and said, if they're interested, we'll deploy it. We've worked with individual school districts. We've worked with individual schools. So it's really about, I would much like, I'm a social worker, right? I would much rather work with the district or the Department of Education at the state and deploy it, right? If I'm thinking about really making a change. I believe, and it's probably just my belief, if I can get to one school in your district and I can invite all the rest of the schools to see what we're doing for that one school, it sells itself. We did that, we had a grant school in Mount Pleasant, Texas. So very rural Texas community. They had a high school that was really needing it. Some of the other schools weren't too sure about mental health professional development. We invited them to it. The entire district paid for the training. So they got free training for their one school. They were willing then to pay $9,000 to get the rest of their district trained in the curriculum because they saw the value. They saw the worth of it, right? And that's one of our recruitment tactics is if you can get me into one school, we're in Virginia by chance. Rolando. Well, where's the community services for it? We serve five localities. Okay. Which includes Monroe City, Salem, Fairfax County. So Stafford County, Virginia was one of our pilot sites as well. So we have some footholds, or at least we've done some deliveries. And Raul, hopefully I'm not getting too ahead of myself, but retired Colonel Page out of the city of Alexandria. We're working with him right now to try to deliver it to the Alexandria school district as well. Again, that's through a community partnership. That's a Concerned Citizen Network, I believe of Alexandria. So again, that's not even the school district. If we can find a community partner that has the relationships with the school, again, we're an APA organization. We need the community members to introduce us. We need the people that the people trust to let them know, okay, no, this is a good program or let's pilot, let's test it here. And then we can show it off to everybody else. Hopefully that answers your question. Okay. Hi, thank you so much for your presentation. I for one am really excited to hear you speak a little bit more on the public mental health crisis that we're facing here with our youth in America. I got my master's in public health. And one of the things that really frustrated me was that they don't have a track for mental health or substance use disorders. If you say you wanna go into those fields, they say, well, why don't you do social work? Or why don't you become a psychiatrist or a psychologist? And I think that there needs to be a little bit more of an emphasis on mental health within the public health infrastructure. So I was wondering if APA has any sort of initiatives to bring mental public health education higher up into the systems. I know we're putting it into the schools like primary care level and high schools, but is there any sort of education being disseminated to public health professionals? Sorry, it's a loaded question. I think you've got the next project for Chris and Joy. Right? Oh, man. You guys would know better than I would, but as a foundation. I'm not sure, I don't know if we're doing, I mean, we're not. Yeah, you're absolutely right. You know, as somebody, when I was doing my own public health degree, we looked at the epidemiology, but as far as interventions, there was very, very little. Most of the interventional level stuff, you're looking at cardiovascular disease, obesity, you're not, there wasn't as much, some substance use, but not a whole lot as far as mental health. And I think that it has been lacking. You know, a couple years ago when I was faculty at the University of California, Irvine, I went and spoke to the public health school there, to the students there, and one of my challenges to them was what would a mental public health intervention look like? And a lot of them, they really had to, I mean, even me, you know, because it's something that we're just starting to look at in a real way. So I definitely think there needs to be a lot more in that space. But I don't think we're quite at the level where we're able to look at interventions. I know, you know, again, from the public health side, the interventions that, the minor interventions that have been successful are more structural changes than they are behavioral changes at the individual level. So you're looking at, you know, kind of structural policy level changes, and those have made a difference. There's some naturalistic studies that have looked at maternal depression and outcomes, both the Appalachian, Smoky Mountain, what's it called, Smoky Mountain studies? I forget what the name of the study is, but it's done in the Appalachian Mountains. And there's also a study out of Ecuador that the World Health Organization has looked at, and they've looked at maternal health, they've looked at increasing family, even when you give families compensation with maternal mental health problems, the outcome for the kids is still better. So one of the biggest things that you look at is maternal mental health, it's oftentimes correlated with, go ahead. I just want to say, so I received my MPH from Boston University, and I heard that they actually recently came out with, we were able to kind of specialize and go into specialized tracks. They actually came out with a mental health and substance use track. And then I also have a friend currently getting her MPH at Johns Hopkins, and I'm asking her right now, I'm like, what is the exact name of your track or program? So I'll share that with you as soon as I hear it. So, I'm going to shift the subject just a little bit. So, we have a lot of small grants in the APA Foundation that we give to small organizations that are doing innovative work in mental health. And, you know, it could be in a church, a school, an outpatient clinic, a youth sort of center. I mean, there are lots of different ways. Of course, you need to have a physician, some psychiatrist or mental health person involved in it. Also, you know, we need to train more and more fellows to kind of go out there and help us with our agenda to increase the sort of IQ of people about mental health and how mental health treatment does work. So, I encourage all of you to, if you work with fellows or you're a fellow yourself or you're an early career person, to look at what's available in the APA in terms of fellowships. We have 175 fellowships. So, what it is, is you don't have to quit your job or anything. You just come a couple of times. There are meetings and a lot of them are virtual and you get assigned to different councils and different committees and, you know, you get mentorship. So, you can sort of have more connections and have more of an impact. So, I want to encourage that. And, of course, any APA member, you know, if you donate to the foundation, even five, ten dollars, whatever it is, a cup of coffee that you would normally have, it really makes a difference. We want to see more, you know, sort of membership, our percentage go up because this is what funds all these programs and funds Notice, Talk, Act. So, I encourage you to get involved. I'm going to give you two challenges. It's social worker in me. Policy programs and partnerships is a division within the APA. Sounds like this would be something that would be right up their alley as far as potential work or policies. And I don't know if you like writing books, but yeah, I think, you know, what we did for justice in mental health professionals was we created a book called Mental Health Professionals' Role in the Criminal Justice System and How They Reclaim Their Patients. What if you made a book for, sorry, public health, public health ministers and public health professionals and their role in mental health and substance use, right? Because if you have that knowledge, if you have that passion, and if we're lacking the resources and the information to share with that, maybe there's an opportunity for you there to create the resource that is needed, too. So, just, I mean, I love to challenge people and I love, I like work, but I also know I have to say no sometimes. So, I'm going to tell Dr. Dubey, no, I'm not going to write that book, but maybe you should. I have a question for Dr. Furlove. Actually, if you could expand a little bit more on your collaborative care model, is it more just, like, education-wise for the pediatricians and family practitioners? Is it more about, you know, incorporating a psychiatrist or a therapist into outpatient clinics? I practice in Atlanta, and I will say that our collaborative care, integrative care model is not great there. I think it's okay at the level of emergency medicine or, like, just, you know, in our children's hospital, you know, of course, the consult teams and stuff like that, but when it comes to outpatient, I don't think we do a very good job with collaborative care. So, if you could expand a little bit more on what you guys are doing. Sure, sure. So, I think, I usually steer away from putting so many words on a slide, but there are so many parts to this program, and I didn't want to shortchange any of the parts. So, that's why there's, this slide is really busy, because not only is there the collaborative care clinic, in which there's the child psychiatrist, there's a pediatrician, there's a psychologist working really close together within that clinic, but there's also the component where they go out and they will help create clinics in the community, help create those collaborative care clinics, and they'll do that by doing the visits, they'll do that by inviting people to just come into their clinic to see how it goes, sitting in as much as possible. They'll do that by these online trainings and small group case discussions. So, it's this multi, I mean, I'm just impressed by how much they're doing in this program. And just one thing, the collaborative care, and one thing we learned when we even trained that school district, was that was the one time that all of the mental health professionals across that district were all together at one time talking about their issues, and I was like, well, why don't y'all do this on a quarterly basis, because this student that you're struggling with in elementary school is going to go to middle school and is going to matriculate into high school at some point, and if you can do a better job of communicating, and one of the things that they talked about was, well, I transitioned from middle school to high school, and a student actually reached out to me because of that relationship that we built, right, and now we could explain, and so also, I think, how do you continue to take your role as a psychiatrist and a mental health professional and encourage some of these other models that we see to be, even if they're not in the best state, and implement them into school so that we are having case consultation, because we know that's a best practice in mental health, right, but if we don't make the time for it, there will never be the time for it. So, I think, I just wanted to jump in there, because that hit my mind. And one other way that they're kind of also selling this program, by the way, is that they are training on how to bill, too, so making it see it like it can be a more, by treating the more complicated patients, right, they'll say, we can teach you also how to bill for those visits. So, that's one way they're reaching even more primary care doctors. Any final questions? Like, you know, we're here until 5.15, but we also, I am all about trying to end early, if we can end early, because y'all need to get to the opening plenary session. It's going to be a good one. It's going to start at 5.30, but if we have any other questions, I'll hang out here. Joy, my program manager, is here. We also have some other foundation staff, so we're happy to answer any questions, if you have as well. So, but if not, I just want to, again, thank Dr. Dubé, Dr. Shapiro, and Dr. Froloff for being a part of this APA-sponsored session. So, let's give them a round of applause.

youth mental health

awareness

school intervention

Christopher Chunseely

Notice Talk Act

truancy reduction

Anish Dubé

mental health disorders

Gabrielle Shapiro

social-emotional learning

telemedicine

public health education