>>> WE JUST OPENED UP THE WAITING ROOM SO WE'LL LET YOU ALL GET IN HERE. GOOD AFTERNOON OR MORNING DEPENDING ON WHERE YOU ARE, AND WELCOME TO THE SECOND PART OF OUR WEBINAR SERIES, LEVERAGING SBIRT TO ENHANCE YOUTH TOBACCO USE PREVENTION. IF YOU WERE HERE LAST WEEK, WELCOME BACK. FOR THOSE OF YOU WHO ARE NEW, WE'LL SHARE LAST WEEK'S WEBINAR SO YOU CAN SEE THAT TOO BUT WE'RE HAPPY TO HAVE YOU HERE AS WELL. CAN YOU PLEASE MOVE ON TO THE NEXT SLIDE. MY NAME IS DANA LANGE, PROJECT MANAGER AT THE NATIONAL COUNCIL FOR BEHAVIORAL HEALTH AND I'LL SERVE AS YOUR MODERATOR FOR TODAY'S WEBINAR. ON THE LINE ARE MY COLLEAGUES. NEXT SLIDE, PLEASE. SORRY, YOU CAN STAY ON THIS ONE FOR A QUICK SECOND. I JUST WANTED TO REINTRODUCE OUR FEATURE PRESENTER FOR TODAY, PAM PIETRUSZEWSKI FROM THE NATIONAL COUNCIL FOR BEHAVIORAL HEALTH. I'LL BE TURNING IT OVER TO HER IN JUST A FEW MINUTES AFTER I COVER SOME HOUSEKEEPING ITEMS. NOW YOU CAN MOVE ON TO THE NEXT SLIDE. TODAY'S WEBINAR IS BEING RECORDED AND ALL PARTICIPANTS ARE KEPT IN LISTEN ONLY MODE. YOU CAN ACCESS AUDIO FOR TODAY'S PRESENTATION BY DIALING IN ON YOUR TELEPHONE OR LISTENING THROUGH YOUR COMPUTER SPEAKERS. YOU CAN SUBMIT QUESTIONS AT ANY TIME THROUGHOUT THE WEBINAR BY TYPING IT INTO THE Q&A SECTION OF YOUR WEBINAR DASHBOARD AND WE'LL BE COLLECTING THEM TO ANSWER WHEN WE HAVE A MOMENT AND AT THE END OF THE WEBINAR FOR SURE. WE WILL ALSO HAVE A PDF COPY OF THE WEBINAR SLIDES AND HANDOUTS FROM TODAY THAT ARE AVAILABLE FOR DOWNLOAD ON OUR WEBINAR ARCHIVES PAGE WHICH IS ACCESSIBLE ON OUR WEBSITE AT BHTHECHANGE.ORG. THE LINK IS ON YOUR SCREEN HERE AS WELL. FINALLY, WE'LL BE ASSESSING A SHORT POST WEBINAR SATISFACTION SURVEY. IT'S GOING TO POP UP ON YOUR SCREEN AT THE END OF TODAY'S WEBINAR AND WE'D APPRECIATE IF YOU TAKE A COUPLE MINUTES TO FILL THAT OUT. NEXT SLIDE, PLEASE. I'M JUST GOING TO GIVE A QUICK OVERVIEW OF THE NATIONAL BEHAVIORAL HEALTH NETWORK FOR TOBACCO AND CANCER CONTROL WHO IS THE HOST FOR TODAY'S PRESENTATION OTHERWISE KNOWN AS NBHN, ONE OF EIGHT CDC NATIONAL NETWORKS FOCUSED ON ELIMINATING CANCER AND TOBACCO RELATED DISPARITIES IN PRIORITY RELATED POPULATIONS. WE PROVIDE WEBINARS LIKE TODAY'S COMMUNITIES OF PRACTICE AND MANY OTHER VALUABLE RESOURCES AND INFORMATION, ALL FOCUSED ON ADDRESSING TOBACCO AND CANCER DISPARITIES IN INDIVIDUALS WITH MENTAL HEALTH OR SUBSTANCE ABUSE DISORDERS. YOU CAN VISIT US AGAIN AT BHTHECHANGE.ORG. YOU CAN JOIN THE NETWORK FOR FREE AND GAIN ACCESS TO WEBINARS LIKE TODAY'S MORE HELPFUL INFORMATION. I THINK WITH THAT I'LL HAND IT OVER TO PAM TO KICK US OFF. >> GREAT, THANK YOU. WELCOME, EVERYBODY. I WANT TO START WITH THIS SLIDE TO BRING YOU TO WHERE WE ARE. AS DANA MENTIONED, IF YOU JOINED US ON JUNE 29 FOR PART ONE, I COVERED CONNECTIONS BETWEEN YOUTH VAPINGS, MENTAL HEALTH, SOCIAL AND CULTURAL FACTORS, TRAUMA, AND THEN I TALKED ABOUT CLINICAL AND OPERATIONAL FACTORS AROUND SBIRT SCREENING. THEN WE ENDED WITH TALKING ABOUT SOME SYSTEMS LEVEL STRATEGIES AS WELL. SO GOING FROM INDIVIDUAL CHANGE ALL THE WAY UP TO SYSTEMS CHANGE. I WANT TO BUILD ON THAT TODAY BY TALKING ABOUT WHEN IT COMES TO SBIRT -- AND I'LL DEFINE THAT IN A MOMENT -- THERE ARE SOME PARTICULAR INTERVENTION FACTORS TO HAVE IN MIND WHEN IT COMES TO TALKING TO ADOLESCENTS ABOUT QUITTING OR CUTTING BACK ON THEIR VAPING. I'M ALSO GOING TO BRING IN SOME TRAUMA INFORMED MOTIVATION VIEWING. THAT CAN BE AN IMPORTANT PART OF THAT BRIEF INTERVENTION AND CONVERSATION, AND THEN SIMILAR TO THE FIRST SESSION, COMING BACK AROUND TO NOT ONLY THE INDIVIDUAL OR CLINICAL LEVEL WORK THAT WE NEED TO DO BUT ALSO ON A SYSTEMS LEVEL. HOW DO WE THINK ABOUT SUPPORTING PEOPLE FOR THIS ULTIMATE GOAL WHICH IS LONG-TERM CESSATION. MY NAME IS PAM PIETRUSZEWSKI, AN INTEGRATED HEALTH CONSULTANT AT THE NATIONAL COUNCIL. I DO A LOT OF TRAINING IN MOTIVATIONAL INTERVIEWING AS WELL AS SBIRT PARTICULARLY FOR ADOLESCENTS, ALSO WITH ADULTS. WE DEVELOPED A COUPLE OF RESOURCES THAT I'LL REFER YOU TO BY THE END OF THE WEBINAR FOR MORE PARTICULAR CONTEXT. IF YOU'RE INTERESTED IN IMPLEMENTING SBIRT EITHER FOR ADULTS OR ADOLESCENTS, WE'VE DEVELOPED SOME CHANGED GUIDES BASED ON THAT WORK, SO I'LL BRING YOU BACK TO THAT AT THE VERY END. IF YOU'RE NOT FAMILIAR, WHAT SBIRT IS AND IT'S PRONOUNCED SBIRT, IT'S AN ACRONYM FOR SCREENING, PROVIDING BRIEF INTERVENTION AND PROVIDING A REFERRAL TO TREATMENT, BETTER KNOWN AS COORDINATING SERVICES FOR TREATMENT, AROUND RISKY SUBSTANCE USE. IT'S AN EVIDENCE BASED APPROACH AND WE ALSO CONSIDER IT A PUBLIC HEALTH APPROACH. SUBSTANCE USE IS SOMETHING THAT CAN IMPACT A LOT OF PEOPLE AND IT CAN INFLUENCE ON A POPULATION LEVEL, AND IT'S BASED ON A LOT OF DIFFERENT SOCIAL AND CULTURAL FACTORS AS WELL. SO WE WANT TO BE ABLE TO THINK OF IT IN A BROAD PERSPECTIVE. THE STEPS OF SCREENING, BI AND REFERRAL TO TREATMENT, IS SOMETHING THAT IN AND OF THEMSELVES AREN'T UNIQUE TO SUBSTANCE USE. WE IN HEALTH CARE TALK TO PEOPLE ALL THE TIME. WE DO SOME INITIAL SCREENING OF MAYBE CANCER SCREENING OR DEPRESSION SCREENING, SOCIAL DETERMINANTS OF HEALTH SCREENING. WE TAKE THE RESULTS OF THAT SCREENING AND WE PROVIDE SOME KIND OF INTERVENTION, DISCUSSION, PLANS FOR WHAT TO DO BASED ON THE LEVEL AND THE RISK OF THOSE SCREENING RESULTS, AND THEN WE COORDINATE SERVICES. WE PROVIDE PEOPLE WITH THE NEXT LEVEL CARE OR RESOURCES IF THEY INDEED NEED IT AND WANT IT, AND THAT'S PART OF THIS WHOLE PROCESS OF SBIRT WHICH YOU CAN SEE FITS WITH A LOT OF OTHER TOPICS AS WELL. PARTICULARLY TODAY WE'LL TALK ABOUT SBIRT AS IT WAS INTENDED WHICH IS FOR RISKY SUBSTANCE USE. WHEN IT COMES TO THINKING ABOUT ADOLESCENTS, I LOVE THEM. I THINK IT'S SUCH A FASCINATING TIME. IT'S A HARD TIME. IT'S AN INTERESTING TIME. IF WE WORK IN HEALTH CARE WE TEND TO THINK ABOUT IT AS THIS TIME OF INCREASED RISK. THERE'S MORE AND MORE POTENTIAL THAT THEY WILL USE OR TRY OR EXPERIMENT WITH SUBSTANCES. WE KNOW THAT THE ONSET OF PHYSICAL AND SOME PSYCHIATRIC CONDITIONS OCCUR DURING THIS TIME OFTEN, AND THEY'RE TAKING A LOT MORE RISKS ANYWAY. THEIR BRAINS ARE STILL DEVELOPING. WE KNOW BRAIN DEVELOPMENT HAPPENS UNTIL AT LEAST AGE 25. WITH THAT, WE KNOW THAT THE MORE SOPHISTICATED PARTS OF THE BRAIN ARE WHAT ARE DEVELOPING LATER, SO THE ABILITY TO MAKE SOUND DECISIONS, TO ADOPT CRITICAL THINKING SKILLS, THAT HIGHER ORDER FUNCTIONING ISN'T ALWAYS IN PLACE JUST YET. THAT PART OF THE BRAIN IS STILL DEVELOPING. HENCE THE REASON WHY RISK TAKING IS VERY COMMON. IT'S ALSO AN EXCITING TIME. IT IS A TIME FOR OPPORTUNITY IF WE ARE TO FRAME IT IN THAT WAY. IF WE ARE WORKING WITH A TEEN WHO'S MAYBE EXPERIENCED TRAUMA, MENTAL HEALTH ISSUE, IS USING SUBSTANCES, IN PARTICULAR, VAPING, WE CAN SEIZE THE OPPORTUNITY AND BUILD ON WHAT IS HAPPENING IN THAT ADOLESCENT'S LIFE, IN THEIR BRAIN WHICH INVOLVES A REAL PROPENSITY FOR NOVELTY. THAT'S ONE OF THE THINGS WHEN THEY EVALUATE WHAT THE DIFFERENT PARTS OF THE BRAIN DO, THE BRAIN PART THAT IS GROWING SO RAPIDLY AT THIS TIME IS SEARCHING FOR NEWNESS AND EXCITED ABOUT NEW THINGS. HENCE THE REASON MOST TEENS I KNOW THESE DAYS ARE WELL PAST FACEBOOK AND EVEN SNAPCHAT. THEY'RE ONTO TIKTOK AND SOME OF THESE OTHER THINGS BECAUSE THEIR BRAIN IS CONSTANTLY SEARCHING FOR NEW. I THINK THERE'S A REAL OPPORTUNITY WHEN WE'RE HAVING BRIEF INTERVENTIONS WITH ADOLESCENTS ABOUT REDUCING THEIR RISK, REDUCING THEIR USE OF SUBSTANCES, TO CAPITALIZE ON THEIR INTEREST IN NOVELTY AND TO SHIFT THE RISK TAKING TO SOME POSITIVE THINGS. I TALKED IN THE LAST WEBINAR A BIT ABOUT THAT AND SOME OF THE MESSAGING WE MIGHT DELIVER, SOME OF THE WAYS WE SHAPE OUR SYSTEMS AND OUR PUBLIC HEALTH APPROACH TO BE FRAMING SUBSTANCE USE NOT AS A DON'T DO THAT, DON'T DO DRUGS KIND OF A MESSAGE BUT MORE OF A LET'S APPEAL TO THAT DEVELOPING HIGHER ORDER FUNCTIONING. ABOVE THE INFLUENCE IS A VERY POPULAR CAMPAIGN RIGHT NOW TO REALLY APPEAL TO TEENS' DESIRE TO HAVE SOME CONTROL, HAVE SOME ABILITY TO MAKE DECISIONS FOR THEMSELVES, SO IT'S A REAL TIME FOR OPPORTUNITY. THIS COMES FROM OUR -- THIS ADOLESCENT SBIRT CHANGE PACKAGE THAT I MENTIONED AND I HAVE IT CITED ON THE RIGHT SIDE, THIS IS HOW WE AT THE NATIONAL COUNCIL HAVE KIND OF PULLED TOGETHER WHAT CAN BE DONE WHEN WE DO SCREENING OF SUBSTANCES WITH ADOLESCENTS AND THEN APPLY THOSE SCREENING RESULTS TO SOME SPECIFIC TYPES OF INTERVENTIONS. AT THE TOP ALONG THE LEFT SIDE, IT'S THE SCREENING QUESTIONS. THIS COMES FROM THE TOOL CALLED THE S2BI, SCREENING TO BRIEF INTERVENTION. I DESCRIBED IT THIS IN THE LAST WEBINAR. BASICALLY THE QUESTION IS IN THE PAST YEAR HOW MANY TIMES HAVE YOU USED ANY ONE OF WHAT'S CONSIDERED THE BIG THREE FOR ADOLESCENT INITIAL SUBSTANCE USE, TOBACCO, ALCOHOL, MARIJUANA. THE SCREENING TOOL GIVES YOU A RANGE OF FREQUENCY RESPONSES WHICH IS THE DIFFERENT COLORS BELOW, A COUPLE STEPS BELOW. FIRST IT MIGHT REPORT NO USE, ONCE OR TWICE THEY'VE USED, MONTHLY OR WEEKLY USE. WITH THIS PARTICULAR SCREENING TOOL, THAT ALIGNS THEN WITH THE LEVEL OF RISK. THAT LEVEL OF RISK NOW TELLS US WHAT WE CAN DO REGARDING AN INTERVENTION. NOW, THIS SCREENING TOOL, WE PUT IT TOGETHER, IS AIMED TOWARD PRIMARY CARE AUDIENCES, PARTICULARLY FEDERALLY QUALIFIED HEALTH CENTERS BUT I THINK THE MESSAGING AND THE THEMES CAN BE APPLIED IN A LOT OF DIFFERENT SETTINGS. I HAVE SOME ADDITIONAL SLIDES THAT WILL GO INTO THE VARIATIONS ON THIS THEME BUT I DO WANT TO WALK YOU THROUGH SOME OF THESE RESPONSES. WHAT WE'VE SURMISED IS THAT IF A PERSON, A TEENAGER, SAYS THAT THEY'RE NOT USING SUBSTANCES AT ALL, IT'S A GREAT OPPORTUNITY FOR SOME ANTICIPATORY GUIDANCE, MEANING ENGAGING THEM, AFFIRMING THEIR DECISION NOT TO USE, MAYBE EVEN STAYING CURIOUS AND ASKING A BIT MORE ABOUT REASONS FOR NOT USING. THE MORE WE CAN PREVENT, THE MORE WE CAN ENGAGE WITH KIDS UPSTREAM, THE MORE LIKELY WE ARE TO INFLUENCE THAT TRAJECTORY OF BRAIN DEVELOPMENT, OF SOCIAL STRENGTHS, RIGHT? SO IF SOMEONE TELLS YOU THEY'RE NOT USING, YOU SCREEN THEM, STILL ENGAGE IN A CONVERSATION. THAT'S GREAT, REALLY PLEASED TO SEE THAT. WE KNOW THAT THERE'S A LOT OF HARMS ASSOCIATED WITH VAPING AND WHY FOR YOU IS IT SOMETHING YOU'VE DECIDED NOT TO DO? WE'RE NOW HELPING THAT ADOLESCENT REINFORCE THEIR REASONS FOR NOT USING. CERTAINLY THEY MIGHT BE UNDERREPORTING AND NOT TELLING US THAT THEY'RE ACTUALLY USING IF THAT'S THE CASE, BUT THE IDEA BEHIND THIS IS WE'RE TRYING TO BUILD A NEW NORMATIVE CONVERSATION AROUND ASKING AND ACCEPTING PEOPLE'S RESPONSES AS WHAT THEY'RE COMFORTABLE WITH TELLING US IN THE MOMENT, AND THEY'RE WATCHING US TO SEE HOW WE ARE GOING TO BE RESPONDING TO THAT AS WELL. IN PARTICULAR -- ACTUALLY, LET ME STOP BECAUSE I'M SEEING A QUESTION ON THE SCREEN. I'LL ADDRESS IT, FROM ALEXANDRA. HAS THE S2BI BEEN STUDIED WITH ADOLESCENTS WHO VAPE? IT WAS CREATED IN MASSACHUSETTS AND THEY DID RECENTLY UPDATE THE SCREENING SO THAT THE QUESTIONS SPECIFICALLY -- AND IT WAS IN THE LAST WEBINAR, BUT PARTICULARLY THEY SAY IN PARENTHESES TOBACCO, VAPING, CIGARETTES, E-CIGARETTES, SO THE QUESTIONNAIRE HAS BEEN ADAPTED TO INCLUDE VAPING AS A METHOD OF DELIVERY, BUT WHAT THEY'VE TOLD US WHEN WE ASKED ABOUT THAT IS THAT IT HASN'T YET BEEN FULLY STUDIED IN WHETHER THAT QUESTION IN PARTICULAR HAS BEEN APPLIED TO ADOLESCENTS WHO VAPE. THAT'S WHY THEY ADDED IT BECAUSE THE SECOND PART OF YOUR QUESTION, I WONDER IF THEY CONSIDER VAPING TO BE TOBACCO, SO THE WAY YOU'RE SEEING THE QUESTION RIGHT NOW IS THE ORIGINAL PURE QUESTION. HOW MANY TIMES HAVE YOU USED TOBACCO, ALCOHOL, MARIJUANA. AND THE SPECIFIC QUESTIONNAIRE NOW HAS IN PARENTHESES, E-CIGARETTES AND VAPING. NOTE TOO THAT SOME SCREENING FORMS OR PEOPLE WHO ASK THESE QUESTIONS MIGHT SAY E-CIGS AND THEY MEAN VAPING, ALL VAPING PRODUCTS, BUT KNOW THAT NOT ALL PEOPLE WILL IDENTIFY E-CIGS AS ALL VAPING DEVICES, RIGHT, BECAUSE THERE'S PODS. SO THE MORE EXPLICIT YOU CAN BE ABOUT WHAT YOU MEAN BY THAT, VAPING PRODUCTS AT A MINIMUM COVERS THE BASES, IMPORTANT TO DO, SO THANKS FOR ASKING ABOUT THAT. THE QUESTIONNAIRE GOES ON TO ADDRESS IF SOMEONE SAYS THAT THEY'RE USING ONCE OR TWICE, YOU KNOW WE OBVIOUSLY WANT TO DO SOMETHING WITH THAT INFORMATION. WE DON'T WANT THIS TO BE HEAVY-HANDED BECAUSE WE'RE ONLY IN AN INITIAL SCREENING AND BRIEF INTERVENTION PHASE. THIS IS MEANT TO BE BRIEF. IT'S MEANT TO ENGAGE THE OTHER PERSON. SO IT MIGHT BE A MATTER OF JUST PROVIDING A LITTLE BIT OF WHAT WE CALL CESSATION ADVICE OR INFORMATION, RIGHT, SO LETTING THEM KNOW THAT THERE ARE SOME HARMS ASSOCIATED WITH VAPING AND LEAVE IT AT THAT, OR MAYBE ASK ONE MORE QUESTION OF WHAT DO YOU THINK? IF WE GO INTO A LONG DIATRIBE ABOUT ALL THE DANGERS, WE'RE PROBABLY GOING TO LOSE THEM QUICK. WE KNOW THAT WITH TEENAGERS, SO THAT'S THE REASONING BEHIND THAT. GIVE THEM A LITTLE BIT OF INFORMATION, ENGAGE THEM IN A CONVERSATION THAT IS NONJUDGEMENTAL, AND THAT'S SUFFICIENT. THE PERSON RECORDS USING MONTHLY OR WEEKLY, NOW WE START TO ADD TO THE BRIEF INTERVENTION. OUR GOAL ALWAYS IN A MEDICAL CENTER IS TO KEEP THIS BRIEF. WE HAVE A ROLE FOR BEHAVIORAL HEALTH PROVIDERS AS WELL BUT ASSUMING THIS PART IS DONE BY NURSES AND MEDICAL PROVIDERS, WE STILL HAVE TO KEEP IT BRIEF BUT IN ADDITION TO THAT CESSATION ADVICE WE'RE GOING TO SEEK TO ENGAGE THAT ADOLESCENT IN A CONVERSATION ABOUT REDUCING THEIR USE AND/OR ANY RISKY BEHAVIORS ASSOCIATED WITH IT. THAT'S ABOUT MEETING THEM WHERE THEY ARE, RIGHT? SO IF THEY'RE WILLING TO NOT VAPE EVERY DAY, IF THEY'RE WILLING TO SWITCH FROM, I DON'T KNOW, ONE PARTICULAR DEVICE TO ONE THAT'S MAYBE LESS RISKY, IT'S ABOUT THAT CREATIVE CONVERSATION ABOUT WHAT DOES LESS RISK LOOK LIKE, WHAT ARE YOU WILLING TO DO, AND CERTAINLY FOLLOWING UP TO SEE IF THEY'VE MADE CHANGE IN THAT AREA AND THEN BUILD ON THAT CHANGE. IF AN ADOLESCENT REPORTS WEEKLY OR MORE FREQUENT USE, WE BUILD ON THOSE LAST TWO STEPS. STILL PROVIDE CESSATION ADVICE, TALK ABOUT REDUCING USE AND REDUCING RISK, AND THEN REFERRING THEM OR COORDINATING CARE TO GET THEM CONNECTED TO A BEHAVIORAL HEALTH PROVIDER, TREATMENT SERVICES, SOMETHING BEYOND JUST A SIMPLE BRIEF INTERVENTION. SO THAT IS THE OVERVIEW OF THAT. OUR CHANGE PACKAGE HAS MUCH MORE DETAIL ABOUT DIFFERENT WAYS TO HAVE THESE CONVERSATIONS AND WHAT CAN GO INTO EACH OF THESE BOXES, BUT I WANTED TO GIVE YOU THAT AS AN INITIAL LOOK AT HOW WE THOUGHT ABOUT SCREENING TO BRIEF INTERVENTION IN A MEDICAL SETTING. NOW, CERTAINLY MANY OF YOU ARE COMING FROM OTHER SETTINGS AS WELL SO I WANT TO SHARE SOME OTHER WAYS OF THINKING ABOUT THESE INVENTIONS AND ENGAGING WITH ADOLESCENTS. SO A LOT OF IT IS ABOUT HARM REDUCTION AND WHAT WE MEAN BY HARM REDUCTION IS ENGAGING WITH THIS PERSON REGARDLESS OF WHETHER THEY ARE WILLING TO COMPLETELY STOP USING, SEEK RECOVERY IN THEIR SUBSTANCE USE. IT'S MEETING THEM WHERE THEY'RE AT. WE CAN WANT SOMETHING FOR THEM. WE CAN WANT AN ULTIMATE GOAL FOR THEM, BUT IT'S THEIR DECISION TO MAKE. IT'S THEIR LIFE, SO HOW DO WE SUPPORT THEM AND TRULY COME ALONGSIDE OF THEM. THAT'S THE IDEA BEHIND THIS, AND WE'RE TRYING TO TREAT THEM AS THE EXPERT IN THEIR LIFE. EVEN A 13-YEAR-OLD, A 15-YEAR-OLD, A 12-YEAR-OLD, IF WE TAKE AWAY ALL CONTROL AND ALL POWER AND WE UNDERMINE SOMEONE AND MAKE THEM FEEL ASHAMED OR LESS THAN, IT'S GOING TO BE COUNTERPRODUCTIVE IN HELPING THEM MAKE ANY AMOUNT OF CHANGE. SO TREATING THEM AS AN EXPERT AND SAY, YOU KNOW, YOU'VE LIVED YOUR LIFE, I HAVEN'T, WHAT IS IT LIKE FOR YOU? THIS IS WHERE WE ALSO WANT TO BRING IN THINKING ABOUT WHAT'S IT BEEN LIKE GROWING UP IN YOUR CULTURE, IN YOUR NEIGHBORHOOD, IN YOUR FAMILY. WHATEVER THAT CONTEXT IS FOR THAT PERSON, THEY'RE FAR MORE AN EXPERT IN THAT THAN WE COULD EVER BE. HARM REDUCTION IS ALSO ABOUT ACKNOWLEDGING ANY ABILITY OR WILLINGNESS TO REDUCE USE. THAT IS A POSITIVE THING. AGAIN, IT'S NOT ALWAYS WHERE WE WANT THEM TO BE, BUT IF THEY'RE WILLING TO TAKE HALF A STEP FORWARD, HOW CAN WE SUPPORT THEM IN THAT AND CONTINUE TO REVISIT THIS. AND THEN CERTAINLY REMEMBERING THAT CHANGE IS NOT A STRAIGHT PATH. ANY OF US THAT HAVE EVER TRIED TO MAKE A CHANGE WHICH I BELIEVE IS 100% OF US, WE KNOW THAT CHANGE DOESN'T ALWAYS FOLLOW A SMOOTH, STRAIGHT LINE. I THINK OF MY EATING HABITS AFTER COVID-19 AND BEING IN MY HOUSE MORE THAN EVER BEFORE. THAT HAS NOT BEEN A STRAIGHT LINE TO TRY AND EAT MORE HEALTHY. SO WE WANT TO APPRECIATE THAT IN THESE ADOLESCENTS TOO. THEY'RE ALSO IN SUCH AN INTERESTING TIME IN THEIR LIVES AND THEIR BRAINS AND THEIR BODIES ARE DEVELOPING LIKE, YOU KNOW, GANG BUSTERS, SO HOW DO WE HELP THEM NAVIGATE THAT PATH, STICK WITH THEM, AND MAINTAIN THIS PHILOSOPHY OF HARM REDUCTION. ULTIMATELY THAT COMES DOWN TO SUPPORTING ALL PATHWAYS. THERE MIGHT BE MORE EVIDENCE BEHIND A PARTICULAR TREATMENT APPROACH, A PARTICULAR TYPE OF CESSATION THAT MIGHT WORK BEST FOR THEM, AND ULTIMATELY WE'VE GOT TO HAVE THIS MEANS TO PUT ALL OF THAT ON THE TABLE AND SUPPORT ALL PATHWAYS THAT WILL HELP THEM A LITTLE BIT FORWARD. I WANT TO NOTE TOO THAT I SEE A QUESTION FROM MICHELLE ABOUT INTERVENTIONS IN SCHOOL SETTINGS. SOME OF THE HEALTH CENTERS THAT WE WORKED WITH TO IMPLEMENT THIS CHANGE PACKAGE HAD SCHOOL-BASED HEALTH CENTERS SO THAT'S NOT THE ONLY TYPE OF SCHOOL SETTING. BUT THAT'S WHERE WE MOST KNEW ABOUT THIS WORK BEING DONE. SCHOOL-BASED HEALTH CENTERS, A LOT OF THEM ARE DOING SBIRT AS WELL. THEY'VE GOT SOMEONE OBVIOUSLY IN THE SCHOOL SETTING. THEY'RE SCREENING KIDS MAYBE ONCE OR TWICE DURING THE SCHOOL YEAR AND CERTAINLY THESE INTERVENTIONS COULD BE DONE AS WELL. I'D LOVE TO HEAR FROM OTHERS ABOUT IF YOU'RE IMPLEMENTING THIS IN SCHOOL SETTINGS, WHAT HAD BEEN SOME OF THE CHALLENGES. IN FACT, THERE'S A GROUP OF THE SCHOOL-BASED HEALTH ALLIANCE AS ANOTHER RESOURCE. THEY'VE GOT SOME SBIRT IN THE SCHOOL SETTING RESOURCES. I'M ON ONE OF THEIR LIST SERVES. A LOT OF THINGS PLAY INTO THAT, CONFIDENTIALITY, PARENT INVOLVEMENT, PERMISSION, FREQUENCY OF CONTACT, AND SO A FOLLOWUP QUESTION ABOUT TRAINING SCHOOL NURSES AND SCHOOL COUNSELLORS. WHEN WE HAD SCHOOL-BASED HEALTH CENTERS PARTICIPATING IN IMPLEMENTING THIS GUIDE, SEVERAL OF THEM WERE IN THE SCHOOLS EVERY DAY. WE HAD SOME RECOVERY SPECIALISTS WHO WERE IN THE SCHOOL WHO WOULD TAKE THE RESULTS OF THE SCREENING AND MEET WITH KIDS IN GROUPS OR INDIVIDUALLY AND DO A LOT OF THESE BRIEF INTERVENTION STRATEGIES. THERE'S ONE SCHOOL COUNSELLOR IN PARTICULAR WHO JUST CALLED IT LUNCH WITH THE COUNSELLOR OR SOMETHING, SO IT WASN'T, YOU KNOW, THIS TREATMENT GROUP OR ANYTHING. THAT KIND OF HELPED WITH THE STIGMA. SOME OF THESE ADOLESCENTS MET WITH PEER RECOVERY SPECIALISTS. IN THE HEALTH CENTER'S CASE THEY WERE YOUNG ADULTS SO THEY WERE MORE LIKE PEERS THAN MAYBE SOMEONE MY AGE. YEAH, SO REACH OUT TO US. LET US KNOW IF YOU'RE INTERESTED IN THIS. AGAIN, THE SCHOOL-BASED HEALTH ALLIANCE, THERE'S A GREAT RESOURCE FOR THAT AND CERTAINLY WE DO TRAINING AS WELL. ALL OF THIS IS TO SAY THAT THE PHILOSOPHY OF HARM REDUCTION, OUR JOB REALLY IS TO MATCH THE PERSON'S READINESS. WE CAN BE FAR READY FOR THEM TO MAKE A CHANGE BUT THAT ISN'T THE SAME AS COMING ALONGSIDE. SO BEING MINDFUL OF WHERE SOMEONE IS IN THEIR READINESS TO CHANGE I THINK IS AN IMPORTANT PART OF THE WORK. SO MOST OFTEN IF WE'RE TALKING WITH AN ADOLESCENT ABOUT REDUCING THEIR USE, THEY'RE PROBABLY NOT IN AN ACTION STAGE BECAUSE THEY MAYBE AREN'T EVEN AWARE WE WERE GOING TO SCREEN AND ASK THEM THESE QUESTIONS FIRST OF ALL. SO THEY'RE PROBABLY IN A PRECONTEMPLATION OR CONTEMPLATION STAGE. IN MANY DIFFERENT HEALTH CARE SETTINGS, WHETHER IT'S MENTAL HEALTH, SCHOOL HEALTH, PHYSICAL HEALTH, THIS ISN'T SOMETHING ADOLESCENTS IN PARTICULAR ARE COMING IN TO SAY, HEY, CAN YOU HELP ME WITH THIS. NOW, IT CAN HAPPEN, BUT KNOWING THAT MOST PEOPLE ARE IN PRECONTEMPLATION OR CONTEMPLATION, WHAT THAT MEANS IS IF THEY'RE IN PRECONTEMPLATION, IT'S NOT REALLY EVEN ON THEIR RADAR, NOT REALLY THINKING ABOUT CHANGING, AND OUR JOB IS TO SIMPLY INCREASE THEIR INTEREST IN ENGAGING WITH US IN MORE CONVERSATION, MAYBE INCREASING THEIR AWARENESS WITH A LITTLE BIT OF INFORMATION PROVIDING BUT NOT TOO MUCH. IT REALLY HAS TO BE A LIGHT TOUCH. THEY'RE LEARNING ABOUT THIS IN SCHOOL. THEY ALREADY KNOW A LOT ABOUT THE HARMS AND THE DANGERS. THEY NEED TO KNOW THEY CAN TRUST US ENOUGH TO ENGAGE IN THE CONVERSATION, AND THEY NEED TO KNOW THAT WE'RE WILLING TO LISTEN TO THEIR REASONS FOR USING. THEN IF THEY ARE CONTEMPLATING A CHANGE, IF THEY'RE CONSIDERING CUTTING BACK OR THEY'RE THERE BECAUSE THEY GOT IN TROUBLE FOR IT AND THEY KNOW IT'S NOT FUN TO BE IN TROUBLE, WE WANT TO REALLY TAP INTO THEIR OWN REWARDS AND VALUES. AGAIN, IT'S ONE THING FOR ME TO SAY, OH, YOU SHOULDN'T BE DOING THAT, BUT THAT DOESN'T APPEAL OR ENGAGE THE OTHER PERSON. SO WHAT WOULD BE SOME OF YOUR REASONS FOR BEING WILLING TO CUT BACK OR QUIT. THEN THERE'S OTHER STEPS IF PEOPLE ARE MORE READY AND THEY'RE ACTUALLY TAKING SOME STEPS, BUT KEEP IN MIND MOST PEOPLE ARE PRECONTEMPLATING OR CONTEMPLATING. CONTEMPLATION IS AMBIVALENCE AND AMBIVALENCE ISN'T A TERRIBLE THING. AT LEAST IN AMBIVALENCE I'M SEEING SOME OF THE THINGS I LIKE ABOUT THAT AND SOME OF THE THINGS THAT AREN'T SO GREAT, AND WE CAN USE THAT IN MORE CONVERSATION. ANOTHER QUESTION FROM HOLLY. THESE ARE GREAT. HOW OFTEN DO YOU RECOMMEND SCREENING? IN MEDICAL SETTINGS WE RECOMMEND SCREENING THE ADOLESCENT AT EVERY VISIT OR AT LEAST ANNUALLY. SO AGAIN, THAT'S A MEDICAL SETTING. HOPEFULLY YOU'RE SEEING THEM FOR A WELL CHILD VISIT ONCE A YEAR. WE KNOW THAT ISN'T ALWAYS THE CASE. AT LEAST ANNUALLY BECAUSE THAT MAKES IT ROUTINE, AT LEAST FOR YOUR PROCEDURES BECAUSE WE ALSO DON'T SEE ADOLESCENTS EVERY YEAR, ALL OF THEM. DOING IT AT LEAST ON EVERY VISIT IS ACTUALLY RECOMMENDED BECAUSE WE'RE CAPTURING THE MOMENT, RIGHT, AND MAYBE WE WON'T SEE THEM AGAIN FOR A COUPLE YEARS AND THIS 13-YEAR-OLD IS GOING TO BECOME A 15-YEAR-OLD AND SO FREQUENT, EARLY AND OFTEN, IS REALLY RECOMMENDED. IF YOU SEE KIDS WEEKLY, I PROBABLY WOULDN'T DO IT THAT OFTEN. YOU KNOW, THEY'RE PROBABLY GOING TO GET FRUSTRATED AND SAY WHY ARE YOU DOING THIS AND IT MAY FEEL LIKE OVERKILL, BUT I WOULD AT LEAST DO IT MAYBE QUARTERLY THEN. IT DOES DEPEND ON THE SETTING AND WHY YOU'RE SEEING THEM AND BUILD IT INTO OTHER SCREENINGS AND WHEN YOU DO THOSE -- AGAIN, THE MINIMUM SHOULD BE ANNUAL. THE MAXIMUM WOULD BE EVERY TIME YOU TALK WITH THEM. BUT AGAIN, THAT'S THINKING ABOUT LIKE IN A MEDICAL SETTING I MAYBE ONLY SEE A TEENAGER A COUPLE TIMES A YEAR. IT DEPENDS IF THEY HAVE OTHER PHYSICAL HEALTH CONDITIONS. REALLY THE IDEA BEHIND IT IS NOT TO BE THIS, OH, SORRY WE GOT TO ASK YOU THESE QUESTIONS AGAIN. IT'S MORE OF A, YOU KNOW, THERE'S A BUNCH OF THINGS THAT CAN AFFECT YOUR HEALTH, CAN AFFECT YOUR EMOTIONAL HEALTH DEPENDING ON YOUR SETTING, SO THESE ARE QUESTIONS WE GIVE EVERYBODY EVERY TIME WE SEE THEM, OR THESE ARE QUESTIONS WE ASK ONCE A MONTH, OR WE JUST WANT TO DO A CHECK-IN ON THIS, MAKE IT VERY MATTER OF FACT. IT'S NOT BECAUSE IT'S A BURDEN FOR YOU OR THEM. THIS IS USEFUL INFORMATION TO HELP US KNOW HOW TO HELP YOU BEST. IN THINKING ABOUT DOING THESE BRIEF INVENTIONS, SOME OTHER THINGS TO KEEP IN MIND IS WHAT DO WE KNOW ABOUT MOTIVATION. WE KNOW THAT IT'S NOT LINEAR AND IT'S ACTUALLY QUITE FLUID. THE ADOLESCENT SITTING IN YOUR OFFICE WITH THE ARMS CROSSED SAYING I DON'T CARE WHAT YOU SAY, I'M NOT GOING TO DO THIS, I'M NOT GOING TO DO THAT MIGHT SEEM LIKE A VERY UNMOTIVATED PERSON BUT MOTIVATION IS NOT THAT ABSOLUTE. YOU MAY HAVE TO DIG. WE MAY HAVE TO STAY PATIENT, BUT THERE'S OFTEN MORE FLUIDITY TO MOTIVATION IF WE GIVE IT A CHANCE TO DEVELOP. AMBIVALENCE IS NORMAL, AND THAT'S SOMETIMES ALL THAT WE'RE SEEKING IS GETTING SOMEBODY TO GO FROM COMPLETELY NO WAY WOULD I EVER STOP DOING THAT TO, YEAH, I CAN KIND OF SEE A REASON, OR, YEAH, IT IS KIND OF A DRAG WHEN I GET CAUGHT AND THEN I'M GROUNDED. THAT STARTS TO TIP THE SCALES TOWARD AT LEAST SOME AMBIVALENCE. THE TROUBLE IS WE OFTEN PUSH. WE DON'T REALIZE AT WHAT POINT HAVE WE TIPPED THE SCALES ON PUSHING TOO MUCH, AND IF WE PUSHED TOO HARD THERE'S WHERE THE RESISTANCE COMES IN. IT'S KIND OF LIKE I'M THINKING WE'RE ON TRACK AND I'M FEELING GOOD ABOUT THIS CONVERSATION AND THEN I SUDDENLY SAY, OKAY, YOU JUST NEED TO DO THIS, CUT TO THE CHASE. THEY'RE PROBABLY NOT NOW TOTALLY BOUGHT IN BECAUSE I SAID THAT. THEY'RE PROBABLY MORE ANNOYED WITH ME BECAUSE I PUSHED. WHAT WE'RE TRYING TO DO AND THIS IS WHERE I'M LEANING, A LITTLE M.I. OR REFRESH OR INTRO FOR YOU, THAT OUR JOB IS REALLY TO EVOKE THE OTHER PERSON'S OWN REASONS FOR CHANGE, THEIR OWN CHANGE TALK, THEIR OWN DESIRE FOR CHANGE. THAT IS WHEN CHANGE IS MOST LIKELY TO HAPPEN. JUST TO MAKE THE FURTHER CASE IN POINT, I FOUND THIS TO BE REALLY USEFUL WHEN WE WERE DOING THIS WORK IN PARTICULAR WITH ADOLESCENTS. THIS ARTICLE POINTED OUT THAT M.I. OR MOTIVATIONAL INTERVIEWING REALLY FITS WITH ADOLESCENT THINKING, SO MORE REASON TO CAPITALIZE ON THEIR APPEAL FOR NOVELTY, THEIR APPEAL FOR INDEPENDENCE. THEY WANT TO MAKE SOME OF THEIR OWN DECISIONS. THAT'S PART OF THEIR BRAIN THAT'S WORKING HARD TO GROW AND DEVELOP SO LET'S HELP THEM MAKE DECISIONS FOR THEMSELVES. LET'S GUIDE THEM IN THINKING ABOUT THEIR OWN REASONS THEY MIGHT BE WILLING TO MAKE A CHANGE. IT MIGHT BE ULTIMATELY THAT WE'RE JUST PLANTING THE SEED THAT THEY CAN COME BACK TO AND CULTIVATE OVER TIME. WHEN I MENTIONED MOTIVATIONAL INTERVIEWING REALLY WHAT I MEAN IS A COLLABORATIVE CONVERSATION AND IT INVOLVES WHAT WE CALL THE SPIRIT OF M.I. WHICH IS THESE FOUR TENANTS. IT'S HOW WE BRING OURSELVES INTO CONVERSATION WITH ADOLESCENTS ABOUT CHANGE. SO IT MEANS WE BRING OUR COMPASSION. WE THINK ABOUT THIS OTHER PERSON'S NEEDS ABOVE WHAT OUR OWN PERCEPTION OF THEIR NEEDS ARE. IT INVOLVES PARTNERSHIP, MEANING ALLOWING THEM TO BE THE EXPERT IN THEIR OWN LIFE, KNOWING THAT WE ARE ONLY HALF OF THE EQUATION OR EVEN LESS THAN HALF. IT'S MUCH MORE ABOUT THEM. BUT BEING VERY OVERT TO SAY, YOU KNOW, I'M NOT THE ONLY EXPERT IN THE ROOM, OR I WANT TO SUPPORT YOU AND ULTIMATELY I WANT TO HELP YOU DECIDE WHAT YOU FEEL IS BEST FOR YOU. NOW THAT BUILDS IN THE AUTONOMY PIECE AND WE ALL WANT TO HAVE CHOICE. WE ALL ARE MORE -- TEND TO BE MORE COOPERATIVE, MORE ENGAGED WHEN WE HAVE OPTIONS, WHEN WE FEEL LIKE WE CAN MAKE SOME OF THE DECISIONS WE WANT FOR OURSELVES. IT'S AN INTERESTING DEBATE IN OUR COUNTRY RIGHT NOW WITH THE ROLE OF WEARING MASKS FOR COVID-19, RIGHT? IN SOME PLACES THEY'RE BEING MANDATED AND REQUIRED, AND IN SOME CASES AS SOON AS SOMETHING IS CONSIDERED MANDATED, THERE'S A RESISTANCE, RIGHT? DON'T TELL ME WHAT TO DO, OR NOW YOU'RE FORCING ME TO DO THIS THING. IT'S A HARD DEBATE AND IT'S SOMETHING THAT I THINK PLAYS INTO THESE CONVERSATIONS WE HAVE WITH ADOLESCENTS. I CAN TELL YOU TO QUIT VAPING BUT YOU'RE NOT GOING TO LIKE ME MUCH MORE WHEN I TELL YOU TO DO IT, SAY THAT'S ENOUGH, I'M YOUR PARENT, YOU NEED TO STOP DOING THAT, VERSUS TRYING TO HAVE A CONVERSATION THAT APPEALS TO THEIR OWN REASONS, THEIR IDEAS FOR CHANGE, AND IF IT MEANS GIVING UP SOMETHING, WHAT ELSE COULD I GAIN IN THE MEANTIME BECAUSE THAT'S WHAT THIS IS ABOUT. CESSATION IS ALL ABOUT STOPPING SOMETHING THAT I MAY BE FEELING IS MUCH MORE OF A BENEFIT SO HOW DO WE THINK ABOUT IT IN TERMS OF AUTONOMY. HOW DO WE PARTNER WITH THEM. LASTLY, eVOCATION, JUST ASKING GOOD QUESTIONS AND DRAWING OUT THE OTHER PERSON'S OWN INSIGHTS, THEIR OWN WISDOM. THEY MAYBE DON'T SEEM THAT WISE IF THEY'RE MAKING DECISIONS THAT AREN'T GOOD FOR THEM BUT WE HAVE TO TRUST THE PROCESS, TRUST THAT THEY HAVE STRENGTHS AND DRAW THAT OUT. THIS PLAYS INTO THIS PARADIGM SHIFT AND THIS IS LOOKING AT THIS FROM A TRAUMA INFORMED LENS. THE QUESTION OF WHAT'S WRONG WITH YOU IS OFTEN ASKED WHEN WE SEE AN ADOLESCENT MAKING POOR DECISIONS OR BEHAVING, QUOTE, BADLY, BUT FROM A TRAUMA INFORMED LENS, IT'S MUCH MORE WHAT HAPPENED TO YOU, WHAT DO YOU NEED, WHAT IS STRONG MUCH MORE THAN WHAT IS WRONG. WE WANT TO BE CAUTIOUS NOT TO LABEL KIDS AS AGGRESSIVE OR BAD OR DIFFICULT. THEY'VE BEEN IMPACTED BY THINGS IN THEIR LIVES AND THEY'RE MAKING THE CHOICES THAT THEY'RE MAKING TO GET THROUGH IT, TO GET BY, TO TRY TO SURVIVE AND SOMETIMES THRIVE, RIGHT? THESE ARE THE KINDS OF THINGS THAT ARE OFTEN IN THE ROOM THAT WE DON'T NECESSARILY CONNECT WITH TRAUMA. IT'S THE BURDENS THAT SOME SEE THEM, OTHERS WE DON'T SEE THEM BUT IT'S THE THINGS THAT PEOPLE MAY BE EXPERIENCING. I THINK EVEN THE WORST BEHAVED PERSON IS TRYING NOT TO SHOW WHAT'S UNDERNEATH THE SURFACE AND SOMETIMES THEY'RE HOLDING IT IN AND OTHER TIMES IT'S COMING OUT IN, QUOTE, DISRUPTIVE WAYS OR LESS HEALTHY WAYS. SO IT'S IMPORTANT TO BE MINDFUL. WE MAY NOT KNOW IF THE PERSON HAS EXPERIENCED A TRAUMA. SOME OF YOU IN YOUR SETTING MIGHT DO SOME TRAUMA SCREENING. WE ALSO JUST WANT TO DO WHAT WE CALL UNIVERSAL PRECAUTIONS. ASSUME EVERYBODY'S EXPERIENCED SOME KIND OF TRAUMA AND LET'S JUST TREAT EVERYBODY IN A TRAUMA SENSITIVE WAY, WHICH MEANS NOT IDENTIFYING THESE THINGS AS JUST PROBLEMS BUT THINKING ABOUT THEM IN A LENS OF MAYBE THERE'S BEEN A TRAUMA EXPERIENCED. SO THAT LEADS ME TO -- THIS MIGHT BE MY FAVORITE SLIDE. I JUST FOUND THIS ON SOCIAL MEDIA AND I THINK IT SAYS SO MUCH, RIGHT? DON'T JUDGE MY STORY BY THE CHAPTER YOU WALKED IN ON. FOR THOSE OF US WORKING IN HEALTH CARE AND SOCIAL SERVICES, WE'RE NOT USUALLY SEEING PEOPLE AT THEIR BEST. WE'RE NOT. THAT'S WHY THEY'RE COMING TO SEE US. WE HAVE TO BE ABLE TO LOOK BEYOND THAT. WE HAVE TO LOOK BEYOND THE ACT OF VAPING OR WHATEVER THE OTHER BEHAVIORS OR MIND-SET SEEMS TO BE FROM THE PERSON AND KNOW THAT THERE'S MUCH MORE TO IT AND NOT TO JUDGE IN THAT IMMEDIATE MOMENT, AND THAT'S WHERE I THINK THESE BRIEF INTERVENTIONS CAN HAVE A HUGE IMPACT, BECAUSE THEY ARE ABOUT PARTNERING WITH THIS PERSON AND IDENTIFYING STRENGTHS AND RESOURCES. SO A COUPLE OF THINGS AROUND TRAUMA, PEOPLE WHO HAVE EXPERIENCED TRAUMA MAY FEEL POWERLESS. THEY MAY FEEL THEY CAN'T TRUST OTHERS, RIGHTFULLY SO. IF YOU'VE EXPERIENCED SOMEONE NOT BEING TRUSTFUL, YOU'RE NOT GOING TO BE AS TRUSTING. SO WE HAVE A JOB TO DO TO REALLY SHOW PEOPLE THAT WE CAN EARN THEIR TRUST. THEY CAN BE SAFE. WHAT IS IT LIKE TO HAVE A SPACE WHERE YOU CAN TRUST SOMEBODY. YOU HAVE TO THINK ABOUT OUR RELATIONSHIPS. WE WANT TO THINK ABOUT MAKING THEM, AGAIN, THAT MUTUALLY RESPECTFUL PARTNERSHIP, MAINTAINING TRUST AND DEMONSTRATING TRUST BETWEEN STAFF MEMBERS, WITH FAMILY MEMBERS, TRUST WITHIN OUR COMMUNITY. IF IT'S NOT THERE, THAT CAN BE SOMETIMES MUCH MORE APPARENT THAN WE REALIZE, AND THOSE ARE ALL OF THE THINGS THAT OUR PATIENTS OR OUR CLIENTS ARE NOTICING. THAT'S WHERE IT COMES BACK TO THE INDIVIDUAL BEING THE EXPERT IN THEIR LIFE, GIVING THEM CHOICES, AND KNOWING THAT EVERYBODY IN OUR ORGANIZATION HAS A ROLE TO PLAY IN THIS. IT'S NOT JUST THE CLINICIAN. IT'S THE FRONT DESK PERSON. IT'S THE BACK OFFICE STAFF. IT'S ALL STAFF THAT CAN CREATE A CULTURE. I WANT TO SHARE SOME WAYS IN WHICH WE CAN CREATE ENVIRONMENTS AND CONVERSATIONS THAT ARE TRAUMA INFORMED, MINIMIZE CLUTTER AND NOISE THAT JUST BUSIES ENVIRONMENT, MAKE US FEEL MORE ANXIOUS AND STRESSED, BE AWARE OF THE PROXIMITY TO THE OTHER PERSON. THEY MAY NOT WANT YOU TOO CLOSE TO THEM. THEY MAY NOT WANT YOU SITTING ACROSS A DESK WHERE IT FEELS LIKE THERE'S A BARRIER BETWEEN US OR THIS AUTHORITY BETWEEN US. BE MINDFUL OF YOUR OWN ENERGY LEVEL. I TRY TO AMP UP THE ENERGY WHEN I'M PRESENTING. MAYBE THAT WOULD STRESS SOMEBODY OUT AND MAKE THEM TOO ANXIOUS. IT COMES DOWN TO THE THINGS WE -- COUNSELLORS KNOW ABOUT MIRRORING, APPROPRIATE EMPATHY, OUR VOLUME, ALL OF THOSE THINGS. ASK SOMEBODY, ASK THE PERSON WHAT THEY WANT TO BE CALLED. THIS ONE I DON'T THINK WE DO ENOUGH, INTRODUCE YOURSELF. TELL THEM WHAT YOU DO, NOT IN AN OPPORTUNITY TO BRAG ABOUT OURSELVES BUT THEY DON'T NECESSARILY KNOW. MAYBE THEY'VE NEVER SEEN A COUNSELLOR BEFORE. MAYBE THEY'VE BEEN TO YOUR HEALTH CENTER A MILLION TIMES BUT THEY DON'T KNOW WHO'S A NURSE AND WHO'S A CARE COORDINATOR. NOT THAT THEY HAVE TO HEAR EVERY LAST BIT OF WHAT YOUR BACKGROUND IS BUT HELP THEM GET TO KNOW WHAT YOUR ROLE IS AND WHAT YOU CAN DO FOR THEM AND HOW YOU CAN WORK TOGETHER WHICH ALSO HELPS WITH THAT PREDICTABILITY, RIGHT? IF I DON'T KNOW WHAT TO ANTICIPATE AND I'M AN ALERT BECAUSE FOR ME FIGHT OR FLIGHT IS A CONSTANT, I'M NOT ABLE TO TUNE INTO WHAT YOU'RE SAYING, I'M GOING TO BE CAUTIOUS, I'M NOT SURE IF I CAN TRUST, SO THE MORE YOU CAN PUT THAT OUT THERE, EXPLAIN WHAT WE'RE DOING, EXPLAIN HOW MUCH TIME WE HAVE, I DON'T KNOW THAT WE DO THAT ENOUGH EITHER. WE MIGHT KNOW THAT WE HAVE 15 MINUTE APPOINTMENTS OR WHATEVER OUR SETTING IS BUT DOES THE OTHER PERSON KNOW HOW MUCH TIME IS AVAILABLE TO THEM AND WHAT WILL BE THE TRAJECTORY OF FUTURE VISITS AS WELL. ULTIMATELY IT COMES DOWN TO WHAT IS OUR VIEW WHEN WE'RE WORKING WITH PEOPLE. DO I BELIEVE THIS 15-YEAR-OLD IN FRONT OF ME IS LACKING INSIGHT? IF I REALLY THINK THAT'S THE CASE AND THAT'S MY WORLD VIEW, PROBABLY GOING TO BE FIXING AND TELLING, AND MAYBE THAT FEELS TO ME LIKE I'M DOING A GOOD JOB BECAUSE I'VE GOT A LOT OF EXPERTISE BUT FIXING AND TELLING DOESN'T REALLY HELP PEOPLE FEEL MOTIVATED. THE M.I. EXPERTS WILL SAY DO YOU FEEL LIKE IT'S GOING TO TAKE A LOT MORE TIME TO DO ALL OF THIS M.I. WORK BUT ULTIMATELY IF THE GOAL IS TO GET CHANGE TO HAPPEN, IT'S MORE LIKELY TO BE MORE COUNTERPRODUCTIVE TO JUST DO THE QUICK FIX AND TELL. SO IT'S ABOUT HAVING A COMPETENT WORLD VIEW, TRUSTING THAT THIS PERSON CAN MAKE SOME DECISIONS, CAN HAVE A BETTER LIFE, THAT THERE ARE STRENGTHS WITHIN THEM AND THAT'S GOING TO TAKE A LOT OF ASKING AND LISTENING. SO IT COMES BACK TO THE SPIRIT. I WANTED TO PUT THIS UP ONE MORE TIME BECAUSE I HAVE A COUPLE OF POLL QUESTIONS JUST TO SEE WHAT YOU ARE SEEING IN A COUPLE OF EXAMPLES AROUND M.I. SPIRIT. KEEP IN MIND M.I. SPIRIT IS ABOUT EMBRACING COMPASSION AND PARTNERSHIP, ABOUT ALLOWING THE OTHER PERSON SOME AUTONOMY, MEANING NOT JUST PUSHING AND FORCING, AND THEN EVOKING, ASKING QUESTIONS, HAVING A COMPASSIONATE CURIOSITY. I SEE DANA IS BACK ON. HERE'S MY FIRST SCENARIO FOR YOU. SAY YOU'RE TALKING WITH A 17-YEAR-OLD AND THEY'RE INSISTING -- SHE'S INSISTING SHE HAS TO VAPE BECAUSE THERE'S NOTHING ELSE THAT HELPS HER ANXIETY. WHICH OF THESE RESPONSES IS THE BEST EXAMPLE OF THE M.I. SPIRIT? THE FIRST ONE IS IF YOU WERE TO SAY, WELL, THERE'S AN EPIDEMIC OF VAPING RIGHT NOW AND IT'S ACTUALLY MORE DANGEROUS THAN SMOKING. THE NEXT ONE IS, IT'S IMPORTANT FOR YOU TO BE ABLE TO MANAGE YOUR ANXIETY. THE THIRD IS, I CAN HELP YOU WITH YOUR ANXIETY. SO NONE OF THESE ARE BAD RESPONSES PURELY SPEAKING. THESE ARE ALL THINGS WE MIGHT BE LIKELY TO DO. WE WANT TO INFORM THEM ABOUT THE CONCERNS WE HAVE, THAT WE KNOW VAPING IS VERY DANGEROUS. WE MIGHT WANT TO ACKNOWLEDGE AND RESPOND TO THE FACT THAT THEY SAID THEY'RE USING IT BECAUSE OF THEIR ANXIETY, AND WE MIGHT WANT TO LET THEM KNOW THAT WE CAN HELP. >> I'LL GIVE FOLKS ABOUT FIVE MORE SECONDS AND THEN I CAN SHARE THE RESULTS. >> ALL RIGHT, SO THE NUMBER ONE ANSWER IS WHAT THE MAJORITY OF YOU CHOSE. 81% SAID THE MOST -- STRONGEST EXAMPLE OF M.I. SPIRIT IS TO SAY IT'S IMPORTANT FOR YOU TO BE ABLE TO MANAGE YOUR ANXIETY. THE REASON THAT ONE IS MOST M.I. SPIRITED IS IT'S COMPASSIONATE, IT'S UNDERSTANDING THE OTHER PERSON'S FRAME OF MIND. IT'S JUST GOING WITH WHERE THEY'RE AT IN THE MOMENT. THEY FEEL IT'S HELPING THEIR ANXIETY. LET'S JUST HEAR THAT OUT. BECAUSE THAT HELPS US TO ENGAGE WHERE WE COULD THEN DOWN THE LINE ALSO LET THEM KNOW I CAN HELP WITH THAT. THAT'S SOMETHING WE DO HERE AT OUR HEALTH CENTER. I JUST WOULDN'T LEAD WITH THAT BECAUSE THEN IT'S A LITTLE BIT MORE ABOUT US, RIGHT? I CAN HELP WITH THAT. I JUST WOULD START WITH HONORING WHAT THEY'RE SAYING. THEN I MIGHT FURTHER ON LET THEM KNOW, AND WE'RE CONCERNED BECAUSE THERE'S AN EPIDEMIC OF VAPING. BUT AGAIN, I WOULDN'T START WITH THOSE THINGS. I'M TRYING TO ENGAGE. SO GREAT. I'M SEEING A FEW REACTIONS AND COMMENTS IN THE BOX SWCHLT I HAVE ONE MORE TO TRY HERE. A 15-YEAR-OLD DOESN'T BELIEVE HIS E-CIG USE IS HARMFUL BECAUSE WHEN HE PLAYS BASKETBALL HE ISN'T OUT OF BREATH. SO WHAT IS THE MOST M.I. CONSISTENT RESPONSE HERE? FIRST OPTION WOULD BE WOULD YOU LIKE TO DISCUSS SOME WAYS TO REDUCE YOUR RISK FOR FUTURE PROBLEMS? THE NEXT IS, WHAT ARE SOME OF THE WAYS YOU'VE KEPT YOUR USE FROM BECOMING PROBLEMATIC? AND THE NEXT IS, YOU MAY NOT BE EXPERIENCING ANY IMPACT NOW BUT IT'S LIKELY THAT YOU WILL. >> LOOKS LIKE WE STILL HAVE SOME FOLKS VOTING SO WE'LL GIVE YOU A FEW MORE SECONDS. OKAY, I'M GOING TO CLOSE IT UP. >> I WANT TO MAKE A POINT OF SAYING THERE'S A MILLION WAYS TO DO M.I. THERE'S A PROCESS BUT THERE'S A MILLION DIFFERENT FLAVORS TO IT. THERE'S OUR PERSONALITY, THERE'S OUR KNOWLEDGE AND RELATIONSHIP WITH THE PERSON. IT'S NOT A REAL EASY BLACK AND WHITE TO SAY WHAT'S BEST, SO I KIND OF FORCED YOU TO PICK AN ANSWER BUT ULTIMATELY WHERE I LAND ON THIS ONE IS WITH THE MAJORITY OF THE 71%, THAT MAYBE THE FIRST THING TO SAY IS JUST TO FIND OUT FROM THEM WHAT ARE THE WAYS IN WHICH THEY'VE BEEN -- THIS IS BUILDING ON THEIR STRENGTHS, RIGHT? WHAT ARE THE WAYS YOU'RE KEEPING IT FROM BECOMING A PROBLEM? BECAUSE THAT'S WHAT THEY'RE SAYING. THEY'RE ALREADY SAYING, WELL, IT'S NOT BEEN A PROBLEM. WELL, LET'S FIND OUT FIRST, IN WHAT WAY IS IT NOT A PROBLEM BECAUSE THERE'S HARM REDUCTION IN THAT. IT MIGHT BE, WELL, YOU KNOW, WHEN I KNOW I'VE GOT A GAME, I ACTUALLY DON'T VAPE FOR A COUPLE DAYS BEFORE THAT, OR, I ONLY VAPE OUT OF SEASON, OR, I USE MY INHALER AND I'M EVEN MORE MINDFUL OF MY INHALER. AGAIN, IT'S MAYBE NOT WHERE WE WANT THEM TO BE BUT THEY'RE GIVING US SOME POSITIVE THINKING, AND THOSE ARE THE KINDS OF THINGS WE WANT TO BUILD ON. LETTER A IS ALSO GOOD, WOULD YOU LIKE TO DISCUSS SOME WAYS TO REDUCE YOUR USE. I JUST PROBABLY WOULDN'T START WITH THAT ONE BECAUSE WE WANT TO START WITH WHAT'S GOING WELL OR WHAT THEY FEEL IS GOING WELL AND THEN BUILD ON SOME WAYS TO REDUCE USE. REMEMBER, REDUCING USE IS ABOUT TAKING SOMETHING AWAY WHICH THEY'RE PROBABLY NOT GOING TO BE EAGER TO START WITH. WE WOULD START WITH SOME OF THE GOOD THINGS, SOME OF THE WAYS YOU'RE MANAGING THIS, AND THEN MAYBE SEE IF THEY'RE INTERESTED IN REDUCING. C IS NOT IDEAL JUST BECAUSE IT'S TELLING THEM THIS ISN'T GOOD FOR YOU AND IT COMES OFF AS I'M THE EXPERT AND IT MAY NOT BE A PROBLEM NOW BUT GUESS WHAT, IT'S GOING TO BE. NO ONE WANTS TO HEAR THAT. GREAT. SO LET ME JUST SAY A FEW MORE THOUGHTS ON THIS. WHAT I'M GETTING AT IS OARS. THIS IS WHAT WE TALK ABOUT IN MOTIVATIONAL INTERVIEWING. THIS ISN'T GOING TO BE A FULL-ON M.I. SESSION BUT I JUST WANT TO PUT THEM OUT THERE. IT'S A LOT OF WAYS THAT WE UTILIZE THE MOTIVATIONAL INTERVIEWING SPIRIT, BY ASKING GOOD QUESTIONS, AFFIRMING STRENGTHS, USING REFLECTIONS. I HAVE AN EXAMPLE I WANT TO SHARE WITH YOU. SAY YOU'RE WORKING WITH DEANNA. DEANNA IS 16. SHE MOVED IN WITH HER SISTER AND HER SISTER'S BOYFRIEND. SHE DIDN'T HAVE A STABLE PLACE TO LIVE. SHE USES TOBACCO AND DRINKS ALCOHOL. SHE'S AFRAID HER SISTER IS GOING TO FIND OUT AND KICK HER OUT BUT SHE DOESN'T WANT TO STOP WHICH IS THE REALITY OF A LOT OF THE KIDS WE'RE TALKING WITH. THEY DON'T WANT TO STOP. SO THAT MEANS SHE'S NOT IN AN ACTION PHASE AS FAR AS READINESS, AND I ALSO PUT IN THEIR -- SAY YOU'VE WORKED WITH HER FOR A FEW MONTHS AND YOU HAVE SOMEWHAT OF A RELATIONSHIP. THIS ISN'T THE FIRST MEETING. HOWEVER, SHE DOESN'T NECESSARILY TRUST ANYONE WHICH IN A TRAUMA INFORMED LENS THAT'S VERY COMMON, AND WE DON'T JUST AUTOMATICALLY HAVE TRUST WITH PEOPLE. I PUT TOGETHER A LITTLE M.I. DIALOGUE FOR YOU TO SEE WHAT IT CAN LOOK LIKE. YOU CAN SAY, YOU'VE BEEN REALLY OPEN WITH ME DURING OUR CONVERSATIONS. THAT'S AN AFFIRMATION. WHAT WE KNOW FROM HAVING MET WITH HER BEFORE, SHE'S BEEN REASONABLE WILLING TO SHARE WHAT'S GOING ON WITH HER. I WOULD DEFINITELY HONOR THAT AND SAY YOU'VE BEEN REALLY OPEN. DEANNA IS GOING TO RESPOND AND SAY, YEAH, WELL, YOU SEEM TO UNDERSTAND ME BETTER THAN MY OWN SISTER. YOU'RE THINKING ABOUT YOUR RELATIONSHIP WITH HER. THAT IS THE REFLECTION. IT'S NOT A FIX. THERE WILL BE PLENTY OF TIME TO PROBLEM SOLVE SOME OF THE ISSUES THAT WE KNOW ARE ON THE TABLE, BUT IT'S MORE IMPORTANT TO ENGAGE WITH THE PERSON. THE RELATIONSHIP IS EVERYTHING. JUST MAYBE SPEAK TO THAT. YOU'RE THINKING ABOUT THAT. DEANNA SAYS I'M WORRIED SHE'S GOING TO KICK ME OUT WHEN SHE FINDS OUT HOW MUCH I'M USING. HER HUSBAND DOESN'T LIKE ME. HE'S LOOKING FOR ANY REASON TO PUT ME BACK ON THE STREET. NOW, I MIGHT WANT TO QUESTION THAT. I MIGHT WANT TO SAY, YOU KNOW, HE SEEMS LIKE A REALLY NICE GUY, I'M SURPRISED YOU THINK THAT. THAT'S NOT GOING TO BE VERY USEFUL. WE WANT TO STICK WITH WHAT DEANNA IS VOICING AND WE COULD USE NOW WHAT'S CALLED THE DOUBLE-SIDED REFLECTION. YOU'RE TELLING ME ON THE ONE HAND YOU DON'T WANT TO STOP USING, AND ON THE OTHER HAND YOU WANT TO BE ABLE TO KEEP LIVING THERE. SHE HAS NOW GIVEN US A REASON TO POTENTIALLY CUT BACK OR QUIT VAPING. SHE DIDN'T OVERTLY SAY IT THAT WAY AND IT MAY NOT BE A VERY STRONG REASON BUT IT'S SOMETHING. SHE LET US KNOW THAT SHE DOESN'T WANT TO BE BACK ON THE STREET, SO WE WANT TO BUILD ON THAT BY ALSO ACKNOWLEDGING THAT SHE DIDN'T SAY SHE WANTED TO QUIT. LET HER KNOW I HEARD YOU. THIS IS HER AMBIVALENCE SPEAKING THAT WE DIDN'T HAVE TO TELL HER. SHE'S ALREADY GIVING IT TO US. SHE RESPONDS AND SAYS, YEAH, I LITERALLY HAVE NOWHERE ELSE TO GO. SO NOW THAT'S DEEPENING HER CONCERN. THAT'S STRENGTHENING A POTENTIAL REASON TO BRING HER TOWARD A CHANGE. GOT TO BE CAREFUL THOUGH, RIGHT? AT ANY POINT I COULD PUSH TOO FAR AND THEN LOSE HER BUT I GOT TO KIND OF LET THAT SIT. SHE SAYS I LITERALLY HAVE NOWHERE ELSE TO GO. I MIGHT REFLECT THAT AND SAY YOU'RE TRYING TO MAKE IT WORK WITH YOUR SISTER, WHICH IS NOW LEANING HER TOWARD THIS POTENTIAL FOR CHANGE BY STRENGTHENING THE RELATIONSHIP WITH THE SISTER WITHOUT HAVING TO ASK HER A BUNCH OF QUESTIONS. REFLECTIONS CAN ACTUALLY BE PRETTY POWERFUL TOO BECAUSE WE'RE GIVING BACK THE THINGS THAT THEY'RE ALREADY TELLING US. DEANNA SAYS SHE PISSES ME OFF SOMETIMES BUT I GUESS I WOULDN'T WANT A PAIN IN THE ASS KID LIVING WITH ME EITHER. DEANNA IS KIND OF COMING AROUND TO US. SHE'S NOT TELLING US SHE'S GOING TO QUIT VAPING BY ANY MEANS, BUT SHE'S KIND OF APPRECIATING THAT THIS IS A CHALLENGE FOR OTHER PEOPLE AS WELL. SHE'S KIND OF ACKNOWLEDGING THAT MAYBE SHE'S NOT MAKING IT EASY. AGAIN, I GOT TO NOT PUSH, SO HERE'S SOMETHING WE MIGHT NOW SAY. SO HOW WOULD YOU APPROACH QUITTING OR CUTTING BACK IF YOU DECIDED TO DO IT? SO THAT MAY NOT LAND IN A GOOD SPOT IF SHE FEELS LIKE IT'S PUSHING. IT MAY BE ENOUGH BECAUSE IT'S A LIGHT WAY OF ASKING WITH ALSO MAINTAINING HER AUTONOMY TO SAY IF YOU DECIDED TO DO IT. AND THAT'S PART IS IMPORTANT. I COULD SAY, YOU REALLY ARE GOING TO NEED TO QUIT OR CUT BACK IF YOU WANT TO KEEP LIVING THERE SO LET'S DO THIS, WHAT DO YOU THINK YOU CAN DO? THAT MIGHT COME OFF A LITTLE TOO FORCEFUL. AGAIN, IT ALL DEPENDS ON YOUR RELATIONSHIP WITH HER, WHAT YOU KNOW ABOUT HER PARTS OF HER LIFE AND ALL OF THOSE THINGS. I JUST WANTED TO GIVE YOU A WAY OF LOOKING AT THIS FROM AN M.I. LENS. JUST A COUPLE OTHER THOUGHTS. THE DETERMINANTS OF HEALTH PLAY INTO ALL OF THIS BECAUSE I CAN DO ALL KINDS OF THINGS WITH DEANNA AROUND HER HEALTH BEHAVIORS BUT I ALSO NEED TO KNOW HER SOCIAL CONTEXT. IF SHE DOESN'T HAVE A PLACE TO LIVE, I'M ASSUMING SHE DOESN'T HAVE MONEY AS WELL OR MAYBE A STABLE SOURCE OF INCOME. SO HOW AM I GOING TO MANAGE THOSE THINGS AS WELL. THIS ALL HAS TO PLAY INTO IT. I GOT TO BUILD UP PROTECTIVE FACTORS AS MUCH AS POSSIBLE, BUILD UP HER RELATIONSHIP WITH HER SISTER, BE THINKING ABOUT HER HEALTH, NOT JUST TELLING HER TO QUIT IN ORDER TO MITIGATE SOME OF THOSE RISK FACTORS THAT SHE MAY ALREADY HAVE. I JUST WANTED TO SHARE A FEW MORE WAYS OF THINKING ABOUT PROTECTIVE FACTORS. BUILDING UP AN ADOLESCENT'S SKILLS IN THEIR OWN RELATIONSHIPS, IN THEIR RESILIENCY. I WOULD ALSO PROBABLY WANT TO AFFIRM FOR THIS GIRL HOW SHE'S MANAGED TO GET THIS FAR AND HOW SHE'S BEEN DOING THIS ON HER OWN FOR SOME TIME, HOW SHE'S BEEN NAVIGATING HER RELATIONSHIP WITH HER SISTER AND THE BROTHER-IN-LAW, THINGS LIKE THAT. WE KNOW THAT THE MORE ADOLESCENT HAS ADULTS THAT THEY CAN TRUST IN THEIR LIVES, THE MORE WE CAN BUILD COMMUNITY, RELATIONSHIPS, POSITIVE PEERS. PROBABLY WANT TO TALK TO DEANNA TOO ABOUT HOW SHE SPENDS HER TIME, WHO SHE'S HANGING AROUND WITH AND BUILDING UP THE STRENGTHS IN THOSE PEOPLE ARE MORE WAYS TO HELP HER. THEN ON A COMMUNITY LEVEL -- I REALIZE WE'RE GETTING SHORT ON TIME. ON A COMMUNITY LEVEL THESE ARE SOME OTHER THINGS CITED IN THESE COUPLE OF SOURCES THAT THE MORE WE CAN GO OUTSIDE OF JUST WORKING WITH INDIVIDUALS BUT THINKING ABOUT IS THE LEADERSHIP IN OUR COMMUNITY REPRESENTING THE CULTURES THAT LIVE HERE. DO WE HAVE OTHER RESOURCES IN OUR AREA, WHETHER IT BE RECREATIONAL SPACE, YOUTH COUNSELS, COULD WE GET DEANNA INVOLVED IN SOME VOLUNTEERING OR WHAT'S HAPPENING IN HER SCHOOL SITUATION. THOSE OTHER SUPPORT NETWORKS GO A LONG WAY IN HELPING THEM. I JUST WANTED TO SHARE SOME THINGS THAT WE'VE SEEN WORK WHEN IT COMES TO DOING SBIRT. HAVING CHAMPIONS WITHIN YOUR SIGHT, THAT CAN HELP BRING ALL OF THESE PIECES TOGETHER. ALSO, WE WORKED WITH A SCHOOL-BASED HEALTH CENTER. THIS WAS COOL. THEY HAD SOME SCHOOL BOARD MEMBERS THAT WEREN'T REALLY SURE ABOUT HAVING PEERS COME INTO THE SCHOOL AND WORK WITH THEIR KIDS OR HAVING SCHOOL COUNSELLORS SPENDING TIME SCREENING. SO THIS HEALTH CENTER POSTED A CELEBRATION FOR KIDS THAT HAD BEEN PARTICIPATING IN THIS PILOT AND IT REALLY WON THE SCHOOL BOARD OVER. SO STORIES, SUCCESS STORIES APPEAL TO US IN A DIFFERENT WAY THAN DATA DOES AND IT'S A REALLY IMPORTANT PIECE. I'LL JUST PUT THESE OTHER ONES UP AS WELL. SO THAT SAID, I KNOW WE WANTED TO TAKE SOME OTHER QUESTIONS. I HOPE I'VE BEEN RESPONSIVE TO A LOT OF THE QUESTIONS THAT HAVE COME THROUGH, BUT CERTAINLY WELCOME TO OTHERS. I ALSO ALWAYS LOVE WHEN PEOPLE SHARE QUESTIONS WITH EACH OTHER LIKE WHAT THINGS HAVE YOU DONE TO BUILD IN PROTECTIVE FACTORS, WHAT THINGS ARE GOING ON IN YOUR COMMUNITIES. FEEL FREE TO BRAG ABOUT THOSE OR SHARE GOOD THINGS. I'D LOVE TO HEAR IT. >> WE JUST GOT A QUESTION. I WAS GOING TO PIVOT TO HOUSEKEEPING. ARE THERE TEEN AA MEETINGS ONLINE? I KNOW THERE ARE YOUNG PEOPLE'S AA MEETINGS. >> GOSH, THAT'S A GOOD QUESTION. I THINK SO. I JUST READ SOMETHING -- I JUST SAW SOMETHING THE OTHER DAY. WE CAN SEND IT OUT OR POST IT. I'M SURE I SAW SOMETHING THAT SAID THERE WAS. THERE'S PROBABLY NOT AS MANY BUT I READ SOMETHING THAT SAID DON'T HESITATE TO REACH OUT TO THE ONLINE GROUPS. FOR SOME PEOPLE THE ONLINE GROUPS, THEY'RE LOVING THEM BECAUSE THEY DON'T HAVE TO WALK IN THE DOOR. THEY FEEL THAT STIGMA. THEY DON'T HAVE TO WORRY ABOUT KNOWING PEOPLE THERE ARE THERE. I'VE SEEN A LOT OF BENEFIT AT LEAST IN THE ADULT POPULATION. OTHERS, IF YOU KNOW OF SOME TOO. >> PAM, WOULD YOU MIND SKIPPING TO THE CLOSING SLIDE AND THEN IF THERE ARE ANY OTHER QUESTIONS WE CAN TAKE THEM. THOSE ARE GOOD RESOURCES TOO. >> RESOURCES, YOU'LL HAVE ACCESS TO THESE AS WELL. >> SOMEBODY ASKED A WHILE BACK ABOUT HOW THEY COULD CONTACT PAM. HER CONTACT PAGE IS IN THE CHAT BOX AND MAYBE YOU CAN THROW THAT IN ONE MORE TIME BEFORE WE GO. SHE'S AVAILABLE AFTER THIS WEBINAR TO TALK THROUGH OTHER QUESTIONS YOU MIGHT HAVE OR OTHER WAYS THAT THE NATIONAL COUNCIL CAN SUPPORT YOU IN GENERAL. PLEASE DON'T HESITATE TO REACH OUT TO ANY OF US. THEN JUST WITH OTHER HOUSEKEEPING ITEMS, I WANT TO REMIND EVERYONE THAT WE WILL HAVE THE SLIDES AND THE RECORDING FROM TODAY AVAILABLE FOR YOU TO VIEW AFTER THE FACT ON BLTHECHANGE.ORG UNDER THE WEBINAR ARCHIVE SECTION AND WE WOULD LOVE YOU TO QUICKLY FILL OUT THE SURVEY THAT WILL POP UP ON YOUR SCREEN WHEN THIS WEBINAR IS OVER. ANY OTHER QUESTIONS AT THIS TIME FROM ANYBODY? >> I WISH I KNEW DEFINITIVELY ABOUT THE AA MEETINGS BUT I CAN'T IMAGINE THAT THERE ISN'T BECAUSE THEY'VE ALSO GONE ONLINE FOR ADULTS. EVERYTHING IS ONLINE NOW. AGAIN, A LOT OF PEOPLE LIKE IT BETTER, OR IT'S A GREAT ALTERNATIVE, SO DON'T HESITATE TO OFFER THAT AND SUGGEST IT. AND TEENS, LET ME SAY, TEENS ARE ALL ABOUT ONLINE. THEY ARE NOT HINDERED BY HAVING CHAT MEETINGS THIS WAY AND SUCH, SO DEFINITELY RECOMMEND IT. >> OKAY, GREAT. I THINK WE'RE AT THE HOUR SO WE CAN WRAP UP. LET'S ALL GIVE A VIRTUAL ROUND OF APPLAUSE TO PAM FOR PROVIDING THIS REALLY INFORMATIVE SESSION TODAY. IF THERE'S ANYTHING ELSE YOU NEED OR ANYTHING ELSE YOU THINK OF, AGAIN, FEEL FREE TO REACH OUT TO US. WE'RE HERE TO HELP AND WISH YOU ALL OF THE BEST LUCK IN CONDUCTING THIS STUFF VIRTUALLY. I KNOW IT'S CHALLENGING BUT I THINK THAT THIS WEBINAR SERIES HAS BEEN HELPFUL IN CLARIFYING SOME PIECES. THANK YOU, PAM, AND THANKS, EVERYBODY, FOR JOINING. >> THANK YOU. BYE.