Trauma-Informed
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Extending Mental
Health Help to Vulnerable Kids A student arrives late to school each morning, downtrodden and listless. A girl can't concentrate in class. Teachers deal with a boy's daily emotional outbursts. A pediatrician is puzzled by a young patient's dwindling appetite. Another child is tormented by anxiety and nightmares. The common denominator for all these kids could be trauma. Poverty, violence, natural disasters or insecure housing may affect a child's mental health. Growing evidence highlights the effects of toxic stress and long-lasting harm to kids exposed to abuse, neglect and dysfunctional households. In response, trauma-informed clinics and schools, and other culturally aware programs, take a different approach to supporting kids. These are just some examples: Baltimore Mental-Health Hub The staff at the Harriet Lane Clinic strives to set a welcoming tone for families in the East Baltimore community. Clinicians enter the waiting room to invite kids back into the treatment area and ease the way for parents who may be apprehensive about seeking out mental health care. For about a decade, Dr. Barry Solomon, interim chief of the division of general pediatrics and adolescent medicine at Johns Hopkins Children's Center, has worked to incorporate mental health services into pediatric primary health care at the Harriet Lane Clinic, which serves a largely African-American population. The effort to co-locate mental and primary health care is growing nationwide, says Solomon, an associate professor of pediatrics at the Johns Hopkins University School of Medicine. Access to mental health care also reaches children when they come in for routine medical care such as wellness visits or asthma checkups. With pediatricians and mental health professionals working side by side, kids with mental health concerns are more likely to be identified and referred for treatment. That's crucial because only a fraction of U.S. children – 20 percent or less – get treatment for common mental health and behavioral issues, Solomon says. Tackling Social Determinants About one-quarter of Baltimore City residents live below the poverty line, encompassing nearly 35 percent of the city's children. Within the core of the Harriet Lane Clinic, a dedicated team directly addresses social determinants of health affecting individual families. Parents or patients fill out a simple brief form, asking if they need help in finding food, housing, health insurance, job resources or adult education; paying utility bills or applying for public benefits; locating child care, childproofing supplies like cabinet locks, clothing and diapers; or accessing legal resources or transportation to clinic appointments. "There's really no wrong-door approach to refer to us," says Sarah Hill, program associate for Health Leads at the Harriet Lane Clinic. Health Leads is a national health care group that connects families to basic resources they need to get and stay healthy. At their convenience, families can visit the help desk, where volunteers such as Johns Hopkins premed students work with them to jump-start the process of locating essential resources. Advocating might mean reaching out to utilities and asking them to restore power in households where kids use nebulizers for asthma. By addressing concerns like these, Hill says, families can redirect their focus where it's needed – on their children's well-being. Digging Deep Open-ended discussions with children and teens can uncover traumatic causes of behavioral and emotional problems. "It's not necessarily asking, 'Would you like access to mental health services?'" explains La Toya Mobley, a pediatric clinical social worker at the Harriet Lane Clinic. Rather, it's posing questions like, "What is your experience at home?" to get at the heart of the matter. "Trauma and ADHD mirror each other," Mobley says. "So we're asking more questions about trauma, especially with the increase in shootings and things like that." Apparent symptoms of attention deficit hyperactivity disorder could actually stem from trauma. "Many times we find that a family member has been killed, or children don't have enough to eat or they're homeless," she says. "Maybe that's why they can't sit still in school versus truly having a diagnosis of hyperactivity." Kids provide conversational cues. "I just hate school," prompts Mobley to probe: "Are people picking on you? Are they being mean?" Eventually, she says, it comes out: "My cousin was killed and I don't like walking down this specific street because I have to go down it to get to my school. When I get to school, I don't like being there because I keep thinking about my cousin." Mobile mental health care is available for some patients, with providers traveling to the home when families agree and kids feel ready for treatment. "I normally make a deal," Mobley says. "How about we get mobile treatment to come out three times? You can call me and say, 'Toya, I hate it,' and they never have to come back again." Most often, she says, kids meet the therapist and it works out well. Mobley describes a long-time, adolescent patient who at different points experienced depression, issues with substance use and physical abuse. A mobile mental health unit went out to this patient while she was pregnant, and she was connected to services including the TurnAround program for victims of intimate partner violence and a work-study program at a community college. She has since graduated and left her abusive partner. She continues with therapy and feels confident taking care of her 2-year-old son. The Harriet Lane clinic also offers a maternal mental health clinic, where mothers are screened and followed for depression on site. This convenient, holistic care alleviates unwarranted stigma adults may feel when coming to a mental health facility, Solomon says. Parents and children benefit alike, he adds: "If the mom's not well, she's going to have a hard time caring for that child." Empowering North Carolina Parents An intervention to counteract "low activation," or a low level of patient or family engagement or self-assertiveness in health care, has boosted involvement among parents with kids getting care at El Futuro, a bilingual mental health clinic serving Latino immigrant families in Durham, North Carolina. "There was evidence that – out of deference for clinicians' training – families were apt to be passive in discussions, taking suggestions [but] providing little feedback to clinicians about any concerns or questions," says Kathleen Thomas, a senior research fellow in mental health services research at the University of North Carolina—Chapel Hill. "Also, the clinic experienced a lot of no-shows for appointments." In a study led by Thomas on the program to increase parental activation, nearly half of the children had been diagnosed with an adjustment disorder. According to the National Library of Medicine, adjustment disorders involve "a group of symptoms, such as stress, feeling sad or hopeless and physical symptoms that can occur after you go through a stressful life event." Kids Mental Health Amid School Shootings Their fears about school safety are real – but so are the ways to help kids understand them. Key program components include emphasizing the important role of the parent acting as a partner in a child's mental health care and practicing the skills to do so. Unfortunately, the current political climate could overshadow gains parents have made, says Thomas, who is also an adjunct associate professor in health policy and management. "One example from our parent advisers is that, while they may feel engaged and self-confident at El Futuro, they have not followed up on suggested referrals to the larger health system out of concerns about payment and documentation requests," Thomas says. Trauma-Informed Schools Schools with trauma-informed staff members – from teachers to cafeteria workers – may serve as places of learning and healing. A Colorado-based consulting program called Resilient Futures expands on the work of the Healthy Environments and Response to Trauma in Schools program developed at the University of California—San Francisco. HEARTS grew out of the need to better serve the growing number of students with trauma. In trauma-informed schools, every adult in the building who interacts with kids and families receives a basic level of training, says Laura McArthur, a clinical psychologist and executive director of Resilient Futures. More intensive training is geared to teachers and certain classrooms, making sure systems are in place to help struggling kids who are most impacted by trauma. Students considered as behavioral challenges could be reacting to trauma. A student may talk about wanting to hurt him or herself, or others, McArthur says. It might be a kid who is becoming physically aggressive, or one who has just lost a family member and shows signs of depression. Trauma outside the school affects the children within. It could be kids in immigrant families feeling pushed out of their communities, or a gun tragedy or death by suicide nearby, McArthur says. "Domestic violence, physical abuse or neglect, really extreme poverty – this kind of stuff is happening all the time to our kids." Behavior plans created from a trauma-informed perspective seek to promote healing, McArthur says. For instance, rolling out "peace corners" in classrooms gives kids a space where they can go to self-regulate. Stocked with supplies like Play-Doh and coloring books, these welcoming spaces help kids calm down if they're angry, or feel better if they're sad. Safe Places Students tend not to talk about issues troubling them outside school, McArthur says. Even so, having a safe place to be during the day can help them feel safe enough to focus and learn. Clinic patients and families are reluctant to reveal their deep-rooted traumas, as well, Solomon says. First, he says, trust has to build: "These are hard issues to tackle. It's not something that you meet them for the first time and you're going to get them to open up. So they have to make sure that this is a safe place." 12
Questions You Should Ask Your Kids at Dinner It’s time to eat. Where are the kids? Parents: Do you routinely sit down to family meals? Research suggests doing so may be beneficial, helping bolster kids’ social skills while improving their eating habits. An American Academy of Pediatrics report in the journal Pediatrics last year noted that regular family meals may help ensure adolescents eat more fruits and veggies, and are associated with a decreased risk of developing eating disorders, particularly for girls. But the benefits may be reduced if you give into distracted dining, constantly checking your mobile device. You must engage – and be thoughtful about what you discuss. To make the most of your time together, parenting experts suggest asking the following questions. 1. What is something interesting (or fun or difficult) you did today? While questions you ask will vary depending on your child’s age, this can be a great place to start. “Sharing what your child's day was like and what is important to them grows your relationship,” says Dr. Gail Saltz, a clinical associate professor of psychiatry at the Weill Cornell Medical College in New York City. “Then it's also important to tell them what you valued in your day.” For school-age kids, you might also ask, "What was the most interesting thing you learned today?" This will be helpful for understanding what excites your child, where she may need extra opportunities or help, and in fostering love of learning, Saltz says. 2. What's on your mind today? Make it clear your children can talk about anything and that you’ll listen. This is not conversational entrapment – getting a kid to spill the beans, only to come down on the child. Experts say it’s important kids feel understood, and can openly share whatever may be on their minds. The topics needn’t be serious or heavy, either. Swap stories to bond, suggests Dr. Shimi Kang, a medical director for child and youth mental health for Vancouver Coastal Health’s community programs in British Columbia. If your child relays difficulties he’s having with certain classes, tell him about subjects you struggled with. And share age-appropriate stories from your childhood. 3. Who did you sit with at lunch today? Experts emphasize parents ask questions that can't be answered with a simple “yes” or “no.” “The reason you need to ask specific questions is because otherwise you will get one-word answers that won't really let you know how your child is doing,” says Susan Bartell, a child psychologist with a practice in Port Washington, New York. “Kids and teens don't really want to make the effort to share the details of school, especially when some of the details may be upsetting, embarrassing or unpleasant.” She adds: “Don't grill your child, but if you hit on something that seems concerning (‘I sat alone at lunch’) it's important to follow up.” 4. Can I tell you about something crazy that happened to me today? OK, maybe it wasn’t that crazy, and you might dismiss this question as merely a request to share your story – but that's the point. “Kids are developmentally quite self-centered. Learning to care about others starts at home, but only if they are shown how to care about the lives of others,” Bartell says. “It is up to you to show them that it is important that they care about your world. This not only teaches them to think beyond themselves, it also helps them feel good that you want them as an audience. In the same way, you can ask their opinions, especially as they get a bit older.” 5. What are all the things you’re grateful for today? Nancy Buck, a developmental psychologist based in Denver, recommends using mealtime as an opportunity to talk about ideas, values or principles you believe are important to teach and instill in your kids. “This is not the time to lecture, but instead is the time to get curious and share,” she says. Along with discussing values your family holds dear, experts say teaching children how to express gratitude is important for their development and overall well-being. Research also links feeling grateful – and being able to express gratitude – with improved relationships and happiness. 6. Do you feel full? For very young kids, Jill Castle – a registered dietitian and childhood nutrition expert based in New Canaan, Connecticut – suggests alternatively asking: “What does your tummy tell you? Is your tummy still hungry or happy?” Not every piece of dinner table conversation needs to be high-minded. Kids and adults can benefit from paying attention to internal cues, like the feeling of hunger, and mindful eating. “Talking about hunger, fullness and satisfaction helps children become aware of their appetite,” Castle says. This is preferable to relying on external cues – like an adult telling a child he or she must eat a certain number of bites – that can lead to overeating. 7. What made you laugh recently? Understanding how your child is feeling about life requires learning more about the way they experience their days – not simply what happened. “When did you experience joy today?” is another question you could ask, Buck suggests. Just as with language development or math, children must learn how to understand and manage their emotions, such as through interactions with parents, teachers and other adults as well as peers. To gauge whether they’ve had a great day or a lousy one, you might also ask, "How would you rate your day on a scale of 1 to 10?" Then take the opportunity to further understand what’s behind their feelings. 8. Do you have any questions about what’s going on in the news? In this hyper-connected, politically charged modern era, kids and adolescents – like adults – are often bombarded with more information than they can handle. This can cause anxiety, and may ultimately lead to concerns or questions they might not feel at liberty to raise. "Kids hear stuff and don't always understand what it's about or how it makes sense in their world,” Saltz says. “Asking your child what's on their radar and discussing their take is useful to correct misperceptions, quell fears [and] be aware of their world.” 9. What do you want to do tomorrow? Take time to involve your child in making plans for the family, like determining how to get the most out of winter. By doing so, you can use dinner as a chance to talk about what he or she is looking forward to doing, in addition to reflecting on what’s happened in your child's life. It could involve discussing family vacation plans or just sticking to how you’d like to spend the next 24 hours. Another approach to capture your child’s changing interests: "What activities do you enjoy most these days?" 10. How are your friends or classmates doing? Is your child experiencing mostly smooth sailing of late or rougher waters – like being picked on by peers? “Talking about the social environment and understanding and helping with potential social pitfalls is important. This is where you may hear about bullying issues, fights, negotiating friendships and friend groups,” Saltz says. “Providing feedback and even role playing about sticky situations can help your child navigate their waters.” Another question to ask to gauge their social connections: "Who do you talk with most often at school?" 11. What do you want to do tomorrow? Take time to involve your child in making plans for the family, like determining how to get the most out of winter. By doing so, you can use dinner as a chance to talk about what he or she is looking forward to doing, in addition to reflecting on what’s happened in your child's life. It could involve discussing family vacation plans or just sticking to how you’d like to spend the next 24 hours. Another approach to capture your child’s changing interests: "What activities do you enjoy most these days?" 12. How are your friends or classmates doing? Is your child experiencing mostly smooth sailing of late or rougher waters – like being picked on by peers? “Talking about the social environment and understanding and helping with potential social pitfalls is important. This is where you may hear about bullying issues, fights, negotiating friendships and friend groups,” Saltz says. “Providing feedback and even role playing about sticky situations can help your child navigate their waters.” Another question to ask to gauge their social connections: "Who do you talk with most often at school?" 13. What did you talk about in English or history (or some other class)? Being specific to a particular class may help you get a better sense of what your child discussed versus asking generally about his or her school day. You might also ask, "What did you talk about over lunch?" Expect more resistance to this question from adolescents who choose to be discrete, and more openness from younger kids. “Use open-ended questions that require your child to provide multi-sentence answers,” says Russell Hyken, a family therapist based in St. Louis. “The topic is not as important as building trust and connections. That said, I think it is important to know about your child’s day. This provides insight into their mood, school and social life." 14. What was your best success of the day? Talking about high points – as
well as, "what was the low point of your day?" –
is another good way to gain insight into your child’s
life. Feel free to talk about what happened to you as well.
By interjecting a slice of your life, this puts you and your
child on equal ground, Hyken notes – and may lead your
child to share a story. Another question, especially if it
seems pertinent to their mood: "Are you
stressed
about anything? “ "It is always about building
connection so when there is an issue, your child will trust
you to help them work through their concerns,” he
says. 10
of the Biggest Health Threats Facing Yours Kids This School
Year Kids these days When Lea Theodore was growing up, her parents screened her calls; after all, friends could only reach her by way of landline. How times have changed. “Children have their own cellphones earlier and earlier, and [parents] don’t necessarily know where they are and they don’t know who their friends are,” says Theodore, president of the American Psychological Association’s Division of School Psychology. Parents may also be unaware of some of the major health risks facing their kids at school. “It’s a very different time,” Theodore says. Here are 10 health issues to watch out for this year – and how to prevent or reduce their effects: 1. Poor nutrition Do you know if – and what – your child is eating at school? Many parents don’t, says Dr. Lisa Asta, a pediatrician in Walnut Creek, California, who often sees kids with ailments like headaches that can be traced back to poor eating habits. “Nutrition feeds into so much,” says Asta, including school performance. She recommends learning about your children’s school meal program and what’s offered in after-care. What and how you eat at home is important, too, adds Theodore, who suggests striving for regular family dinners, keeping only healthy snacks on hand, teaching your kids about good food choices while bringing them on grocery trips and – most importantly – modeling healthy eating at home. 2. Physical inactivity Red rover, tag and other classic recess games are getting the boot at schools across the country due to concerns about bullying, Asta says. The result: rule-laden, structured exercise – think mind-numbing lap-running – during recess, if kids get recess at all. “For many kids, that equates physical activity with just torture,” Asta says. To help your kids develop a love of movement, try inviting them to join you for a run or a yoga class, suggests Theodore, also a psychology professor at the College of William and Mary. “A lot of parents say one of the things they like to do is engage in those activities because it becomes a lifelong bond.” 3. No school nurse When a kid gets sick at school, he goes to the school nurse. But in the nearly 50 percent of schools that don’t employ a registered nurse full time, that’s not possible, says Beth Mattey, the Wilmington, Delaware-based president of the National Association of School Nurses. She encourages parents to ask, "Who is meeting the health needs of my child in school?” and then get to know that person, especially if the child has a chronic health condition. Keep a contact list of school and mental health support staff handy, too, suggests Scott Bloom, director of school mental health services in the New York City Department of Education's Office of School Health. 4. Asthma Asthma, which affects close to 9 percent of children, has been on the rise since the early 1980s, according to the Asthma and Allergy Foundation of America. That’s serious, since the condition is the top reason kids miss school, and it also compromises their sleep, concentration, self-esteem and other areas of mental health, Theodore says. “Overall, it diminishes their quality of life because it kind of alienates them,” she says, noting that some psychological interventions like guided imagery and mindfulness have been shown to improve symptoms. School nurses, too, can teach students how to use an inhaler, avoid triggers and recognize when to visit a health care provider, Mattey adds. 5. An overpacked schedule Asta is sick of writing notes scolding schools about the amount of homework they assign. “Last year, I had a middle schooler who stayed up to 11 finishing a tsunami of homework,” she recalls. That's not OK, nor are so many before- and after-school activities and structured social plans that kids don’t have enough time to sleep, play freely, spend time with their families or eat a healthy breakfast, Asta adds. She recommends families take a good look at their calendars before the school year begins. Ask yourself, “What’s your schedule and what’s your child’s schedule?” she suggests. “How are you going to pull it off?” 6. Sexually transmitted diseases First, the good news: Teens today are far more likely to delay sex than their parents were at that age, according to data from the Centers for Disease Control and Prevention. But that doesn't mean they're avoiding all sexual activities that can cause sexually transmitted diseases, namely HPV, says Theodore, who's seen children as young as 10 with the condition. That’s why she urges parents to talk to their kids about sex, peer pressure and how they can respond early on. It’s also important to vaccinate your children against HPV, which can lead to cancer, she says. “It’s a shame to see a child have cancer from something that could have prevented.” 7. Poor social skills If you can tweet, why talk? If you can send an emoji, why smile? If you can “like,” why verbalize a compliment? “Children don’t have the same social skills that we did growing up because they don’t need to,” Theodore says. That’s a detriment to their mental health, since it can cause them to disengage from activities, alienate themselves from (real) friends and even lead to situational depression and anxiety when, say, they’re excluded from social events. To keep your kids’ people skills up to snuff, initiate a no-technology rule at family dinners, Theodore suggests, and ask everyone to share the “peaks and pits” of their days. 8. Stress School psychologists see a lot of young perfectionists these days, Theodore says. “They’ve gotta get the best grades, they have to be a Division 1 athlete,” she says. Indeed, a 2014 survey from the American Psychological Association found that teens’ self-reported stress levels are higher than those of adults during the school year. That type of pressure exacerbates all physical and psychological disorders, including depression, Theodore says. One solution: simply spending quality time with your kids. “If you have … parents who talk to you, model good eating behaviors and teach you about coping skills and problem-solving skills," she says, "children will fare much better.” 9. Concussions Just because your son isn't a high school football star doesn't mean he's in the clear when it comes to concussion risk. Young kids who tumble off the swing set or topple from their bikes can also suffer traumatic brain injuries, which can manifest as difficulty concentrating, headaches, light sensitivity, memory problems and more, Mattey says. If you notice those symptoms or others such as changes in mood or sleep after a knock to the head, encourage your child to rest and talk to his or her teachers about lightening the workload if necessary, the American Academy of Pediatrics suggests. If symptoms worsen, talk to your pediatrician immediately. 10. Cyberbullying Bullying is not a modern phenomenon,
but its inability to be left at the schoolyard when the
dismissal bell rings is, Theodore says. One study
from the Cyberbullying Research Center, for example, found
that more than one-third of 11- to 15-year-olds have been
cyberbullied. "We're seeing [mental health] issues
magnetized because of social media," Theodore says. To help
your kids cope with this and other health issues, first
listen to and validate them, and then don't hesitate to
reach out to school staff, Mattey adds. "The school wants to
work with your child," she says. "We want your kids to
succeed." Trauma
Informed Care Principle: Peer Support and Mutual
Self-Help There are many examples of peer support and mutual self-help in response to the public health crisis of COVID-19. Groups and neighbors forming to offer to go grocery shopping, make masks, or help to pay rent. We also see this as we address the public health crisis of racism that Leslie Gregory has been educating us about for years (see campaign here)—joining with peers to advocate, hold accountable, and make changes. So, who are your peers? They may not always be the people who you live with, work with, or hang out with. You likely have different peers for different needs. Being with those who have different experiences is essential for us to grow, evolve, and create. We also need spaces where we can be our authentic, beautiful, messy self. Peer support is necessary for coping and thriving. Holding the organizational focus of our work, I ask you, How are you creating space right now for Black and Brown colleagues and coworkers to practice peer support? Consider this advice from Rebecca Davis, MA, CSWA, a black, indigenous, queer woman who does antiracist, trauma informed work (see their work at ARTIC):
There is harm and pain happening right now—witnessing current racialized violence, having a history of these experiences be resurfaced for BIPOC, being retraumatizated when systems fail. Racism is at the root of so much trauma. This is why doing antiracist work is prevention work. In this video, Black Lives, TIC, and Workforce Wellness, listen to the wisdom of these Black voices who were willing to share their lived experiences in the service of Black wellness and white action. Listen and learn about Racial Battle Fatigue, Black community care, a call to action for white people, the balance of having both fear and hope, and more. Working towards needed changes with others can be uplifting, hopeful, and healing. It can also be exhausting and when it is not centered and led by Black and Brown voices it can be harmful. Think about this, How can we organizationally, and how can I as a white colleague, not add to the burden of BIPOC colleagues? I started this list, for white people, to offer some examples of how to operationalize some of this wisdom. I look forward to your additions, critique, and edits. What white colleagues can say to Black and Brown colleagues right now:
Helpful Blog Posts From this newsletter’s contributors, here are some blogs posts that show the importance of peer support and mutual self-help.
TIO Updates
To Do List:
Peer
Support and Mutual Self-Help as Healing Antidote Historically, and currently, our systems (including social service systems) are built on hierarchy and power—student/teacher, teacher/administrator, lawyer/judge, nurse/doctor, doctor/surgeon, etc. In different environments, different social constructs are considered in establishing this hierarchy, including age, education, job title, socio economic status, etc. It has been evident that since the conception of the institution of the United States, power hierarchy has been defined by racist policy. The belief of the superiority of white (male, heterosexual, cisgender, wealthy, able bodied) people over all others, has been the bedrock of the formation of the United States, and has been perpetuated through silent contracts of hierarchy embodied in our policies. What does this have to do with trauma? We know that one way that trauma happens is with lack of consent, and not all have consented to be part of this silent contract of a racist culture. We know that power-over is a pillar of abusive dynamics, and that marginalized access to equitable resources and opportunity has led to racism being a public health crisis. We know that silencing peer support and mutual self-help, perpetuate the operational belief of one story and only one truth, and ultimately deny that any abuse or trauma has occurred. What we also know—thanks to the voice of lived experience—is that peer support and mutual self-help is profoundly empowering, healing, and enriching, not only on the individual level but also on the operational/systemic level. Creating opportunity and policy for peer support to exist in all environments is to create antiracist policy, thus dismantling normalized systems of hierarchy/superiority currently alive in our institutions, systems, and communities. The trauma informed care (TIC) principle of peer support challenges us to uplift practices and policies that honor that:
Training & Workforce Wellness Updates:
Hosting
a Virtual Meeting Using Trauma Informed Principles
© 1) Emotional & Physical Safety. • Set up security measures, such as a secure link, password, and/or wait room, in order to ensure that only those invited to the meeting are in attendance. • If the meeting will be recorded, allow for advanced notice and consent. • If you set (developmentally appropriate) expectations and norms, explain why (e.g., “I need you to have your eyes on the screen and not be dancing so you do not distract the presenter.”). • Remind people that the meeting may not be entirely confidential, especially if there are others in the home who are able to listen in on the meeting (requesting that people use headphones may somewhat mitigate this issue). • Invite participants to setup their work area in a way that supports their full participation and emotional regulation, including having a fidget toy, water, and limited distraction.
1) Emotional & Physical Safety. • Set up security measures, such as a secure link, password, and/or wait room, in order to ensure that only those invited to the meeting are in attendance. • If the meeting will be recorded, allow for advanced notice and consent. • If you set (developmentally appropriate) expectations and norms, explain why (e.g., “I need you to have your eyes on the screen and not be dancing so you do not distract the presenter.”). • Remind people that the meeting may not be entirely confidential, especially if there are others in the home who are able to listen in on the meeting (requesting that people use headphones may somewhat mitigate this issue). • Invite participants to setup their work area in a way that supports their full participation and emotional regulation, including having a fidget toy, water, and limited distraction 2) Cultural, historical, and gender consideration. • Invite (don’t require) people to customize their profile name and add pronouns. • Offer breakout rooms or additional time for peer to peer/affinity group connection, including small group connection based on certain identities. • Provide captioning or a transcript of the meeting for accessibility. 3) Trustworthiness and transparency. • Normalize the nuances of virtual learning/gathering, including screen fatigue. • Inform participants of the meeting agenda prior to the start time, and stick to the agenda (including timeframes). • Identify roles and their functions (e.g., will the facilitator mute/unmute? Will the facilitator call on participants?). • If you encourage private chats between people, note if they are truly private or visible to the host of the meeting. 4) Peer support and mutual self-help. • Use breakout rooms to encourage connection and shared power. • As the host, log in a few minutes early to assist with technical issues. • Use a brief check in activity to inquire about well-being or any needs during the meeting. • When you offer breaks (ideally every 60 minutes), offer suggestions of ways for people to use the break (e.g., move your body, hydrate, draw), reminding them about the goal of restoration rather than multitasking. • As the host, limit distractions, including turning off the bell when individuals join the call garding camera being on or off. 5) Collaboration and mutuality. • Use the chat function to enhance connections but have someone manage this in sync with the facilitator. • Identify group norms around silence (e.g., silence is OK, and as the facilitator you may call individuals into the conversation). • Allow a place for feedback about the meeting (e.g., poll, emails, etc.). • Use a Google Doc or other shared document platform to cocreate and share power. 6) Empowerment, voice and choice. • Constantly assess whether the online format is best/necessary—many things could be achieved via a phone call or a shared Google Doc. • Utilize polling, chat boxes, or breakout rooms in order to encourage voice. • Establish meeting norms around
how other voices are heard (e.g., raised hand, mute when not
speaking, popcorn style, “I will count to 10 and then
move on,” etc.).
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