Talking to Children About Parental Substance Use

Talking with Children About Parental Substance Use

Steve Shuman: I think we're ready to start. We have some friends of Karli who are going to be presenting from Sesame Street in Communities. Kama and Andrea, take it away.

Andrea Cody: Hi, Steve. It's great to be here. We're so excited to present to you a little bit about our resources on parental substance use today, and to introduce you to Karli, who's this really cute, lime green Muppet you see on our opening slide here. Today's conversation, we're going to give you an introduction into what Sesame Street in Communities is, as we know some of you might be new to it. You are probably familiar with the show, but Sesame Street in Communities is something else entirely. Of course, utilizing our beloved Muppets. We're going to give you an overview of our parental addiction, parental substance use initiative and the goals, as well as how we created the resources – our advisory takeaways, our formative research. And then finally, we're going to dig into the resources themselves. Give you some peeks into the resources, and also give you some tips on how to use them and some firsthand experience from some of our partners on how they've used it. And at the end, we will wrap things up with a Q&A, where Kama and I will answer as many questions as we have time for.

We are happy to be a part of the National Center on Health, Behavioral Health, and Safety. We’re relatively new partners to this. I am Andrea Cody. I'm a senior project manager in our U.S. Social Impact Department. And among my projects, I manage several of our SSIC initiatives, as well as our Sesame Street and autism work. And I'm so grateful to be here today with my colleague Kama, who I'm going to let introduce herself.

Kama Einhorn: Hi, everyone. I wish I could see all your faces. I'm so glad that you came today. We're so excited to share this work with you. I'm Kama Einhorn, and I develop a lot of the content that you're going to see today.

Anybody who grew up on Sesame Street remembers the power of the Muppets, and we are fortunate to be able to leverage this power to reach the most vulnerable children. In 1969, Sesame Street started with this big idea by our founder Joan Ganz Cooney: Could we use television to teach? If television is teaching children jingles for beer on commercials, could it teach the ABCs and 123s? It was a very research driven experiment, and of course, the answer was yes. Since that time, we have met children where they are. At first, it was about needing to learn to read, and during kindergarten, as you all well know ... Head Start has done so much to change that, and we look to you as a model of so many best practices. So really, thank you for all of your work on the ground. We are serving you.

We've met children as time has gone on. It's become more social emotional needs. And a lot of the work that you'll see on Sesame Street in Communities shows that we are reaching children in the most vulnerable moments of their young lives – traumatic experiences – including this topic on parental addiction. Slide. We know a lot about trauma and its impact on the brain. We also have another initiative on the site. When you go to Sesamestreetincommunities.org, which is all free and bilingual, you can click on different topics. One of them is “traumatic experiences,” so you can find a much broader approach. We also have, of course, specific traumatic experiences, such as parental addiction. But we know that trauma impacts the brain in really – really sad ways. Our mission is to help kids grow smarter, stronger, and kinder as a nonprofit. But we know that trauma impacts children's ability to learn, creating obstacles to becoming smarter. It affects their overall wellness, they're less likely to be stronger. And of course, socially emotionally, it changes the way they interact with everyone, making kindness, sometimes sadly challenging. Slide.

What is Sesame Street in Communities? It is the hub of all of this social impact work. Anyone – any teacher, any other provider, anyone serving children in a professional capacity, as well as any parent can go to the website and look up what they're looking for support with. It could be ABCs and 123s; it could be healthy eating; it could be supporting children with autism; it could be supporting children who have lost a parent, whose parent is incarcerated; it could be COVID resources – we've put out a lot of work around supporting children through the pandemic. And here, of course, you'll find multimedia resources around addiction. It's printable pages, videos – lots of great videos – articles, digital interactive, story books, and so on.

The communities piece is because all of this work is disseminated through community by community providers. We have a variety of local and national partners and pilot communities that work to get this material out to the kids who need it the most. This may be a social worker passing it along to a parent; it may be someone doing a parent training class; and of course, people like yourselves at Head Start. I mentioned smarter, stronger, kinder, that is our mission. We're a nonprofit. We are philanthropically funded, and especially Sesame Street in Communities depends on the generosity of our funders. And here we are.

[Laughter]

Andrea: I wanted to give a …

[Interposing voices]

Andrea: I wanted to give a quick little disclaimer that this video, of course, was filmed before COVID, when we were all in our offices together, but it gives you a little preview into our team and a little bit of a taste of what Sesame Street in Communities is. We'll go a little bit deeper after we watch the video together.

[Video begins]

Entire Group: Welcome to Sesame Street in Communities. We're so glad you're here.

Speaker 1: The Sesame Street mission is to help kids grow –

Speaker 2: Smarter,

Speaker 3: Stronger,

Trio: and Kinder.

Speaker 4: And to meet our mission, we create resources to support young children's well-being. Helping them to develop important skills that they need in order to thrive especially during the toughest times.

Kama: Research shows that traumatic experiences can affect children's learning, development, and health, and impact them over their lifetimes.

Speaker 5: But we also know that the presence of a caring adult can help mitigate the effects of trauma and foster resilience.

Speaker 6: We're learning that the more we can help kids and grown-ups build nurturing relationships, the better their chances of success in school and in life.

Speaker 7: The trick is to enlist the entire community – every adult that touches the child's life –and to do so within the first 5 years, when 90% of their brain is formed.

Speaker 8: We call this the “Circle of Care.”

Entire Group: We're all part of the Circle of Care.

Speaker 9: We created Sesame Street in Communities to support you.

Speaker 10: It's a hub of multimedia resources designed to support caring grown-ups,

Speaker 6: providers, and caregivers like me,

Andrea: to celebrate the important role you play in a child's life.

Speaker 6: Come along with us, and let's explore the resources together.

Group: Welcome to …

[Video end]

Andrea: Sesame Street in Communities is a model that reaches vulnerable children and families in communities around the United States through an online content hub, professional development resources, and implementation with partners. And really, we see all three of these pillars as being crucial to what Sesame Street in Communities is. And today, we'll walk you through the online experience – that content hub on Sesame Street in Communities that features – I think at this point – thousands of activities in both English and Spanish. Everything on the website is available in both languages, excepting some of our PD resources that are English only. Our professional development is both online. We do have recorded webinars and online training videos as well as some online courses on a variety of topics. And then we do in-person trainings or virtual trainings in the COVID world that are a little bit more specific to certain organizations, like Head Start or certain communities. Kama mentioned, I think we're in about a dozen communities across the United States. Pre-COVID, we would travel and do trainings in those communities. Now we're relying a little bit more on our virtual Zoom trainings to get the information into the hands of providers. Our partnerships on the ground really help us to engage families and kids and help them utilize the resources and know how to seek the resources out.

Every topic on Sesame Street in Communities includes a variety of different kinds of resources, and we'll show you those resources through the parental addiction, parental substance use topic in a little bit. But these topics range from healthy habits and healthy bodies, healthy minds, to ABCs and 123s – the really early learning basics that all kids need – as well as our tougher topics in our traumatic experiences. [Inaudible] we feature printables, interactive games for kids, videos for both kids and adults, and of course, we highly encourage co-viewing between kids and adults, especially around our tougher topics. We have lots of interactive story books available as well as articles for adults and workshops for providers, which walk providers through how to use different resources in events or in activities with parents and families.

And that brings us to our parental addiction topic. Our parental addiction topic is what you'll find it under on the website. And we wanted to raise awareness around the impact of parental substance use on children and families. We know that there is extraordinary stigma around the topic with kids and families not seeking help because there is such a stigma around it, so we wanted to open up the conversation. By bringing this topic to Sesame Street, we know that that helps mitigate some of the stigma and normalize asking for help. Our other goal is to support children by providing and modeling strategies to help them cope with the trauma of parental substance use and to build resilience. Really, all of our traumatic experiences work – our goal is to help kids not only not feel alone but also to build skills to cope with the feelings that come with these challenges. We also offer providers actionable strategies for working with children and families. We'll take you through some of those strategies as we review the resources.

Why did we want to address parental substance use is an interesting question. You don’t think of Sesame Street and often think of the tough topics, but Sesame Street has never shied away from the tough topics, from addressing Mr. Hooper's death in the 80s, to addressing parental incarceration and divorce, and helping military families throughout the years. We have addressed a lot of these tougher topics in ways that are child appropriate and developmentally appropriate. And we know that 5.7 million children under the age of 11, which is about 1 in 8 children in the United States, live in households with a parent with substance use disorder. And 1 in 3 children enter foster care because of parental substance use. This is a statistic from 2017, and that was a 53% increase over the 10 years prior. And we know that the trauma of parental substance use can impact children's mental and physical health over a lifetime, including an increased risk of addiction on their own. We know that there is often a cycle of addiction within families. And giving kids the help that they need at a young age and giving the whole family support together can help to break that cycle of addiction and can help kids to set them on a trajectory for success in the future.

As with all of our topics on Sesame Street in Communities, we convened an advisory board of people who are experts in the field, both academics and people working on the ground as therapists, working in the health care system, working with community partners around the subject of addiction. We convened these amazing experts together for a day to learn more about how they thought Sesame Street could utilize our brand to help kids and families experiencing parental substance use. Their insight is invaluable. And throughout the project, these amazing advisors have also provided feedback and incredible help to us as we develop all of the resources. They reviewed scripts; they reviewed the story book; they helped us develop strategies featuring our Muppets to help kids and families as they experience this issue. And just as importantly, after the resources launched, these people are really our ambassadors for the project. And they have really greatly been evangelists for our resources.

Our advisory – we came out with a few key takeaways. We know that the shame isolation and stigma of parental substance use can cause children to experience more fear and loneliness. We also know that caring adults play a key role in explaining the situation in age-appropriate ways and helping children to talk about their feelings without criticism or judgment. And we know that adults often find this topic very difficult to speak about with kids, but that there are age appropriate and developmentally appropriate ways to address the topic. And kids are very perceptive. They may not understand everything around an issue, but when there are substance use issues in a home, kids are affected, and they do pick up on what is happening around them. Another one of our key takeaways was using the 7 Cs, which you will see throughout all of our resources, and they can help children understand the key messages. You didn't cause the problem, you cannot cure or control it, but you can care for yourself by communicating your feelings, making healthy choices, and celebrating yourself. And most importantly, our resources should help children and families build resilience, hope, and optimism, and should communicate that challenges can help make a family stronger. And that working together through the challenges can help a family, and it can help in a parent's recovery to include the whole family. That's something that we've heard again and again from our amazing advisors.

In addition to working with advisors, we also take everything we do into formative research. We want to test messaging and content with people who are going to be the end users. We tested with providers and parents and as well as with grown adults who had in the past experienced apparent substance use.  And we found out some very interesting things. Parents and providers wanted us to provide specific language for explaining the terms addiction, drugs, alcohol, and treatment to young children. They knew that using these words was important. And we also knew that using these words and not shying away from them would make our resources easier for people to find. People are searching online for help. There's not a lot out there to help young kids understand these concepts, but there are ways to help them understand it. Parents in recovery, in one of the groups we worked with, listed their main concern as “causing irreparable harm.” They didn't want their children going down the same path as them and reliving that cycle of addiction. They were also worried that their children wouldn't forgive them. Providers recommended we explain to parents that children are resilient – that they love you, and they want to forgive you. That, of course – it's a process, but  kids want this to work out. Providers also recommended that we provide children with a mantra such as, “I can have hope,” “Things will be OK,” “I am special,” “I am not alone,” “There are people who love and care about me,” “It's a grown-up problem,” and “It's not my fault.” And that last message, “It's not my fault,” is a key message that we explore again and again throughout a lot of our resources on traumatic experiences and tough topics on Sesame Street in Communities. And it's really key to helping kids address their feelings, is to help them understand that it's OK to have those feelings, and it's OK to feel big feelings and to learn how to name those, but that they didn't cause them. Providers also emphasized that parents should hear the messages, “You are not alone,” “Addiction is a sickness,” and “You can get better,” and “It's brave to ask for help.” We really wanted to help reduce stigma around reaching out and asking for help and using these resources.

All of these wonderful resources can be found at SesameStreetinCommunities.org. There is a topic page called “Parental Addiction.” We have the URL directly to the topic page there, as you see in the top left-hand corner. There's the “Español” button, and that is how you would access this page in Spanish. Everything is bilingual, English and Spanish, as mentioned. You're also able to filter the assets by the time it takes to do an activity, by the age range of children, and also by the type of assets. If you're just looking for videos or just looking for printables, you can use that filter and get exactly what you're needing really quickly. I'm going to pass it on to Kama to explain to you some of the resources that live on the topic page.

Kama: Sure. Andrea really detailed how we learn what the messaging should be, what's missing out there. The advisors really download for us the state of the issue now and what kids need and what they don't have. What we can do best, how we can leverage Muppet power. Shortly, we'll show you the intro video that we used, “Choosing and Crafting This Language for Young Children.” And our age band, it's 0 to 6. We are assuming that children around 4 to 6 and possibly older will be using these materials. But finding exactly the right language to explain to a very young child is a very interesting and careful process with a lot of expert eyes on it, so you'll see how we did that. You'll also see how we highlighted the power of a supportive community. We never said that this was a 12 step program or a child version of a 12 step program. Our role at Sesame is to not recommend particular modalities or interventions. It is simply about support and the spirit behind what a group can do and how so much healing takes place within social bonds in a community. And that's something that you see underlying a lot of our work on the site. You'll also see several more videos, which I don't think we're showing you in this one, but please go and enjoy them. And I should just mention that in any program, there are so many ways to use these resources. You can email them  – simply email the links around. You can show them in professional development. If there's a reception area in your site, you can play them on a loop, and you can print out the articles and distribute them, and professional development trainings, and so on. Let's take a look at how we explained it. And we used Elmo here because we didn't want to have Karli, the new Muppet, be front and center, sort of with too much focus on her. We didn't want to put too much responsibility on her. Here, Elmo is ready to know about it, and it's not a direct trauma in his life. We make the Muppet choices really carefully as to who does what. Here we have it.

Andrea: And for those of you listening in Spanish, all of these videos are available in Spanish, and we have, in the resource pages, the links directly to the Spanish videos. So we do encourage you to take the time after our presentation to go forth and watch them in Spanish.

[Video begins]

Elmo's Daddy: You played basketball terrific today, son. I'm so proud of you.

Elmo: Thank you, Daddy. Elmo had a lot of fun with Karli today. She is a great friend.

Elmo's Daddy: Yeah. She sure is.

[Laughter]

Elmo: Elmo knows that Karli's mommy was away for a while. But now she's back. But Karli's mommy looks and acts different than she did before.

Elmo's Daddy: Yeah. Karli's mommy seems much healthier since she's been back.

Elmo: How come Karli's mommy had to go away?

Elmo's Daddy: Well son, Karli's mommy has a kind of sickness, and she had to get some help.

Elmo: Sickness? Like when Elmo had that sniffle?

[Laughter]

Elmo's Daddy: No, it's not that kind of sickness. Karli's mommy has a disease called addiction. Addiction makes people feel like they need a grown-up drink called alcohol or another kind of drug to feel OK. That can make a person act strange in ways they can't control.

Elmo: But why doesn't she just stop?

Elmo's Daddy: It's not something you can just stop doing. Not without help from the right grown-ups.

Elmo: Daddy? Will Karli's mommy get better?

Elmo's Daddy: Well, she's working hard on it. She's taking good care of her body and mind so she can stay healthy and make good choices.

Elmo: OK. Elmo is really happy for her.

[Laughter]

Elmo's Daddy: Me too, son. Now, you want to show me how you bounced that monster ball?

Elmo: Oh yeah!

[Video ends]

Kama: Before we share the next video, I'd just like to say, we often have disclaimers on our content that says, “Please view this yourself before deciding to share with your child or the children in your care.” And of course, this is a sensitive topic, and many adults are uncomfortable with addressing this for whatever reason. Obviously, you are very likely to work with children and families who struggle with parental addiction, and so we just suggest that you use these materials in whatever way work for you. You know your communities best, so we are certainly not recommending that you play this in the most public area on loop.

This one is one of our favorites. Chris is one of the caring adults on Sesame Street. And you'll see how Karli has a supportive community around her. And you also see that Chris is a friend of Karli's mom, and Karli's mom is in a meeting, and Chris is supporting her mom. She's got what we call a “circle of care” going on. And we know that when we're talking about childhood trauma, that the presence of a caring adult is the key factor in mitigating those effects of trauma. Let's see “Lending a Hand.”

[Video begins]

[Singing]

Karli: Thanks Chris for watching me and Elmo while my mom's at a meeting.

Chris: Oh, of course, it's no problem. I'm always happy to help her out, she's a good friend.

Elmo: What meeting did Karli's mommy have to go to?

Chris: Well buddy, Karli's mom has been having a hard time. So in order to help her get better, she goes to a meeting with her group. And they all sit-in a circle.

[Laughter]

Elmo: Elmo likes singing circle time in school. Does Karli's mommy sing science in a circle?

Karli: No, they talk about grown-up problems. She goes every day so that she stays healthy. You see … Well, my mom needs help learning to take better care of herself, so she talks to people with the same problem.

Chris: You see, buddy, everybody there is having the same kind of hard time, so they talk with each other about it.

Elmo: Oh. Well, when Elmo talks about a problem that Elmo's having, it helps Elmo feel better.

Karli: Me too. And so, I go to a special kids only meeting. Our parents all have the same problem. We sit-in a circle, and at the end, we hold hands, and we sing.

[Laughter]

Elmo: Well, Elmo really likes holding hands with his friends.

Chris: Holding the hand of a friend can really help you feel better.

Elmo: Yeah.

[Laughter]

Karli: Yeah. Yeah. It sure can. Hand in hand.

[Music playing]

[Video ends]

Kama: Now we're going to meet Salia. Salia is a real child, not a furry one. She's 10. And she and her family have been there, and they are thriving. She's an example. She can serve as an example to Head Start kids. She has some younger children who may have previously been enrolled in Head Start. And she's a great way for parents and teachers to start conversations about this topic.

We present on the site – we present a lot of discussion questions and ways you might use this on your site. Questions for before, during, and after viewing. But what's important about videos like this is that she presents some very concrete strategies. And there are strategies that will be relevant for any trauma that any child is moving through. Strategies such as such as breathing, drawing your feelings, spending time moving and eating well, and being outside. A lot of these specific traumas that we do – addiction, family homelessness, parental incarceration, foster care – you'll see them all on the site. A lot of them – a lot of the strategies we present are based on general trauma-informed strategies that you'll see used really – really broadly. Let's meet Salia. She's a great kid.

[Video begins]

Salia: My name is Salia, and I am 10 years old. In my family, I have my 3 sisters, my mom, my dad, and me. Caia is 6, Fay is 2, and my baby sister Levi is 9 months. When I was little, my mom and dad had to leave, and I had to stay with grandma and grandpa. And my parents were struggling through a bad time with addiction. They had to go to a place to help them feel better. Addiction is a sickness. Addiction is getting attracted to something so you keep doing it over and over again. It makes people feel like they need drugs and alcohol to feel OK. And they can't stop doing it, and they aren't acting like themselves. They were gone for 60 days, but it felt like 60 years. Because when I was this age, you had to leave.

Salia's mom: Yeah. We had to leave for 60 days to go get help because we wanted you to have a good life. But first, we had to take care of ourselves so that we could do that.

Salia: That's why dad's so sad.

Salia's mom: In that picture …  

Salia's dad: That is why I am so sad. That's when Dad was drinking a lot.

Salia: For any sickness, people need treatment to feel better. My mom and dad got treatment, and that makes me feel happier for them. I remember the hard times, but I write down things that I feel inside. I can like express things. I, like, let my journal know first. My parents help us stay safe. They say they work very hard to stay healthy so that our family stays healthy. Now that mom and dad are in recovery, we can do fun things together like going to the beach.

[Sound of waves] [Playful screaming]

I find so much stuff in the water like shells and like little creatures.

[Music playing]

I'm proud of mom and dad for asking for help and not using drugs or alcohol anymore. And they're proud of me for just being me.

[Music playing]

Going through tough times is harder for families but when they get to the end of it, they end up stronger.

[Music playing]

[Video ends]

Kama: Love that family. Just as important as spotlighting the child's perspective, which is something Sesame is in a unique position to do, it's important for us to spotlight the providers who serve them – the providers like yourselves. Many of our professional development videos feature a provider that is working directly with kids.

Cynthia Galaviz works at the Betty Ford Clinic at the Hazelden Children's program. When parents are in treatment, these children come for a week to go to a sort of camp. And it's just them, and it's led by trained therapists. Here we have a bit of a day in the life of some of the social workers. Let's take a look.

[Video begins]

[Music playing]

Cynthia Galaviz: There's a special magic that when you just even interact or talk to the child, they can teach us so many things because there's more to that child than just the addiction in the family. My name is Cynthia, I'm the supervisor of the Children's Program here in California at the Hazelden Betty Ford Center Foundation. And my mission in life is to help families and children find their voice and to know that their stories matter.

[Music playing]

Adults are usually getting help. There's so many treatment centers out there for people to go get better, which is great. But there's not enough for children to be able to say, “This is how it hurt me.” If I'm able to just listen to them and their OK, their lives can be a little bit more hopeful and have a little bit more healing by the time they do grow up. They can say, “OK, I went through this experience, then somebody reached out and helped me.” It's not about, “Wait till all these kids are using drugs and alcohol because they saw it at home.” It's trying to stop it or avoid it earlier.

Mark's Dad: My son is Mark. He's 7 years old, and Ellie's 9. They came here because I had a relapse.

Mark: My dad was hooked on drug and alcohol, so we had to go to this recovery center for 180 days, and it's pretty sad because I only get to see him once a week. But now I can see him all the time. I'm so glad that my dad is not hooked by addiction anymore.

Mark's Dad: We think because they are 7, or they are 5, or they are 6, they don't worry. They worry, and they know dad's not right. When they understand the terminology and they understand the thing of addiction, it makes everything better. Now everything's on the table, and the forgiveness starts. We have to change the future. And the future is our kids. If junior doesn't understand about addiction, his chances of walking down the same path is high.

[Music playing]

[Video ends]

Kama: I just saw in the chat somebody said, “We need centers like this in each state.” I couldn't agree more. It's a model program. We try to model best practices that providers around the country are doing in hopes that any provider anywhere can use simple activity, such as the bag of rocks that you saw. You saw they had rocks in their backpack. The rocks had feelings written on them, like anger and fear and resentment, and about … I think there were about 10 heavy rocks in that bag, and it was to demonstrate what it's like to carry those rocks around in your backpack, and how it feels to take it out and put it down. How your backpack is lighter. And how one of the ways you do that is by talking. And that, again, is true for any trauma with any child. In fact, even children who have not endured trauma, that can be very helpful in your classrooms in your programs.

Next, I'm going to share with you a digital storybook. We have many of these on the site, and they are voiced over, so a child can hear it read to them. But their best used in engagement with an adult. Here we wanted to focus on play therapy because so many of our advisors reminded us that play is how children work through what's going on – the big stuff. What we have here is little Karli in a classroom, where she's really struggling. They're playing kitchen –they're playing with a toy kitchen. And she and her friend are making peanut butter and jelly sandwiches, and Karli says, “You have to make 100 now. We have to make all these peanut butter and jelly sandwiches.” She gets in a conflict with this other little monster because he didn't want to make that many. It came out … This caring teacher, Ms. Moe, who is actually named after Jerry Moe, who was one of our advisors who started the kids program at Hazelton, and he's the creator of the 7 Cs, which we'll talk about a little more later. But I digress. This caring adult in Karli's life saw what was going on, knew about her mom's treatment, and helped her in a very playful way through her struggle. It came out that Karli wanted to make all these sandwiches in her pretend play because she was having to do that at home because her mom was not well enough to cook her dinner. She needed to know that she would have enough food. She was enacting that trauma with another child who, of course, would not be able to help guide her through this, but the caring adult does. That's a powerful story to use with children. They're enacting it with little elephants. The animal is sort of one step away from the child, which we see a lot in children's literature. The animal represents the child when the themes and the feelings are too intense for the reader to internalize as their thing. If and when you share this with children, there's a lot of suggestions on the site for before, during, and after reading activities. Andrea is going to talk about one of our interactive, which features the 7 Cs that I just discussed.

Andrea: Yes, we can't get enough of the 7 Cs, and this interactive, you see this beautiful color, but it really is a color – kind of a color by numbers inspiration for younger kids. In the interactive, kids go through each of these images, they hear the saying “I didn't cause it,” “I can't cure it,” et cetera. And at the end, they celebrate themselves. They color each of these images by tapping, and they'll hear reassuring messages from Karli explaining each of these 7 Cs. At the very end, they all join together to make a beautiful quilts. We can celebrate kids, and it's a nice payoff very exciting for them. But it's a great tool for them to use over and over again. We really recommend that for this interactive, that you can sit with a child and help them learn how to play the game. You can tap or click depending on if you're using a tablet or a desktop device, and show them how the blank areas color in. You can encourage them to play it again and again so that they understand and remember each of the seven ideas and begin to connect them to their own situations. Children’s responses and understanding will vary depending on their age. But even a preschooler can practice communicating their feelings, and you can encourage them to use these ideas as ways to describe their feelings, especially when you get into the communicating their feelings, making healthy choices, taking care of themselves, the things that they can control.

The 7 Cs were developed by Jerry Moe, who is a member of the board of advisors at the National Association for Children of Addiction, and currently serves as the national director of the Hazelden Betty Ford Children's Program. He based them on the original 3 C's, which was “I didn't cause it,” “I can't cure it,” and “I can't control it,” but wanted to add what kids could do. To adapt this idea – I believe that Allen [Inaudible] is the originator of the ideas of the 3 Cs – but to give kids some agency and help them understand where they do have control in their lives. It can definitely help them through the traumatic experiences connected to parental substance use to help them feel like they do have some control over some areas of their life. They can't control the addiction, they can't control their parents recovery, but they can do things like expressing their feelings and celebrating their emotions that really help themselves.

Lest we forget the 7 Cs, we have some wonderful printables, and we encourage you to use these printables in a variety of ways. You can give them to parents at home visits as a home visitor or give them out at the end of the day or the beginning of the day at drop off and pickup. Include them in a child's folder or their backpack, but also you can post them, especially this “Addiction: Resources for Providers & Families.” You can post this in an area that receives some traffic. We know that families struggling with parental substance use and addiction are often scared to ask for help. So seeing that there are resources available as they walk past – if it's a waiting room, if it's a bulletin board in your classroom – that can help inspire them to take next steps and to find some help. It can help family members – those who aren't experiencing addiction – to know where to start when helping their loved one who is experiencing addiction.

We have some this great printable in the middle here for children and grown-ups. It's an adult and child coloring page. You can see that some of the areas are a little bit more intricate and some are a little bit easier to color. And we really encourage you to inspire families to do this together. For an adult and a child to sit down and do this activity together, there are lots of great conversation starters on the website. But we also know that using art and doing art together, sitting there quietly, even that can be a therapeutic moment in and of itself. And that whether conversation comes out of this activity or not, it is a moment where a child can feel safe, feel nurtured, and express their feelings in a way that they may not have the words for it, but they can often express their feelings through coloring and drawing. And of course, it features Karli, and it has the 7 Cs at the bottom so families can go over that together. I'm going to pass it back to Kama for this “Karli & Me” activity book because it's a newer resource that we've developed.

Kama: Sorry. This is actually a printed piece, but it is also available on the site as a black and white PDF. And we wanted a way of – really concrete tangible way – for children and adults to interact around all of these important messages that Karli is there to convey. We also wanted to directly and personally introduce children to Karli as their friend, because the Muppets have this special power to reach – go straight to the hearts and the heads of children in a way that humans can't. Muppets do what humans can't. By interacting in this book – and it's a lot of activity pages which kids are personalizing – they are sort of working alongside Karli and learning from her because at this point, her family has moved through their crisis. They just include things like focusing on what is good, celebrating what's good in your life – that's one of the 7 Cs. So kids are drawing their own examples of what's good, they're drawing self-portraits of themselves next to Karli, and so on. It's really about building resilience. And all of the activities in the book can be used for general resilience practices. Only several of them – actually, I think only the introduction mentions substance abuse.

These are pages you can use with all children who are coping with the effects of trauma. It's about emotional understanding, being able to label your feelings. It's the building blocks of resilience. Emotional understanding, problem solving skills, having some healthy coping strategies, and having confidence and optimism and a healthy self-esteem, and “I can do it” attitude. That will allow you to hope for a better future. And the aim of everything, of course, is to help caring adults like you help children feel less shame, less isolation, engage them in conversation, explain addiction in the language that we've shared. And so many of you have commented on how we've gotten that right, and that really means everything to us because you spend much more time talking to children than we do. And just to offer all of those concrete coping strategies and support. And we suggest that children and adults sit quietly together and complete these pages. We also offer a number of articles. Sometimes they are written by guests, like Jerry Moe of Hazleton, and we cover a variety of topics. We always have a guide for you, the provider, resources for how to use everything you see on the site. We have an article about the language that we've been talking about. Really, scripts on how to answer these questions because in focus testing, so many parents say “We just want to know what to say.” And we give them some suggested sentences, really, as well as an article on rebuilding trust, which was something that came up so much in focus testing. Parents wanted to know how to rebuild. And I know we're running short on time, so Andrea will talk about the webinar series now.

Andrea: After we launched the resources in the fall of 2019, at this point, we heard from a lot of our partners on the ground that they love the resources and they wanted to know more details on how they could use them specifically in their fields. So we developed a four part webinar series for providers, and each features an expert in a particular field that provides tips for that field specifically and also in working with kids and family in any setting. We address, specifically, educators, therapists, first responders, and the faith-based community. The first webinar is “The Child's Voice,” and this at first started as a way to address educators but it really is wonderful for anyone. It features Sis Wenger, who is the president and CEO of the National Association for Children of Addiction, and she's been working in this field for decades and really knows how the child's perspective should be highlighted. And she paints an eye opening picture of what so many children experience daily and offers ways that an individual can offer support and care. This is great for anyone who knows a child who has addiction or substance use in their family. And really helps to paint the picture of the child's perspective, which is, we know, crucial in helping kids to understand their feelings and to move on and cope. And we know that treating the whole family together is also a really effective way to encourage success and recovery.

And in our second webinar in this series, we bring on Jerry Moe, and he explains a little bit more about his background and offers ways that any provider, including family therapists, can use the resources specifically in their work with families, and offers a lot of firsthand stories on how the resources have been used in his program and by providers that he knows. Just one quick story, I know we're a little short on time, but he received feedback from a provider who used the “Play, Talk, Imagine!” storybook with a child who is experiencing a parent's addiction. And the child related it to their own experience. They had taken care of their younger sibling. This child themselves was very young, maybe 6 or 7, taking care of their younger sibling by heating up hot pockets and pop tarts. They really related to eating those peanut butter and jelly sandwiches and feeding themselves and taking care of themselves and saw themselves in Karli. And we know that these resources can be conversation starters for family. And Jerry emphasizes that treating the entire family is crucial, and that addressing the needs of the entire family can help the patient who is in recovery maintain that recovery and keep the family strong together.

We also have a webinar called “Responding With Care” where we speak to some first responders. We know that a lot of times substance use issues are addressed by first responders, and they need to take care in when these situations involve a child and remembering how difficult these situations are for children and how traumatic it could be to have first responders appear. They offer specific ways that first responders can help understand the child's perspective and also use the resources with them to help bridge the gap. Our final entry in this webinar series is “Supporting Families in Recovery” with Reverend Jan Brown. And she describes what recovery looks like for young children and families, what special supports they need, and how faith-based communities and organizations can accompany them in their recovery journey. This entire series is just full of a lot of wisdom from people on the ground who have been working in this field for a long time. And I especially encourage you to check out “The Child's Voice” and the “Healing Families Together.” I think those two are particularly useful for anyone working within a Head Start Center or doing home visiting and helping the family together.

Lastly, before we get to questions, we wanted to remind you that there are some incredible resources available to you on the ECLKC. And these are just a few that I picked out. I was looking at them the other day. There's incredible stuff on understanding the basics of substance use disorder and talking to families about them and screening and consultation, as well as some success stories. We know that imparting hope in families is really important, so showing them families and parents and children who have gone through the experience successfully, much like Celia and Karli, can help inspire them. We also participated in this “Impact of Substance Use on Children and Families” webinar series, which is full of lots of great knowledge. I highly encourage you to check out those links after the presentation. So that brings us to questions, and I believe we have someone who's going to be moderating that for us.

Kelli McDermott: Yes. Thank you so much, Andrea and Kama. That was a lovely presentation. And if you can scroll quickly through the chat, you can see how much these resources have resonated with the audience. The Center for Health, Behavioral Health, and Safety could not be more thrilled to partner with you in our work together. We have some questions that have come in through the Q&A. And I want to start, you touched on this a little bit with the webinar series at the end, but I'm wondering if you have heard anything through folks that work with you but have connection to the work on the ground about whether or not these resources and materials have been used for families who didn't engage in formal treatment systems, but instead, are accessing recovery in different ways, using different pathways, or just utilizing the materials on their own?

Andrea: I think a lot of our firsthand experience comes from the more traditional route, but a lot of the ways that they're used can really be applied across. We received a lot of feedback when the project launched directly from a lot of adults who experienced a parent's addiction in their childhood. And their gratitude around the resources really spoke to the need to address this in a child friendly way and the dearth of resources out there. When I was growing up, this was not something that there were resources around even though we had the drug wars and everything in the 80s and 90s. But I think using storybooks and using printables are great ways to bridge the gap. And we know that not everyone has access to incredible treatment programs that include the entire family. By modeling the best practices, we hope that other important providers in a child's life can use some of the strategies and get the messaging across that families can heal together and that they will be stronger through healing together. And I know a lot of people have used the storybook, in particular, on a little bit more of an informal basis to help explain why mommy or daddy has to go away for treatment or why they go to meetings regularly. And we know that that's not the path that everyone takes, and our job is not to prescribe the path, but instead, to offer resources for anyone who takes different ways of recovery.

Kelli: Thank you so much. I think we have time for just one more quick question. Folks have expressed lots of curiosity about whether or not they can purchase materials from SSIC or if they're just available for download. Can you speak to that a little?

Andrea: Everything is available for free on the website, so no need to purchase anything. It is all digital, but you can download the printables. You can access the storybook on your mobile devices and the interactive as well. We do recommend – you can bookmark the pages for kids so that they know directly where to go. But you can walk through the topic page. If you sign up for an account on Sesame Street in Communities, you can favorite activities, so that's a good way to kind of organize it for families. And also, if you sign up for an account, you have access to all the professional development resources on the website as well.

Kelli: Perfect. Thank you again so much. I know we are bumping right up until at 3 o'clock, so I'm going to pass it back over to Steve.

Steve: Thanks Kelly and Andrea and Kama. That was just remarkable. Wonderful comments in the chat. Certainly, the work of Sesame Street in Communities has followed the incredible example of Sesame Street and Sesame Street Workshop over these many – many years. Thank you for putting up the evaluation link. It's been posted in the chat a number of times. Barbara will post it again. That is how you access your certificate. You complete the evaluation, you hit “Submit,” and then a new page will appear with a URL to the certificate. If that's a problem, you're going to have to write to health@ecetta.info. All of this information, the handouts, and a copy of the PDF of the slides will be attached to an on-demand recording that will be sent out in the next 24 to 36 hours. After that, the recording will be posted on the ECLKC, so you'll have lots of opportunities to review and share today's remarkable session. If you can move to the next slide for me. Andrea, could you move the slide? There you go. I want to thank everybody for attending today. Your patience with some of the technical glitches was remarkable, and we so appreciate it. You can always reach us at health@ecetta.info Our materials live on the ECLKC, the web – the URL is there. We also have a toll-free number. We thank you all, and remember when the Zoom closes, the evaluation link will appear. Don't worry if you can't get in right away because it's going to be a little busy with over 1,000 people joining. Thank you Barbara and Kelly and Kate and Martine and Cecilia and Kaylee and especially, Andrea and Kama. And I should say thank you to Chris and Karli and Elmo and Louie, and all the Sesame Street in Communities gang. It was just a wonderful session.