Substance Use Disorder and the Family: A New iLookOut Course

Melissa Lin: On today's webinar, we're so pleased to have Dr. Sangeeta Parikshak, Dr. Benjamin Levi, Ms. Anne Auld, and Ms. Amy Hunter presenting. First, I'll turn it over to Sangeeta.

Sangeeta Parikshak: Thank you so much, Melissa. It's so nice to be here with you all today. Welcome to our webinar. We're celebrating the launch of Substance Use Disorder and the Family, a new iLookOut course. My name is Sangeeta Parikshak. I am the Senior Behavioral Health Lead for the Office of Head Start at ACF, which is part of the U.S. Department of Health and Human Services.

I'm really pleased to be joined by colleagues from across the country who have expertise in child welfare and behavioral health. I really think you all are in for a real treat today to hear from some leading experts in the field.

You may remember that three years ago, in November 2021, the Office of Head Start partnered with Penn State to bring Head Start and the broader early childhood community iLookOut for Child Abuse, a mandated reporter training for Head Start staff. Today's webinar is a follow-up to that webinar we did in 2021.

We're going to cover a few different things today that I'll outline for you all just you know where we're headed. This webinar is really here to help you to understand the role of a mandated reporter and Head Start and Early Head Start programs.

We'll be discussing the updated Head Start Program Performance Standards on safety practices and standards of conduct. We will revisit the iLookOut for Child Abuse course with Dr. Levi, the director of iLookOut and Professor at Penn State College of Medicine. And hear why talking about substance use is important in the context of child welfare and family engagement. You will learn about the new iLookOut course on Substance Use Disorder and the Family. You will hear from Anne Auld and Amy Hunter from the National Center on Health, Behavioral Health, and Safety, on how to talk about substance use with families and resources to learn more on this topic.

Let's get started. You may have heard that the Office of Head Start released a new Head Start Program Performance Standards in August of this year on supporting the Head Start workforce and consistent quality programming.

You can find the new standards under the Performance Standards Information section on the front page of the ECLKC. Go to eclkc.ohs.hhs.gov. You'll go to the first box that you see on the left. It'll say Performance Standards Information Center, and you'll get all the information you need on the updated standards.

We have a lot of updates on the Performance Standards. I'm not going to go over everything here today, but I am going to focus on a couple of pieces that I think are going to be really helpful as we're thinking about the topic of child welfare today and around substance use.

We revised and strengthened aspects of safety practices within the standards. I'll highlight some of the changes for you today under subpart D, which is now titled Health and Mental Health Program Services.

This is section 1302.47. There's a link here on the slide that if you put it into your web browser, you'll be able to go directly to the section that I'm talking about. Really what this section does is it establishes expectations for Head Start programs to ensure basic health and safety measures are taken for the protection of all children.

Specifically, the updated standards broaden who must follow safety practices. It states that in addition to staff and consultants, contractors and volunteers must be aware of and also follow all safety practices.

We have outlined that contractors specifically are ones that are individuals on a contract whose activities involve contact with or direct services to children and families and any contractor who could have unsupervised access to children and families.

The Safety Practices section also includes reporting of suspected or known child abuse and neglect, as defined by the federal Child Abuse Prevention and Treatment Act or CAPTA. We did cover CAPTA a little bit when we initially brought you the iLookOut core course.

But as a reminder, CAPTA was originally enacted in 1974. What it does is it establishes a national definition regarding child abuse and neglect, which sets a consistent minimum standard for Head Start programs to follow.

But of course, we also know that programs must comply with state, local, and tribal laws, which may have additional stipulations related to defining child abuse and neglect, and also other requirements for mandated reporting. If there are any discrepancies between federal, state, local, and tribal laws, programs need to comply with the more stringent regulation.

Other safety practices included in the Head Start Program Performance Standards include all standards of conduct. This section requires staff, consultants, volunteers, and contractors to not engage in behaviors that maltreat or endanger the health or safety of children. The standards of conduct can be found under subpart I, which is Human Resources Management. But the section here is 1302.90, Personnel policies.

We've always had this section in the Standards, but the important changes are the requirements and the standards of conduct related to child maltreatment and endangerment of children. The goal of this set of requirements is to be clear about what behaviors Head Start considers to be inappropriate when interacting with and caring for children.

The updated standards align with four major categories and definitions of child maltreatment and endangerment that have been adapted from the Centers of Disease Control and Prevention or the CDC.

I have the slides up for you here so you see how the language is written. But essentially, we have four categories of maltreatment. We have examples next to them. They're not meant to be an exhaustive list of examples, but they pull from the previous Head Start Program Performance Standards, as well as other common examples in the various categories.

The categories include: corporal punishment or physically abusive behavior defined as intentional use of physical force that results in or has the potential to result in physical injury; sexually abusive behavior, defined as any completed or attempted sexual act, sexual contact, or exploitation; emotionally harmful or abusive behavior, defined as behaviors that harm a child's self-worth or emotional well-being; and neglectful behavior, defined as the failure to meet a child's basic, physical, and emotional needs.

Those are the four categories. You can definitely review them later. They shouldn't be new to you, butwe're hopeful that putting the standards of conduct into these categories is a little bit more clear as to what we mean when we're talking about harmful behaviors.

On the next slide here, thank you, note that we have the category stated as behavior and not as abuse. We really want to emphasize that it is not the role of a Head Start staff to investigate and determine if maltreatment actually occurred, but rather to report any behaviors that fall under those definitions to your local authority as a mandated reporter.

The updated Head Start Program Performance Standards also require programs to provide annual training on mandatory reporting of suspected or known child abuse and neglect cases that comply with applicable federal, state, local, and tribal laws.

This is really where the iLookOut core course for child abuse comes in. Next, I'm going to turn it over to Dr. Benjamin Levi to revisit the original iLookOut for Child Abuse course. Dr. Levi, I'll turn it over to you. Thank you. 

Dr. Benjamin Levi: Thank you very much. It's a pleasure to be back again. Very strong affiliation with Head Start from my early childhood. First, I just want to let folks know that we have no particular conflict of interest. That while I'm here presenting, there's a core team that's part of the iLookout group and a much larger team that we rely on. It takes really a village to do these kinds of things.

The iLookOut project here at Penn State College of Medicine is focused on the same things that Head Start is, which is to promote child well-being. We've focused primarily on issues related to child maltreatment and adverse childhood experiences.

We create curricula and we try to establish that it's evidence based. We want and we do research on the curricula that we create to test to make sure that it actually does what we hope it does. Then our goal is to get it out to the world. One of our greatest successes is actually being able to provide the nation's only evidence-based mandated reporter training to Head Start programs around the country.

As a brief reminder, I know we're here to talk about substance use disorder, but I want to just revisit briefly the Mandated Reporter training, which we demonstrated improves knowledge and changes attitudes.

The current version for Head Start was specifically designed, not just for early childhood professionals, specifically for Head Start. It's available on the iPD portfolio. We've actually just transitioned to a new platform that should make it, from our standpoint, easier to administer.

Head to toe, the course is three hours. It involves a pretest course and then a posttest. It is based on video-based storylines and uses gamification as an intended to be not only interactive, but respectful of learners. Because we know that you come not as blank slates. You bring a lot of experience and wisdom. Our goal is to really respect that in the course of the training.

Probably the key learning objective is knowing when and how to report. Part of that involves also critical thinking. The reason that's important is that people often mistake poverty for neglect.

They make assumptions about what they're seeing. One of the central goals of the iLookOut course is to help our learners appreciate how our assumptions drive, not only our expectations, but those assumptions are sometimes involved – we all have biases. And those biases affect our decision-making. One of the tragedies of that is it can result in certain populations or certain kinds of people being more likely to be reported to child welfare.

Part of our goal is to help people appreciate the diversity that exists across our country and in the ways that people rear their children. That the more we appreciate the nature of that diversity, the more it's going to help us interpret what we see.

To that end, one of our goals is to help people ask better questions of themselves, of their colleagues, and sometimes of children and their parents. As Sangeeta mentioned, mandated reporters, myself included, are supposed to pay attention and report when we have reasonable suspicion of child maltreatment. It is not our job, and we're actually prohibited from investigating.

There's a fine line between knowing enough to believe that one has reasonable suspicion and actually looking further to find proof or evidence, which is not needed for reporting that. This course has been available for almost three years now. We've had, I think, over 7,000 Head Start staff take it. Thankfully, people like it. They give it about a 9.2 out of 10 on satisfaction. We're really very pleased with that.

Other key learning objectives beyond those that I've already mentioned include knowing, what are the red flags that might indicate that a child is being maltreated? What are true risk factors versus things that are actually not true risk factors about when a child's well-being is at risk?

We want to help people identify children at risk. We want to help you find resources to support children and families. That has been done in concert with the National Office of Head Start in terms of identifying within Head Start resources, where those are, and how you can connect with them.

In particular, to help you help families connect with those resources, because it doesn't help anyone if they don't know actually how to get there from here. To that end, one of the things that we talk about in the course is this notion of adverse childhood experiences.

These are experiences that children have that introduce stress, sometimes direct harm. An accumulation of these adverse childhood experiences, or sometimes called ACEs, have been shown to make a child more prone to a whole range of harmful consequences.

This is going to be a little bit of a busy slide. One of the things that you see here on the left is that if a child has more than four adverse childhood experiences, the likelihood of family stress goes up significantly. The concern is that we know that of all the things that are out there, family stress predisposes to child maltreatment.

What's interesting in the data I'm about to show you is that adverse childhood experiences can be modified in a sense in terms of their effect by positive childhood experiences, where positive childhood experience is having examples or having at least two nonparent adults who genuinely care about a child, and when a child has a sense of belonging.

Obviously, we're talking about the kinds of environment that Head Start promotes. What this slide shows is that the more – this is on the x-axis – the more positive childhood experiences a child encounters, the lower the likelihood that there's going to be stress introduced to the family. This is what's sometimes called a protective factor.

One of those adverse childhood experiences, and this sort of brings us to our new course, is exposure to substance use disorders. Now this is an issue because there are a great many people, over 46 million in the United States, who struggle with substance use disorders.

Many of them involve alcoholism, but over 10 million involve drug use disorder. Annually, there are over 100,000 deaths from overdose each year currently. That means that 9 million children in the United States live with an adult who has a substance use disorder, and that about a third of them are young children, exactly the population that Head Start serves.

Clearly, when there is a substance use disorder, it can affect family dynamics and sometimes can affect a child's immediate safety. It's certainly a stressor for a child, for their growth, and well-being and for the family at large.

Of course, there are many substances that exist. Many of us use various of these at different points. But there's a difference between use and disorder. That's an important distinction that the course tries to reinforce.

The notion of a substance use disorder involves that the use of that substance makes a significant impairment for the person using it and those around them. That can include health problems, disability, their inability to meet major responsibilities, whether it's at work, at school, at home.

One of the things we know is that the opioid epidemic has generated a great amount of risk and harm to especially young children, the youngest children. That's one of the things that we address in this course.

The course itself is about an hour long, and it covers these kinds of things. First, what is a substance use disorder? What characterizes it? How can substance use disorders actually impact children and their families?

What kinds of resources and supports are available both out in society in general and specifically for Head Start staff? What are the best practices, when you think about developing policies, about substance use disorders? How we should engage with parents that are struggling with this? What kinds of resources we should provide to Head Start staff themselves? Again, these are things that will be discussed by my colleagues here today. 

The course itself involves animation and gamification. It also provides readings and handouts on a variety of things that we're hoping really make a difference in terms of your skill set and your knowledge base for dealing with children and their families.

The course is designed specifically to help you support families who are living with substance use disorders. In particular, to appreciate and this is really key, that addiction is a disease, it is not a moral failing.

I think this is one of the things that people often struggle with. I teach medical students, and one of them actually just this week turned in a project on her implicit bias about judging people who are living with substance use disorders.

One of the things that she came to appreciate over the last month when she did reading and she visited substance use disorder clinics and she read online forums was that addiction really is a disease.

As a disease, there are many treatments that can be used, and people can get better. There are ways that we can support individuals and families that actually make a real difference. This course covers some of that material.

It also matters not just what we do, but how we think about this issue, because how we respond to people who are living with substance use disorders can cause a profound change in their lives, either for the positive or for the negative.

People who are living with substance use disorders often experience discrimination. They discriminately experience fewer resources. They are not included. They are not offered things. Part of what we want to help our learners understand is that our attitudes towards people who are living with substance use disorders in and of itself can make a positive difference in their lives.

Sort of as a whole, the goals of this course are: to help those who work in early childhood education programs understand substance use and their impact; to prepare you to identify red flags for substance use disorders, which sometimes can rise to the level of maltreatment, oftentimes in terms of neglect; and particularly to point early childhood care and education staff to resources for programs and for families. With that, I'm going to turn it over to Anne, and she will continue our presentation.

Anne Auld: Thank you for all of that information. I think what's really exciting about what's happening with Head Start right now is there are many opportunities to learn and grow in our understanding around substance use disorders and how to work with families.

Depending on your capacity or your abilities to get into longer or shorter trainings, there's lots and lots that we're going to go through in the next 15, 20 minutes around additional resources to add into the work that you are already doing within the iLookOut.

A couple of things that I want to keep in mind as we look through those, if this is the hour that you have to give to this, is that there's a lot of things that we can be doing that we are already doing with our work with families when it comes to the complexities, and understanding the complexities and working within the complications of substance use. Because substance use is complicated, but having those conversations with families doesn't have to be. You're already having multiple difficult conversations with families in many different areas. Talking about substance use or substance use disorders doesn't have to be any different than some of the work that you're already doing.

The pieces to keep in mind is that substance use alone does not mean that a child is unsafe. That slide that Dr. Levi showed about all of the different kinds of substances. Many of you woke up this morning and had caffeine, had a cup of coffee. That's a substance.

Some of us might have a glass of wine or beer with dinner tonight. Like there is all kinds of substance use and how it looks in our society. Oftentimes, it's very, very common. Just because we have use doesn't, again, mean that we necessarily have an unsafe household.

We're looking at those behaviors. What are those things, going back to what Sangeeta said in the beginning, that what are the behaviors that are concerning to us? Because we all know that you can have an unsafe situation and there's no substance use involved.

They're not automatically connected to each other. As we discussed, like substance use is a spectrum. We can have everything from no use to misuse – perhaps there's a prescription that is not being used as it was prescribed or intended – all the way to the substance use disorder.

How it is that we are building those relationships with families and connecting with them builds on that ability to be able to have those conversations when they need to happen. Again, they don't have to look any different.

As we look at the next slide, one of the things to keep in mind is really around our language. Again, we know in lots of different areas that language is important. How we use first-person or person-first language is really important.

When we're having conversations with families, ensuring that we are not alienating families or making families feel – unintentionally, even – bad about themselves. When we look at words like clean and dirty. Whether it's the tox screen or the urine analysis came back dirty as opposed to it came back positive, or someone who is in recovery is clean as opposed to somebody who's not is dirty. Thinking about how some of that language lands and how that feels and wanting to make sure that we are thoughtful in our language so that we're creating those spaces where we can have that interaction with families in a positive way.

One of the other ones, when we think about MAT or medicated assistant treatment, thinking of that as a medication in the same way that we think of insulin as a medication as opposed to a drug. Again, just the language pieces and how we're thinking about that.

Next slide. All right, as a reminder, you all are already doing so much of this work. You are already building those relationships with families or working with your staff who are working directly with families to build those relationships.

I love that we started this one out around the Mandated Reporter training and understanding where your role is in that, and also understanding that there may be times where providing resources and ensuring families have the connections that they need is what's needed as well.

We're going to go through a whole list of resources starting on our next slide with the conversation guide for professionals on substance use children and families. iLookOut, giving you great foundation, giving you that one hour, that is easy, I say that with understanding how capacity can look different, but incorporating that, wonderful. 

Then being able to build on that. This is a four-hour course that really allows for that interactive interaction between peers on, how do these conversations look? How do we practice having these conversations? How are we thinking about substance use based on safe homes, safe caregiving, building those protective factors? How are we looking at the strengths that families already have? The truth is that when we break down substance use and think about it in terms of safe homes and safe caregiving, that conversation becomes a lot less daunting.

We created this training several years ago because what we were hearing from the field was that ‘I don't know how to talk to folks about substance use, so therefore I'm not talking about it at all.’

Wanting to ensure that we're building confidence within whether that's home visitation or whether that's in the child care or whether that's in a center or building that confidence within the supervising staff to ensure that through supervision, they're able to give, again, some additional steps and resources on how it is that we are wrapping around with families and having conversations in a strength-based way.

Keeping in mind that substance use is oftentimes generational. That substance use meets a need, whether that's from trauma, whether that's from historical trauma, whether it is from daily stresses that are happening in life, it meets a need. How is it that, again, we are working with families and providing alternatives to meet those needs or at least resources or linkages into the community where they can find those? 

If we go to the next slide, I'll pop that up because there's a QR code here. We have trainings for the next several months. There's at least two a month unless it's busy times of year up there.

As you go to sign up for those, there's also – if none of those dates work for you or they're already filled, there's a place to put your name in there and we'll give you, we'll shoot you out an email when we add new sites or add new dates or when additional spaces become available.

But with the training, you receive an actual conversation guide that has scripting in there, and again additional resources in there to build that confidence in having those conversations with families, and the trainings are virtual.

Then we mail out to you safe storage bags. There's a parent brochure that goes with that as well. A little prop to start those conversations because again, when we can start with the safe home and we're talking about or car seats or having conversations around safety or bleach or Tide Pods.

We're incorporating, what are some other things that could go in this bag? Like edibles or prescription medications. Normalizing those conversations in a way that allow them to feel easier for you to connect with families and have those conversations. We can go on to the next slide.

The substance use, there's a brief resource guide that – Amy, correct me if I'm wrong. I'm not sure that this one is out in the public yet. It is coming. It is a great resource that condenses all of these into one place to look for the information.

Although in the next couple of slides, which you all have access to, we'll list a bunch of the pieces that are here. But as soon as this is officially dropped, I'm sure there will be some announcements around that.

Amy Hunter: It's been held up because the ECLKC keeps changing. As soon as we make a list of where everything is, then things get reorganized. That's the holdup. But you are and is about ready to go through a number of resources that you can find on the ECLKC that would be included in this resource list.

Anne: Awesome. Thanks. All right. Anywhere and everywhere I go, if I can bring up Sesame and Sesame Workshop, I will. If you are not familiar, if you have not been to one of the Sesame webinars, there are tremendous resources available at sesameworkshop.org around substance use and families and parental addiction.

On the next slide, we can start to see that there are resources available for parents, there's resources available for professionals, there are videos, there's articles, there's storybooks. The resources are free.

On the next slide, we can see some examples around the video selection that they have. Thinking about how it is that you could incorporate these with children, but also with parents. One of the things that I always like to say is that Sesame speaks to all of us.

Even if we're adults, sometimes we hear a message differently from a Muppet than we do from an adult. Understanding that these resources, some of them were created specifically for children, but I do think adults can gain a lot from viewing these as well.

Amy: Anne, before you go on, I just want to be another commercial, I guess, for these resources because often families ask, ‘I don't know how to talk to my child about this,’ or as you said, even to find the words for each other. These resources have been incredibly useful.

Anne: I think on the next slide, we've got some additional examples. Yeah. The printables, articles (for adults), interactive. If you just go in and spend some time and tool around in there, there's limitless, it feels like, examples of different opportunities to incorporate this into the work that you are doing with families.

I think there's one more Sesame slide around. I love that this slide is included because we know that substance use is complicated. Oftentimes with substance use, there are other co-occurring complexities within families.

Having those additional resources around building resilience, around emotional well-being, and around self-care are important aspects in that entire healing journey when We think about substance use and families. Be sure to check out the additional spaces there and know that those are pieces that can be woven together.

All right. On the next slide. Additional resources. Again, you all have access to all of these. Don't feel like you've got to quickly write them down or anything like that. Looking through data for FAQs, I know there's a lot of questions that come around secondhand smoke, especially whether that's tobacco and/or cannabis products. 

I am from the state of Colorado. We have had legalized cannabis, whether medical or recreational, for 14, 15 years now. Some of these resources are directly from the state of Colorado. Understanding that many of those FAQs or additional – the ”Responsibility That Grows Here” is a really great one on just understanding pieces around pregnancy, breastfeeding, community resources.

One of the things that I would suggest for folks is we are continuing these conversations around substance use and thinking about resources that oftentimes the resources you get are national resources.

If I were to ask you right now, how many food banks in your community could you list for me right now off the top of your head or at least you would know exactly where to go? My guess is that many of you understand your local resources pretty well when it comes to food or perhaps at least I would know how to get them hooked up to WIC or some of those other pieces. 

I encourage folks that when it comes to substance use disorders, when it comes to understanding the treatment providers in your area and your local resources, that it will be to your advantage to understand what is in your community around this topic, the same way that you are understanding other topics that are impacting families. Know that you have access to national resources.

It may be something to be thoughtful about in understanding your local resources as well. All right, next slide. Then the ECLKC, I love saying that one. Most of the time, I get it right. Lots and lots and lots of resources available there.

When we think about Strategies for Engagement: Attitudes, and Practices, Engaging with Families in Conversations About Sensitive Topics. Again, these resources that have been out there for a long time are around things that are complicated, around things that are hard.

We're just incorporating substance use right into those learnings that you have already possibly had or are aware of. Then again, preparing for challenging conversations with families. Amy, I'm going to invite you to if there's anything else around these three particular ones that you wanted to add.

Amy: I think you covered it beautifully. These are from our partners at the National Center for Parent, Family, and Community Engagement. Some of you on this call, I'm sure, have been to some of their trainings. As Anne said, their training and their resources fits perfectly with the kinds of messages about substance use as well.

Anne: All right. And then next slide. All right. This is your reminder that available on the iPD, that the Substance Use Disorder and the Family course is up and running. It is live. Right after this, go take it. And then the next slide.

Again, some additional resources. All of these are video series or I think both of those are videos that are, again, addressing that opioid crisis or understanding substance use and recovery. Next slide.

Continuing on with that. Head Start success stories, those are fantastic if you have not had the opportunity to go check those out. Those in Sesame are some of my personal favorites because really getting that family voice around what Head Start meant to them and their road to recovery.

I think it's beautiful when you can understand that you do play a role in the support of families even when it comes to substance use. Those are great little pieces, especially to add in to maybe if you have some staff meetings or things like that or some family nights or things that you're doing with families, again, to see that relationship and that relatable piece of like there's lots of us going through this and understanding.

I think an important piece is that the staff that you work with are people too, and they may be also people who are struggling through a substance use or a substance use disorder. How are we supporting them as well?

Amy: Just to piggyback on what you said here, Anne, these are real stories of real Head Start families who were – we felt so honored that they were willing in many cases to stand up in large audiences and share their stories and then be filmed. Some are animated, some are documentary style, different styles and different stories.

I think you will find them helping you to connect back to your purpose, which we all need sometimes to see the incredible power that Head Start has to really change lives, not only of children, but of families.

I encourage you to – they're short. There's some longer ones. But most of them are very short, like three to five minutes. They really touch at your heart strings. I encourage you to take a look. 

Anne: That's for sure. All right. Then I think our final slide of resources. You all are getting your fair share of resources today, which again, is really exciting, that there are so many ways that you are able to build your knowledge and your confidence in this subject matter.

Here are three additional videos that are available. Prior presentations. The Shatterproof is another organization that put together some videos and really looking at that bias piece. How are we again keeping in check the biases that we bring into to every situation and especially around substance use?

Because the truth is, is that we all have some sort of history, whether it's personal or family, or we know someone that is touched by this. How are we using our histories to our advantage and not having those stand in the way as a barrier and connecting with families?

All right. Finally, let's hear from you all. You all have been listening to us for 45 minutes now. Thinking through some of the things that you've heard, some of the trainings that perhaps you've already partaken in, we're just asking folks to answer this in the chat. We'll have a little bit of a conversation around that.

Thinking through, like it's the end of the day. A mother arrives in a car to pick up her three-year-old daughter. You're not certain, but the mother seems to be slurring her words. You think her breath smells of alcohol. What do you do? What are some of your first steps? What are some of the things that you're thinking about when this situation arises? 

I'm going to give folks a minute to put that in the chat. I want you to know that these are the types of scenarios that will come up in that iLookOut training. They'll be continued to have discussions about this. Also when we think about the conversation guide training that a lot of the conversation is based on, what do we do? What does that look like next? All right. Answers starting to come in. 

Yeah, asking her if she's feeling okay. Yeah, continue talking to her, extending the conversation in a safe condition to drive the child home. Ask her if she feels okay. A lot of what I'm seeing here is gather some more information. Let me see if Ms. Mom is doing okay.

Dr. Levi: These are great. One of the things I noticed is that the responses are about calling in rather than calling out. I think that concept of that we have a relationship and alliance with somebody allows us to position ourselves as someone to help rather than someone to surveil and accuse.

Amy: I love that. I love that you called that up.

Anne: Because the truth is that we may recognize that something's going on, but it may be a medical condition. We talked about diabetes earlier. Like perhaps, there's a diabetic incident happening. Perhaps, she has been drinking. Like we don't know. How are we and again, in these really caring ways that we're seeing here, how are we starting that conversation?

Then as that advances and there's more information that we're understanding where we are in this situation, does our organization, does our site have a policy around what to do in this situation? Thinking through that, is there additional staff that we need to bring in to have some conversations with?

How are we addressing and if the child leaving the building and knowing that is an important piece, whether it's a medical condition, or there is substance use involved there, that we want to make sure everyone's okay and that everyone is safe. “Asking open-ended questions. Never assume or accuse mom.” Yeah, thank you, Ashley.

Dr. Levi: This is great. The responses are really talking about the idea of, what is our mindset? What is it we recognize might be happening? When do we give a sense of largesse to be humble and curious about what's going on rather than judgmental?

Amy: I put in the chat, but it really reminds me of the strategy of wondering. Taking that exactly as you said, Dr. Levi, that curious stance. Not assuming that we know what's going on or not assuming that there might be something related to alcohol abuse. But really taking that step back, as you said, and being curious and mindful and wondering.

I see Ashley says that there's been similar. I don't think this is – I think this is a common scenario. Just looking through the chat. Great answers. If you have – continue to put your thoughts in the chat, please – if you have other questions, we have a little bit of time and we are happy to answer other questions. 

Could be related to this particular scenario or other questions related to substance use, substance use disorders, addiction. The iLookOut courses that we went over earlier in the webinar, both the iLookOut course on child abuse and neglect and reporting and the course on substance use and families. I don't see any questions yet, but please don't be shy. We have the experts on. “Any resources for school-aged children,” I see is a question.

Anne: A lot of early childhood goes up to age 8. A lot of your resources that are specifically for early childhood, including those Sesame, do have some components for elementary-aged kiddos.

There are some pieces within the conversation guide, as well as within some of those other resources that were in your list about having conversations with older youth or youth in general in the home around substance use.

Understanding that really working with substance use is a full family circle. Understanding those having – what do those conversations look like from professional to parent and parent to child, and again, that entire family focus. There are some that are included in each of those places.

Amy: I see a question and it's a great one about any, for home visiting with children under the age of 3 and their family.

Anne: To speak to the conversation guide for professionals on substance use children and families, we wrote that specifically with home visitation in mind originally, because that was a place that we were seeing in some voluntary programming that we were missing an opportunity to resource families, the services, and the support that they needed. That was originally written for home visitation and then was broadened to include a larger population.

I'm sure with the iLookOut courses as well, that there's components in there that are certainly applicable to being in someone's home. Some of those conversations or things to be thoughtful about.

Amy: Dr. Levi, there's a question. Is the training available now on the iPD or coming soon? The comment is the link says it's not available yet. But I thought maybe it was available.

Dr. Levi: I believe it's supposed to be available sometime this week. There's some final testing that was going on to make sure that within the iPD it work. The course is done and it's just there may be a couple of technical things. If it's not available today, please check tomorrow or Friday.

Amy: Perfect. Yes. I do know there was some testing to try to make sure that it's easy for folks. Great. Any other questions? We have a couple more minutes and we'd love to hear from you.

Dr. Levi: One thing I would add is that we also welcome comments, if people have as they go through the course, if they have suggestions for things that could be done differently or better, we're always interested in your perspectives.

Amy: Wonderful. Absolutely. We also accept questions here, but also comments here. If you have – I know some people put comments in about the information that was shared today and the relevancy that some of you have had these experiences in your centers. They feel like they match your experience.

As you go through the resources, if you have questions, you can always email and we will be able to get back to you with more specific information, or if you find that as you peruse the information, it generates more questions. This is not your only chance to ask. We can get back to you in the future. All right. Well, I think if there's no other questions, I'm going to turn it over, Livia, you have a few final announcements, I think.

Melissa: Thank you.

Amy: Melissa. I'm sorry.

Melissa: No worries. Thank you, team. Thank you, Amy and Anne, Benny, and Sangeeta for sharing all of this important information today. We're pleased to hear your interest. If you have more questions, please go to MyPeers, or write to health@ecetta.info.

Please also complete the evaluation. The QR code is on the screen. You'll also see it when you leave the Zoom webinar today, and you'll also see it in an email. If you miss it immediately, not to worry. But the evaluation link after you complete it, you'll be able to download your certificate. Note that the evaluation survey is anonymous and your feedback helps us improve future training and technical assistance offerings.

We thank you for choosing to spend a part of your day with us. And as always, follow us on social media. You can hop on to MyPeers to continue the conversation with your colleagues.

If you have more questions, please write to us at health@ecetta.info. You can find all of today's resources and more on the ECLKC in the health section. Subscribe if you don't already to our mailing list. Here is the link, as well as in the handout that's in the chat.

Thank you so much for joining. I can give it a moment so that if anyone needs evaluation link and then we'll close the webinar. Thank you all.

Amy: Thank you, for those of you who presented and those of you behind the scenes and all of those of you out in Head Start and child care, other early childhood home visiting. We appreciate all the work that you do and know that it makes a tremendous difference in the lives of children and families.

Melissa: Thank you, Amy. Thank you, everyone. Kate, you may close the webinar.