Podcast

We learned that putting a magnifying glass on the outcomes that we wanted to provide, created a community where not only children were having positive experiences, but also early childhood workers and their families could find ways to have a more positive outcome…. -Javiera Brierley Vera, MD

Robert Sege: Welcome to the HOPEful Conversations about Child Development podcast series. I’m Bob Sege, a pediatrician and director of the HOPE National Resource Center at Tufts Medicine.

Baraka Floyd: And I’m Baraka Floyd, a community pediatrician at Stanford and HOPE Facilitator and Champion. The Healthy Outcomes from Positive Experiences, or HOPE Framework, emphasizes the Building Blocks that children need to thrive: relationships, environments, engagement, and emotional growth. In this podcast, we interview leaders in child health and development in order to learn more about how to support families in creating positive childhood experiences for their children. You can learn more about HOPE by visiting our website positiveexperience.org.

Sege: We’re back this week with Dr. Javier Brivera Vera and Flavia Maccio, who are leading HOPE en Espanol. Last week, we discussed some of the cultural issues from Spanish-speaking people who come from 21 different countries. And, I think that the lesson that I got from that is that really approaching people with curiosity and cultural humility, asking about what each of the Building Blocks means to them and to their families. We had a wonderful conversation last week, and this week, we’re going to continue it and offer some particular tips for people who work with Spanish-speaking families. So, with that, I’m going to start with Flavia and ask you a question, if that’s okay.

Flavia Maccio: Yeah, of course.

Sege: Flavia, I understand as a HOPE Champion, you’re able to use the HOPE Framework to transform your community and agency in Michigan. Can you tell us what problem you faced, how HOPE helped, and what results you obtained?

Maccio: Yeah. So, as we work in early childhood system building, we have worked very closely with many community organizations in our county. One of them is an organization that runs the Head Start program, which is the federally funded early childhood program. As anybody in the field knows, early childhood has a high turnover rate and burnout. We had just found HOPE very recently, and we were eager to implement HOPE on the field. Veronica Pecumer is our lead, and she had the great idea to connect with this community partner and say, “Hey, we think that we can support you with this new framework that we have been exploring.” We work with this organization from all levels, from the director to the teachers, facing families, introducing them to HOPE, and other frameworks that created the spaces for them to communicate with each other with their coworkers, reflect on goals and work together in a strength-based approach. We know that in workplaces there are conflicts, there are things that we all have to work out and navigate. We wanted to support the teachers in that respect and also as they serve families. This process was done in an area of a high Spanish-speaking population. So, we had professionals and families that we were supporting indirectly. This process took two years, and the results were amazing from the director’s perspective. She shared with us that the turnover rate decreased very noticeable from two figures to one. And, they heard from staff that the atmosphere was more welcoming, a better place to work. From the data that we collected, the staff reported using strength-based approaches more often, and the communication with people and supervisors improved. We learned that putting a magnifying glass on the outcomes that we wanted to provide, created a community where not only children were having positive experiences, but also early childhood workers and their families could find ways to have a more positive outcome was key in this process.

Sege: Flavia, I really love to hear that story and the first time I heard it was really so wonderful because the people who work with children and families also need support. And, I was wondering, before we go on to the next question, can you give us one or two examples of specific things that you did to support the early child workers using the HOPE framework?

Maccio: At the beginning, we started meeting with managers and the upper [leadership] of the organization. But, I think that our turning point was when we connected with direct service professionals, when we talk to the teachers. And, that’s where really the project took a new life. Because, for them, it was so important to be listened to, to trust, to have us be some sort of connection between the assumptions that sometimes are made when people make decisions that we don’t agree with and just supporting them in the sense that what they are doing every day matters, that they have strengths that they are modeling for parents, that the way that they talk to children is a way to parents to learn how they can continue that learning at home. I think it was instrumental when the teachers, the staff that is facing families every day when they could see how applying the Building Blocks and the strength-based was making the impact. I think that’s where we got our, their buy-in. If we don’t know why we are doing something, it’s unlikely that we’re going to jump on it. Right. And I think that was their why, understanding that they have strengths, that the families had strengths and that when we incorporate the strengths to everything else that we noticed that can make a difference.

Sege: And Flavia, I just want to just reiterate how wonderful it is because I remember when you first told me the story and told our team that particular agency wasn’t able to hire enough staff to care for as many children as they were licensed to care for. And then, after using the HOPE implementation, not only were the staff happier, but they were able to take care of more children, which was absolutely spectacular. And, I heard from an early child educator, not from your community, from a different one, that she, when she learned about HOPE, viewed her job differently because she started out thinking, I live in an under-resourced community and just doing childcare, I can’t change all the systems issues of which there are a lot. And then, she realized that she was giving a gift to these children because for the hours that they were there, they had relationships with each other and with the staff. They had an environment that promoted curiosity, that was safe, they weren’t being told no all the time, they were engaged. And, she told a story of how the three-year-olds helped set the table and clear the table for lunch. So, it was their spot. And, you can’t even begin to think about emotional growth because all kinds of growth happen in those little kids. But, that made her realize that what she was doing was a gift for life, that would last the whole lives of these children. And that is just amazing to hear. So, thank you.

Floyd: Javiera, you’ve worked to incorporate HOPE into public health in Chile. Can you tell us about how this work has helped organizations in Latin America improve access to positive childhood experiences?

Javiera Brierley Vera: Yes, of course, Baraka. So nice to be here again. It’s been a process. We know that for advocacy work, it takes some time. And, it started small when I was doing the elective back at the [HOPE] National Resource Center. And, I would say after three years of bringing the whole framework into Chile, we’ve had a lot of conversations with a lot of key stakeholders. And I’ve went to plenty of organizations, and I had to build a team around positive childhood experiences and positive experiences in general, so we could have more people talking about the same. But now, I’ve found out that after having many conversations with different organizations, it just makes sense to them and they want more. What has happened is that, for example, America Solidaria took the trainings and then incorporated the HOPE framework into their projects. Also at my university, Universidad Catolica de Chile, in the Department of Family Medicine, we’ve incorporated the HOPE framework. For example, in the infant mental health course, now with the team, we’re working into putting together positive childhood experiences Congress at the end, hopefully of the year. Yeah. So, you are all invited and we would love to spread the message. And, I think, what we need to do is to talk about this. As Flavia was saying, we are the positive experiences as providers as well. We can be the positive experience for our organizations, for our governments, and we need to spread the message. And, for that, the National Resource Centers give us the tools, so they give us the trainings, they can help organizations become certified. And, we’re working towards that in Espanol as well. We are working to translate the materials, so we can implement Spanish cohorts and bring the local examples and the culturally resonant materials to each of the 21 Spanish speaking countries. We’re working towards that. So, basically, having lots of conversations with key stakeholders. We’re having these conversations because we believe in the power of positive childhood [experiences], believing that we can make the change and we have the power to transform our context.

Floyd: So what I hear is really trying to build collective impact. Can you tell us a little bit more about the initial folks that you started to build your team with?

Brierley Vera: Yes, of course. I started with people I trust. We started building a team of four or five people, family medicine physicians that wanted to spread the message. And, we’ve been working together monthly in order to have, for example, the capacity to build the National Congress at the end of the year or the capacity to train more people here in Chile. And then, for example, America Solidaria also has their trainers, they train their own organization and some other organizations are asking us to give them training now. It starts with getting embedded of the HOPE framework, get to know it well, get to know the evidence behind it, and then starting to spread the message.

Floyd: For our listeners, I just want to highlight the fact that Javiera’s group was not just people that she trusted, but they were individuals that had the capacity to get to collective impact by being able to internalize and understand the framework and spread it to an amount of people that would matter. All right, yes, thank you so much.

Sege: Flavia, in your agency, you support early childhood professionals who work with recent Spanish-speaking immigrants to the U.S. Can you tell us one or two things that’s unique about their experience and those of us who work with new immigrants should know?

Maccio: Yes, I think that one of the things is being cognizant of sometimes the isolation that a person in a new country experiences. Another one is sometimes the financial toll that they have because they are not just seeking employment to support their family here, but also they are sending financial resources to their family and their country of origins. They must be sustaining a whole family there with their work here. That is important to know, and to acknowledge as part of how they connect with each other. And what’s the importance of relationships for them.

Sege: Thank you.

Floyd: What is your audacious goal for HOPE in espanol for the future?

Brierley Vera: I can go first, Baraka. What I would love is that we would have every Spanish-speaking government speaking in the language of HOPE. That every government that is working with children and adolescents can systematically promote access to each Building Block in Spanish with materials that we create ourselves about the HOPE framework. And, we also want to create a community of practice that meets regularly. We can have a shared agenda and shared objectives, how to spread this more widely. And I feel like it’s the momentum. It’s a great momentum to scale this. We have lots of HOPE Facilitators that speak Spanish and are already doing the work. We would like to put them all together in a big network so we can promote access to positive experiences in the languages. We are already doing it. It’s just a matter of time in which we can speak about this in Spanish the same way we speak about this in English right now.

Maccio: Yeah, I totally. Yeah, I agree with Javiera. I think that is, yeah, it’s a little bit dangerous to ask us what is our goal, because we’re going to be asking for the moon right now. We are so encouraged by the work of supporting professionals in working with families that we are diving deeper into making forms, policies, HOPE-Informed. We are in our neck of woods. We are revamping every single paperwork that a preschool family receives to make sure that is parent friendly, that is strength based. We’re looking for funds to repeat this project that I told you about with preschool programs and community programs, because we believe that HOPE not only supports families, but the professionals that work with them. That way, we can expand capacity and make it go farther and farther.

Floyd: Flavia, you just said it all right there. HOPE supports kids and families like and builds capacity. Thank you so much.

Sege: I want to join Baraka in thanking you guys both so much for joining us. Javiera, Flavia, I’ve learned so much from you during this session and last week’s session. And, what I’m left with is that Spanish-speaking people like everyone else, responds to these Building Blocks of HOPE, identifies with them and the people, bring with them their own culture if they immigrate or if they live in Chile or Argentina. And, the idea that HOPE is spreading throughout the Americas, thanks in part to you, not only in English, but in Spanish. And, I remember when we were discussing this in advance, there are 500 million people whose heart, language is Spanish. Javier said her audacious goal for HOPE en Espanol is to reach all of them. That is a wonderful goal. Cannot thank you enough both for joining us in this podcast and for each of you for the work you are doing in your communities to support children and families using the framework of HOPE. Thank you.

Floyd: Thank you.

Brierley Vera: It’s been amazing. Thank you, Bob. Muchas gracias.

Sege: Muchas gracias.

Maccio: Gracias.

Sege: The HOPEful Conversations about Child Development podcast was produced by Kris Markman and Patricia Reyes at the Tufts Clinical and Translational Science Institute. Funding for this podcast was provided by the Freedom Together Foundation. For more information, a transcript, and resources related to today’s HOPEful conversation, please visit us at positiveexperience.org or follow us on LinkedIn.

The [Four] Building Blocks [of HOPE] are the same in any language… But, what we really need to do is to listen very carefully of what that family, what that organization, or that government think should be put into each Building Block. -Javiera Brierley Vera, MD

Robert Sege: Welcome to the HOPEful Conversations about Child Development podcast series. I’m Bob Sege, a pediatrician and director of the HOPE National Resource Center at Tufts Medicine.

Baraka Floyd: And I’m Baraka Floyd, a community pediatrician at Stanford and HOPE Facilitator and Champion. The Healthy Outcomes from Positive Experiences, or HOPE Framework, emphasizes the Building Blocks that children need to thrive: relationships, environments, engagement and emotional growth. In this podcast, we interview leaders in child health and development in order to learn more about how to support families in creating positive childhood experiences for their children. You can learn more about HOPE by visiting our website, positiveexperience.org. Buenos Dias. Today, we’re taking HOPE on a cross-cultural trip. On today’s episode, we have a great conversation with two guests who lead our growing network of HOPE in Espanol. They build locally sourced, culturally responsive resources to spread HOPE in ways that are natural to each region, country, or county where Spanish-speaking individuals reside. Dr. Javiera Brierley Vera is a family medicine physician and faculty member at Pontifica Universidad Cattolica de Chile. Her practice focuses on children and adolescents where she collaborates with HOPE National Resource Center to cultivate not just linguistically, but culturally aligned materials to bring resilience and thriving into clinical spaces, communities and beyond. We met her just a couple of years ago when Javiera sold her car to come to Boston and learn about HOPE. Flavia Maccio is a HOPE Champion, someone trained to implement the Building Blocks children need to thrive at a systems level. Flavia is an early childhood specialist working in Oakland County, Michigan. Flavia has led an implementation of HOPE in the early childhood setting, which has helped to improve staff recruitment and retention. She has not only used her skills to change workplace culture, but to infuse early childhood education, a sector in her local area, with culturally aligned content for families, children, and communities.

Sege: Welcome, Flavia. Welcome, Javiera. And, my first question is for Javiera. Javiera, you’re a family physician, and you teach medical students and residents. Tell us the story of how you got started with HOPE.

Javiera Brierley Vera: So excited to be here, Bob. Of course. I was a family medicine resident in Pontificia Cartolico University de Chile. I was in my psychiatry rotation and, my teacher there, Carmel Lagos, was telling us about ACEs and everything that happened with adverse childhood experiences and all the outcomes that came after that. And, I was like, what do we do now with that? Like, how can we improve lives of families and how we can serve them better? And looking in Google, at the existing evidence at that time, I came across the HOPE framework, and then I started to learn about positive childhood experiences and how they change outcomes even when adversity was happening. It’s crazy, Bob, because I took the online course, and things changed for me. Like, I resonated deeply with everything that was being told. I made a crazy choice. I decided I needed to see firsthand what you were doing and I sold my car and went to Boston and took an elective with you guys at the HOPE National Research Center. Then, you gave me the opportunity to work with you in person. And then, three years later, I’m still working together with you and the team towards promoting access to positive childhood experiences. But now from Chile.

Sege: Javier, what a pleasure. I still remember when you showed up at my office, and I had no idea what to make of you. But clearly, you’ve taken HOPE to such wonderful places, and I’m so delighted that you and Flavia are here with us today.

Brierley Vera: Thank you. Pleasure of mine.

Floyd: Flavia, you lead an early childhood program in southeast Michigan. Can you tell us the story of how you got started with HOPE?

Flavia Maccio: Yeah. So, hello. Thank you for having us. From the early childhood perspective, we’re always looking for ways to support professionals that work with families and young children. We are always trying to support teachers, childcare providers, home visitors, anybody that work with that age range from birth to five. Veronica Pechumer, our team leader, heard about HOPE and she got trained. And then, as a team, we just jumped right in because we found it to be exactly what professionals needed to support families. And, we think this is such an important time for families to be supported from a strength-based perspective.

Floyd: And, when you say exactly what professionals need, can you tell me a little bit more about that?

Maccio: I think that early childhood is such an interesting field because there are a lot of professionals that are trained to support families when they’re in preschool and then elementary school and beyond. But, it’s hard for families of young children, especially when they are with the first child, to find professionals that can help them in this parenting journey. And as, as we know, early childhood professionals are not as well fed as they should and the trainings tend to be a little bit limited. Every time there is something for them, we are looking for research, research-based, and good resources too, to share with them. We knew about, like Javiera mentioned, we knew about ACEs, but we founded that there was a missing piece for professionals to support families. So we felt that HOPE was answering that question, because, like Javier mentioned, no matter how many adverse experiences parents and children experience, there’s always HOPE for them, because they can build those positive experiences that can mitigate trauma.

Floyd: You found that the early childhood professionals, they really could identify problems and were well-versed in that from the trainings that they had. But, what HOPE did was really allowed them to kind of see the other side.

Maccio: Yeah, exactly. That’s exactly how you said it. Because we’re always looking to supply what’s missing. We lack that part of looking at what is strong in families, especially when it comes to a family that has a lot of trauma. We tend to only see the trauma because that’s what we want to address and how we want to support them. But, as we say, the trauma is not the whole story. And, the strengths of the family is also what can determine how that family is going to overcome and provide a better future for the children.

Sege: Flavia and Javier, you guys are both here and you’ve been very much involved in creating materials for people whose heart, language and culture is in Spanish. I just wanted to ask you if you could tell us and tell our audience how the Building Blocks of HOPE resonate with the culture of Spanish-speaking families.

Brierley Vera: The [Building] Blocks are the same in any language, Bob. In Spanish, in any language, is the same word, is the same concept. But, we, what we really need to do is to listen very carefully of what that family, what does that organization, or that government think that should be put into each Building Block. It makes sense for them. We really need to be very mindful of what are they saying, how are they saying it, what examples are they giving to me. Then, I can help them and accompany them on that journey of promoting positive childhood experiences in each of those Building Blocks systematically help them, thrive into each one of those areas. Because, that’s where the framework does. It guides us to systematically approach to each [Building] Block so we have access to positive experiences in all those areas that make our families thrive.

Sege: Thanks so much. And Flavia, I believe you’re originally from Argentina and Javier, you’re obviously in Chile. For those of us who are not from a Spanish-speaking culture, are there differences between the different Spanish speaking communities and nationalities? Because I know there are around 500 million people in the world whose first language is Spanish. Since you’re from different countries, can you talk a little bit about how this all works?

Maccio: Yes, that is exactly true. I mean, like you mentioned, there’s like a lot of Spanish speakers. Javiera and I are, like, from our respective countries. We are, we’re neighbors, and we are soccer rivals too. But, there are 21 Spanish-speaking countries in the world, and they are all represented here in the [United] States. We all speak Spanish and, like it happens with any other language, there are other accents, there are different expressions that are more typical of one country than another. What I would say the Spanish-speaking community shares is a very strong understanding of relationships. And, as Javiera was mentioning, the Building Blocks are just based on human nature. Right. We all know about relationships, we all know about engagement, environment, and what it feels to help our children and ourselves grow emotionally. I think that it’s universal. The message of HOPE is universal. And, especially families, Spanish-speaking families understand the concept of relationships and how important they are to provide positive experiences, not just for children, but for adults. Because typically the family is not just mom, dad and children. It’s also grandma and grandpa and uncles and cousins and second cousins. Because, sometimes we have a big family living under the same roof. Sometimes, it’s just the typical family. But, the connections, the shared experiences with the families is a little bit more intense in Spanish-speaking families. I think it’s, it’s important to know that it resonates. I was having trainings with Spanish-speakers and there is no translation needed. The Building Blocks of HOPE are perfectly understandable in any culture, and especially in the Spanish-speaking culture too.

Floyd: Flavia. What I’m hearing is that while there’s not translation needed, what’s beautiful is that particularly for the relationship Building Block for families, it’s expansive. In Spanish culture, where it may not be so expansive in American culture. And, just thinking about how important it is for us when we’re thinking about these Building Blocks, to really listen to our families and really listen for, when they’re talking about their relationships, who those relationships are with and what those relationships mean. Because, when we think about someone’s environment and who’s in that environment, we might think, oh, you live with so many people, that must be so uncomfortable. But, if they have strong relationships with all of the people in that environment, actually that might be wonderful for that child. You know, just really thinking and listening to our families, around what those relationships are and what they mean is just so important.

Maccio: Yeah. And again, the Blocks are 4. But, I feel that starting with relationships is what has really caused that resonating. And, when talking with Spanish-speaking families, because they move that relationship into everything, right into the engagement that they have with their community because they got to that specific organization or that opportunity through their relationships, the environment in which they move. Because that environment depends on the people that are around them and how much they trust them. And, trust is built in relationships and the same, of course, for emotional growth. I think that is why we can see Javiera, from her role in supporting countries and people from different countries, that are getting to know HOPE and myself from inside the States and working with Spanish families that came to the States, that we can get that really immediate buy in, with Spanish-speaking families.

Brierley Vera: I would just want to add, Flavia, that is crucial that we engage everyone involved and It’s not that hard to make the content of HOPE resonate culturally everywhere. I think we just need to have the conversation. Because, if we have the conversation, then we know their words, we know their examples. And then, for example, if an organization wants to implement HOPE in Espanol because they speak Spanish in their organization, then it’s just taking steps on their own learning process of the HOPE framework, put their own words into that and spread the message. I feel that the work we’ve done in HOPE en Espanol about translating materials, it’s about that. It’s about talking with each other, what makes sense for ourselves, even when we speak the same Spanish but in a different country. Maybe, we just need to do some tweaks here about the words, but the content is the same. We need to have the conversations and to see what makes sense for us in order to spread HOPE in our own example.

Sege: This is just terrific. And Javier and Flavia, I both hear you’re saying how important family relationships and other relationships are. And Javiera, I know you’ve also been involved in a bunch of organizations and I think maybe if you can spend just a minute telling us about one of them, America Solidaria.

Brierley Vera: Yes, of course. It’s a great example, Bob. America Solidaria Chile learned about the HOPE Framework around three years ago. And then, they took the trainings, the Train the Facilitator trainings, and then started spreading the HOPE framework in their organization. What happened there is that the whole framework started to be available source, at the beginning was like, oh, this is very interesting. And, little by little, it started to become a central pillar of the organization and about their strategy. They started to incorporate the whole framework into each of their programs. They thought on the programs they have with adolescents and with children, and they started to think, really put thought into thinking what they would do, for example, in the relationship Block or in the environment Block, and then how to promote that in each of their projects, such as, for example, Accionadores or Design for Change. So, they adapted it to the local Chilean reality and they promote that with also the volunteers that work with them. They’ve done an amazing work of bringing HOPE into their local organization and spread it very widely into their programs, into their way of how they talk about positive childhood experiences. They have like a common, language now in which they promote positive childhood experiences. From this paradigm, the paradigm of strength, the paradigm of seeing what things work.

Sege: That’s really wonderful. Can you just tell the audience a few of the countries where America Solidaria works?

Brierley Vera: Yeah. So, America Solidario works widely in Latin America. America in Chile, in Uruguay, in Mexico. And also we’ve had experiences with other organizations here in Chile that are taking the whole framework, such as Universidad Catolica de Chile. And, also there’s a lot of work being done with the EASTIE Coalition in Boston. And also, for example, in Maryland, Washington State, and San Diego State University. We have so many Spanish speakers bringing positive childhood experiences all over.

Sege: That’s wonderful. And Baraka, I think you had a question you wanted to ask before we wrap up.

Floyd: Yeah. How does HOPE reinforce the Spanish-speaking community’s storytelling about their ancestors and traditions? I think in polarizing times like these, it’s really important for providers to honor these traditions, even when their backgrounds are different.

Brierley Vera: Yes. What I would say, Baraka, is that in order to honor their traditions is kind of like this thing we were saying before. We need to listen very carefully. We need to ask the important questions. Say, asking like, what matters? What’s most important to you? What is going well with you? Or, maybe I’m a provider. One of my favorite questions is like, what would you like to improve? Or, what would you like to happen here? Then, we can team up with the families or with the organizations and accompanying them so they can honor their beliefs and their traditions and their needs and their aspirations. Having that conversation, I think is crucial. Yeah.

Floyd: And, I think having that conversation allows you to really kind of fit things in those Building Blocks. Right. Because a lot of times what comes up is it’s like certain types of relationships that they want to improve or certain types of activities that kids want to participate in. And a lot of times those activities might be cultural activities or places that they want to engage that might help connect them to their culture or their ancestors. Flavia, what about in the early childhood system?

Maccio: In the early childhood, we have a framework that articulates so well with HOPE. It’s called Help Me Grow. And it’s a system by which there’s a centralized access and families can call to the affiliate in their county or in their state and they can get connected with early childhood resources. Sometimes, they may be looking for preschoolers, sometimes they might be looking for reassurance about their child development so they can do a developmental assessment, to see if they are on track or they need more support from early intervention or home visiting or other kinds of works. We have that connection with families in the way that they can call us to see how can we support them. Sometimes, they call and they find out that there’s other things. And in that, we have a lot of callers from the Spanish-speaking community. Sometimes they call with a little bit of fear because they don’t know what that entails, the share of information or what is confidential. So, we really put their concerns at rest saying that we just use their information to find the resources that they need, not for anything else. And, we always say that our work moves to that speed of trust with families having those conversations, listening to them, understanding that preschool does not look the same for all families or they don’t have the same idea of preschool because they come from another country where preschool look, look very differently. That, that is always what we pay attention to. And, like Javiera said, we’re listening, asking the right questions, and just moving at the rhythm that their trust establishes.

Floyd: Flavia, you made two really important points there. One, moving at the speed of trust, and the second, that preschool looks different for everyone. And, I just want to highlight that, you know, with HOPE, we talk about the fact that families define what’s positive. That aligns with the idea that preschool looks different for everyone. Positive childhood experiences look different for everyone. I think moving at the speed of trust also aligns with that as well. Thank you so much, both of you, for this wonderful conversation today. We look forward to seeing you back next week.

Maccio: Thank you.

Brierley Vera: Thank you.

Sege: The HOPEful Conversations about Child Development podcast was produced by Kris Markman and Patricia Reyes at the Tufts Clinical and Translational Science Institute. Funding for this podcast was provided by the Freedom Together Foundation. For more information, a transcript and resources related to today’s HOPEful conversation, please visit us at positiveexperience.org or follow us on LinkedIn.

And so, it’s really around combining these tools. One, to identify risk and cost, and then two, then to line up what’s the solution? The solution is family supports, PCEs, HOPE framework, child-parent psychotherapy… Underlying systems change is policy. -Nadine Burke Harris, MD, MPH, FAAP

Robert Sege: Welcome to the HOPEful Conversations About Child Development podcast series. I’m Bob Sege, a pediatrician and director of the HOPE National Resource Center at Tufts Medicine.

Baraka Floyd: And I’m Baraka Floyd, a community pediatrician at Stanford and HOPE Facilitator and Champion. The Healthy Outcomes from Positive Experiences, or HOPE framework, emphasizes the Building Blocks that children need to thrive: relationships, environments, engagement, and emotional growth. In this podcast, we interview leaders in child health and development in order to learn more about how to support families in creating positive childhood experiences for their children. You can learn more about HOPE by visiting our website, positiveexperience.org. Welcome back to HOPEful Conversations. We’re back with Dr. Nadine Burke Harris this week, the first Surgeon General of California, who led the Covid response in California, as well as training over 20,000 pediatricians and other clinicians to screen for adverse childhood experiences and treat for toxic stress. In our last week’s episode, we discussed her experience learning about treating toxic stress at Center for Youth Wellness and creating one of the first tools to do so, and her process for screening for risk for toxic stress and how to treat and prevent toxic stress, utilizing a holistic approach to assure that there are both buffers and a response that includes the whole family. Welcome back, Dr. Harris.

Nadine Burke Harris: You guys had me back. Thank you so much.

Floyd: Thank you so much for being back with us.

Sege: Of course, we invited you back. The last time we talked, we had a great conversation, but let’s talk about the practical applications for our audience in their work. You’ve mentioned that buffers, or positive experiences, like the HOPE Building Blocks, are a key component to treatment and recovery from toxic stress. From your experience, how can we incorporate these essential ideas into policies that support children and families?

Burke Harris: So, there’s a lot of pieces to that, but when we think about how do we incorporate these essential Building Blocks into what we are delivering for kids and families, there’s a couple different pieces to it, right? So, when we’re thinking about systems transformation and we’re thinking about policy, one of the things that was really instrumental in the way that we did things in California was we used the ACEs framework to do a much better job at accurately assessing the cost. So, we did the economic analysis to look at the cost of ACEs to the state of California in cardiovascular disease, in chronic lung disease, in mental health disorders. And, it was a huge number. Like the previous economic analysis, the cost of child maltreatment nationally over the lifetime, was $124 billion. That was the previous estimate. But, when we used the ACE framework, and we looked at the cost of ACEs to the state of California, we found it was $112.5 billion per year. And that was really important because when we’re doing these analyses, we want to make sure that we were doing systems change, right? Underlying systems change is policy change. And so, at the time, that was the best evidence that we had to make the case around the cost of not doing anything.

And, then we really used that to open the door to support putting in an infrastructure, getting a reimbursement infrastructure that supports these buffering interventions. And, so it’s really around combining these tools. One, to identify risk and cost, and then two, then to line up what’s the solution? The solution is family supports, PCEs, HOPE framework, child-parent psychotherapy. Like, that is the solution. You know, in my role as California Surgeon General, it wasn’t just like, thinking of the science and the framework and all that stuff. It was also sitting down with the Department of Finance and saying, “Here’s the cost, and then here’s the opportunity that we have.” And, that was actually how we were able to get some of these things paid for so that we can have a system that is durable, so it’s accessible for families and also durable. And, that was, you know, it was, probably my favorite thing about being in government was expanding access to families for all of these buffering care services.

Sege: It’s such a huge impact. And, you know, we followed in your footsteps. And last year, we published a paper about the economic impact of positive childhood experiences. It was published in a national journal over the summer. And like you, we showed there are really hundreds of billions of dollars at stake. And, once you have that kind of impact, it really makes it seem like a very wise expenditure to do these interventions for children, which actually are not very expensive, and help ensure our future.

Burke Harris: That’s right. So it’s really just like there’s all, all of these different pieces to the puzzle when we think about systems transformation. And then, also, like, how are we working with the current system to be able to do this systems transformation? Right? So we know, for example, HOPE works with, there are so many clinicians, a lot of the times when we think about transforming outcomes for kids and families, we think we need some brand-new intervention or some brand-new, you know, some magical pill, right? And, it turns out we know what helps families heal. We know that relational health, safe, stable and nurturing relationships, PCEs, right, are essential ingredients in helping families heal. And, that’s why, you know, the work that you guys have been leading through HOPE has been so important and groundbreaking.

Floyd: Thank you so much for that summary. As I think about your response, I wonder if there is, like one key, pithy example that you might be able to share, kind of soup to nuts, from your experience as a Surgeon General for our listeners, that might help people think about where to get started. Because, I hear understanding the costs, understanding the system that we’re working in, collaborating with people in the Office of Finance to understand how we are going to pay for things. And, then I’m also thinking, if I were to want to start to do this, where might be the best place to start?

Burke Harris: When I think about where you are with HOPE, you’re well on your way. Like, just what Bob was describing in terms of analysis, that was one of the things that we did. As you’re moving towards scale and continuing to build national practice, different clinical settings, like in different communities, right? All of these different pieces, these are the Building Blocks. I think one of the other pieces that is really important is recognizing how do the things that we’re suggesting or recommending fit within the existing delivery system? So, how does it support, reinforce, partner with the existing delivery system? A great example of that, specifically, if we’re talking about my experience in the Surgeon General’s office with ACE screening, one of the pieces that was really important was, I remember I sat down with one of the governor’s key strategists, and I was saying, listen, the whole point of ACE screening, we know there are so, there are a lot of interventions, right? You know, I talked about child-parent psychotherapy. There’s EMDR, there’s, you know, internal family systems therapy, there’s HOPE, there’s Healthy Steps, these different, there are all these wonderful interventions that can support individuals at different stages of need, right? Some that are broad-based, like HOPE, that are for literally every family, and some like CPP or EMDR, that are specialized for individuals who really need deeper support.

So, having that whole continuum of care, and what I was clear about, I said, the whole point of ACE screening is to help identify those people who need additional intervention earlier, before harm happens, right? And, so biggest thing that I cared about was getting access to services based on risk rather than based on harm. So, in California, when I took office, in order for a child or youth to get access Medicaid to pay for wraparound services or mental healthcare, they needed a mental health diagnosis or they needed to be in the foster care system. And, you know, one of the things I said was the data on ACEs is so strong. We know that an individual with 4 more ACEs is, you know, almost 5 times as likely to develop depression. We know that they’re between 12 and 37 times as likely to have suicidal ideation. Let’s not wait for that outcome before they get services. Let’s identify those who are high risk. We can identify that easily. And, I remember that moment, I was talking with the governor strategist, and he had worked for many governors and he was like, “I get it.” Back when HIV came on the scene, and we developed and antiretrovirals were available, Medicaid only paid for them if someone already had an AIDS-defining diagnosis, right? So, just, let’s just think about that for a second. And, what they saw was that the mortality rate was really high. And, even though those medications were really expensive, right, when scientists said, hey listen, I know it’s really expensive, but we’re actually going to make a really strong scientifically-backed case of why we should let folks who are HIV positive, who don’t have an AIDS-defining diagnosis, they should get access to the medications because, even though they’re asymptomatic, it actually turns out that when you apply the intervention earlier, they have much better outcomes.

And, that’s what ACE screening was all about. It was about assessing those, identifying who’s at high risk. And, then in California we changed our policy to say that a child in California can get access to wraparound services or specialty mental health paid for by Medicaid on the basis of the ACE score and they don’t need a diagnosis. And, that was transformative because that dramatically increased access to services.

Sege: Nadine, as a primary care pediatrician, I love that because I know that it actually conforms to what parents want because parents know their child is struggling in school or having this problem, but it’s really difficult to diagnose a 4-year old with anything. Right. Strep throat’s easy, but you know, all the mental health diagnoses are really around adults. And this, what you’ve done is really opens up so much support for children and families. And I actually, personally, I admire you so much for making that connection because it wasn’t just giving people a number like, you know, you’re a number 4 or number 7, but it was opening up resources that were available so parents could do what they really want to do, which is help their children and be supported in doing that.

Burke Harris: That’s the whole point. And, can I say, this was based on the research. When we did the Pearls trial, the randomized control trial, where we did the validation around ACE screening, you wanna know what we found? Initially, what we found was that there, there wasn’t a strong association between ACEs and ADHD. And I was shocked. In my clinical practice, we had seen this incredibly strong association between ACEs and ADHD. But then, when we actually did executive functioning testing of the individuals who went through the randomized control trial, what we found was there were clinically measurable executive functioning deficits. But guess what? The mean age was 5. We could see clinically measurable deficits in executive functioning. They didn’t yet rise to the level of a clinical diagnosis of ADHD. And, that’s the point. Early detection and early intervention don’t wait for someone to be so impaired that they meet the diagnostic criteria.

Floyd: The other thing I think that kind of goes without saying, but I’m going to say it anyway, is especially as you think about getting support for mental health diagnoses, this also makes it where it’s less stigmatizing because they’re more available and it’s more accepted. And, so I will say in my experience as a general pediatrician In California, since ACEs Aware has started, it has become somewhat easier to get people to start, to tap into the idea of getting support because it’s more available. They know more people who are getting support now. And, it’s not as much of having to wait and wait and wait until the other shoe drops and their little one’s having a lot more trouble.

Sege: We could go on and on about this. I love this conversation. And, what we’ve read longitudinal studies that look at the effects of positive childhood experiences on growth. In Australia, they had a study that started with the birth cohort and followed those kids into adolescence. And, kids who had more positive experiences had less mental health problems as teenagers. Then, you look into, like, what are the positive experiences and their relationships, environment, engagement, emotional growth. So, the things that we can do to just promote those. And, you know, one of the things Robert Putnam wrote about this is decreasing the cost of out of school time activities for kids, so every kid can be on a team or sing in a choir or do art, are all those things that make kids know that they matter and that they have all these skills, even if they’re not a math whiz. It’s really important. And, these are simple things that we can do as a society, based on this really strong research. It’s like so many things in the world that first we start understanding the pathology, like what’s wrong? And then, later, you figure out what you, what you need to promote normal functioning. And, we’re at that wonderful place now where you can have these conversations about all the factors that affect children. And, following your example and how cost effective it is for society to invest in children and to help them when they’re trouble, to make them strong. That’s great.

Burke Harris: Bob, this is what you’re saying, I think, is exactly right. I mean, I think that when we look at public health approach, and as a former Surgeon General, that’s like literally all of what I’m about. And, we think about a true public health approach has, you know, what are the things that we support for everyone, right? And, then it’s kind of like that tiered support. Like, what is. What do we do for everyone? What about for folks who are struggling? And, part of the reason why our work goes together hand in hand so closely. Right. Is that, you know, one of the things we see in clinical practice is a parent’s ability to provide positive childhood experiences for their child is, in part, can be so strongly facilitated by when they get care for their ACEs, right? So, it’s like this is where the ACE framework and the HOPE framework goes together so well, because we know the data is so clear, right. That, in fact, when an individual has 4 more ACEs, if they have high levels of buffering PCEs and supportive relationships, we can actually reduce the likelihood of developing an adverse outcome, physical, mental health, behavioral health outcome, by as much as 59%. So, we know, like, that liberal sprinkling of and support of PCEs across the general population. It’s like fluoride in the water. It’s like vaccination. We want to have vaccinations, and we also want antibiotics, right? Like, we need a whole system of care.

Floyd: One of the other things I think that we all think about in this work is vicarious trauma in doing this work and trying to systems build because there are fits and starts, right? And, so we’ve talked about building systems for preventing and treating toxic stress in today’s episode. I’m curious, as the first Black woman Surgeon General, and with all these inaugural roles, what systems do you put in place for yourself? You think about caring for yourself? I think that would be a benefit for, our listeners to hear.

Burke Harris: So, there’s a couple of pieces there. Healthy environments are as important in the clinical setting as they are in the family setting. Part of the reason why I say that is because, for myself, as a Black woman, the key piece of this for me is the supports, the infrastructure of support that I put in place in my life. Right. I all the time say infrastructure is love at scale.

Floyd: I love that.

Sege: I love that. Yeah.

Burke Harris: Which is on a regular basis. So real talk. So there were things that I did in my personal life. I get tremendous support from my husband. He’s amazing. I also have a squad of girlfriends and really strong familial relationships. I also do all the things. I meditate, I do my therapy, like, all of that stuff. But interestingly, I was in office, I reached out to a handful of other government leaders, and we just really had this informal kind of lunchtime conversations for those of us who are in leadership roles. It was after George Floyd, and I was like, how can we be effective in responding to racial trauma? Not just each of us by ourselves in our individual roles, but, like, how do we have authentic conversations about what it looks like trying to do this work, and be truthful about what some of the obstacles are and be talking about what we’ve been trying to get through for six months and we don’t know, you know, why it’s so challenging and how do we support each other and, like, secretly back channel so that when we’re in the next meeting and one of us says something and the next one. That’s a great idea, right? So building systems of support on the personal level, on the professional level, and that is what enables us to then build those systems of support to the communities and the populations that we’re serving.

Floyd: Thank you so much for sharing that. It makes me reflect a lot on. I have a group text that, like, I think about after George Floyd, how I would not have gotten through those first few months without my group text. Because, in the same way, it was like, as we were moving through our day, it was reminding that person who’s going to the meeting after you, like, don’t forget, make sure that you let them know that this is happening so they hear it over and over again. Because we want this particular thing to be successful. We want this to get through. And it really is. It’s making sure that you have all of those circles of support around you so that you have that system in order for you to be able to do your work effectively. Bu, I love infrastructure is love at scale. Like, I’m so stealing that.

Burke Harris: No, crazy.

Sege: I feel like this whole experience has been like a big group hug. And, I think that we’re really on the verge of a really important movement in terms of understanding what the implications of childhood experiences are how society can invest in them, the stories that we each have as providers and that we’ve learned from you today as a leader, both for your personal sanity and for the changes you can make in society. And Dr. Burke Harris, thank you so much for the time you spent with us, for your lifetime of dedication. And I have to say, we’ve been talking for a long time and honestly, for your friendship. Thank you.

Burke Harris: I am so excited to be walking shoulder-to-shoulder with both of you in doing this important work because I believe that together we are transforming our systems. Like, all these uncomfortable feelings we’re feeling right now, that’s the feeling of systems transformation. And, I just want to say to all the listeners out there, to all the HOPE Facilitators out there, your work is so important. Thank you for what you do every day. And this how we do it. This is how we transform outcomes for kids and their families. And we’re doing it.

Sege: The HOPEful Conversations about Child Development podcast was produced by Kris Markman and Patricia Reyes at the Tufts Clinical and Translational Science Institute. Funding for this podcast was provided by the Freedom Together Foundation. For more information, a transcript, and resources related to today’s HOPEful conversation, please visit us at positiveexperience.org or follow us on LinkedIn.

The most important ingredient for a healthy child is a healthy caregiver. -Nadine Burke Harris, MD, MPH, FAAP

Robert Sege: Welcome to the HOPEful Conversations about Child Development podcast series. I’m Bob Sege, a pediatrician and director of the HOPE National Resource Center at Tufts Medicine.

Baraka Floyd: And I’m Baraka Floyd, a community pediatrician at Stanford and HOPE Facilitator and Champion. The Healthy Outcomes from Positive Experiences, or HOPE framework, emphasizes the Building Blocks that children need to thrive: relationships, environments, engagement, and emotional growth. In this podcast, we interview leaders in child health and development in order to learn more about how to support families in creating positive childhood experiences for their children. You can learn more about Hope by visiting our website, positiveexperience.org.

Sege: On today’s episode, we’re talking to Dr. Nadine Burke Harris. She’s an award winning pediatrician, researcher and public health leader who has spent her career tackling some of the toughest health challenges of our time. As California’s first ever Surgeon General, she helped guide the state through Covid, co-led vaccine allocation efforts, and launched a groundbreaking statewide initiative, training more than 20,000 clinicians to screen for adverse childhood experiences, bringing trauma-informed care into everyday medicine. Her work has always centered on vulnerable communities. After training at Harvard and Stanford, she founded a clinic in San Francisco, Bayview Hunters Point, where she identified childhood adversity as a major driver of poor health and helped develop one of the first clinical ACE screening protocols. She later founded the Center for Youth Wellness, led landmark research on toxic stress, and helped transform how pediatric medicine and society responds to childhood trauma. Dr. Burke Harris is the author of “The Deepest Well”, creator of one of the most watched TED talks of all time on childhood trauma, and a leading voice on the science of resilience and health equity. Her work has shaped national policy, public awareness, and how we care for children now and for the long term. Dr. Burke Harris, welcome to HOPEful Conversations.

Nadine Burke Harris: Hey, thank you so much for having me.

Sege: In your TED Talk, “In the Deepest Well”, you share narratives of patients’ experiences with early childhood trauma and some of the impacts on their bodies. Can you share a story of trauma and resilience that sticks with you today?

Burke Harris: Yeah, absolutely. You know there is a story that I share in “The Deepest Well” which I think is just, like, it’s one of my favorite examples, and it was a patient who had come to see me and she was a 2-year, 9-month old girl who came in for a well-child check, and her parents’ only concern was that she was little, she wasn’t growing very well, and, you know, when I plotted her height and weight and all of that stuff, they were right to be concerned. She was below the third percentile for height, weight, and head circumference. And, in fact, her previous pediatrician had made a diagnosis of failure to thrive and had prescribed PediaSure. Right. Like the number one treatment for failure to thrive, nutritional supplementation. But, it didn’t seem to be working. Her mom said that it didn’t, she still wasn’t growing. And, in my clinic at the time, we did one important thing that helped us get additional information that informed what was going on with the patient, but also our treatment approach. And that was the ACE score. So, it turned out this two-year, nine-month old girl had an ACE score of 7. And, what that told me was that she was at high-risk of having a dysregulated stress response. And, we know that one of the impacts of a dysregulated stress response, biologically, can be on growth. So, for that patient, in addition to usual care, right, we also prescribed child-parent psychotherapy, CPP, an evidence-based intervention. It’s a dyadic intervention, and it’s really about helping to enable parents to actually be able to deliver protective factors and positive childhood experiences. Right. Because we know that every parent wants to give their kids positive childhood experiences. But, the reality is that, for many parents, their own history of adversity can be impacting their ability to create safety in the home, to be able to have those moments. So, in addition to PediaSure, we added CPP, really built capacity for, in this case, the caregiver was the mom to be a buffer to her child’s stress, and her growth rate went from 2.3 cm per year to 7 cm per year. Right. So, when we’re talking about resilience and the body’s ability to get back into that biological balance, like, literally we saw it physiologically in this child who then, you know, we saw it in her growth rate, in her body’s ability to lay down long bone, you know, but, it really was biological resilience which was, it’s one of those things that just makes me so exciting because that is the power of buffering care. Right.

Sege: I love this story because it shows how those positive experiences can help somebody heal. Even though already at that tender age she had suffered adversity, she could heal and grow again. And also it really talks about the multi generational approach. You can’t just take a two-year, nine-month old baby and say get better the parent cycle. Parent-child psychotherapy really works for the parents as well. Can you just make a comment on how the mom did with that? Did was there a change in her personality, her enjoyment of life?

Burke Harris: So, it was really interesting because when I did the ACE screen and initially when I saw that it was a 7, the ACE score was 7. I literally thought mom accidentally put her own ACE score down instead of her child’s. And, when I explained like, oh, you know, let me say we’re asking about these exposures for your child because we understand it can affect her biology. Her mom was like, “Yeah, absolutely. I noticed that when there’s stuff going on in the household, when her dad is upset, that, that really impacts her.” Like, it made intuitive sense to this mom. And, one of the power of this work was when that mom was able to understand the dynamic between violence in the home, like stress and trauma. And, I said to that mom, “The most important ingredient for a healthy child is a healthy caregiver.” And, that mom was able to understand that how she was doing had actually had a profound impact on how her daughter was doing. Over the 18-month treatment period, we saw not only a transformation in mom, right, which is, like, amazing, right? The idea of her own safety. Because, for mom, there was a lot of work that we had to do. Child-parent psychotherapy really helps to explore the parents’ history of adversity and helps them to be able to set boundaries, right? To be able to put in place the structures so that mom could have her own safety. So, that was transformative. But, for this particular family, what we also saw was that dad got insight into his ACEs. So, mom had lots of ACEs and that was part of the process. And, so doing this dyadic intervention helped to support mom in supporting her own safety and well-being. So, we saw a huge transformation in mom. But, interestingly, in this, ultimately for this case, I ended up writing a letter to the court because CPS ended up getting involved. I ended up writing a letter to the court saying, you know, dad’s, what was going on in terms of the violence at home was actually impacting the child’s health. And, the court mandated dad to be able to do trauma therapy for himself. And, that dad, ultimately, was able to say to his child, “I know that because of what I did that that was really harmful and daddy is working on healing.” So, we actually saw whole family transformation in that particular situation.

Floyd: That’s amazing. And I think about just how much you opened access to the positive childhood experience of relationships for that child. Identifying that ACEs score of 7, connecting that child to child-parent psychotherapy, seeing that change in the family, building that strong relationship between the child and her mom, the child and the dad, and then availability of trauma therapies, for adults, really helping to open up healing for dad as well. That, in and of itself, is really kind of all around. And, then thinking about how that probably had a big change in that child’s environment and that Building Block of environment as well. I mean, like, over the moon.

Burke Harris: This is exactly right. And in order to change the environment, this is one of the pieces that was so key to be able to say to kind of everyone in this family system. Right. So for mom, it was because of what your daughter has experienced, her body’s making more stress hormones than it should, and it’s affecting her growth. So, that’s why the safe and stable environment at home is so important. But, that’s not where it ends. The next step is mom, because of what you’ve experienced, your own ACEs that can impact your ability to establish safety in the home. And, so we are going to address your stress response. Right? And then the next step was with dad saying, because dad’s ACEs was the highest. Right. And so he said, dad, because of what you’ve experienced, your stress response is dysregulated. And how does that show up? That shows up in you. Something happens, you feel threat, you respond with this huge surge of stress hormones, and that ends up in violence. You know, your executive functioning goes offline. Right. And so here are tools to help you, dad, when you are feeling that overwhelm and your stress response is getting really activated. And, so for everyone in the household, underpinning our interventions with an understanding of the biology was absolutely critical for, especially for the parents to be able to have empathy for themselves and to be able to understand why environment is so important, why the power of the relational interaction. So, the idea that what was happening in the home was actually arresting this child’s growth, that biological understanding was something that, you know, this mom said she had never heard before.

Sege: Nadine, you mentioned the surge of cortisol, but we’ve talked about this, the other thing that happens when you fall in love or you see a new baby or you have one of these wonderful interactions and is you get a surge of oxytocin. So, what we know is that our brains respond to all of our experiences. And, that’s the beauty of your story, is you started with all the stress stuff, but then all these other things happened. And, seeing the family heal was amazing.

Burke Harris: So, this is exactly right. And this is one of the things that we shared with this family is that when you have, when you have that snuggle, when you have that sweet time, that parent-child interaction, it releases oxytocin, and oxytocin directly inhibits the activation of the biological stress response. And so, that truly is the antidote to trauma, but it has, how do we do that in a way that is supporting families so that is sustainable, so that they get enough of a dose of these supportive relationships, interactions, and environments?

Sege: I think it’s so beautiful that the body is so complicated, that there are, in all of us, mechanisms for healing as well as mechanisms for trauma. And, that listening to these stories is just, it’s wonderful being a doctor because we get to see all these things play out in real time.

Floyd: Yeah, I, one of the things I think that is so important to bring to the forefront is during your tenure as California Surgeon General, you made sure that in screening for adverse childhood experiences, that we didn’t overlook the social determinants of health, including discrimination. And, I think as we’re thinking about addressing adverse childhood experiences in treating and preventing toxic stress, I would love for you to share with my audience why that was important. I mean, I have my thoughts, and obviously it’s clear that I am aligned with the decision that you made.

Burke Harris: Yeah, so, the ACE data, like, when we look at the traditional 10 ACEs, it doesn’t include discrimination. Right. And, but, what it does do, it gives us a powerful understanding, like ACE, we understand when we look at the science is that ACEs dramatically increase the risk of developing a dysregulated stress response. And, we know that that’s associated with changes to brain, immune system, hormonal system, even the way our DNA is read and transcribed. And, biologically, we understand that as the toxic stress response. But, what the science shows is that ACEs are not the only risk factors for the development of the toxic stress response. And, ultimately, the ACEs Aware Initiative was, the whole point of it, was to do early detection of risk of toxic stress and then treating that underlying biology. If we know that discrimination is a risk factor for developing the toxic stress response, we want to identify that and connect individuals and families to services that can help to address that underlying biology. Because, like, ultimately came to this work the way that I even started reading the science of ACEs and all of this other stuff was, the focus of my clinic was around addressing health disparities. Like, I was working in this underserved neighborhood in San Francisco, Bayview, Hunter’s Point, shout out to HP, and what we were seeing over and over again. And, this is why understanding discrimination as a risk factor for toxic stress is so important. Is that not only do we know that experiencing that sense of threat and that absence of buffering can, can lead to dysregulation of the stress response, we also know, and I saw this in clinic over and over again, was that when a person shows symptoms of a dysregulated stress response, poor executive functioning, difficulty with impulse control, right, for certain communities and particular, let’s just say like black and brown communities, they’re much more likely to be met with harsh, harsh punitive responses. So, we have a biological problem that’s viewed through this social lens and the consequence I just saw it over and over again in my patients. Just outsized consequences. And, so being able to respond to, particularly to communities of color and moving from that what’s wrong with you to what happened to you frame and supporting, doing early identification to support kids and families with those evidence-based buffering interventions. That is what it’s all about.

Floyd: So, really telling the truth through the lens of the evidence that we see.

Burke Harris: And also, I think it’s really important, like, I think that early identification and early connection to supports also has the ability to transform outcomes.

Floyd: It does. It can completely change the trajectory. Like, I think all three of us on the call have seen that.

Burke Harris: That is what your work and HOPE is all about. Right? Is that when we do early detection and we are connecting kids and families to support, that literally is…

Floyd: It’s literally what it’s all about.

Burke Harris: What it’s all about. Yeah.

Sege: So, Nadine, I want to add a friendly amendment. I think everyone needs support even before they experience trauma,

Burke Harris: 100%.

Sege: I don’t want to have playgrounds that are set aside for children who need to recover from trauma. Every child needs the opportunity for child centered play. And, I think as a society we can really do this and make people more resilient and help prevent some of the toxic stress that you spent your career working on. And. I know you do a lot of work on prevention, but just to emphasize that positive experiences aren’t just for some people, they’re for all people. And, that’s, it’s really one of the, one of the things. In our next episode, we’re going to talk with you about how we make systems change. So. we’ve heard a lot from you today, about your work with patients and what you’ve learned about ACEs and toxic stress and the healing power of positive experiences, which has been great. So, I hope people tune in next week when we have the next episode and we get to talk with you about how we develop systems that can help us have more resilient children and help us all heal. Thank you so much, Nadine, and looking forward to seeing you next week.

Burke Harris: It’s my joy. Thank you for having me.

Sege: The HOPEful Conversations About Child Development podcast was produced by Kris Markman and Patricia Reyes at the Tufts Clinical and Translational Science Institute. Funding for this podcast was provided by the Freedom Together Foundation. For more information, a transcript, and resources related to today’s HOPEful conversation, please visit us at positiveexperience.org or follow us on LinkedIn.

“What we try to help them understand is that the meaningful unit of relational connection is literally seconds long. It’s not 45 minutes, once a week. You know, you don’t have to give them a psychotherapy session. You just have to see them. You have to be present with them and have a sincere, engaged moment. And, that’s a physiologically powerful thing.” – Bruce Perry, MD, PhD

Robert Sege: Welcome to the HOPEful Conversations about Child Development podcast series. I’m Bob Sege, a pediatrician and director of the HOPE National Resource Center at Tufts Medicine.

Baraka Floyd: And I’m Baraka Floyd, a community pediatrician at Stanford and HOPE Facilitator and Champion. The Healthy Outcomes from Positive Experiences, or HOPE Framework, emphasizes the Building Blocks that children need to thrive: Relationships, environments, engagement, and emotional growth. In this podcast, we interview leaders in child health and development in order to learn more about how to support families in creating positive childhood experiences for their children. You can learn more about HOPE by visiting our website: positiveexperience.org. Bruce, I really want to thank you for coming back for this episode.

Sege: In our first episode, we had a really wonderful and far-ranging conversation about all the factors that influence how children grow up. Of course, adversity, child abuse, all those things are terrible for kids. But, you also mentioned how relational health and rich interaction of relationships can really support children, and, in many cases, counteract some of the difficulties that they face. Now, I’d like to direct the conversation towards practical ideas for providers who are using the HOPE framework in their interactions with children. And, we’re thinking of parents, teachers, human services providers, pediatricians, pretty much everyone, coaches who interacts with kids. So for the next 20 minutes or so, let’s talk, let’s get down and dirty and talk about how those of us who care for children, including children who have some emotional issues, can best use positive experiences and the work we do to help them heal. So, welcome back.

Bruce Perry: My pleasure. Yeah, you know, the practical application of some of these concepts is surprisingly easy. And, you know, one of the things that we spend a lot of time trying to help people appreciate a little bit more deeply is when we talk about how important it is for you to be present for a child or to interact with the child or to value a relationship, and, you’re a teacher, and you’ve got 25 kids in your classroom, it’s terrifying, it’s overwhelming that, oh my God, I’m, you know, being present for 25 kids. How am I supposed to do that and also teach algebra at the same time? What we try to help them understand is that the meaningful unit of relational connection is literally seconds long. It’s not 45 minutes, once a week.

You know, you don’t have to give them a psychotherapy session. You just have to see them. You have to be present with them and have a sincere, engaged moment. And, that’s a physiologically powerful thing. It makes somebody’s stress response quiet down. It makes somebody’s reward neurobiology activate. And, it literally has a whole cascade of positive neuroendocrine effects. And, if you have the gift of a relational milieu where there are a lot of people who will give you these little rewarding and regulating interactions throughout the day, you essentially are in a very rich, developmentally positive environment. And, it’ll be easy to learn, it’ll be easier to interact.

But, we talk about these P’s: present, parallel, patient, and persistent. Those are the qualities that just as an adult making your way through the child’s life, they end up, they determine and control the nature and the intensity of the dyadic interaction. Right. If you’re driving in parallel with your teen and they start talking, and that’ll be way different than if you sit across from the table and say, how was your day at school? They go, “Fine.” “What’d you learn?” “Nothing.” “You learn nothing? I’m going to call the school. Don’t be a jerk.” You know, that’s the interaction with the teen. But, if you’re driving them and in parallel, and there’s this pattern, repetitive, rhythmic, pretty soon they start talking because they feel more regulated. But again, it’s these moments. And, that’s what I think is so powerful and important for folks to feel safe with. It’s okay. You don’t have to be like a super therapist parent all day long. Just be, find a moment, let them know you love them, you see them, you’re present, and you’re around.

Floyd: Bruce, I love that. One of the things I think about, especially for school-aged or young children, is the opportunity that parents have for small things like Reach Out and Read, for example, that we use in pediatric offices and taking those few minutes a day, just to read with their child. Because that allows you to be present, that allows you to have a physical connection. It allows you to do an activity with your child, and it helps their brains develop and grow. And, it just reinforces how important it is not just for us to say it’s important to read, but really how it builds that relational connection. So, you have a good foundation as that child turns into that teen that might not want to talk to you very much.

Sege: And, the other thing, going back to the other providers, we go and give workshops all around the country to people and we talk about HOPE and positive experiences. And, you would not believe, maybe you would, how many times people cite a single teacher or a coach or someone who saw them for who they were. Of all the dozens of people who you interact with when you’re a child, all it really takes is one person to make you feel seen and heard. And, people remember that for decades of their lives, that so-and-so saw me. And, it’s just, it’s a wonderful thing. And, I love what you’re saying about those are the little moments of interaction that really make it, make it.

Perry: Yeah.

Floyd: What that reminds me of is the saying, “You might not remember what someone said to you, but you’ll remember how they made you feel.” And, just how important that relational connection and those four Ps, Bruce, that you brought up, can be.

Perry: Yeah. You know, and I think everybody, if you sort of think back on your life, there are these moments where it’s one person, one coach, one teacher. And, I’m, even when you said that, Bob, I thought, came directly to my mind, one teacher and I had been, you know, no surprise to you, Bob, but I used to sit in the back of the class and goof off all the time. I’ve been in board meetings with Bob. He’s like… Anyway, but he came up to me, and he made me stay after class, and he said, “Listen, you know, you have to stop what you’re doing.” And I said, “Okay.” And he said, “But, you really need to keep writing.” And I was like, “Really?” He said, “You should. Yeah, you’re really good at writing.” And it was like, wow, just that, that one thing motivated my interest and my willingness to keep writing as an undergraduate, into college and then beyond. But, if I hadn’t had that little bit of encouragement, I just don’t think I would have ever even kept it in my head that I should do this or that I should practice, I should keep trying. And, I think that those moments are just powerful.

Floyd: Yeah, it is.

Sege: But, I think that going back to something we’ve talked about is that for all of us and even human services providers, people who have sort of a limited interaction with families, those can be really important. And, I think that all of us as professionals who work with families have heard stories about how people were treated in all the various billion things you have to do for your children. So, I like where this conversation is going.

Perry: Yeah. Yes. I get asked a lot by people that we work with. You know, when we do a lot of teaching about how the brain changes and how important repetitions are and that kind of thing. So, the obvious question comes up. Well, I only see somebody for 15 minutes. You know, how am I supposed to have an impact on their life? That’s where you have to sort of back up and say, listen. The quality of the interaction can have incredibly indelible impact if somebody truly feels that you are respecting them, you’re listening to them, you are seeing them, and it really has much more impact than you tend to appreciate. And, I think all of us, as clinicians, probably have stories where you had a brief interaction with somebody, and then 10 years later you find out it had some impact, and you’re shocked, and it’s like, really?

But, I’ve had so many incredible stories other people have told me about the power of, like a policeman interacting with a six-year-old kid in a domestic violence situation, simply by saying, “Hey, you know, I feel bad for you. Things are going to get better for you. Here’s my lucky coin. I’ve had this.” And he gives him a quarter, right. So, this kid is now a principal of a high school, and he pulls out the quarter and says, “Every time I feel bad about stuff, I pull this quarter out, and it’s my lucky quarter.” I’m like, crazy. And he gave me that as an example of how powerful these moments can be, even though they’re very brief. And, I think that that’s so true about, whether you’re a caseworker or a teacher or you’re supervising kids at lunch, they remember you if you interact with them in this specific way where you truly see them and they can feel your compassion.

Floyd: I really appreciate you highlighting a police officer example because it just highlights the fact that each and every one of us can have a positive impact on the children around us, simply by being present. And I think we don’t say that enough. I think for our local communities in general, just thinking about all of the different types of people that can interact with a child in the course of their day or in the course of their life. And, thinking about it in that way makes it easier, I think, for people to get past the activation energy of, well, “How do I help? How do I contribute,” just simply being present.

Sege: Can you give some ideas of exercises that people can do when they’re beginning to feel burnt out or they’re doing their job, and it doesn’t bring them joy, how they can help do that little mental switch? Because, the most important thing that we’re talking about is a change between the ears of the people who interact with children.

Perry: You know, part of what has helped us when we interact with folks that do this hard work… And, it really is hard work. You know, you get beat up by the system. You have all kinds of regulatory impediments. You are forced to do things that you know are not the best way to do. And the truth is, almost all of our systems are set up to induce moral injury in the people that do the frontline work. And what we try to encourage the people we work with to do is to think about the bubble around the areas that you can control. That, even though all around you, it can be sort of this mess, you can create a bubble of effectiveness and of positive concern. And that’s a big part of your job, to recognize where that barrier is. So, if you keep complaining about the change and suit, you’ve got a new leader, and he has these ideas and blah, blah, blah in your system, you can’t change that. So don’t, you know, you can mention it, and it can bother you, but don’t let it dissolve the barrier. Spend your energy maintaining this bubble of effectiveness. And within that, you have agency.

You make a change. Even if you see somebody for 10 minutes, in those 10 minutes, you can interact in a way that will make their life better. And they’re going to take that out of your interaction and they will pass that on. That’s just the nature of the neurobiology of social contagion. And so, we keep reminding people that they’re much more effective than they think they are. And help them understand, listen, you’re obviously not going to be effective to change your new boss. You can’t change him. He is the way he is. But, you do control what happens when somebody comes in, sits in front of you. And that’s actually a much more important area of impact anyway because they’re going to leave this organization, they’re going to go out in the neighborhood, interact with their kids, and their kids are going to act with other kids, and you literally are going to create this billiards game of positive energy, and it’s going to make a difference in the world.

And, I think one of the biggest things about burnout and moral injury is when you feel like you have no impact, you know, that sense of helplessness, you can shift that. I mean, if people recognize you’re not helpless, you are an agent, you’re an effective agent of change. You may not see all of it, but it’s going to happen. So, that’s a big part of what we do. It’s kind of psycho-educational. We try to give people little mental exercises to kind of go, all right, what are you upset about? What’s important to you? Can you change that? All right, put that in that bucket. And then, you go, can you influence some stuff? Maybe. How do you do that? You can write a letter. Okay, write a letter. But, what can you control? And so there are these three different circles, if you will: one is where you have no impact. The other one is sort of you have influence. And the inner one is you; you have control there. And when you have a sense of efficacy, it really does help.

Floyd: Sorry, go ahead, Bob.

Sege: Bruce, I love what you just said. And, also when we think about relationships, they’re not one way. And, I find myself when I’m in practice and I start asking these questions, it brings a joy to me because I can see what parents have put in, what their strengths are, all the good stuff, as well as my checklist of problems. And, I end up admiring people and feeling better at the end of the day because I think the thing we forget about relationships is we’re not just doling out relationships like we dole out penicillin. We’re entering into a relationship and it can bring some of the joy back.

Perry: Exactly. Yeah. That’s so true. I just think the most important thing that people need to hear is that what you all are doing about centering positive relationships and the power of connectedness and being in connection, that’s central to the problem-solving process. For every field that we have right now, all the things that we’re trying to deal with, whether it’s mental health, child welfare, juvenile justice, whatever system you’re in, whatever activity you do, if you don’t center the positive relational stuff we’ve been talking about, you’re going to be frustrated by your problem-solving process. It just, you will tinker around the edges, but if you don’t center this stuff, it won’t lead to big change.

Sege: Thank you so much.

Floyd: So, thank you again for spending time with us today. I want to make sure that we recap the high points for our listeners. So last week, you told us about how children’s brains respond to positive and negative experiences and experiences of all kinds. One of the things that you highlighted was despite the fact that we have all of these ways of virtual connection, the in-person connections and relationship building is so very important for children because it activates different parts of the brain, and that repetitive interaction is very important. And, building community is important to build engagement for relational interaction, and also to help take some of the load off from parents so that they’re not having to do everything because we’re meant really to live in community.

The other thing you highlighted that I thought was really interesting was the power of proximity, and how when we place people in the same place, it really allows for social contagion to happen by building relationships. And then finally, I just want to highlight you talked about these four P’s: being present, being in parallel, being patient, and being persistent, and how that allows for you to tap in with a child for a short period of time. And, that practical application of supporting the relational health of a child is actually easier than we think. And, I really appreciate that because so often for me, especially as a pediatrician and talking with families, they’re often like, “But, I don’t have time.” And, so I think that’s one of the things I really want to speak into my practice.

And, then the last thing I want to highlight is thinking about burnout from the perspective of the bubble of effectiveness and positive concern, and how when we think about the things that we actually can control and leaning into the positive experiences, positive interactions is really the way that we make change. And, that’s why we all started this work in the first place. So, thank you so much for taking the time to be with us today.

Perry: My pleasure. Thanks for having me.

Sege: The HOPEful Conversations about Child Development podcast was produced by Kris Markman and Patricia Reyes at the Tufts Clinical and Translational Science Institute. Funding for this podcast was provided by the Freedom Together Foundation. For more information, transcript, and resources related to today’s HOPEful conversation, please visit us at positiveexperience.org or follow us on LinkedIn.

“As we looked at this in a really systematic way, one of the things that we found that’s very powerful, and I think not well appreciated, was that the history of relational connectedness was a better predictor of current function than their history of adversity.” -Bruce Perry, MD, PhD

Robert Sege: Welcome to the HOPEful Conversations about Child Development podcast series. I’m Bob Sege, a pediatrician and director of the HOPE National Resource Center at Tufts Medicine.

Baraka Floyd: And I’m Baraka Floyd, a community pediatrician at Stanford and HOPE Facilitator and Champion. The Healthy Outcomes from Positive Experiences, or HOPE Framework, emphasizes the Building Blocks that children need to thrive: Relationships, environments, engagement, and emotional growth. In this podcast, we interview leaders in child health and development in order to learn more about how to support families in creating positive childhood experiences for their children. You can learn more about HOPE by visiting our website: positiveexperience.org.

Sege: To kick off our HOPEful Conversations podcast series, it is my pleasure to introduce our guest, the renowned psychiatrist Dr. Bruce Perry. His bestselling books about trauma and its effects on children introduced the concept of a neural developmental approach to understanding the effects of childhood trauma. His book, “The Boy who Was Raised as a Dog and Other Stories From a Child Psychiatrist Notebook” has become a classic. In 2021, he co-authored a bestseller with Oprah Winfrey called, “What Happened to you: Conversations on Trauma, Resilience and Healing.” Bruce’s work has introduced millions of people to the lifelong effects of childhood trauma and ways to help children recover. Bruce and I met when we were both on the board of Prevent Child Abuse America. We’ve had many opportunities to discuss the effects of childhood experience on lifelong health. Last summer, we had a chat about how best to incorporate an understanding of positive childhood experiences to complement our understanding of the effects of adversity. Bruce offered the terrific advice that HOPE create a podcast series built around conversations that dive into our understanding of how children’s brains and psychological health respond to their experiences. Not only did I take Bruce up on his advice, but he was gracious enough to agree to be our guest on today’s episode. Bruce, you’ve written books that describe how adult mental health is affected by childhood trauma. The HOPE National Resource Center focuses on the four kinds of experiences that children need to thrive: Relationships, environment, engagement, and emotional growth. I wonder if you can tell us a story about a child whose positive experiences help them with recovery from trauma.

Bruce Perry: Thanks, Bob and Baraka. It’s nice to be here. I appreciate the opportunity for having a little bit of a conversation about this. Yeah, it’s interesting. The only reason I’ve been able to kind of stay in this field without burning out is that I have so many wonderful stories about how children have come through terrible times with the help of other people and the attention and the care and the love of a parent, a coach, a grandparent. I think as a lot of people in medicine, when we first start studying anything, we kind of focus on the bad stuff. We focus on pathology. And so, when I started looking at the impact of experience on development, we were looking at the impact of bad experiences, negative experiences. One, for example, had really very little easily identifiable trauma in their history, but they had lots of problems with attention and relationship into maintaining healthy relationships and all of the kind of classic things that you’d expect from developmental trauma. And then, there would be another child who had really incredibly terrible adversity, physical abuse, abandonment, neglect, multiple repetitive physical assaults. And that child would be doing better than the other child.

And I was like, what in the hell is going on here? Because it doesn’t make sense if you’re trying to sort of create this linear causality relationship between adverse experiences and outcomes. And quickly, what I started to do—and I would recommend anybody to do this—is I started to listen and learn about the history of the child. What’s their story? Where’d you come from? How did this happen? And in the case of the child who had terrible adversity but was doing pretty well, he was doing well in school, he was better at forming relationships. He struggled, but it was nowhere near as much as this other child that I was working with. And what happened was, even though he had one parent who beat the hell out of him, who humiliated and did terrible things to him, he had another parent who was attentive, who was supportive, who was protective as much as she could be. And he also benefited from a tremendous community of connection in his neighborhood and in his classmates and in his after-school sports teams.

And it was at that point I realized that these relationships have protective effects. They’re able to help buffer these terrible adversities and provide opportunities for healing. And from that point forward, rather than just simply measuring ACEs, or adversity, and then looking at mental health functioning or whatever we’re looking at, we started to look at the presence of positive experiences, predominantly relationally mediated positive experience, connection to family, to community, to culture, and looked at how they counterbalanced all these adversities. And, as we looked at this in a really systematic way, one of the things that we found that’s very powerful, and I think not well appreciated, was that the history of relational connectedness was a better predictor of current function than their history of adversity. And certainly now if you kind of just scan through social media and the literature, people are focusing a ton on ACEs and adversity, and not as much on this other part of the scale. And I think that that needs to be changed. And that’s one of the reasons I think the work you guys are doing is so important.

Floyd: Thanks so much, Bruce. So what I heard in the story that you just shared is really that this attentive supportive parent of our relationship building block and then having an after-school program, community, supportive school community, really helped kind of counterbalance and help this child recover from the trauma that they were experiencing in their home. Bruce, I’m curious what happens when children miss opportunities for positive childhood experiences, because I’m hearing that they’re really important in helping promote recovery and long-term health.

Perry: Yep. You know, that’s actually an area that we’re very focused on and concerned about. And it’s essentially we kind of refer to it as relational poverty. That we’re seeing in the last 40 years, a tremendous shift in the relational opportunities that all children are having. There’s more screen time, there’s more dilution of the ratio between teacher and student, there’s a lot more transience in neighborhoods. And again, one of the dilemmas we’re struggling with is that more and more people are having experiences of social isolation, loneliness. They’re not connected to a community of faith, they’re not connected to culture, they’re not connected to their extended family.

And what we’ve found, and this we’ve looked at over 200,000 individuals now: When you look at a person’s developmental history and you find people that don’t have that much adversity, you know, it’s not a whole bunch of bad stuff developmentally. But if they have relational poverty growing up, their risk for all of these bad outcomes are the same as if they had a tremendous number of adversities. So, what we’re finding is that if you don’t have relational connectedness, you are at tremendous risk for social problems, mental health issues, and I think physical health problems as well. And I think this, again, this is something that the World Health Organization has identified as a key issue. It’s something that our previous Surgeon General wrote a whole book about—about loneliness. And it’s something that we have to figure out because our modern world, we have all these new remarkable things, the technologies we have and ways to kind of create new exciting communities and ways to do transportation and ways to do work virtually.

What we haven’t figured out really is, and or really yet solved the problem around, is that a lot of these things actually are exacerbating that relational poverty. And I think that the first step towards solving that is actually being much more aware of it. And again, I think that’s one of the things that you guys are doing that’s so important, is when you point out how important after-school programs are, all of these positive things, you know, positive childhood experiences, almost all of them can be connected to relational connectedness in some way. And I think that that’s something that once we sort are more aware of it, you know, human beings are good problem solvers, but I think right now not enough people are as appreciative of this as they should be.

Floyd: Bruce, it’s so interesting that you are talking about relational poverty in a space where people feel that they’re so connected because of technology, allowing them to connect to others from different areas, different cultures, and different identities. And I think it’s fascinating that though we have all of this technology to connect us, it’s really, it sounds like that interpersonal in-person connection is really what’s missing.

Perry: What I will say about that, is that I actually love these new technologies in many ways. I mean, we’re able to do things that are pretty cool. You know, we’ll have a kid in isolated parts of northern Canada who we can problem solve with a pediatrician in New Orleans and a child psychiatrist in Texas, and we can get an occupational therapist from Arizona, and they can all problem solve and help this child. But, what we do know about these virtual communication things is different parts of the brain are activated, and are involved in Zoom interactions compared to in-person interactions. And particularly for a developing child, the parts of our brain involved in reading and responding to other people, the parts of our brain involved in forming and maintaining healthy empathic relationships requires repetition with real experiences with real people, with real conflict, with real solution. Kids playing a spontaneous pickup game, making their own rules and compromising about what, you know, you’re a lot bigger than me. So when you hit that far, that’s a ground rule double. But when I hit it that far, it’s a home run, right? That kind interpersonal negotiation you can’t do as easily virtually. And I think you can’t get the same neurobiological impact.

Sege: Bruce, I love what you’re saying. And just to have a comment first, I love the concept of relational poverty because, in my work, I’ve had the privilege of taking care of patients who are wealthier than me and patients who don’t have two nickels to rub together. And I think relational poverty is different than material poverty. And it’s really important to think about that because I think all across society and the factors that you mentioned really contribute to that. Because I just want to add, because you know me, I do public health stuff and I’m kind of a nerd. Just two studies that I really loved, the Chicago Neighborhood Study, showed that they had these people, they had research assistants looking at city squares and playgrounds and watching what happened. And the children did better in communities where people who were not blood relatives of them yelled at them when they misbehaved. I thought that was like such a classic thing. And another work, Judy Langford and her colleagues at the Center for Study of Social Policy were trying to identify markers for high-quality childcare. And you know that there are all these things you can look at and checklists. What they ended up finding is that they opened a closet door and there were full-size chairs so adults could come and participate in some way. That was a marker. There were enough adult participation they had to buy folding chairs. That was a good thing. And I love those little markers because that’s all about the interrelationship, what you call the relational richness that goes on and supports kids. And they’re not things that you can actually—they just happen organically in those environments.

Floyd: Bob, the other thing that makes me think about, is the fact that when we look at it that way, it really gives people an opportunity to engage in a way that’s organic, like you’re saying. Right. And it doesn’t feel so heavy when we’re asking people to solve a problem for a family or solve a problem for a child. That feels like a big ask, but when it’s really being a part of a community, building a relationship with the child and simply saying, “No, please don’t run in the street. I don’t want you to get hit by a car,” that’s different. Like, that’s just being part of a community. And I think it gives an opportunity for everyone to contribute to the relational richness for each child and for the children in that space.

Perry: Yeah. You know, we use a term called the power of proximity. And really what that is referring to is that if you just put people in the same space, there will be this natural process that begins to evolve that is ultimately good for everybody. And some of my favorite examples have to do with co-housing or just putting in proximity a retirement population with an early childhood population. And when those are co-housed, all kinds of relational things start to happen that are good for the children and good for the retired population as well. And I think that that’s one of the reasons that, you know, somewhat counterintuitive way, I think that things like urban planning are some of the most important things that you can do when you’re thinking about population health.

And again, a study, you know, being a nerd, one of my favorite studies about that is this study about the housing projects in Chicago. There were three big Cabrini Green, these big 20-story towers. And one of the things that they did is they went into one of the projects and created a little garden and a playground and put some benches up for people to sit on. And in that tower alone, not other towers, the violence and violent crime plummeted by 30% and stayed that way. And they tried—like again they tried to figure this out. And a lot of it was basically it was the power of proximity. People got to know each other, people got to see each other’s faces, people were greeting each other, people were nodding to each other. And there’s this tremendous power, there’s this neurobiological pull to belong and to be connected. And it really has physiological consequences that are important. And I really think that again as we think as all the different folks trying to solve these problems, I really do think that what you guys are talking about in terms of recognizing how important positive experiences are and how do you create, how do you increase the probability that there will be a positive experience? Well, the power of proximity is part of that. We have to put people together.

Sege: Yeah. Bruce, I love the story you just told about Cabrini Green. And I think that when we talk about HOPE, one of our Building Blocks is environment. So children have places to live, learn and play. And you described a really simple environmental change in one part of Cabrini Green that led to this richness of interaction. And I think as we go around the country and speak with so many people who are working, that sort of solution is really inspiring because that’s not a multi-billion dollar thing that has to be allocated by the President and Congress. That’s a tweak that can be done because people love their children and as you said, when we interact with each other and we end up developing affiliations, those little things really matter. And I just want to thank you and thank you for this session on your work. I want to invite our listeners to stay tuned. We’re going to have another session also with Dr. Bruce Perry and Dr. Baraka Floyd and myself. And we’re going to move to practical advice for people who care for children and their families. And Bruce, thank you again for this first installment of our conversations with you.

Perry: Pleasure.

Sege: The HOPEful Conversations about Child Development podcast was produced by Kris Markman and Patricia Reyes at the Tufts Clinical and Translational Science Institute. Funding for this podcast was provided by the Freedom Together Foundation. For more information, a transcript and resources related to today’s HOPEful conversation, please visit us at positiveexperience.org or follow us on LinkedIn.