Shanna M 00:11
It's time to be well with your health. I'm Shanna,

Nimeet K 00:13
and I'm Nimeet.

Shanna M 00:14
Welcome to the "Adventist HealthCare & You" podcast! Today we have two awesome experts to talk to us about Adventist HealthCare's the Lourie Center for Children's Social & Emotional Wellness and Early Childhood Trauma. So not something that a lot of people really know about the Lourie center or how early childhood trauma can affect us later in life.

Nimeet K 00:36
Absolutely

Shanna M 00:37
I'm really excited to talk about that. I'm a mom, Nimeet you're a new dad.

Nimeet K 00:41
I know slightly terrifying me, to be a dad and just being aware of you know childhood trauma and what are the factors, I think it's gonna be so valuable in this podcast.

Shanna M 00:50
So we have today, Renee Stewart, a early childhood mental health specialist with the Lourie Center's Head start Program. Welcome.

Renee Stewart 00:58
Thank you.

Shanna M 00:59
And Stephanie Nti, who is also with the Lourie Center Head start Program, and an early childhood mental health specialist.

Stephanie Nti 01:07
It's great to be here. Thank you.

Shanna M 01:08
Thank you for being here. Thank you for all that you do here and how you help children. I mean, I know we haven't dug into it, but I just know what you do is so special and important. So thank you for what you do.

Renee Stewart 01:19
Thank you for having us.

Shanna M 01:21
Well, let's start with a stat that not all of us, I think, even understand or even realize. Did you know? That about 34.8 million children, and that's ages zero to 17. And also, that's nearly half of American children as well, are exposed to adverse childhood experiences that can harm their future health and well being.

Nimeet K 01:47
That number terrifies me!

Shanna M 01:48
When we actually say adverse childhood experiences, what could that mean.

Stephanie Nti 01:52
Adverse Childhood Experiences (ACE) can occur to children from a very young age. And so this is why trauma is something that is not something that necessarily happens as children get older. But it can actually happen even in utero, considering if a parent, if a mom is highly stressed, if she's going through a domestic abuse situation, if she's on substances, or pain medication, all those factors can have a direct traumatic effect on the unborn child. But ACES in particular speaks about adverse childhood experiences from aged zero to 17. And it includes many of these factors that I'm going to explain in addition to others. So we're talking about witnessing domestic abuse, we're talking about physical sexual abuse, we're talking about witnessing violence in the community as well. Living with family members who may have mental health, substance use issues,which they're exposed to, poverty, which means not having enough food or basic necessities of life.

Shanna M 02:52
Which you don't really think about that as trauma, but it is, or but it affects your whole being.

Stephanie Nti 02:58
Absolute development. Right. So it goes back to Maslow's hierarchy of needs food and shelter. If you don't have those basic elements, how do you thrive? How do you think, how do you go to school? How do you show up, right, and so that's a basic need that is unmet. We're talking about having a family member dying of suicide, or even just the death of a loved one. In our program, we've seen parents pass and leaving young children behind, and how traumatic that must be on the family, but also on a child who's now grieving, and what grief looks like in a child, right grief and loss. And then we also have parents who may go to prison, and leaves a huge gap or a big void in a child's life. And so you have instability, in separation or even divorce when parents are no longer together, and the child now has to go from a two parent home or having more support, and now having been reduced to either a single parent household. Oftentimes with lower income, which also has a huge economic impact, and quality of life.

Renee Stewart 03:55
I wanted to punctuate with Stephanie is highlighting, when we think about adverse, we think about something that is out of the norm, we think about something that could be traumatic, maybe not always, but has the propensity to be traumatic. And so some of the circumstances that Stephanie highlighted, really is we're talking about maybe a parent who is preoccupied or for whatever reason, whether it's through death or incarceration, they aren't able to be present and supportive of a child or even for themselves, as well. So I just wanted to punctuate that as well, that the preoccupation or the lack of presence, whether physically there, or not physically there can certainly have an impact.

Nimeet K 04:35
I think the various factors you guys mentioned is unfortunately more common now. And you know, we're seeing that more and more, you know, people below the poverty line or one parent household income, you know, just things like that are coming up a lot more, divorces are more common now as well. So I think, you know, families and children's seeing that is definitely challenging. But talk to us about your role. How do you support families like these, or children with these families? So what is your role within AHC? And how does the Lourie Center support it?

Renee Stewart 05:11
Sure, so I'll speak for both of us because we share the same role, but we are early childhood mental health specialists. And so what that means is that we promote the psychological health and well being of not just children and families, but also our staff, and teachers, as well as managers, anyone who's coming in contact with children, we want to support them in terms of building their capacity to understand behaviors on a granular level, but then also understand and be able to recognize some of the adverse experiences as well. So we do that by offering trainings, workshops, conversations with teachers, conversations with and discussions with parents as well, to really help them to understand what they're seeing and give it some proper context as well. So our goal is capacity building, and psychological health of the program, we know that children need that. But the adults that are caring for the children, that are the attachment figures for children, they also need to sort of have the most appropriate lens, and so we base that our tutelage on best practices as it relates to trauma informed care as it relates to social emotional health and well being.

Nimeet K 06:24
I'm assuming that helps build resiliency as well and ensure that you know, there's so much thrown up the parents, the teachers, that they're able to make a logical decision based on the observations that they're seeing.

Shanna M 06:36
and give their best for the children.

Nimeet K 06:37
Exactly

Renee Stewart 06:38
And so much of giving their best has to do with if I personally believe that I can do my best. And so what would that look like for me as an adult, so that I can properly care for the child?

Shanna M 06:49
Tell us a little bit about the Lourie center. So we've sort of talked about it, and and some of the things that that you all do to to support the kids and the staff and parents and families. What is the Lourie center?

Renee Stewart 07:00
Well, the Lourie center Head start is a program that is federally funded, it's community based for low income families, as well as pregnant women with children from birth to age, five years old. And so the Lourie Center has a number of components to it, we have a clinic setting where we have families to come in for therapy, parent child interaction therapy, so they practice PCIT, they use a attachment framework to support and guide the work that they're doing with families and children. But we also have a head start program as well. So we have teachers there who are there to support children and families who have qualified to be in our program, who meets some of the qualifications for maybe foster care families or families who are considered to be unhoused, I'll say, and our mission is to promote healthy prenatal outcomes and to ensure the children have appropriate psychological, social and emotional support. I'm saying children but also the family origin as well. So we know the unit is important to be supported by a program like this. It also affords parents the opportunity to have their children to be a part of our preschool, early preschool, we know that early intervention is very, very important. And so being able to go to school or attend school and be in a social setting, and learn some of those really foundational skills that they will need as they matriculate through school is really important. It's something that is often not afforded to families outside of traditional tuition or being able to get your child to a place where they can, you know, be in school. And so the Head start Program allows families to be able to bring their their young children into a school like setting.

Shanna M 08:47
Okay, and provide them with the support that they need.

Renee Stewart 08:51
Absolutely. Absolutely. Families and children get the support that they need.

Stephanie Nti 08:55
And I'm gonna add to that, we are based in the community. So we are throughout Montgomery County, Prince George's County. And so we serve a wide range of community members, particularly people of color. So marginalized communities, again, those below the poverty income levels. And so we're very intentional about making the staff also represent the community, so that the children and the family members feel connected to the people who are working and serving their children, so that there's a cultural component incorporated into this as well. And that communities feel safe in our company and in the company of our staff.

Nimeet K 09:35
I think all the work you guys are doing it's like

Shanna M 09:37
Phenomenal

Nimeet K 09:38
it's so great, it eliminates a lot of disparities that we see in the community and I think you know, just bridging that gap is so valuable.

Stephanie Nti 09:45
So if I can add

Shanna M 09:45
Well and I'll even say this, you know, when you think of Adventist HealthCare, people think of our our hospitals, doctors offices, but really a part of our mission is mental health. And that is starts in childhood, that starts in utero you even mentioned that trauma can happen and, and, you know, it speaks to why that these programs are so needed and valued is the fact that, you know, when you think about trauma and adults, and when we have trauma, how hard it is to process it, think about how hard it is for children and how much it affects us later in life, and then how you can carry that through.

Shanna M 09:47
Yeah

Stephanie Nti 09:47
to your point, in fact, ACES are linked to chronic health problems,

Shanna M 09:56
Yes

Stephanie Nti 09:56
mental illness, substance use problems in adolescence and adulthood. And so you can see how ACES can also negatively impact education, job opportunities and earning potential. But the good news is that it can be prevented. And what our program does is to mitigate the risks of these risk factors. By having these protective factors in place to support the community.

Shanna M 10:54
The work that you all do is so important to help these children and families find their way.

Renee Stewart 11:03
So much of what we do has to do with the relationship building, and building the capacity to manage the relationship. So that's even on a parental level. So we look at teachers as caregivers, we look at teachers we look at the directors of our center, or our leads of our center as attachment figures as well. Because sometimes children are coming from homes where I might have a preoccupied parent or I might have a parent that is I'm unable to access for whatever reason. And so when I come to school, I have people that can support my wellness and support my well being. And so a lot of the work that we do is on capacity building and helping the people that are around the children to see themselves as attachment figures. So often, I'm pretty sure a lot of us in this room can remember that teacher, you know, that educator that really sort of spent time with us, and really helped us to feel nurtured and valued in that relationship is so important. It's so important to mitigating trauma, as well.

Nimeet K 12:01
So as a new parent myself, you know, what are some of the signs that I should be looking for for my child, I have an 18 month old?, So you know, you said as early as in utero, like you could see impact for babies or you know, fetuses like, what are some things that I should be looking for for my son now, that I may not be aware of?

Renee Stewart 12:21
Well, Congratulations. Congratulations. Well, one of the things that we look for if a child has witnessed or experienced trauma, you know, for whatever reason that we, and it depends on the age too. So we want to be careful in terms of the ages, and so your, your little one is 18?

Nimeet K 12:26
18 months

Renee Stewart 12:33
18 months old. And so it can be a little tricky. I always say for very, very young children, whatever you see, as a parent, I think you have to follow your instincts and follow up with their pediatrician. But for some children, they may not make eye contact for other children, they may start with Bedwetting, some may have changes in their mood, sleep patterns, anything that is a change from the normal, what will be outside of what you would consider to be normal for your child, you want to highlight that and bring it up? It may not mean that anything is wrong, perhaps, but it could and we don't know. So any slight changes would be considered something that would be viable and needs. So maybe easily startled, I may have mentioned this and not making eye contact, as well. Maybe they're not saying as many words, as they need to say there is a connection between trauma and language as well that traumas sort of it could even take away the language and promote some regressive behaviors in a child as well. So if you noticed that your child is regressing? Perhaps they were doing well saying couple words or however many words they need to say 50 Words, 100 words, and then you notice that it's starting to scale back for some reason.

Renee Stewart 13:51
It doesn't have to be traumatic. It could have just been, I don't know, something that that that has maybe a little hiccup or change in the environment, perhaps. But highlight those things to your pediatrician, I always tell parents that nothing is too small.

Nimeet K 13:51
Right?

Nimeet K 14:06
Yeah.

Renee Stewart 14:07
And nothing is too small. You spend a lot of time with your child, rely also on the resources that you have. So if your child is in school, ask their educators ask their teachers and say, hey, i've noticed this at home, are you also noticing this in the classroom? They may say yes, or they may say no. So I would say of course you all have heard the term that you are your child's biggest advocate, you really, really are.

Shanna M 14:30
If you're seeing these things in your child, what advice would you give to a parent or a family member who might be hesitant or afraid to ask these questions? Just don't know what resources are available, or maybe you just don't realize what's happening and you don't know where to go. So what advice do you have for parents that are interested or want to seek advice?

Stephanie Nti 14:58
Well, I would say first we have to normal Is the conversation about mental health? trauma? We have to make it a conversation that is not rooted around stigma or shame or guilt. Right, we need to be able to come to the table and have an honest, non judgmental conversation with parents. So then take the shame out of it, we're having a conversation about your child's development. You've noticed that when we talk about mental health or trauma, it creates a reaction very different than if you had a physical ailment, naturally, take your child to the doctor, something is wrong with the child physically, we have concerns about their physical well being, it's not the same when it comes to concerns about behavior, mental health, it comes with a lot of stigma, a lot of criticism, and I think people themselves feel a sense of they've, they've done something wrong. And so it becomes a personal internalized sort of feeling. So first of all, normalize the conversation, take the shame out of it, and let them know it's okay to have this question to have these conversations and that no one is going to judge you. Because we also know that the earlier you get help for your child, the better the outcome, right, and that's what early intervention is about. So when you prolong an issue, the child suffers unnecessarily, you as the parent suffer unnecessarily, because you're worried. And also the child is not able to cope with what's happening. And I think that's when trauma really sets effect when the child's coping mechanisms are not enough to deal with what's happening. And so you as the parent are in a position to help guide that child through different supports through whether it be developmental pediatrician, whether it is working with a behavioral specialist, whether it's working with clinical social workers, like Renee and I, at least assessing the issue and a better understanding what is behind the behavior, because we know all behavior is communication. So what are they communicating through their behavior? And when you don't ask those critical self reflection questions, you're often left without knowing. And that's where the fear comes in. When you don't know something, you're afraid of it and you tend to avoid it. And so just to kind of validate their emotions, validate their their fear, and talk through what that must be like for them, but offer that support. And oftentimes, it's holding their hand in the process. Wouldn't you say?

Renee Stewart 17:03
I will say, and I think that a lot of parents don't want to be talked at they want to be spoken to, you know, I think it's important to hear what their fears are, what are your concerns, and like Stephanie has said, and I'm going to punch away to really validate that. But also, what we also like to help parents to know is that you know, when you pose questions to your child's pediatrician, when you ask friends, hey, you know, is your child doing this or that, when you start to sort of wonder about what you're seeing, that can really open the doors to even validate what you are also seeing. Because I think it can feel really lonely and really isolating, If you feel that this is only my child, it must be something that I'm doing wrong. And I know it's really hard to maybe take that first step. Because maybe in some ways, that's admitting that I'm not the best parent that I thought I was in. It's really not admitting anything. It's just saying that you know what, I am a good parent, because I'm good enough, that I'm going to ask the questions, because that's what parents who want to know do. And if you don't ask questions, that doesn't mean that you're a bad parent, it just means that you're struggling to maybe think about your child in a different way in a way that you may not be ready to think about them. But asking questions can also validate, maybe some fears that you're having as well, that you've had for a long time. And you didn't know that other people are experiencing that.

Shanna M 18:25
Goes back to what you said, Stephanie, normalizing the conversation, normalizing how we think about it. So that's, really important, how parents, family members find, these resources in the community know that you mentioned, you're in the community, where are these resources.

Stephanie Nti 18:47
One of the amazing things about being a part of Adventist HealthCare is that we have a behavioral, behavioral unit, department or resources. So we like to have partnerships in the community. And that includes with Adventist HealthCare. The Lourie center is also very well connected with other providers who provide social emotional support in the community, culturally informed resources for family members, where there's language and other cultural significance that we want to honor to make the experience much more welcoming. But oftentimes, it is on a case by case basis, we really have to do an assessment about what are the needs and what's going to fit this particular family. It's not a one size fits all approach. You really want to be intentional and really be mindful of who you're referring individuals to and really ask those questions. Where would you be more comfortable? What setting would make more sense is it home base, is it going into a clinic? Some people have mistrust of going into buildings, institution, sometimes they prefer you coming to the home, which is much more personal. Come see me where I'm at with me where I met you how I live, and that can make the difference in the world. I think it's also important to recognize that the parents themselves may be dealing with their own trauma unresolved, they may not even realize that they have their own trauma. So that's also getting in the way of them being able to either support their children, or for themselves getting the help that they need. Because in order to be strong parents, you have to also deal with your own stuff, you have to be able to have that reflection and say, I need some help myself. And so maybe I've experienced some acute trauma, in my own life. Maybe i've had some intergenerational trauma that often comes from racism, discrimination and other things, which is, by the way, another one of the ACES, discrimination. And so I've experienced discrimination, and now I'm dealing with that, and I've harbored that inside of me, how am I showing up for my child? My triggers? How do I, you know, how do I cope? And so being mindful of what I need, as much as what my child needs, oftentimes takes a parallel process?

Renee Stewart 20:42
Absolutely. I find that when we start there, and when we open up the conversation and asking parents, you know, what kind of resources would be helpful to you, so much of what you just spoke about, Stephanie comes out about my own insecurities around my own struggles, and how oftentimes parents might even have resources, but I'm struggling in some ways, so I can't see my child, but I can't see what they need. Because I'm only sort of focused on my needs. And it's not intentional, oftentimes, it's unintentionally, maybe stifling the process. And so oftentimes, when we talk about resources, we don't throw resources at families, because we really need to sort of understand, how available are you to hearing about the resources that are here for you and your child, and some are not as available, and we've got to work through that first.

Nimeet K 21:30
And I think adults, you know, they didn't do the best job of taking care of their emotional being as well, that's usually put on the backburner as well. So I think as you're saying that parents are going through their own emotions and trying to deal with that, encourage them to, you know, we'll take care of you as well and find you the resources or get you to the right resource for yourself. So you could take care of your loved one, you know, it's like the same philosophy as the teaching airplanes, put your mask on first.

Renee Stewart 21:53
And that's so hard sometimes, especially culturally, yeah, think about I don't, I don't take care of myself, my job. And my role is to take care of my children, or to be more preoccupied with my community and doing that. So that's, that could be a cultural shift in thinking as well. So we always have to be mindful of that, that Stephanie and I in our program, either hands for for our parents, and by that I'm using circle security language, we're talking about attachment and relationships. But oftentimes, we are the hands for parents so that then they can be the hands for the children. But we've got to put on our masks, so we can help them to understand why putting on your mask is important. Yeah. You know,

Shanna M 22:31
Yeah, well, what you all do is amazing. It sounds like people can kind of come into the program in a lot of different ways, talking with the pediatrician, talking with their teachers, and just sort of being exposed, just starting that conversation. And then could be, they could need a variety of different things or need a different type of program based on their needs. And so it could start in a couple of different ways. But it all starts with the conversation with either a pediatrician, your own doctor,

Renee Stewart 22:32
or a social worker at a hospital

Shanna M 23:03
or a social worker at a hospital, or a teacher or within that within the school system, it could even start there, too.

Stephanie Nti 23:12
And one of the great things about the Lourie center is that we have the Head start program. We also have TNP, which is a therapeutic nursery, which is for children who may be experiencing greater need, and may need some hands on support from licensed clinical social workers and psychologists who are in the room at all times, really helping to support and regulate some of the behaviors. And these are typically children sometimes who get kicked out of the public school system, because they don't have the tolerance, they don't have the understanding, the patience, or the background to truly understand what's showing up, is that this behavior is communicating in need. And when you don't understand the need, well, then you miss diagnose the problem, and then you start treating the child as the problem. And as encircle of security. And all the foundational work that we do at the Lourie center is really based on social, emotional development of the child. We look at that as the foundation of all kinds of learning, without that foundation it's hard to learn anything else. Yeah. If you can't connect, if you can't communicate, if you can't feel safe and secure, based on the attachment theory. Everything else is just much more harder for a child.

Shanna M 24:21
Yeah.

Stephanie Nti 24:21
And so when kids are acting out, we have to ask ourselves, what's behind the behavior? What do they need? And how can I as a caregiver, as a teacher, as a parent? How do I step in, right? And help organize that child's feelings.

Renee Stewart 24:34
And I think the Lourie Center is very unique, because under a medical model, you don't typically see a mental health model too. And so I think the Lourie center is unique in that they're sort of bridging the gap between the medical model and the mental health model so that they, we also know that this is sort of the life cycle is that we have physical needs, we have psychological needs, we have lots of different needs and oftentimes those two systems have been separate. You know, we'll go to the doctor's for a headache or a broken leg, or we, you know, something's happening internally. But when it comes to our mental health, right, oftentimes, maybe this system, I'm not even going to say people, because I think sometimes we know that our mental health feels important to us. But is it important to the systems that are guiding, you know, my health as well? Absolutely.

Shanna M 25:23
Well, I think I would be remiss in not even saying donations will allow a special place like the Lourie Center to exist, but it is, it's a needed program, and the work that you all do is just amazing.

Stephanie Nti 25:37
And we certainly want to give a shout out to the teachers, they do so much good work, often unrecognized.

Shanna M 25:44
Yes.

Stephanie Nti 25:45
Often not seeing the value of what they bring, for the long term impact of children. The same goes for the home visitors who go into the homes, sometimes unsafe conditions, to go in and support families and communities where there is challenges with gun violence and other types of atrocities. But they show up and they go into those homes, the family support workers who bring resources and invaluable information to the families to make sure that they have what they need to survive, especially for undocumented families to really be there to help guide them through the system to get what they need to feel

Shanna M 26:22
part of a community. Yeah, Part of the community.

Stephanie Nti 26:25
Exactly. And so it's a team effort. We have directors, we have a whole coaching model that we use at the Lourie center to help coach teachers and staff. And so we're very interconnected. Our work is multifaceted, but it is worth the work. It's hard work, but it is good work. And we go home every day, we feel like we've made a difference.

Nimeet K 26:45
That's great.

Shanna M 26:46
Well, we need more people like you all.

Renee Stewart 26:48
We couldn't do it without our team.

Shanna M 26:52
Anything else you all would like to add? Did we cover everything?

Renee Stewart 26:55
I think we covered quite a bit. Actually, just punctuating the relational model. I think that that's our biggest and most integral and important goal when you talk about the FSW and the home visitors and our staff is really about supporting the adults that support the children, that we are very much here to support the children. But we know that we are sort of in charge in some ways. And so we take that very seriously. And we really want to promote wellness with staff, as well so that our children will be okay.

Shanna M 27:27
Yeah, absolutely.

Stephanie Nti 27:29
And all of this right before Mental Health Month, right. So that's what we're here to really to just highlight the mental health of our staff, but also to really get the word out about the Lourie center. I feel like were a best kept secret. Not everybody knows about the work that we do, and we have grown exponentially like we are pretty huge, and we're still growing.

Shanna M 27:46
Yeah

Stephanie Nti 27:47
We have international work that we've done. I've had the opportunity to do some work with Dr. Jimmy Venza in Lesotho, Southern Africa, supporting the ministry of early childhood mental health, to really help put together or support them in putting together a model similar to the Lourie center of supporting the people in the suit to particularly the children who have been devastated by HIV and AIDS and trauma and so forth. And so this model is universal.

Renee Stewart 28:13
Absolutely.

Stephanie Nti 28:13
And so we have had a chance to be part of those conversations part of those meetings and be on the ground outside of this country to help support the work of the Lourie Center and push it forward with the of course guidance of the countries in which we've been welcomed to work with.

Shanna M 28:28
Oh, it's just amazing. Well, I think a couple of things that we hit on that our listeners can take with them if they take nothing else, which is take care of yourselves, take care of your mental health, normalize it. Talk to your doctor, go to your pediatrician. Take care of yourself. Yes. And reach out. Yes, yeah, sure. Yes. All right. Well, thank you. I could listen to you all day. I hope we have a chance to have you all back for even a deeper conversation. If we ever have a chance to

Renee Stewart 28:58
We would love that.

Shanna M 28:59
Yeah. Thank you for your time today to find information about our experts today. Visit LoriCenter.org and you can search Head start, there's also information on some of the other programs available. And then we'll add some information to today's show notes as well. We'd also love to hear from our listeners. You can let us know if you liked the podcast by leaving a rating or review or you can email podcast at AdventistHealthCare.com, and let us know what healthcare topics you want to know more about. So if you want to know more about the Lourie Center, more about childhood mental health, let us know. And don't forget to subscribe to the podcast so you get new episodes. Thank you and be well!