Mental Health

Description of the video:

I'm so pleased to have Steve Viehweg with us and he and I, mostly Steve will be chatting and I might just chime in occasionally and ask some questions or comments as we go along. But as we think about infant toddler, mental health and it's all about relationships. One of the things that can throw off relationships is having expectations for young children that are too hard, right? Or not developmentally appropriate. And then what happens is we get frustrated. Kid gets frustrated because they can't do what it is that we're hoping that they'll do or we're expecting them to do. As we learn more about social emotional milestones, the goal here is to think about how can understanding these milestones help us to better form solid and secure relationships with these kiddos. Because that's what they need in order to be able to learn how to manage emotions and all the other things that we want them to be able to do at home and in school, et cetera. That was more than a sentence. Steve, I'll turn it over to you. I was going to say that was an amazing sentence, but well said, I love that you brought up how this all came about because we have a longstanding partnership anyway, Katie Heron and I, in this work, and we both have this burning desire to understand better mental health and what can we do as providers. Whatever role we play to better help those young kids that goes across things like not only service but even thinking bigger and widening our lens about what do we do programmatically? What do we do around training and understanding? What do we do about policy? How do we get folks that make decisions about where resources go to understand the complexity of this and to think about the youngest kids, and they need us to do that. We have to be a voice for the babies. That's something we always try to say, is that we invite you to be a voice for the babies if we don't know each other. I am Steve Viehweg. I have a lot of letters after my name. I do that on purpose for a couple of reasons. One is so that you know I'm a licensed clinical social worker, but I'm also endorsed as an infant early childhood mental health provider. And you too, likely, could get those letters after your name, if you don't have them already. And that's one of the other webinars that's coming up is to learn more about that. Learn how you too could get those letters and please check it out. The goal is that folks that have knowledge, experience, and understanding about early childhood social emotional development would embrace this competency driven endorsement so that you too could have letters after your name. But really the big reason is that we're trying to create a community of practice so that wherever there's a kid that needs help, we could identify them and get them connected to folks that have a clinical background when necessary, to help them out. The CDC has learned the science. I'm the Act Early Ambassador to Indiana. And that's another connection that Katie and I have, because she's now the Mental Health, I guess, Ambassador, we could call it. Katie as she'll introduce herself. But the CDC is interested in trying to get information out about early childhood development. We're going to focus on that today as Katie was inviting us to think about the developmental piece around this. And we acknowledge that the social emotional domain is the hardest one to describe, to understand, to assess, and to deal with. But we have some information that could help us standard in my day job. I work for the Indiana Lend, which is our Leadership Education and Neurodevelopmental Disabilities Training Program at the School of Medicine in Indianapolis. And I'm also the Associate Director of the Center for Translating Research to Practice. We do like to let you know you mentioned Angie Tomlin who's a coauthor with me in a book called Teching Tough Stuff. It's aimed at home visitors that support families. But really, it's a practical guide that can help anybody. And some of this material is in there, like understanding the behavioral pieces that might connect with development, invite you to look at, so that's who I am. And the question is, what about the other one? Katie? Who are you? Okay. I'll chime in quickly here. And I have your book on my shelf. By the way, I am the director of the Early Childhood Center at the Indiana Institute on Disability and Community. So I'm located at Iu Bloomington on campus. For the last year, I have been the CDCs Mental Health champion to Indiana. We have been looking at ways to connect these milestones with mental health. It was interesting looking at those social emotional milestones on these slides, and I'll ask when we get there, but it's interesting me, there isn't more emotional stuff on those milestones. Yeah, I don't know if you have thoughts on why that is and we can get there. But I thought I was really reflecting on that when I was looking at the definition of mental health and then looking at the milestones. I thought it seems like there was maybe a little disconnect there. And the other thing that we'll naturally observe, we'll just throw out before we get there, is that when you look at the other domains that sometimes I look at, maybe something in communication and go, doesn't that look like social emotional development for young kids? There's a lot of crossover. I think that's an important message, right? That it's messy and complicated. But we can use the evidence. The other thing we'll say about these milestones that we look at today is that they are evidence space. The CDCs only put out milestones that they could say comfortably, we have evidence that this really is the thing, and that most kids, 75% or more would have this skill, this activity, by that age. That also helps, I think, answer your questions like why are there more things? But we don't have evidence for them, But here's what we have evidence for. It's a high criterion to become a stone makes a lot of sense. We all have to work on this, right? We all have to work together to keep building the evidence space about what's behind this. Yeah, that's true, because mental health and early childhood, we're pulling pieces from a lot of different places to try to build that base. And it's not always there yet. That's me, we can keep going. Well, the other thing you said that was really key in the long introduction sentence was that's all about relationships. And that's a good place for us to start as we just reflect back on a definition of infant, early childhood mental health, which you can see coined by zero to three, The National Association of Zero to Three. If you haven't visited their website, go do it. Just type in zero to three.org and you'll get there. But look, this was in 2002 and has remained the go to definition because it's just good. When we talk about infant, early childhood mental health, we're talking about the child's developing capacity to do three things. One is to form close and secure interpersonal relationships. And you can think about how that happens, right? That's the babies are born experience expectant and they need adults to help them navigate the world that begins at birth. Is that connection with hopefully with a secure interpersonal relationship. Which by the way, is something we need throughout our lives to be able to do that. And second, to experience, regulate, and express emotions. When babies are born they're learning this skill and it comes with lots of practice. The adult caregivers help them understand and calm down and learn how to get needs met. But also like how to regulate, how do I do this in a way that's not so disruptive? Then third, to explore the environment and learn another skill that turns out to be really important for later on. All of that is within the context of family, community, and cultural expectations. The nuances of how that might work, I like to always throw in that I think all of us could share this idea with folks that do public policy, that make decisions about where dollars go. Because the work that you and I do in early childhood, it turns out, is very important for something you need later on. If you're in Indiana today and we may have folks from outside the state joining us, I don't know, but Indiana is a state that works. I saw it on the side of a building downtown. We value work and you think about what employers want. They want people who can do these things. They want them to be regulated, dependable to be able to solve problems, to interact with others, and to do what they're supposed to do. We are at the beginning of making that happen, we are today thinking about kids in the context of relationships and social emotional development. Another way to look at this and maybe more simplified way is comes from our colleagues, our friends in the infant early childhood mental health world at Fitzgerald. And Debbie Weatherston, some others. They say that this directs our attention to the well being of all infants and toddlers within the context of secure and nurturing relationships. Just think about that, but what happens and why relationships are important. And then the role that we all might play in supporting those caregivers in whatever way we can to build those connections with kids. You might have come to this today wondering, can babies and toddlers have mental health problems? And the answer is yes, they can. There is evidence that would say that kids even under the age of five, can experience what we might call grown up feelings like all those listed here. Extreme fear, grief, sadness, hopelessness, intense anger, even rage. Now, it might look different, right? So we have infants and early toddlers who aren't able to articulate these things using words. But there are ways that they can share some of their big emotions and you can imagine why kids might have these big emotions, right? It could be lots of reasons where there could be traumas or things that happen in their lives or things that interrupt their connections with adult caregivers. We just need to become better at knowing what to look for with those young kids and to try to understand, hence our conversation today. Trying to understand what this might look like, what does mental health look like? And young kids ways we might figure this out or begin to wonder it is if there are delays in development. I think this group is probably really good at observing young kids and being aware of when things are not on track. We might not always have the ways to explain what it is, but we have a sense, right, of when we're observing kids. We might also notice kids that are having trouble regulating in all the different ways. That might be whether it's through sleep or other behaviors or eating or the things that they're doing notice might have particular fears or they might be in emotional distress. Have you looked at kids? Sometimes and you can tell that they're not feeling comfortable. It's not comfortable for me to see that, but we might observe that and be aware there's a lot of talk about attachment, how kids connect with those adult caregivers. And there's a whole literature about attachment. Most kids have what they call a secure attachment, but sometimes they don't. They might have what's a disordered attachment? And there are some descriptions about how we might understand that and try to intervene and help kids get better attachment. And it could be for lots of reasons. Certainly we know about kids that have difficult behaviors, including aggression. And we can begin to wonder what's going on, and that's what we'll explore. What could be behind this, Maybe feeding or sleep problems, or even physical problems. They're growing, they're not growing in the right way. Lots for us to think about, but think about how some of these symptoms might in fact be related to mental health. The mental health and well being of kids. We could say that these problems can be serious chronic. We need intervention for them, but we can do that. We know that we could successfully treat these things and be able to help kids and families who might be having these challenges. You wonder how common is this? Well, the data would say the best estimates of serious behavior concerns in kids ages two to three might fall 10-15% That's enough kids that we should pay attention to that parents in pediatrician report says that behavior problems, there's 10% of one to two year olds. Even those really young kids, they're reporting behavior problems. We might flip it around and wonder like how many kids are being kicked out of preschool because they have behavior problems? Right? I'm not sure what the data would say about that. That's hard to collect, but our own experience might be it's too many. What could we do to help kids stay in the environments that they're in? Some more data, up to one in four kids under the age of five are at moderate to high risk for developmental, behavioral, or social emotional delays based on the National Survey of Children's Health. And these reports are like the incidence concerns of older kids. So it's similar, it's about the same. We should be paying attention to this and trying to understand when parents are reporting challenging behaviors. They're also sharing that there might be delays in social emotional competence. When we're listening to what they say, they report being worried about their kids behavior. And certainly they're telling us that the behaviors interfere with family activities. That's some clues for us that gets us to thinking about the developmental piece, about this. The CDC, the Centers for Disease Control, is they've been putting together for a long time now. They've had the materials out, they learn the science, act early materials. What prompted them as an agency to think about this was understanding that developmental disabilities are common and not usually identified before kids get to school. But the data would say that 1.6 kids between the ages of 3.17 ends up with the developmental disabilities. That's a lot of kids. What could we be doing ahead of time to better understand that? The latest data that just came out of the CDC through their Atom network, their autism and developmental disabilities monitoring network, says that 1.36 children age eight meet the criteria for having autism spectrum disorder very quickly. The way they figure that out is they have teams of researchers looking at medical charts, eight year olds, and seeing if kids meet the criteria based on what's documented there. That doesn't mean all those kids have that diagnosis, but it means a large number of kids would meet the criteria. We also know that early intervention ahead and ask you a question. Sure. Or maybe it's a it's a comment and a question. I'm looking at that list of ways behaviors that we might see when a kid might be struggling. You shared that list then you shared that slide. Yeah, that's the one. Yeah. I was thinking there's probably some things on that list that are going to be Really stand out to childcare providers or teachers as potentially disruptive in a classroom. Or we've got our externalizing behaviors that are, it's hard to ignore those. And then we've got our internalizing that are a little quieter. So I'm looking at that and then I'm listening to you talk about the kiddos that actually need clinical intervention or may have a disability or delay. I'm thinking about a teacher. A couple of preschool teachers I was talking to the other day that were saying that they have an inclusive classroom where they have kids with Ip's Right. So that are getting special education services. And then typical kids in their class and the behaviors of the typical kids were so challenging that they were having trouble serving and providing the specialized services that the kids with Ip's needed. So I guess I just wanted to point out that it's so interesting to think about all of the ways that it's important to identify when kids are struggling because it doesn't always reach the need for clinical intervention and it doesn't always become a disability. But if we identify when we see some of these behaviors, even in smaller doses or in certain situations, I think we're seeing it so much at lower levels that I don't know what my question is. I guess I just wanted to point out, it's not like we're only talking about the kids that get a diagnosis. We talk about this stuff. You're making me think about all the things that have happened. Let's talk about we had a pandemic, in case you didn't know, we're still all learning. Like what the impact of that was. I hear early care education providers talking about the kids that were in settings and then out because we were all at home and then came back. Or we have kids who were never in and now we're coming in. There's lots of things that could influence that. Then I think you're right, it's probably helpful for us to just step back and understand what's going on developmentally, for all kids to try to understand like what's behind the behavior, what's going on. Because there could be any number of things. It could be serious. It could be not so serious, but it's impacting my behavior. Now if I understand it, maybe we can find ways to help with that. I also was thinking about how people have been embracing self care, ideas like mindfulness and yoga. Or how all the meditation and applying that to very young children as another tool to help them with some self regulation. When those things occur, like when we're all getting out of control in our classroom. But we can learn as a group of kids like, well, when we get like this, we got to use our whatever skill to help us calm down instead of becoming a behavior problem. Sure, Yeah, I have good observation. Yeah. When we have Crystal and Nancy and Shannon come on June 15 to talk about some of the initiatives that Costal is doing. They're going to talk about how the call map is available and free to all childcare providers now as well as teachers. I hear a lot of providers saying that they're using it in their classroom. I think they're using it for themselves as well as using it in their classroom with these littlest learners learning to be calmed by music, mini meditations, things like that. When I've heard examples of when that's been introduced into classrooms, where when things get out of control, then the kids themselves go, okay everybody, we're getting a little bit, whatever the word is, it's time for us to use this skill so that we can calm down and they can do it themselves. And isn't that what we want? Right. And then built at home. Exactly. Yeah. Yeah. Somebody just commented in the chat that they worked in a school as a therapist and they had built in mindfulness into the school. And then I think this is interesting, they added one mindfulness session after a code red. If something stressful happened in the school, they worked in a procedure. They had a process where they were automatically going to take a few moments to calm down. I love that. That's a great idea. Yeah, this ties into this notion that earlier intervention is better, right? We're just throwing out lots of examples of when we notice things that need attention, then we should do it as early as possible and get whatever support services are necessary. But at the same time, it's never too late either. Like we don't have to say, oh, you missed that birth of three window or birth of five window. So there's no hope. I think we should always be trying to do but the earlier, the better. Hence these conversations. Now one aspect, how do we just look at development to better understand that? I don't think we have to sell you on the idea of early intervention. Everybody's here is like, yeah, let's do that. So let's focus now on looking at the CDC materials and understanding just how they set these up. And then we can play with some of the materials that they have to dig a little deeper. But the CDC put together these materials because there was a piece missing, they felt. That whole umbrella of understanding child development. And what do you do when there's a concern? They are on the end of keeping track or monitoring and looking at milestones which they would just define as things that kids do by certain ages. How they play or how they learn or how they speak or how they act, or how they move. The things that you and I see every day and looking at those milestones give us some clues about where kids are developmentally. Parents may need our help in understanding what those are. If any of us have kids or grand kids, we didn't just automatically know everything that kids are supposed to do, we might need a resource to help us. Cdc said, well, we'll put together materials that are aimed at parents. They're in parent friendly language, they're sensitive to the culture, and they're evidence based. They're written in accessible language and presented in ways that makes sense to people that everybody would have the ability to have some common language about what kids do at certain ages. But also understanding that kids develop at their own pace. And some are going to reach certain milestones earlier or others. This is not scientific in the sense that it's not a measurement. It's just a tool to help us begin to understand and communicate about it. And tracking again, go ahead. Yeah, my lens, I'm a parent of a child with a disability, and then I also have done a lot of work in this field, particularly in early intervention. And one of the things that I hear from parents when they have kiddos that do have delays over and over again, is that milestones can be a bummer. They can be sad because if you're so far behind, if your kiddo is so far delayed in a particular area, it can just be a sad conversation. I've heard a lot of really skilled professionals use them in lovely ways with kids that do have delays and disabilities around. Not so much focusing on how behind a child is, but talking about what's coming next and what did you just accomplish. It's this individualized thing. I love that you talk about how kids develop at their own pace. And then just thinking about how, beyond that the messaging works when kids are developing at their own pace, I think is really important. You'll see in the materials that the CDC is developed that alongside the milestones is a lovely list of activities, things that we could do to encourage development at that stage. You're right. If we can separate out the age piece, we have to start somewhere. Like if we're trying to identify where kids are and if there's a delay, then we start at age 30 months. And yet we could use this tool still in a sensitive way that's supportive, as you're saying, when we identify a problem. What I hope we all take away too is I hear a lot from providers that they're hesitant to talk about delays with families for lots of reasons. It may be that we're not diagnosticians, so we don't feel comfortable saying there's a concern. But I also understand, and I say again, we're all observers and how many of us are constantly watching kids wherever we are. And when there's something that doesn't seem right, we're right, that doesn't look right. And how do we know that? We know that because we have this experience. We have this knowledge. It's okay if we were to bring this up and support families. The other thing I would tell you is that in our research with these materials, is that families would say that they trust their early care education providers to tell them about what their kids are doing and when there's a problem more than they would their doctors. And why is that? Because as Katie said, it's all about relationships. We develop relationships, partnerships with families. They're expecting us to tell them. You could use these tools as a way to help build that language and that opportunity to talk about it in ways that makes sense. I think what you're saying is that when you have that relationship, it's much more likely to be strength based. Whereas in a pediatrician's office or something like that in 15 min, you may end up with this deficit based approach accidentally from any attempt to be mean, but just it's quick, it's straightforward. But when we build relationships, we really can use this tool in a strength based way. Well, think about the opportunity of partnering together. When we're looking at what kids are doing, we're understanding what's happening. Then we have that opportunity to go, oh, what do we do here? Here's what we're trying in the program, here's what you can try at home. And when there's a bigger question, then we can have that conversation about what do we do next? We screen, right? So if we're monitoring and keeping track when we have a question, then the next thing we might do is get more information. And that's exactly what Elmira says in the chat. She says that teachers also observe longer and have more take it away. That's a perfect segue. It is. We wanted to just set this out there, but today we're talking about monitoring and just understanding, develop, and keeping track of all of us do that. And we're looking at milestones, the things that kids do from birth to five. It just helps us look first, celebrate what kids are doing. So that's what we could use this with everybody. And then it helps us talk about progress with everybody that's involved. It helps us know what's next. Also helps us identify if there's any concerns. Materials we could use that we'll look at today are the free CDC materials. When there is a question, then we would talk about doing some screening. That is a more formalized tool. Again, it's not scientific, it's not a measurement to say you have a diagnosis or a delay. But what a screening tool will do is also looking at milestones, but in a more organized way, is going to tell us if things are okay or if we need to go to the next level and get a child and family connected for an assessment, that would be done by whatever provider. It could be a psychologist or a speech therapist or any of those folks that have their even more refined tools that could get to a diagnosis. You see we're not doing that. We're just talking about what kids do is on track. If it's not, we should get more information that would help us know how to support that child, where they are, and to keep them going. I hope you're taking away from this, that tracking is important, keeping track of what kids do. It gives us a chance to know where we are, catch early signs of development, et cetera. That gets us to a place like, let's play with this a little bit and we always like to start with when we talk about development, to know what are the five domains of development. Here's the quiz portion. Tell us what they are. You can unmute, you can go ahead and type it in the chat. I'll see how fast you could do that, but okay, social, emotional. Yeah, cognitive. Somebody that motor. In the chat I see physical, adaptive, problem solving. Someone said problem solving, Language and literacy. Fine motor. Oh my gosh. We got way more than the number you said. Well, let's talk about that, Katie, because they're using some words that might be in the same categories. Definitely. So what we're going to show you is what comes out of part C of Idea, the Individuals with Disability Education Act. So these are the five domains, here they are. And Elmira, you win the prize if there only were one to say social emotional first. And that's my bias, it might be Katie's bias. That one is what we should be putting at the top for lots of reasons. Not just because I'm a social worker, but because none of the other stuff happens. A child doesn't have a good connection with an adult. If they're not connecting, then they don't grow. Their brains don't grow, they don't grow physically, et cetera. Then the second one here is called communication, and that talks about both expressive and receptive. That's a second on my list because a lot of the issues we might identify that are behavioral might be related to communication. Right. When kids are having trouble with either understanding or expressing what they're looking for, then we had cognitive, some of you listed that as problem solving. Okay, that's fine. Adaptive is in here, I will say, is that the materials we look at today from the CDC and also like in the ages and stages screening tool leaves out that domain because like we've said earlier, there's so many crossovers for this young age group, it's not necessary to include that as a specific category to look for. Then the last one on our list here is physical, which by the way, includes both those motor things, the gross motor and the fine motor, but also a focus on nutrition, hearing, and vision as part of that physical domain. Now we have that background. The Cdc's milestones are available in lots of different ways. What we'll look at today are the check lists they have put together. And you can see in the middle here of this screen an example of your child at 15 months. What they've done is this is something that you can access online, you could print, you could use it a variety of ways. And it has just a few of the milestones from each of those four domains. And it's in a checkbox format. You could use this tool, talking with a family or a caregiver, and compare, does the child do this or not? Are all these milestones are the ones that have evidence? And the CDC would say that at least 75% of kids or more would have these milestones by this age. Then in a little bit down there, you can see that pink area are some open ended questions, and that's designed to get at the nuances of some of this. There's some questions where you could talk about just to get a better understanding of what the child does, what do they do together, et cetera, to have more conversation and a better understanding of where this is. Now I will say on the left, you can see that there's a picture of a phone. Because all of this that we're looking at is available on an app that's free and downloadable. But of course it's also available if you look at the right and a nice little print edition because some people like little booklet, they've made it available in lots of different ways. And see it's available in Espanol, all of this in Spanish and English. You can download it, get it, et cetera. Enough of that. We thought we would spend some time looking at some of the social emotional milestones in some of the areas. I pulled out the social emotional milestones from the 15 month checklist. Here's the five things that they show. By the way, if you look in the Or if you just do the check in the app. The question would ask you, is the child doing this? Yes, not yet or not sure. So that gives you that choice. Now, the beautiful thing is in the app, or if you go to the milestones and actions at the CDC website, is if you're not sure what these things are, then there's either a picture or a video clip and they're trying to get more video clips. What it looks like, here's what it looks like. If you go to the CDC website where the milestones and actions are. These checklists, here we are on the checklist page for 15 months. And we can scroll down, here's what most babies do by this age, social emotional milestone here. There's pictures for some of these. And then there's a video. You can just click on the video and it'll pull it up eventually. Now we're in super slow. Sorry about that. So it's just a short video clip that shows you what that looks like. Okay. Or there's a picture, you can see a picture of copies, other kids and what this looks like. So how did these sound to you? I mean, that was Katie's question. You're like, looking at these, do you have any comments about what these things look like? I think we have to know the parents that we're working with. So like for example, if we have parents who like to be perfect, having a list might be overwhelming and could be like, oh, my kid doesn't clap, but they do other things just knowing the parent and the kid. Yeah. Yeah. That's a piece of this, isn't it? Is. How do we use these tools in ways that are accessible to families based on what we know about them? Yeah, One of the things that I was thinking about when I was looking at this list and thinking about all of the times when I hear about challenging behavior right, with our little kids, is something like copying other children while playing. Right? Taking toys out of a container when another child does. If we had somebody who wasn't as familiar, a parent that was less familiar with developmental milestones, they might be really frustrated to watch a 15 month old child because maybe is playing with something and another one comes over and wants to do the same thing. That could look like trying to take away the toy, or not playing nicely, or not sharing. But we know that taking turns and sharing takes a lot of stuff that those 15 month olds don't have yet. But really what they're doing is showing you something that's developmentally appropriate, which is showing interest in a toy that another child has, and trying to do something similar. Thinking then about one, if we're always frustrated by that, even though it's typical that's getting in the way of the relationship, then also, what could we do instead then we don't want to sit there and ask them to take turns, right? Because they're not quite ready to do that in 15. Right. Could we provide two or multiples of things that the kids are interested in or what are the ways that we then handle that differently? Well, I was thinking about we pulled up the one here, that's 15 months, so think about how that's a one year old with a couple of months afterwards. Right. So what does that look like? And by the way, also the CDC, when they revised and updated all of the milestones, added a 15 month and a 30 month checklist that used to not be there, but there's enough of a difference between a 12 month old and an 18 month old to have a 15 month old check list. And it is interesting just to see what these things are. And I like what you were saying, Katie, about how we present, so how we understand it and translate this could be really important, right, about this child at this age. The other thing I was reflecting on is when we participated in the CDC and helping look at the one year old book that they created called Baby's Busy Day. We test drove it with groups of parents and have them read it and look at it. I remember the Spanish speaking families. A couple of them remarked that there was little note in there that says, shows imagination, and families, like one year olds are imaginative, had not thought about it that way. And what a delight to see them like. That's really cool that my one year old has an imagination. And this is what it looks like, right? To have a way to understand it. I think it is important for us to think about that. To look at what these are and how do we explain them. Which is why it's nice to have a picture or a video clip. To just talk about what it looks like and then how does it translate to what we're trying to do within our classroom. Always remembering that the pacing is different for individual kids. And then thinking about if you do have a kid with a delay or a disability, how they may be doing some of these things but in slightly different ways. You mentioned earlier, which I thought was such a good point that yeah, we're focusing on social emotional, but all these domains impact each other. When my child who had a disability was little, he couldn't walk until he was six and he didn't have a wheelchair until he was four. Imagine not being able to move, which is a primary way of imitating or interacting with other young people. And imagine the impact that might have. So if everyone is jumping and my son couldn't jump, how is he trying to do what you be like, what the other kids are doing? And are there ways of adapting that and recognizing the impulse though? It's just it's tricky and it's good to keep an open mind. I mean, these are super helpful. But also keeping an open mind, right? Yeah, right. Well, and keeping the lens wide because I think I appreciate that you brought up earlier like this is, this is good for everybody. I mean, everybody benefits parents, caregivers, teachers. He's interacting with the child to have a sense of like, well, what do kids typically do at this age, even if there's no delay? Because when we're learning about it, we can celebrate it. And it helps us to understand how could we include this child over here who's not moving, and why, why would we do that? Because it does relate to some of these other things. I think that's a good point. And you can see on this checklist that we're showing here, the language milestones And the cognitive milestones. I always admire looking at these and sometimes think like how does this not fit like a social emotional thing, because they tie together. Right? And that's a good point. Okay, let's see here. We pulled out a couple of the older ones now like to just take a speed through the 30 month and maybe the three year because probably more of the time that we're all experiencing questions about behavior is when kids are 22.5 Three is when we're seeing that. Here's the 30 month one. This was the new one that they added. Here's the social emotional milestones. You can see the difference here. In the 15 month, what did it say? Copies other children while playing, like taking toys out of the container. Here at 30 months is the milestone, says plays next to other children and sometimes plays with them. So what does that look like? Shows you what she can do by saying, look at me as a social emotional milestone. Follow simple routines when told, helping to pick up toys. And you say it's cleanup time again, we can go to the website and you can see what this page looks like. And by the way, this is designed. If you go to the website and Katie put in the chat with the Urls, but I always just put Cdc.gov slash act early and you'll get right there. That's what I can remember, Cdc.gov slash act early, then you can easily find the milestones. And by the way, there's also like a whole video library of all the pictures and the video clips that they've put together by age and domain. If you wanted to just go find that to show a family or a staff member what this stuff looks like, you could easily find it and download them and use them however you like. Here's at the 30 months, what your baby does by 30 months. And there's more videos here and they're trying to get more in there, but we could look at this video. This is their example of what it looks like for a child playing next to just doesn't exam. Again, I'm thinking about what this might look like in a classroom of this is 30 months. So 2.5 year olds. Yep. 2.5 year olds at 2.5 having everybody come to Circle Time to do ring around the Rosie or something. It might work for kids and it might not work for others. Or in that moment, some kids might want to do that with everybody and some kids might not want to engage and thinking about ways you can have some options for a child who doesn't feel like doing that particular game. Because at that age, sometimes they play with others and sometimes they may feel more like just being nearby or watching and thinking about that and then look at the language. Right. So as you mentioned earlier, are our expectations realistic? At 30 months, we're saying that kids, 75% or more kids would say about 50 words. So that's a fairly limited number of words around doing what you just suggested, right? Offering choices. And like the next activity, I might not have the ability to process all that right away. And then if I'm doing something I like and you're telling me to do something else. Might my behavior look like? I might not be able to say, you know what, I'm really enjoying this activity right now and I prefer to play a few more minutes, if you don't mind. Could we change your agenda? I can't do that at each start, but I might throw the toy at you because I'm mad because this is one way to let you know that I wanted to keep doing this. To keep it in perspective. Yeah. No, I think that's really important because again, if we think about all of this as the bottom line is we want kids to be successful. We want families and caregivers to feel like they're successful as well. So for example, if you need to transition activities and the kids enjoying themselves, you say, okay, go ahead and put away your toys, Come over to the carpet and sit quietly. Now, it says here follows simple routines. When and under cognitive, we can get to two steps. There you go. And what did I just say? I said toys. I counted three. Go to the carpet and sit quietly. Yeah. Those kids are going to forget to sit quietly or forget the carpet or go to the carpet first because they saw somebody else do it and forget about the toys. Right. We're already setting ourselves up to be frustrated if we don't have a sense of where we need to be with the milestones. Melissa's got a long comment and here about challenging piece of going to daycares where there's a wide variety of expectation in settings. It's hard for the little ones that we're working with is their developmental level doesn't always match the age, right? But they required to be separated based on age. That is an interesting question. They push for a circle time which includes a Bc's counting colors, et cetera, which may not always be a good match. You're right, those are things to think about. Using these tools might help us have some of those conversations at every level. Whether I'm the parent caregiver or whether I'm a teacher, maybe I'm asking those questions because I'm in that setting and wondering about this or wherever we might be able to have that. If you're a preschool director or childcare director, sometimes having these milestones available for children or for families can help you to explain why you might not be at Circle time for 10 min doing a Bc's for 2.5 year olds. Right? Because sometimes parents they'll see a very strict or regimented preschool or childcare and think, yes, they're getting ready for school. Excellent. Really, that's not a developmentally appropriate space. Right. It depends on the age of the child and what we're working on. Ideally, all spaces, even going into school through regular school, should be looking at the, looking at learning from the idea of offering options. It's called Universal design for learning, and it is the most accessible way for kids with disabilities, for kids without disabilities to acknowledge that kids learn differently and sometimes need options. But that's a whole other. So then six months later, here's three years. So look at the two that have evidence, right, for social emotional milestones. And it's the first one says calms down within 10 min after you leave her. Like at a childcare drop off at three years. We would expect that most kids would be able to calm down after 10 min when you leave them right now. Now that's interesting to me when I think about, you know, dropping off your kids and what that might be like even earlier. We're hoping by age one that I can do a quick drop off and not have the trauma that we think might happen. But this is a milestone that we don't expect until three. Then the other one is for social motions, notices, other kids, joins them to play. Just to take a quick look at what that might look like, you can see there's nothing yet for the calming down. That means they're working on it. They're working on getting these videos and pictures. But here's the video clip of noticing other kids and joining them to play. Maybe, there you go. So think about how you could use a video clip like that, right? To have a conversation either with a caregiver, a parent, or staff. And just what you could parse out from that. And sometimes I think about these videoclips could look at not only a social emotional, any of the other milestones and how they fit together about how these kids were communicating or how they were playing, or what they were doing. In addition to, in this example, what the social emotional milestone would be. And then let's do it this way, just so you can see comparison of one year later here. And the Cdc's materials will go at three years, then four years, then five years. There's a gap in there once we get going along. But they have several more under social emotional of what this looks like. Another. Other way you might use these. Sometimes I'll create questions with polls to say, when does a child pretend to be something else during play? And give people choices like is this a 30 month, is a three year, four year, five year. And then let them see, then show them the video clip. Then you can have very nice conversations about, well, why did we think about that? Well, it may be because most of the kids I'm working with already have that skill. That's my experience with my own children said that that was the case. But others may have different experiences. You can use it to have nice conversations and to get some insights and learning about how that looks. Here's the example. We'll go to the CDCs website. Again, you can see there are some of these videos, but now we're looking at a four year old. And here's what social emotional milestone might look like at age four. And you'll see that this is a little bit different from age three. Well, maybe you will. What are you going to do? You're going to put out the fire. We'll wait for ten fire a firefighter will. Yeah. Okay, so that gives you an example. And we might even just for a moment, flip down to what are the language communication milestones. And now there are fewer here in this one that have the evidence behind them. But says sentences with four or more words, that's something we'd expect at age four. The majority of kids would say sentence with four or more words. What does that look like? Something out. I hear a lot when we're talking about communication and when we're thinking. Talking also about challenging behaviors. That saying a sentence with four or more words, that's when we're in the frontal lobe, that's when we're calm and we're able to think, right? But sometimes if we're trying to negotiate about a toy or a child is tired or upset about something that can go away. Right? This context specific. And I think it's really important to remember because one of the things that can really challenge a relationship is if we try to reason with a kiddo who isn't in that part of their brain. If they're upset and they're in that more active emotional part of their brain, they just can't do some of those things in that moment. If we get frustrated and say, I know they're capable of saying these words and they're not, then are they being naughty or no, Or are we acknowledging that there could be trauma and other things going on and we have to let them calm down and regulate before we can see some of these things. That makes me think too about when there might be discrepancies between what kids are doing during the day and what they might be doing with us at home in the evening. Because I know my own kids, they were very attentive, very busy during the day, and then they would come home and they had used up all that energy I think, and so they weren't able to be in that space anymore, and they were more in the reactive space. When we would have the parent teacher conferences and they'd say, oh, they're so helpful. Like who are you talking about? But I think that might account for that. Right. They're tired and they don't have the same, it could look different. Yeah. That would be a really important conversation to know like, well, what are the things that work during the day that we might try at night and vice versa? What are they doing at home that might be important for you to know during the day when you're caring for them. And also just knowing that context of what's going on with that kiddo. Of course, that takes us to family engagement in all kinds of things, but I was just talking to a colleague who was sharing that some counties around Indiana have adopted a handle with care program. If you heard about this, where law enforcement is collaborating with schools to share, if a child has had an interaction, if let's say they had domestic violence in the home or something has happened where that child has come into contact with law enforcement, they will reach out to that kindergarten teacher or preschool teacher or whatever and say handle with care. They're not going to share details, they're not going to say what happened, they're going to write handle with care. That way we know that something possibly traumatic happened to that little kid and we can know what emotions we might be seeing and why we might be seeing bigger emotions or fewer of those milestones on a particular day. I've seen that also offered by teachers, just classroom by classroom, where they'll send home a little note to the mom saying, or dad, or grandma, or whoever, saying if something happens, if the kid just has a rough morning and is grumpy, just send me handle with care. You can put it in the folder. You can email me or text me and you don't have to tell me anything more than that. I'm going to know that something's going on. I love that. I just want to well, I hope what we're able to take away from this is based on this conversation or based on our skills and abilities going to be able to diagnose a social emotional issue. That isn't the goal of this conversation today. What we're hoping is that we can take away an appreciation for learning more about what is typical development, what are some clues then that would help us know when things are going awry. And then then another session we can spend more time learning about, well, what do you do then? Where do you refer to? Try to get more assessment or information about whether or not there is some social, emotional, mental health issue going on that we've not been able to address in the ways that we've been just throwing out and tossing around today that might need the support of some other provider. See, there's lots of opportunity here for us in the work that we do to better understand, and that's part of it, I think is seeking to understand what's going on with this particular child and then acting accordingly and doing it in ways that maybe match where they are developmentally. I do want to throw in just to note here that the CDC has other materials that are available that highlight all of these milestones and ideas about activities in some different ways. In addition to the checklists and the print materials and the app, they also have three books. So far, there's a book for one year old, two year old, three year old, They're very interactive. The pages of the book, it just lists what milestones being addressed and maybe a suggested activity. You could use all of these in lots of different ways. They have training on line called Watch Me, and it's aimed at early care education providers. It takes about an hour and you get credit for it. You can print off your certificate if you need that. Then the other list of things they have is something called fact sheets. This is just some helpful information, some aimed at parents like how do I help my kid or how do I talk to my Dr. there's a sheet there for you and me about how do we have difficult conversations, but all of this stuff is available on the website. What we're hoping you're taking away an appreciation that kids have mental health challenges. Yes, that understanding and keeping track of milestones is important, that we've got free resources to help us do this. And that understanding social emotional development in kids can be challenging, but it is possible. We've, I think talked about some practical ways to make that work, just in some conversation. Then we've raised a question that when it goes beyond this, that we need to get more information. That might be a screening or it might be getting connected to a mental health professional that can dig deeper into understanding what it might be. So, I'm aware that we are close to the time. There a slide with a Qr code, Steve? Yes, there is. To here. I just put the link in the chat and that you can fill out a super brief survey and then you'll get a certificate. You can also scan the Qr code with your phone and get to the same survey that way.